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He Y, Guo Y, Guo X, Han N, Xin B, Wu Y, Wan Q, Shi P, Yang S, Ksebe W, Jiang W. Role function and job satisfaction of community nurses in China: A cross-sectional study. Nurs Open 2024; 11:e2109. [PMID: 38391101 PMCID: PMC10830912 DOI: 10.1002/nop2.2109] [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: 10/28/2022] [Revised: 07/11/2023] [Accepted: 01/11/2024] [Indexed: 02/24/2024] Open
Abstract
AIM To evaluate role function and job satisfaction, determine their relationship, and explore the factors influencing job satisfaction among community nurses in China. DESIGN Cross-sectional study. METHODS This study was conducted between March and June 2020 on a cluster random sampling of 302 community nurses from 24 community health centres and stations in Xi'an, China. Self-reported data were collected using the Demographics Questionnaire, Role Function of Community Nurses Questionnaire, and Job Satisfaction of Community Nurses Scale. Descriptive statistics, Pearson's correlation analysis, and multiple linear regression analyses were performed to analyse data. RESULTS Community nurses' main role function was organiser and manager (M = 2.56, SD = 0.987) and coordinator (M = 2.43, SD = 0.971). The lowest job satisfaction was for salary and benefits (M = 3.12, SD = 0.891) and personal development (M = 3.65, SD = 0.738). A positive correlation was found between the roles of caregiver, educator, navigator, and salary and benefits (p < 0.05) among community nurses. Multiple linear regression analyses indicated that monthly income and working experience in nursing explained 61.1% of the variance in job satisfaction.
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Affiliation(s)
- Yuxin He
- School of Nursing, Health Science CenterXi'an Jiaotong UniversityXi'anChina
| | - Yan Guo
- School of NursingShaanxi University of Chinese MedicineXianyangChina
| | - Xiaoyuan Guo
- School of Nursing, Health Science CenterXi'an Jiaotong UniversityXi'anChina
| | - Na Han
- Dongguan South Street Community Health Service CenterXi'anChina
| | - Bo Xin
- School of Nursing, Health Science CenterXi'an Jiaotong UniversityXi'anChina
| | - Yixin Wu
- School of Nursing, Health Science CenterXi'an Jiaotong UniversityXi'anChina
| | - Qiuyuan Wan
- School of Nursing, Health Science CenterXi'an Jiaotong UniversityXi'anChina
| | - Panpan Shi
- School of Nursing, Health Science CenterXi'an Jiaotong UniversityXi'anChina
| | - Shan Yang
- School of Nursing, Health Science CenterXi'an Jiaotong UniversityXi'anChina
| | - Waleed Ksebe
- School of Nursing, Health Science CenterXi'an Jiaotong UniversityXi'anChina
| | - Wenhui Jiang
- School of Nursing, Health Science CenterXi'an Jiaotong UniversityXi'anChina
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Lu Y, Liu C, Yu D, Wells Y. Conditions required to ensure successful detection and management of mild cognitive impairment in primary care: A Delphi consultation study in China. Front Public Health 2022; 10:943964. [PMID: 36211650 PMCID: PMC9540221 DOI: 10.3389/fpubh.2022.943964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/06/2022] [Indexed: 01/21/2023] Open
Abstract
Objective Detection and management of mild cognitive impairment (MCI) in primary care has been recognized internationally as one of the strategies that can be employed to delay the development of dementia. However, little is known about what role primary care should play. This study aimed to develop a checklist of conditions necessary for successfully detecting and managing mild cognitive impairment in primary care in China. Methods This study employed the Delphi method to establish expert consensus on the conditions required for successfully detecting and managing MCI in primary care in China. Twenty-four experts who specialized in general practice, public health, neuropsychology, or community health service management rated the importance of pre-defined conditions (44 items measuring providers' preparedness, patient engagement, and system support in line with the Chronic Care Model). The degree of consensus among the experts was measured using four indicators: median ≥ 4, mean ≥3.5, Co-efficient of Variance < 0.25, and retention in the checklist required ≥ 80% agreement with a rating of important or essential. The checklist and descriptions of the conditions were revised according to the experts' feedback and then sent out for repeated consultations along with a summary of the results of the previous round of consultations. Consensus was achieved after the second round of consultations, which was completed by 22 of the experts. Results The experts endorsed a checklist of 47 conditions required for successful detection and management of MCI in primary care in China. These conditions were categorized into four domains: prepared general practitioners (17 items), engaged patients (15 items), organizational efforts (11 items), and environmental support (4 items). Conclusions Successful detection and management of MCI in primary care in China requires a dedicated and competent workforce of general practitioners, as well as the engagement of patients and family caregivers. Adequate support from healthcare organizations, health system arrangements, and the broader society is needed to enable effective interactions between general practitioners and patients and efficient delivery of the services required to detect and manage MCI.
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Affiliation(s)
- Yuan Lu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- Academic Department of General Practice, Tongji University School of Medicine, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Dehua Yu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
- Academic Department of General Practice, Tongji University School of Medicine, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Yvonne Wells
- Lincoln Center for Research on Aging, La Trobe University, Melbourne, VIC, Australia
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Wang F, Wei Y, Wang M, Pan Z, Jin G, Lu X. Process quality of type 2 diabetes mellitus care and association with patient perceived attributes of family doctor service in urban general practices, Beijing, China. BMC PRIMARY CARE 2022; 23:228. [PMID: 36071391 PMCID: PMC9454121 DOI: 10.1186/s12875-022-01838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 08/29/2022] [Indexed: 11/25/2022]
Abstract
Background Family doctor service (FDS) is a scheme oriented to improving the access and continuity of primary care in China. Type 2 diabetes mellitus (T2DM) management is a core component of FDS. However, evidence on the quality of T2DM care is lacking and the potential association between FDS attributes and T2DM care is largely unknown. This study attempted to assess the process quality of T2DM care in general practice and explore the association between patient perceived FDS attributes and process quality of T2DM care. Methods Total 400 patients were recruited from 5 community health service centers in two urban districts in Beijing. Questionnaire survey and extraction of data from electronic health record (EHR) were conducted to collect patient characteristics, patient perceived FDS attributes (accessibility, continuity and team-based care) and process quality indicators (monitoring and health counseling indicators). Chi-square test and a two-level generalized linear mixed model (GLMM) were used to explore the association between FDS attributes and process quality. Results The utilization rate of all the 12 indicators in monitoring, 6 indicators in health counseling and all the 18 process indicators, was 12.8%, 23.8% and 6.0% respectively. Over half of the patients (56.8%) perceived all the 3 FDS attributes. There were statistically significant associations between accessibility of care and lipid (p = 0.008), electrocardiogram (p = 0.016), retinopathy (p = 0.037) and peripheral neuropathy (p = 0.006) monitoring and each of the 6 health counseling indicators (all the p values < 0.05). Regular follow up (p = 0.039), plasma blood glucose (p = 0.020), blood pressure (p = 0.026), body mass index (p = 0.044) and foot (p = 0.005) monitoring as well as each of the 6 health counseling indicators (all the p values < 0.05) were more likely to be received by patients when continuity of care was ensured. Patients who were managed by a GP team had higher utilization rate of glycosylated hemoglobin monitoring (p = 0.026) and each of the 6 health counseling indicators (all the p values < 0.05). When the patients perceived one more FDS attribute, the indicators they received significantly increased by 1.50 (coefficient = 1.50, p < 0.001). Patients between the age of 65 and 74 years received 1.15 more indicators than those under 65 (coefficient = 1.15, p = 0.003). Patients with more than ten years duration of T2DM received 0.74 more indicators (coefficient = 0.74, p = 0.028). Patients taking both insulin and oral medicine received 0.97 more indicators than those taking oral medication only (coefficient = 0.97, p = 0.027). Patients who were managed by GPs with on-job training experience received 1.19 more indicators (coefficient = 1.19, p = 0.040). Among the patients who had completed junior high school or below, having better self-report health status (≥ 60) received 2.40 less indicators (coefficient = -2.40, p = 0.004). Conclusions Improvement of key monitoring and health counseling indicators might be needed in T2DM care in general practice in Beijing, China. Policies for improving process quality of T2DM care should be considered. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01838-0.
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Matovu F, Gatome-Munyua A, Sebaggala R. Has Strategic Purchasing Led to Improvements in Health Systems? A Narrative Review of Literature on Strategic Purchasing. Health Syst Reform 2022; 8:2151698. [PMID: 36562734 DOI: 10.1080/23288604.2022.2151698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Strategic purchasing is noted in the literature as an approach that can improve the efficiency of health spending, increase equity in access to health care services, improve the quality of health care delivery, and advance progress toward universal health coverage. However, the evidence on how strategic purchasing can achieve these improvements is sparse. This narrative review sought to address this evidence gap and provide decision makers with lessons and policy recommendations. The authors conducted a systematic review based on two research questions: 1) What is the evidence on how purchasing functions affect purchasers' leverage to improve: resource allocation, incentives, and accountability; intermediate results (allocative and technical efficiency); and health system outcomes (improvements in equity, access, quality, and financial protection)? and 2) What conditions are needed for a country to make progress on strategic purchasing and achieve health system outcomes? We used database searches to identify published literature relevant to these research questions, and we coded the themes that emerged, in line with the purchasing functions-benefits specification, contracting arrangements, provider payment, and performance monitoring-and the outcomes of interest. The extent to which strategic purchasing affects the outcomes of interest in different settings is partly influenced by how the purchasing functions are designed and implemented, the enabling environment (both economic and political), and the level of development of the country's health system and infrastructure. For strategic purchasing to provide more value, sufficient public funding and pooling to reduce fragmentation of schemes is important.
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Affiliation(s)
- Fred Matovu
- Department of Policy and Development Economics, Makerere University School of Economics, Kampala, Uganda
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Realigning the provider payment system for primary health care: a pilot study in a rural county of Zhejiang Province, China. Prim Health Care Res Dev 2020; 21:e43. [PMID: 33032674 PMCID: PMC7577833 DOI: 10.1017/s1463423620000444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aim: This work aimed to evaluate a pre/post-reform pilot study from 2015 to 2018 in a rural county of Zhejiang Province, China to realign the provider payment system for primary health care (PHC). Methods: Data were extracted from the National Health Financial Annual Reports for the 21 township health centers (THCs) in Shengzhou County. An information system was designed for the reform. Differences among independent groups were assessed using Kruskal–Wallis H-test. Dunn’s post hoc test was used for multiple comparisons. Differences between paired groups were tested by Wilcoxon signed-rank test. Two-tailed P < 0.05 indicated statistical significance. Data were processed and analyzed using R 3.6.1 for Windows. Findings: First, payments to THCs shifted from a “soft budget” to a mixed system of line-item input-based and categorized output-based payments, accounting for 17.54% and 82.46%, respectively, of total revenue in 2017. Second, providers were more motivated to deliver services after the reform; total volumes increased by 27.80%, 19.22%, and 30.31% for inpatient visits, outpatient visits, and the National Essential Public Health Services Package (NEPHSP), respectively. Third, NEPHSP payments were shifted from capitation to resource-based relative value scale (RBRVS) payments, resulting in a change in the NEPHSP subsidy from 36.41 to 67.35 per capita among the 21 THCs in 2017. Fourth, incentive merit pay to primary health physicians accounted for 38.40% of total salary, and the average salary increased by 32.74%, with a 32.45% increase in working intensity. A small proportion of penalties for unqualified products and pay-for-performance rewards were blended with the payments. The reform should be modified to motivate providers in remote areas. Conclusion: In the context of a profit-driven, hospital-centered system, add-on payments – including categorized output-based payments to THCs and incentive merit pay to primary care physicians (PCPs) – are probably worth pursuing to achieve more active and output/outcome-based PHC in China.
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Behzadifar M, Martini M, Behzadifar M, Bakhtiari A, Bragazzi NL. The barriers to the full implementation of strategic purchasing and the role of health policy and decision-makers: past, current status, ethical aspects and future challenges. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E119-E124. [PMID: 32490277 PMCID: PMC7225644 DOI: 10.15167/2421-4248/jpmh2020.61.1.1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022]
Abstract
Healthcare systems are complex, multi-level, highly integrated organizations, comprising of different professional figures, institutions, and resources. Such breadth and complexity reflect the multi-dimensionality of the concept of health, which implies the adoption of a holistic approach. Health, rather than merely being the absence of disorders or infirmity, is a highly dynamic state, which represents the abilities of an individual to cope with adverse social, physical and emotional/psychological events and conditions, continuously adapting to them. Ensuring an adequate health state is one of the most important concerns, and the healthcare systems are called to renew themselves in order to meet with the new challenges and health needs. Throughout the last decades, due to demographic shifts and transitions, epidemiological and societal changes, technological achievements and scientific advancements, healthcare systems have undergone an extensive series of reform plans. Therefore, health policy- and decision-makers have made efforts to develop and implement initiatives for preserving the quality of the healthcare provisions. Strategic purchasing is an approach of purchasing that takes into account several health-related issues such as a proper, comprehensive planning of service delivery, the design and selection of the best packages of services and provisions, the appropriate selection of providers and the allocation of economical and financial incentives to provide better services and to motivate managers to adopt appropriate policies to implement strategic purchasing. Here, we intend to consider the various dimensions and aspects that can be effective in strategic purchasing, as well as the main barriers and obstacles that hinder its full implementation.
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Affiliation(s)
- M Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - M Martini
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- UNESCO Chair, "Health Anthropology Biosphere and Healing Systems," University of Genoa, Italy
| | - M Behzadifar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - A Bakhtiari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - N L Bragazzi
- UNESCO Chair, "Health Anthropology Biosphere and Healing Systems," University of Genoa, Italy
- Department of Mathematics and Statistics, York University, Toronto, ON, Canada
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