1
|
Gao Q, Zhang B, Zhou Q, Lei C, Wei X, Shi Y. The impact of provider-patient communication skills on primary healthcare quality and patient satisfaction in rural China: insights from a standardized patient study. BMC Health Serv Res 2024; 24:579. [PMID: 38702670 PMCID: PMC11069204 DOI: 10.1186/s12913-024-11020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVES In middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China. METHODS Data were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians' communication skills on healthcare quality and patient satisfaction. RESULTS The findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians' knowledge and other factors, demonstrated positive associations between physicians' communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training. CONCLUSION This study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction.
Collapse
Affiliation(s)
- Qiufeng Gao
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, 710119, China
| | - Bin Zhang
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Qian Zhou
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, 710119, China
| | - Cuiyao Lei
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, 710119, China
| | - Xiaofei Wei
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, 710119, China
| | - Yaojiang Shi
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, 710119, China.
| |
Collapse
|
2
|
Yang Y, Gong X, Song F, Guo R. Evidence-Do Gap in Quality of Direct-To-Consumer Telemedicine: Cross-Sectional Standardized Patient Study in China. Telemed J E Health 2024; 30:e1126-e1137. [PMID: 38039353 DOI: 10.1089/tmj.2023.0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
Background: The evidence-do gap between the availability of clinical guidelines and provider practice is well documented, resulting in low health care quality. With the rapid development of telemedicine worldwide, this study aimed to investigate the evidence-do gap and explore the factors for the evidence versus practice deficits as well as low quality in direct-to-consumer telemedicine. Methods: We adopted the standardized patient approach to evaluate the health worker performance and calculate the evidence-do gap in quality of the consultation process, diagnosis, and treatment in telemedicine based on China's national clinical guidelines. Moreover, we further explored the factors associated with the gap through multiple linear regression and logistic regressions. Results: Validated physician-patient interactions (N = 321) were included. On the one hand, the consultation process and treatment quality are less commendable with the huge evidence-do gap. More than three-quarters of the physicians provided low-quality care, as against standard clinical guidelines. On the other hand, the level I, specialized hospitals, doctor, associate chief physicians, and attending physicians, sponsored by Internet enterprises, more times of provider's responses and words were associated with high-quality processes; More total times of provider's responses, urticaria, and nonoffice hours of the visit were associated with high-quality diagnosis; Sponsored by Internet enterprises, more total words of provider's all responses, and urticaria were associated with high-quality treatment. Conclusions: Our findings have important implications in an era in which to better comprehend the evidence-do gap. Efforts to bridge the evidence-do gap should be focused on the important role of institutions and physicians.
Collapse
Affiliation(s)
- Yuting Yang
- Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China
| | - Xue Gong
- Department of Quality and Efficiency, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Faying Song
- Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China
| | - Rui Guo
- Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Turnbull I, Camm CF, Halsey J, Du H, Bennett DA, Chen Y, Yu C, Sun D, Liu X, Li L, Chen Z, Clarke R. Correlates and consequences of atrial fibrillation in a prospective study of 25 000 participants in the China Kadoorie Biobank. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae021. [PMID: 38572088 PMCID: PMC10989653 DOI: 10.1093/ehjopen/oeae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 04/05/2024]
Abstract
Aims The prevalence of atrial fibrillation (AF) is positively correlated with prior cardiovascular diseases (CVD) and CVD risk factors but is lower in Chinese than Europeans despite their higher burden of CVD. We examined the prevalence and prognosis of AF and other electrocardiogram (ECG) abnormalities in the China Kadoorie Biobank. Methods and results A random sample of 25 239 adults (mean age 59.5 years, 62% women) had a 12-lead ECG recorded and interpreted using a Mortara VERITAS™ algorithm in 2013-14. Participants were followed up for 5 years for incident stroke, ischaemic heart disease, heart failure (HF), and all CVD, overall and by CHA2DS2-VASc scores, age, sex, and area. Overall, 1.2% had AF, 13.6% had left ventricular hypertrophy (LVH), and 28.1% had ischaemia (two-thirds of AF cases also had ischaemia or LVH). The prevalence of AF increased with age, prior CVD, and levels of CHA₂DS₂-VASc scores (0.5%, 1.3%, 2.1%, 2.9%, and 4.4% for scores <2, 2, 3, 4, and ≥5, respectively). Atrial fibrillation was associated with two-fold higher hazard ratios (HR) for CVD (2.15; 95% CI, 1.71-2.69) and stroke (1.88; 1.44-2.47) and a four-fold higher HR for HF (3.79; 2.21-6.49). The 5-year cumulative incidence of CVD was comparable for AF, prior CVD, and CHA₂DS₂-VASc scores ≥ 2 (36.7% vs. 36.2% vs. 37.7%, respectively) but was two-fold greater than for ischaemia (19.4%), LVH (18.0%), or normal ECG (14.1%), respectively. Conclusion The findings highlight the importance of screening for AF together with estimation of CHA₂DS₂-VASc scores for prevention of CVD in Chinese adults.
Collapse
Affiliation(s)
- Iain Turnbull
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Christian Fielder Camm
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Jim Halsey
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Huaidong Du
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Derrick A Bennett
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Yiping Chen
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
| | - Dianyianji Sun
- Department of Epidemiology and Biostatistics, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
| | - Xiaohong Liu
- Medical Records Archive, Pengzhou Traditional Medicine Hospital, Penzhou, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Peking University, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Robert Clarke
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| |
Collapse
|
4
|
Ding Y, Chen X, Guan H, Du K, Zhang Y, Shi Y. To investigate the individual and household-level factors influencing the willingness to pay for cataract surgery among patients aged 50 years and older in rural China: a cross-sectional study. BMJ Open 2023; 13:e069985. [PMID: 37541756 PMCID: PMC10407343 DOI: 10.1136/bmjopen-2022-069985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/26/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES To investigate the factors influencing the willingness to pay (WTP) for cataract surgery among patients aged 50 years and older in rural China at both individual and household levels. DESIGN A cross-sectional study. SETTING The study was conducted in Gansu, China. PARTICIPANTS Patients aged ≥50 years who were diagnosed with cataracts indicated for surgery and lived rural in Gansu from October to December 2020 were included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES The main study outcome was the patients' WTP for cataract surgery. The association of individual characteristics, knowledge about cataracts, health status and household characteristics with patients' WTP was also evaluated based on the collected data using structured questionnaires. RESULTS A total of 324 (85.94%) patients in the study reported that they were willing to pay for their cataract surgery. However, only 179 (47.48%) patients were willing to pay over ¥1000 to cover the cost of cataract surgery under the New Rural Cooperative Medical System (NRCMS). Patients aged 75 years and older were significantly less likely to pay for cataract surgery (p=0.037). Better visual status (p=0.032), self-reported severe poor visual status (p=0.001), higher annual household income (p=0.052) and a higher level of children's education (p=0.076) were significantly more likely to pay for cataract surgery. CONCLUSIONS The WTP for cataract surgery in rural China is still insufficient. More than half of patients' WTP for surgery do not cover the cost of cataract surgery after reimbursement by the NRCMS. Both individual and household characteristics contribute to the low WTP for cataract surgery.
Collapse
Affiliation(s)
- Yuxiu Ding
- Center for Experimental Economics of Education, Shaanxi Normal University, Xian, China
| | - Xiangzhe Chen
- Center for Experimental Economics of Education, Shaanxi Normal University, Xian, China
| | - Hongyu Guan
- Center for Experimental Economics of Education, Shaanxi Normal University, Xian, China
| | - Kang Du
- College of Economics, Xi'an University of Finance and Economics, Xi'an, China
| | - Yunyun Zhang
- College of Economics, Xi'an University of Finance and Economics, Xi'an, China
| | - Yaojiang Shi
- Center for Experimental Economics of Education, Shaanxi Normal University, Xian, China
| |
Collapse
|
5
|
Chen Y, Sylvia S, Dill SE, Rozelle S. Structural Determinants of Child Health in Rural China: The Challenge of Creating Health Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13845. [PMID: 36360724 PMCID: PMC9654689 DOI: 10.3390/ijerph192113845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Over the past two decades, the literature has shown a clear gradient between child health and wealth. The same health-wealth gradient is also observed among children in China, with a large gap in health between rural and urban children. However, there are still unanswered questions about the main causes of China's rural-urban child health inequality. This paper aims to review the major factors that have led to the relatively poor levels of health among China's rural children. In addition to the direct income effect on children's health, children in rural areas face disadvantages compared with their urban counterparts from the beginning of life: Prenatal care and infant health outcomes are worse in rural areas; rural caregivers have poor health outcomes and lack knowledge and support to provide adequate nurturing care to young children; there are large disparities in access to quality health care between rural and urban areas; and rural families are more likely to lack access to clean water and sanitation. In order to inform policies that improve health outcomes for the poor, there is a critical need for research that identifies the causal drivers of health outcomes among children. Strengthening the pediatric training and workforce in rural areas is essential to delivering quality health care for rural children. Other potential interventions include addressing the health needs of mothers and grandparent caregivers, improving parenting knowledge and nurturing care, improving access to clean water and sanitation for remote families, and most importantly, targeting poverty itself.
Collapse
Affiliation(s)
- Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sarah-Eve Dill
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, CA 94305, USA
| | - Scott Rozelle
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, CA 94305, USA
| |
Collapse
|
6
|
Fang Y, Jiang S, Jiang P, Zhou H, Yang M. Are Rural Primary Care Providers Able to Competently Manage Common Illnesses? A Cross-Sectional Study in Rural Sichuan, Western China. Healthcare (Basel) 2022; 10:healthcare10091750. [PMID: 36141362 PMCID: PMC9498850 DOI: 10.3390/healthcare10091750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/25/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Strengthening primary care is a key focus of the latest healthcare reforms in China. However, many challenges, including the workforce competence, still exist. This study aimed to evaluate the common disease management competency of rural primary care providers in Sichuan Province, western China. Methods: A cross-sectional study was conducted in 9 township health centers and 86 village clinics in 3 counties. Diarrhea and respiratory infection were selected as the evaluation cases. General partitioners were assessed through their abilities to (1) take history; (2) make diagnoses; (3) propose treatment; and (4) deal with clinical cases. Results: In total, 362 healthcare workers were surveyed, and 130 general practitioners were enrolled into our study. On average, rural primary care providers could only answer 46.4% of questions absolutely correctly, with 29.7% partly correctly and 23.8% incorrectly. Conclusion: We suggest strengthening training to improve rural primary care providers’ competencies, especially their capacities of history taking. Policy action is also needed to address regional disparities.
Collapse
Affiliation(s)
- Yian Fang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- School of Public Health, Peking University, Beijing 100191, China
| | - Shaohua Jiang
- The First Affiliated Hospital, Xinjiang Medical University, Urumqi 833054, China
| | - Pei Jiang
- School of Public Health, North Sichuan Medical College, Nanchong 637100, China
| | - Huan Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Min Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- Faculty of Health, Design and Art, Swinburne University of Technology, Melbourne 3122, Australia
- Correspondence:
| |
Collapse
|
7
|
Meng S, Wang Q, Wu Y, Xue H, Li L, Ye R, Chen Y, Pappas L, Akhtar M, Dill SE, Sylvia S, Zhou H, Rozelle S. The know-do gap in quality of health for chronic non-communicable diseases in rural China. Front Public Health 2022; 10:953881. [PMID: 36062129 PMCID: PMC9435052 DOI: 10.3389/fpubh.2022.953881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Abstract
Proper management of non-communicable diseases (NCDs) is a severe challenge to China's rural health system. This study investigates what influences the poor medical treatment of NCDs (diabetes and angina) by evaluating the "know-do gap" between provider knowledge and practice. To determine whether low levels of provider knowledge low quality of patient care is the primary constraint on the quality of NCDs diagnosis and treatment in rural China. Providers from Village Clinics (VC) and Township Health Centers (THC), and Standardized Patients (SP) were selected by a multi-stage random sampling method. Clinical vignettes were administered to 306 providers from 103 VCs and 50 THCs in rural Sichuan Province. SPs presented diabetes symptoms completed 97 interactions with providers in 46 VCs and 51 THCs; SPs presented angina symptoms completed 100 interactions with providers in 50 VCs and 50 THCs. Process quality, diagnosis quality, and treatment quality were assessed against national standards for diabetes and angina. Two-tailed T-tests and tests of proportions for continuous outcomes and tests of proportions for binary dependent variables were used to compare vignette and SP results. Differences between vignette and SP data calculated the know-do gap. Regression analyses were used to examine the providers/facility characteristics and knowledge/practice associations. THC providers demonstrated significantly more knowledge in vignettes and better practices in SP visits than VC providers. However, levels of knowledge were low overall: 48.2% of THC providers and 28.2% of VC providers properly diagnosed type 2 diabetes, while 23.8% of THC providers and 14.7% of VC providers properly diagnosed angina. With SPs, 2.1% of THC providers and 6.8% of VC providers correctly diagnosed type 2 diabetes; 25.5% of THC providers and 12.8% of VC providers correctly diagnosed angina. There were significant know-do gaps in diagnosis process quality, diagnosis quality, and treatment quality for diabetes (p < 0.01), and in diagnosis process quality (p < 0.05) and treatment quality for angina (p < 0.01). Providers in rural China display low levels of knowledge when treating diabetes and angina. Despite low knowledge, evidence of the know-do gap indicates that low-quality healthcare is the primary constraint on the quality of NCD diagnosis and treatment in rural China. Our research findings provide a new perspective for the evaluation of the medical quality and a technical basis for the development of new standardized cases in the future.
Collapse
Affiliation(s)
- Sha Meng
- Department of Health Behavior and Social Medicine, West China School of Public Health, West China Fourth Hospital, West China Hospital, Sichuan University, Chengdu, China,Department of Operation Management, West China Hospital, Sichuan University, Chengdu, China
| | - Qingzhi Wang
- Department of Health Behavior and Social Medicine, West China School of Public Health, West China Fourth Hospital, West China Hospital, Sichuan University, Chengdu, China
| | - Yuju Wu
- Department of Health Behavior and Social Medicine, West China School of Public Health, West China Fourth Hospital, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Xue
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Linhua Li
- Department of Health Behavior and Social Medicine, West China School of Public Health, West China Fourth Hospital, West China Hospital, Sichuan University, Chengdu, China
| | - Ruixue Ye
- Department of Health Behavior and Social Medicine, West China School of Public Health, West China Fourth Hospital, West China Hospital, Sichuan University, Chengdu, China
| | - Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lucy Pappas
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Muizz Akhtar
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Sarah-Eve Dill
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Huan Zhou
- Department of Health Behavior and Social Medicine, West China School of Public Health, West China Fourth Hospital, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Huan Zhou
| | - Scott Rozelle
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| |
Collapse
|
8
|
Wu Y, Ye R, Wang Q, Sun C, Meng S, Sylvia S, Zhou H, Friesen D, Rozelle S. Provider competence in hypertension management and challenges of the rural primary healthcare system in Sichuan province, China: a study based on standardized clinical vignettes. BMC Health Serv Res 2022; 22:849. [PMID: 35778732 PMCID: PMC9248120 DOI: 10.1186/s12913-022-08179-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/01/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Improving primary care providers' competence is key to detecting and managing hypertension, but evidence to guide this work has been limited, particularly for rural areas. This study aimed to use standardized clinical vignettes to assess the competence of providers and the ability of the primary healthcare system to detect and manage hypertension in rural China. METHODS A multi-stage random sampling method was administered to select target health facilities, providers, and households. The clinical vignette script was developed to evaluate provider competence in managing first-visit patients with symptoms of hypertension. Logistic regression was used to explore the factors correlated with provider competence. Provider referral and management rates were combined with patients' facility sorting behaviors to assess the ability of the rural healthcare system to manage hypertension in three policy scenarios. RESULTS A total of 306 providers and 153 facilities were enrolled in our study. In the 306 clinical vignette interactions, 25.9% of providers followed the national guidelines for hypertension consultation. The correct diagnosis was achieved by only 10.1% of providers, and 30.4% of providers were able to prescribe the correct treatment. Multi-variable regression results showed that younger providers (OR = 0.85, 95%CI: 0.73, 0.98) and those who work in township health centers (OR = 4.47, 95%: 1.07, 18.67) were more likely to provide a correct diagnosis. In a free-selection scenario, 29.8% of patients with hypertension were managed correctly throughout the rural system. When all patients first visit village clinics, system-level correct management is reduced to 20.5% but increases to 45.0% when all patients first visit township health centers. CONCLUSIONS Rural primary care providers do not have enough competence to detect and treat hypertension cases in China to an acceptable degree. Policy constraints may limit the competence of the rural healthcare system. Research to improve detection and treatment competence in hypertension and optimize health policy is needed.
Collapse
Affiliation(s)
- Yuju Wu
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ruixue Ye
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qingzhi Wang
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chang Sun
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Sha Meng
- Department of Operation Management, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Huan Zhou
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Dimitris Friesen
- Freeman Spogli Institute for International Studies, Stanford University, California, Stanford, USA
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, California, Stanford, USA
| |
Collapse
|
9
|
Huang J, Du K, Guan H, Ding Y, Zhang Y, Wang D, Wang H. The Role of Village Doctors in Residents' Uptake of Eye Screening: Evidence from Ageing Residents in Rural China. Healthcare (Basel) 2022; 10:healthcare10071197. [PMID: 35885723 PMCID: PMC9317018 DOI: 10.3390/healthcare10071197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
The lack of formal eye screening is the main reason for insufficient eye care utilization in rural China. Cataract, in particular, is increasingly prevalent with the aging population, but the treatment rate is relatively low. Village doctors are the most accessible health care resource for rural residents, receiving few empirical investigations into their role in eye care. This study aims to assess the role of village doctors in residents’ uptake of eye screening (vision and cataract screening), the first step of cataract treatment. Data come from a community-based, cross-sectional survey conducted in 35 villages of a county of the Gansu Province, Northwestern China, in 2020. Among 1010 residents aged ≥ 50 and 35 village doctors, the multivariate logistic regression shows that village doctors’ age, time spent on public health service, and service population were positively associated with residents’ uptake of vision and cataract screening. Village doctors were capable of playing an active role in primary eye health services due to their richer knowledge about cataracts than residents (accuracy rate 86.75% vs. 63.50%, p < 0.001), but less than half of them were willing to undertake eye screening. This study highlights the positive role of village doctors in aging residents’ eye screening and the potential role in improving the uptake of eye screening by offering health education.
Collapse
Affiliation(s)
- Juerong Huang
- College of Economics and Management, China Agricultural University, Beijing 100083, China;
| | - Kang Du
- College of Economics, Xi’an University of Finance and Economics, Xi’an 710100, China;
| | - Hongyu Guan
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710119, China; (Y.D.); (Y.Z.)
- Correspondence: ; Tel.: +86-186-9188-9621
| | - Yuxiu Ding
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710119, China; (Y.D.); (Y.Z.)
| | - Yunyun Zhang
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710119, China; (Y.D.); (Y.Z.)
| | - Decai Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou 510060, China;
| | - Huan Wang
- Center on China’s Economy and Institution, Stanford University, Stanford, CA 94305, USA;
| |
Collapse
|
10
|
Chen Y, Sylvia S, Wu P, Yi H. Explaining the declining utilization of village clinics in rural China over time: A decomposition approach. Soc Sci Med 2022; 301:114978. [PMID: 35461080 DOI: 10.1016/j.socscimed.2022.114978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/19/2022]
Abstract
With a goal of improving health system quality and efficiency, reforms of China's health system over the past decade have sought to strengthen primary healthcare in lower-level clinics and health centers. Despite these wide-ranging reforms and initiatives, population-based studies have documented dramatic declines in patients' use of primary care facilities during this period. In this paper, we explore the determinants of this trend in China's rural areas using detailed longitudinal data following a nationally-representative sample of rural households and village clinics from 2011 to 2018. We estimate that between 2011 and 2018, the probability that individuals sought care at village clinics when ill dropped by 44%. At the same time, the utilization of outpatient services in county hospitals increased by 56% and patient self-treatment increased by 20%. Detailed Kitagawa-Oaxaca-Blinder decompositions suggest four primary drivers of this trend: the shifting burden of disease in rural areas, changes in how patients choose to seek care given different disease conditions, declining drug inventory in village clinics, and the decreasing importance of remoteness as a determinant of healthcare seeking behavior. Our results highlight the deteriorating role of village clinics in the rural healthcare system and the increasing importance of self-treatment and higher-tier primary care services.
Collapse
Affiliation(s)
- Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Paiou Wu
- School of Advanced Agricultural Sciences, Peking University, Beijing, China.
| | - Hongmei Yi
- School of Advanced Agricultural Sciences, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China.
| |
Collapse
|
11
|
Rao S, Xue H, Teuwen DE, Shi H, Yi H. Measurements of quality of village-level care and patients' healthcare-seeking behaviors in rural China. BMC Public Health 2021; 21:1873. [PMID: 34657604 PMCID: PMC8520638 DOI: 10.1186/s12889-021-11946-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Although the progress in global health initiatives has improved the availability of primary health care (PHC), unqualified healthcare remains a serious challenge in low- and middle-income countries, where PHC is often underutilized. This study examines factors associated with patients’ healthcare-seeking behaviors in rural Chin—seeking healthcare at village-level PHC providers, at higher-level health facilities, self-medicating, and refraining from seeking medical help. We focus on provider-side factors, including (1) the unobservable quality indicator, (2) the observable quality indicator, and (3) the observable signal indicator. Methods We analyzed 1578 episodes of healthcare-seeking behaviors of patients with diarrhea or cough/runny nose symptom from surveys conducted in July 2017 and January 2018 in 114 villages of the Yunnan province. We investigated the correlation between quality-related factors with patients’ healthcare-seeking behaviors by multinomial logit regression. Results We found that rural patients were insensitive to the unobservable quality of healthcare providers, as measured by standardized clinical vignettes, which might be attributable to the credence nature of PHC. The observable quality indicator, whether the clinician has received full-time junior college formal medical education, was associated with patients’ healthcare choices. Patients, however, were more likely to select healthcare based on the observable signal indicator, which was measured by the availability of medicines. Additionally, the observable signal indicator had no significant association with two quality indicators. Notably, socioeconomically-disadvantaged patients relied more on the village-level PHC, which emphasized the role of PHC in promoting the welfare of rural populations. Conclusions Our study found an inconsistency between objective quality of healthcare provided by providers and subjective quality perceived by patients. Patients could not identify the actual quality of PHC precisely, while they were more likely to make decisions based on the observable signal indicator. Therefore, the quality of PHC should be more observable to patients. This study not only supplements the literature on healthcare-seeking choices by examining four types of behaviors simultaneously but also clarifies rural patients’ perceptions of the quality of PHC for policy decision-making on increasing the utilization of PHC and improving the medical welfare of the vulnerable. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11946-8.
Collapse
Affiliation(s)
- Sihang Rao
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Room 408B, Wangkezhen Building, No. 5, Yiheyuan Road, Haidian, Beijing, 100871, China
| | - Hao Xue
- Stanford Center on China's Economy and Institutions, Stanford University, California, USA
| | - Dirk E Teuwen
- Medical Sustainability, UCB, Brussels, Belgium.,Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Haonan Shi
- Business Development Center, Red Cross Society of China, Beijing, China
| | - Hongmei Yi
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Room 408B, Wangkezhen Building, No. 5, Yiheyuan Road, Haidian, Beijing, 100871, China.
| |
Collapse
|
12
|
Sun Y, Li Z, Guo X, Zhou Y, Ouyang N, Xing L, Sun G, Mu J, Wang D, Zhao C, Wang J, Ye N, Zheng L, Chen S, Chang Y, Yang R, He J. Rationale and Design of a Cluster Randomized Trial of a Village Doctor-Led Intervention on Hypertension Control in China. Am J Hypertens 2021; 34:831-839. [PMID: 33605981 DOI: 10.1093/ajh/hpab038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In China, hypertension prevalence is high and increasing while the control rate is low, especially in rural areas. Traditionally, village doctors play an important role in infectious disease control and delivering essential health services to rural residents. We aim to test the effectiveness of a village doctor-led multifaceted intervention compared with usual care on blood pressure (BP) control and cardiovascular disease (CVD) among rural residents with hypertension in China. METHODS In the China Rural Hypertension Control Project (CRHCP), a cluster randomized trial, 163 villages were randomly assigned to the village doctor-led intervention and 163 villages to control. A total of 33,995 individuals aged ≥40 years with an untreated BP ≥140/90 mm Hg or treated BP ≥130/80 mm Hg or with an untreated BP ≥130/80 mm Hg and a history of clinical CVD were recruited into the study. The village doctor-led multifaceted intervention is designed to overcome barriers at the healthcare system, provider, patient, and community levels. Village doctors receive training on standard BP measurement, protocol-based hypertension treatment, and health coaching. They also receive technical support and supervision from hypertension specialists/primary care physicians and performance-based financial incentives. Study participants receive health coaching on home BP monitoring, lifestyle changes, and adherence to medications. The primary outcome is BP control (<130/80 mm Hg) at 18 months in phase 1 and CVD events over 36 months in phase 2. CONCLUSIONS The CRHCP will provide critically important data on the effectiveness, implementation, and sustainability of a hypertension control strategy in rural China for reducing the BP-related CVD burden. CLINICAL TRIALS REGISTRATION Trial Number NCT03527719.
Collapse
Affiliation(s)
- Yingxian Sun
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhao Li
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaofan Guo
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ying Zhou
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Nanxiang Ouyang
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Liying Xing
- Department of Chronic Disease, Centre for Disease Control and Prevention of Liaoning Province, Shenyang, Liaoning, China
| | - Guozhe Sun
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jianjun Mu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shanxi, China
| | - Daowen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jun Wang
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ning Ye
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuang Chen
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ye Chang
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ruihai Yang
- Cardiovascular Research Institute, Hanzhong People’s Hospital, Hanzhong, Shanxi, China
| | - Jiang He
- Cardiovascular Research Institute, Hanzhong People’s Hospital, Hanzhong, Shanxi, China
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| |
Collapse
|
13
|
Daniels B. Primary care providers are, fundamentally, risk managers - And this is a challenge for health policy. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2020; 3:100037. [PMID: 34327385 PMCID: PMC8315607 DOI: 10.1016/j.lanwpc.2020.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 11/23/2022]
|