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Jia Z, Niu Z, Wang JJ, Hernandez J, Li YT, Wang HHX. Trajectories of Treatment Burden Among Primary Care Patients with Long-Term Conditions in Southern China: A Latent Class Growth Analysis. Risk Manag Healthc Policy 2024; 17:2009-2021. [PMID: 39188662 PMCID: PMC11346491 DOI: 10.2147/rmhp.s464434] [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: 02/17/2024] [Accepted: 07/21/2024] [Indexed: 08/28/2024] Open
Abstract
Background Treatment burden is a patient-centred, dynamic concept. However, longitudinal data on the changing pattern of treatment burden among patients with one or more long-term conditions (LTCs) are relatively scanty. We aimed to explore the longitudinal trajectories of treatment burden and associated risk factors in a large, patient population in primary care settings. Methods We analysed data from 5573 primary care patients with long-term conditions (LTCs) recruited using a multistage sampling method in Shenzhen, southern China. The treatment burden was assessed by the Mandarin Chinese version of the Treatment Burden Questionnaire (TBQ). We used latent class growth mixture modelling (LCGMM) to determine trajectories of treatment burden across four time points, ie, at baseline, and at 6, 12, and 18 months. Predictors of trajectory classes were explored using multivariable logistic regression analysis. Results The mean TBQ scores of patients with a single LTC (n = 2756), 2 LTCs (n = 1871), 3 LTCs (n = 699), and ≥4 LTCs (n = 247) were 18.17, 20.28, 21.32, and 26.10, respectively, at baseline. LCGMM identified three discrete classes of treatment burden trajectories over time, ie, a high-increasing class, a low-stable class, and a high-decreasing class. When controlling for individual-level factors including age, education, monthly household income per head, smoking, alcohol consumption, and attendance in health education, patients who had a clinical diagnosis of 3 LTCs (adjusted odds ratio [aOR] = 1.49, 95% CI = 1.21-1.86, P < 0.001) or ≥4 LTCs (aOR = 1.97, 95% CI = 1.44-2.72, P < 0.001) were more likely to belong to the high-increasing class. Sensitivity analysis using propensity score methods obtained similar results. Conclusion Our study revealed the presence of discrete patterns of treatment burden over time in Chinese primary care patients with LTCs, providing directions for tailored interventions to optimise disease management. Patients with 3 or more LTCs should receive close attention in healthcare delivery as they tend to experience a greater treatment burden.
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Affiliation(s)
- Zhihui Jia
- School of Public Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Zimin Niu
- School of Public Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Jia Ji Wang
- School of Public Health, Guangzhou Medical University, Guangzhou, People’s Republic of China
- Centre for General Practice, The Seventh Affiliated Hospital, Southern Medical University, Foshan, People’s Republic of China
| | - Jose Hernandez
- Faculty of Medicine and Health, EDU, Digital Education Holdings Ltd., Kalkara, Malta
- Green Templeton College, University of Oxford, Oxford, UK
| | - Yu Ting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Harry H X Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Department of General Practice, The Second Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, People’s Republic of China
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Luo D, Zhu X, Qiu X, Zhao J, Li X, Du Y. Healthcare preferences of chronic disease patients under China's hierarchical medical system: an empirical study of Tianjin's reform practice. Sci Rep 2024; 14:11631. [PMID: 38773132 PMCID: PMC11109171 DOI: 10.1038/s41598-024-62118-8] [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: 01/23/2024] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
To alleviate the contradiction in healthcare resources, the Chinese government formally established the framework of a hierarchical medical system in 2015, which contains the following brief generalities: " separate treatment of emergencies and slows, first-contact care at the primary, two-way referral, and upper and lower linkage, ". This study systematically summarizes and models the connotations of China's hierarchical medical system and a sample of 11,200 chronic disease patients in Tianjin, the largest port city in northern China, was selected for the empirical study to investigate the relationship between chronic disease patients' policy perceptions of the hierarchical medical system and their preference for healthcare. We found that under the strategy of separate treatment, improving the healthcare accessibility, drug supply, and lowering the cost of medical care would have a positive impact on increasing the preference of patients with chronic diseases to go to the primary hospitals. Under the two-way triage strategy, improving the level of physician services, referral convenience and treatment Standards have a positive impact on chronic disease patients' preference for primary care; The impact of the hierarchical medical system on the preference for healthcare differed between groups, focusing on differences in health literacy level, age and household type; The role of " upper and lower linkage " is crucial in the hierarchical medical system and it plays a part in mediating the influence of the " separate treatment of emergencies and slows" design and the "two-way referral " order on the treatment preferences of chronic disease patients. The results of the study provide a reference for the further development of a scientific and rational hierarchical medical system in the future.
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Affiliation(s)
- Da Luo
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin, 300350, China
- Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Xumin Zhu
- School of Economics and Management, Tiangong University, Tianjin, 300387, China
| | - Xinyu Qiu
- Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Jing Zhao
- Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
- Tianjin Municipal Health Commission, Tianjin, 300070, China
| | - Xiangfei Li
- School of Economics and Management, Tiangong University, Tianjin, 300387, China.
| | - Yue Du
- Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
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Zhu D, Shi X, Chen S, Ye X, Nicholas S, He P. The role of primary health care in improving health status, financial protection and health equity in the context of China's health system reform. Int J Health Plann Manage 2024; 39:311-328. [PMID: 37915063 DOI: 10.1002/hpm.3722] [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: 09/11/2020] [Revised: 12/15/2022] [Accepted: 10/14/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Stronger primary health care (PHC) is critical to achieving the United Nations' Sustainable Development Goals. However, there is scarce evidence on the impact of PHC on health system performance in developing countries. Since 2009, China has implemented an ambitious health system reform, among which PHC has received unprecedented attention. This study investigates the role of PHC resource in improving health status, financial protection and health equity. METHODS We obtained province-level and individual-level data to conduct a longitudinal study across the period of China's health system reform. The dependent variables included health outcomes and financial protection. The independent variables were the number of PHC physicians and share of PHC physicians in all physicians. Mixed-effect models were used for adjusted associations. RESULTS From 2003 to 2017, the number of PHC physicians slightly increased by 31.75 per 100,000 persons and the share of PHC physicians in all physicians increased by 3.62 percentage points. At the province level, greater PHC physician density was positively associated with life expectancy, negatively associated with age-standardized excess mortality, infectious disease mortality, perinatal mortality low birth weight, as well as the share of health expenses in total consumption expenses. At the individual and household level, greater PHC physician density was positively associated with self-assessed health, and negatively associated with incidence of catastrophic health expenditures. Compared to other quintiles, the poorest quintile benefited more from PHC physician density. CONCLUSIONS In China, an increased PHC physician supply was associated with improved health system performance. While China's PHC system has been strengthened in the context of China's health system reforms, further effective incentives should be developed to attract more qualified PHC workers.
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Affiliation(s)
- Dawei Zhu
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Siyuan Chen
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Xin Ye
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, New South Wales, Australia
- Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangdong, China
- School of Economics and School of Management, Tianjin Normal University, Tianjin, China
- Newcastle Business School, University of Newcastle, University Drive, Newcastle, New South Wales, Australia
| | - Ping He
- China Centre for Health Development Studies, Peking University, Beijing, China
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Liu Y, Wang D, Chu M, Yang Z, Luo Y, Wang D, Zhao J. Value of the stroke 1-2-0 prehospital stroke education system: the experience of a general practitioner team. BMC Neurol 2023; 23:431. [PMID: 38062426 PMCID: PMC10770900 DOI: 10.1186/s12883-023-03476-0] [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: 03/18/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Stroke is one of the leading causes of death worldwide, especially in developing countries. In China, there is an urgent need to educate people about stroke awareness and the importance of using emergency medical services (EMS) quickly after a stroke has occurred. OBJECTIVE We sought to explore the effects of the Stroke 1-2-0 Prehospital Stroke Education System based on the experience of a general practitioner team. METHOD We prospectively enrolled 119 community general practitioners to be trained in the procedures advocated by the Stroke 1-2-0 Prehospital Stroke Education System. The training content included early detection of ischemic stroke, first aid for stroke, and intravenous thrombolysis; The effects of the training were later evaluated via a before-and-after comparison. The 119 enrolled physicians formed a Stroke 1-2-0 lecturer group and taught stroke knowledge to community residents. The group remained active for 6 months, during which the medical treatment data of stroke patients (i.e., stroke onset time, prehospital delay, whether an ambulance was called, and whether thrombolytic therapy was performed) in each of 5 jurisdictions were recorded for the month before (January 2021) and that after (August 2021) the 6-month community education program. Finally, the effects of the community education program were evaluated. RESULTS The participants' understanding of intravenous thrombolysis in the treatment of acute ischemic stroke improved significantly after the training as compared with their earlier understanding (96% vs. 78.99%; P < .001), and their understanding of the time window for intravenous thrombolysis increased from 26.05% before to 72% (P < .001) after the training. Most of the participants (90% vs. 67.23%; P < .001) said that they would immediately call the 120 emergency number of China's emergency phone system if they encountered individuals who appeared to be victims of acute stroke. A total of 82 stroke patients were seen before and 67 after the community education program. As for the use of the emergency call system, more patients with stroke activated that system after the program versus before (21.95% vs. 37.31%; P = .04). The 3-hour arrival rate after the program was nearly three times higher than that before the program (62.69% vs. 19.51%; P < .001). Also, regarding receiving thrombolysis after the occurrence of a stroke, the program triggered a substantial increase compared with the total earlier (19.4% vs. 6.1%; P = .013). CONCLUSION We found that the Stroke 1-2-0 Prehospital Stroke Education System significantly improved community residents' knowledge regarding stroke.
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Affiliation(s)
- Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
| | - Daosheng Wang
- Department of Neurosurgery, Minhang Hospital, Fudan University, Shanghai, China
| | - Min Chu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Zhenzhen Yang
- Department of General Medicine, Xinzhuang Community Health Service Center, Shanghai, China
| | - Yunhe Luo
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Delong Wang
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China.
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Bai J, Lu W. A comparative study for accessing primary healthcare between planning assessment and actual utilization for older adults: a case from Dalian City, China. Front Public Health 2023; 11:1207098. [PMID: 37744518 PMCID: PMC10513472 DOI: 10.3389/fpubh.2023.1207098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/02/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction As China has rapidly evolved into an aging society, the Chinese government has developed a community-oriented primary healthcare system to vigorously expedite the transfer of primary health care (PHC) from higher-level hospitals to community health centers (CHCs). However, current planning standards for CHCs have not considered the heterogeneity of older adults in supply-demand services, such that the areas with severe aging may comprise of underestimated levels of accessibility. Methods This study focuses on the gap in PHC access between planning assessment and actual utilization for older adults. We conducted an empirical study in the city area of Dalian based on the check-in and survey data from CHCs during the COVID-19 pandemic. A comparison model was built to calculate matching probability using a modified Gaussian Two-Step Floating Catchment Area (G2SFCA) method. Results As indicated by the results, the communities in the primary healthcare shortage area (PHCSA) increased 6.8% by considering the heterogeneity of older adults; these communities with underserved PHC were ignored by the current planning assessment. Based on the comparison of actual and theoretical accessibility for older adults, we found that the average matching probability was about 76.6%, which means approximately a quarter of older adults have been misestimated the accessibility of PHC. Discussion Further analysis for the older adults with mismatched accessibility showed two causes of the gap, one is the lack of connection between the spatial distribution of facilities and the allocation of service supply, and the other is the subjective cross-catchment visit to CHCs for older adults.
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Affiliation(s)
| | - Wei Lu
- School of Architecture and Art, Dalian University of Technology, Dalian, China
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Yu X, Li YT, Cheng H, Zhu S, Hu XJ, Wang JJ, Mohammed BH, Xie YJ, Hernandez J, Wu HF, Wang HHX. Longitudinal changes in blood pressure and fasting plasma glucose among 5,398 primary care patients with concomitant hypertension and diabetes: An observational study and implications for community-based cardiovascular prevention. Front Cardiovasc Med 2023; 10:1120543. [PMID: 37077741 PMCID: PMC10106827 DOI: 10.3389/fcvm.2023.1120543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/06/2023] [Indexed: 04/05/2023] Open
Abstract
AimsTo assess longitudinal changes in blood pressure (BP) and fasting plasma glucose (FPG) in primary care patients with concomitant hypertension and type 2 diabetes mellitus (T2DM), and to explore factors associated with patients' inability to improve BP and FPG at follow-up.MethodsWe constructed a closed cohort in the context of the national basic public health (BPH) service provision in an urbanised township in southern China. Primary care patients who had concomitant hypertension and T2DM were retrospectively followed up from 2016 to 2019. Data were retrieved electronically from the computerised BPH platform. Patient-level risk factors were explored using multivariable logistic regression analysis.ResultsWe included 5,398 patients (mean age 66 years; range 28.9 to 96.1 years). At baseline, almost half [48.3% (2,608/5,398)] of patients had uncontrolled BP or FPG. During follow-up, more than one-fourth [27.2% (1,467/5,398)] of patients had no improvement in both BP and FPG. Among all patients, we observed significant increases in systolic BP [2.31 mmHg, 95% confidence interval (CI): 2.04 to 2.59, p < 0.001], diastolic BP (0.73 mmHg, 0.54 to 0.92, p < 0.001), and FPG (0.12 mmol/l, 0.09 to 0.15, p < 0.001) at follow-up compared to baseline. In addition to changes in body mass index [adjusted odds ratio (aOR)=1.045, 1.003 to 1.089, p = 0.037], poor adherence to lifestyle advice (aOR = 1.548, 1.356 to 1.766, p < 0.001), and unwillingness to actively enrol in health-care plans managed by the family doctor team (aOR = 1.379, 1.128 to 1.685, p = 0.001) were factors associated with no improvement in BP and FPG at follow-up.ConclusionA suboptimal control of BP and FPG remains an ongoing challenge to primary care patients with concomitant hypertension and T2DM in real-world community settings. Tailored actions aiming to improve patients' adherence to healthy lifestyles, expand the delivery of team-based care, and encourage weight control should be incorporated into routine healthcare planning for community-based cardiovascular prevention.
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Affiliation(s)
- Xiao Yu
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yu Ting Li
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Hui Cheng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Sufen Zhu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Xiu-Jing Hu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jia Ji Wang
- Centre for General Practice, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
- Guangdong-provincial Primary Healthcare Association, Guangzhou, China
| | - Bedru H. Mohammed
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
| | - Jose Hernandez
- Faculty of Medicine and Health, EDU, Digital Education Holdings Ltd., Kalkara, Malta
- Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Hua-Feng Wu
- Shishan Community Health Centre of Nanhai, Foshan, China
- Correspondence: Harry H.X. Wang Hua-Feng Wu
| | - Harry H. X. Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
- Usher Institute, Deanery of Molecular, Genetic & Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
- Correspondence: Harry H.X. Wang Hua-Feng Wu
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Wei Y, Wang F, Pan Z, Wang M, Jin G, Lu X. Physical examination performed by general practitioners in 5 community health service institutions in Beijing: an observational study. BMC PRIMARY CARE 2022; 23:7. [PMID: 35172736 PMCID: PMC8759261 DOI: 10.1186/s12875-021-01619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/22/2021] [Indexed: 11/11/2022]
Abstract
Background Physical examination is a core component of consultation. Little is known about the status quo of physical examinations performed by general practitioners in community health service institutions in China. The aim of this study was to investigate general practitioners’ performance of physical examinations in consultations. Methods An observational study was conducted in 5 community health service institutions in Beijing between November 2019 and January 2020. Eleven general practitioners were observed for one workday. Information of consecutive consultations was recorded including patient characteristics, reasons for encounter, physical examinations performed by general practitioners, length of consultation time and time spent on specific activities in consultations. Results A total of 682 consultations of 11 general practitioners were recorded. Physical examinations were performed in 126 consultations (15.8%). Physical examination was more likely to be performed in patients visiting with symptoms (P < 0.001). Majority of the 126 physical examinations were distributed in “Head, face, and neck examination” (n = 54, 42.9%) and “Cardiovascular examination” (n = 55, 43.7%). No physical examination was performed on skin, male genitalia, female breasts and genitalia, and neurological systems. Total 2823 min of activities were observed and recorded. General practitioners only spent 3.1% of the recorded time on physical examination, which was less than the time spent on taking history (18.2%), test (4.9%), diagnosis (22.7%), therapy (38.4%), and health education (8.6%). The average time spent on physical examinations was 0.8±0.4 min per consultation. Conclusion Physical examination was insufficiently performed by general practitioners in community health service institutions in Beijing. More time and commitment should be advocated for improving the quality of physical examinations in primary care. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01619-1.
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Li B, Chen J. Barriers to Community-Based Primary Health Care Delivery in Urban China: A Systematic Mapping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912701. [PMID: 36232001 PMCID: PMC9566097 DOI: 10.3390/ijerph191912701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/21/2022] [Accepted: 09/30/2022] [Indexed: 05/15/2023]
Abstract
Providing access to a range of basic health services, community-based primary health care (CB-PHC) plays a vital role in achieving the goal of health for all. Driven by a strong political commitment, China's CB-PHC progress in the past decade has been swift and impressive. However, a well-functioning delivery system for care has yet to be established. This systematic mapping review synthesizes selected evidence on barriers to CB-PHC delivery in urban China and draws lessons for policy development. We performed searches on five electronic databases: CINAHL, MEDLINE, Scopus, Web of Science, and China National Knowledge Infrastructure, and included studies published between 2012 and 2021. The Downs and Black and Critical Appraisal Skills Program checklists were used to assess the quality of eligible papers. We conducted our searches and syntheses following the framework set out in the Primary Health Care Performance Initiative (PHCPI). We synthesized the results of the included studies using a thematic narrative approach and reported according to PRISMA guidelines. Six salient barriers arose from our syntheses of 67 papers: lack of comprehensive health insurance schemes, lack of public awareness, superficial care relationships, gaps in communication, staff shortages and poor training, and second-rate equipment. These barriers are grouped into three subdomains following the PHCPI framework: access, people-centered care, and organization and management. A host of negative impacts of these barriers on community-based health care were also identified. It was not possible to determine clear causes of these barriers from the contributing evidence because of the lack of conceptual frameworks and research methods constraints. Non-eastern regions of China and access-related barriers require further exploration. It follows that, at the national level, the problems are likely more severe than the research suggests.
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Affiliation(s)
- Bo Li
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Correspondence:
| | - Juan Chen
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong, China
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Gao S, Li N, Wang X, Yu Y, Zhao R, Trigo V, Ramalho NC. An Assessment Framework for the Training of General Practitioners and Specialists Based on EPAs. Front Public Health 2022; 10:896097. [PMID: 35875034 PMCID: PMC9300895 DOI: 10.3389/fpubh.2022.896097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThe purpose of this study is to explore the practicality and feasibility of EPA (level 4 theory) for establishing medical training and service model in China.MethodWe opted for a mixed qualitative and quantitative research method, considering both explanatory and exploratory sequential designs. The qualitative research comprehended focus groups and interviews conducted with two panels of experts. The quantitative research was conducted to collect data about the applicability of international entrustable professional activities (EPAs) pediatrics standards in the Chinese context by organizing a seminar with a sample of 60 pediatricians. A questionnaire was designed with EPAs and distributed within professional networks. Structural equation modeling and statistical analysis were used to process the data.ResultsIn this study, Medical Service-Groups Model (MSGM) with four levels was successfully established to measure the correlation between specialized and general EPAs. As expected, results showed that specialized EPAs were built on top of general EPAs. There may be a mediating mechanism that general EPAs contribute to the lower level of specialization EPAs. In addition, levels 1 and 2 were primarily needed to lay the groundwork for levels 3 and 4, and these higher levels of EPAs were still the most informative for specialized Gastroenterology EPAs.ConclusionsThe diagnosis and treatment level of primary general practitioners, as the basis of the pediatric medical service chain, affected the clinical disposal ability of specialists. The establishment of MSGM provided a theoretical basis for the linkage training of general practitioners and specialist physicians. In future studies, scholars must explore China's EPAs based on unique national conditions.
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Affiliation(s)
- Shenshen Gao
- Departments of Technology Development and Pediatric, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Clinical Research and Development Center of Shanghai Municipal Hospitals, Shanghai Shenkang Hospital Development Center, Shanghai, China
- Department of Human Resources Management and Organizational Behavior, ISCTE Instituto Universitário de Lisboa, Av.das Forcas Armadas, Lisboa, Portugal
| | - Na Li
- Departments of Technology Development and Pediatric, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Tropical Diseases, Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, The Second Affiliated Hospital of Hainan Medical University, School of Tropical Medicine, Hainan Medical University, Haikou, China
| | - Xinqiong Wang
- Departments of Technology Development and Pediatric, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Yu
- Departments of Technology Development and Pediatric, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ren Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ren Zhao
| | - Virgínia Trigo
- Department of Human Resources Management and Organizational Behavior, ISCTE Instituto Universitário de Lisboa, Av.das Forcas Armadas, Lisboa, Portugal
- School of Health Services Management, Southern Medical University, Guangzhou, China
- Virgínia Trigo
| | - Nelson Campos Ramalho
- Department of Human Resources Management and Organizational Behavior, ISCTE Instituto Universitário de Lisboa, Av.das Forcas Armadas, Lisboa, Portugal
- School of Health Services Management, Southern Medical University, Guangzhou, China
- *Correspondence: Nelson Campos Ramalho
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Zhao X, Xiao J, Chen H, Lin K, Li X, Zeng Z, Huang S, Xie Z, Du J. Patient preferences and attitudes towards first choice medical services in Shenzhen, China: a cross-sectional study. BMJ Open 2022; 12:e057280. [PMID: 35613747 PMCID: PMC9174822 DOI: 10.1136/bmjopen-2021-057280] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 04/22/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to explore the characteristics of Shenzhen residents' preferences and influencing factors regarding their first choice of medical institution at various medical levels, and to understand their attitudes towards community health services. DESIGN Cross-sectional survey. PARTICIPANTS A total of 1612 participants at least 18 years of age were randomly sampled with stratification among 10 districts in Shenzhen. Data were gathered through a self-designed questionnaire. The effective questionnaire response rate was 93.05%. All patients participated in the study voluntarily, provided written informed consent and were able to complete the questionnaire. MAIN OUTCOME MEASURES We measured and compared the participants' expected and actual preferences and influencing factors regarding their first choice of medical service at various medical levels. RESULTS More than 50% of the participants preferred municipal and district hospitals as their first choice, and 27.5% chose medical institutions according to specific circumstances. Univariate analysis indicated that age, education, income, medical insurance, housing conditions and registered permanent residence were significantly associated with the actual and expected preferred first medical institution. The main factors influencing participants' actual and expected preferred medical institution differed. With the actual preferred first medical institution as the dependent variable, education, monthly income, medical technology, convenience and providers' service attitude and medical ethics were the main factors (χ2=212.63, p<0.001), whereas with the expected preferred first medical institution as the dependent variable, occupation, Shenzhen registered permanent residence, education and medical technology were the main factors (χ2=78.101, p<0.001). CONCLUSION The main factors influencing participants' preferred medical institution and their actual first visit differed. Patients with high education or income or registered permanent residence preferred high-level medical institutions for the first visit.
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Affiliation(s)
- Xinyu Zhao
- Department of Epidemiology and Statistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, China
| | - Junhui Xiao
- Institute of Health Law and Policy, Guangdong Medical University, Dongguan, Guangdong, China
| | - Huida Chen
- Department of Epidemiology and Statistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, China
| | - Kena Lin
- Department of Epidemiology and Statistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, China
| | - Xiaoman Li
- Department of Epidemiology and Statistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, China
| | - Zhiwen Zeng
- Department of Epidemiology and Statistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, China
| | - Shuyun Huang
- Department of Epidemiology and Statistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, China
| | - Zhikui Xie
- Shenzhen Administration Institute, Shenzhen, Guangdong, China
| | - Jinlin Du
- Department of Epidemiology and Statistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, China
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11
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Yang H, Huang X, Yang C, Zhu S, Chen X, Zhang M, Yu X, Wang HHX. Time Window for Acute Stroke Management: A Cross-Sectional Study Among Community Healthcare Practitioners in Primary Care. Int J Gen Med 2022; 15:4483-4493. [PMID: 35518516 PMCID: PMC9064173 DOI: 10.2147/ijgm.s361189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/14/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Time-to-treatment window is critical for managing acute ischaemic stroke. The community healthcare practitioners (CHPs) who deliver frontline care in the health system play an important role in stroke prevention and treatment. Methods A multi-stage sampling design was adopted in Guangdong province, China. A total of 997 CHPs who participated in the survey were divided into two groups (the awareness group vs the unawareness group) according to their knowledge on the time window for stroke management. Logistic regression analysis was performed to explore factors associated with the awareness of “time window”. Results Overall, less than half (49.1%) of CHPs were aware of the time window for stroke management. The proportion of CHPs who were able to recognise stroke symptoms were higher in the awareness group (42.7%) than that in the unawareness group (38.8%). Most CHPs (82.9%) in the awareness group had the knowledge about the effectiveness of intravenous thrombolysis in treating acute cerebral infarction, whereas this was perceived by only less than half (43.6%) of CHPs in the unawareness group. Factors associated with the knowledge of time window for stroke management included participation in cerebrovascular disease management training (adjusted odds ratio [aOR]=4.203, 95% CI: 1.707–10.348, p=0.002), awareness of the time frame for CT initiation (aOR=5.214, 95% CI: 1.803–15.078, p=0.002) and for urokinase thrombolysis administration (aOR=11.927, 95% CI: 4.393–32.382, p<0.001), accurate perceptions about the target for blood pressure lowering (aOR=4.181, 95% CI: 1.713–10.207, p=0.002) and blood glucose control (aOR=2.446, 95% CI: 1.019–5.869, p=0.045), and the familiarity with prehospital stroke management principles (aOR=3.593, 95% CI: 1.383–9.332, p=0.009). Conclusion The CHPs need to enhance their ability to address the acute ischaemic stroke onset promptly to provide effective treatment within the beneficial “time window”. This may help improve the stroke chain of survival with better multidisciplinary decision support systems that enable optimal stroke care delivery.
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Affiliation(s)
- Huajie Yang
- School of Health Technology, Guangdong Open University (Guangdong Polytechnic Institute), Guangzhou, People's Republic of China
| | - Xiang Huang
- Department of Public Health, Sanxiang Community Health Service Centre of Zhongshan, Zhongshan, People's Republic of China
| | - Chunyu Yang
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Sufen Zhu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Xiaoyi Chen
- School of Nursing, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Man Zhang
- Department of Public Health, Sanxiang Community Health Service Centre of Zhongshan, Zhongshan, People's Republic of China
| | - Xiao Yu
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Harry H X Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Department of General Practice, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.,JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
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12
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Wei Y, Wang F, Pan Z, Jin G, Wang D, Lu X, Cao Q. Work Content of General Practitioners in Beijing, China: A Multi-method Study. Front Public Health 2022; 10:870224. [PMID: 35570960 PMCID: PMC9096235 DOI: 10.3389/fpubh.2022.870224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite the dramatic growth of primary care in China, little evidence showed what general practitioner (GP) do and how GP provided medical service in Beijing. Objective This study aimed to explore the work content of GPs in primary care in Beijing. Methods A multi-method study was conducted in five community health service institutions using non-participant observation and critical incident technique interview. Eleven GPs was recruited by purpose sampling, with each GP recording details of 100 patient encounters. Health problems of patients and activities of GPs were observed in consultations. Then, critical incident technique interviews were conducted focusing on GPs' works out of clinics and challenge. Results A total of 1, 100 patients encounters and 1,897 reasons for encounter (RFEs) were recorded from 11 GPs. There were 1897 RFEs (1.72 per encounter) and 2,762 health problems (2.51 per encounter) from 1,100 encounters during our observation. GPs' work related to consultation was focus on disease diagnoses and treatment. Physical examination and investigations were performed in only 15.5 and 17.1% consultations, respectively. Procedures for chronic disease management were infrequently provided to patients (0.4–26.6%). Time spent in each work process in consultations ranged from 0.68 ± 0.27 min for reservation to 4.00 ± 2.45 min for surgical treatment. In addition to clinical work, there were tasks about health files, contracted family doctor services, health education, teaching students, and scientific research. Conclusion This study illustrated the complexity of GPs' work and heavy workload in Beijing, China. More attention and effort are needed to develop GPs performance and release GPs' work workload in primary care.
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Affiliation(s)
- Yun Wei
- Department of General Practice, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Feiyue Wang
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Zhaolu Pan
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Guanghui Jin
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Dawei Wang
- Department of General Practice, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaoqin Lu
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Qiumei Cao
- Department of General Practice, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Qiumei Cao
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13
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Pan J, Wei D, Seyler BC, Song C, Wang X. An External Patient Healthcare Index (EPHI) for Simulating Spatial Tendencies in Healthcare Seeking Behavior. Front Public Health 2022; 10:786467. [PMID: 35433571 PMCID: PMC9009093 DOI: 10.3389/fpubh.2022.786467] [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: 11/10/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Healthcare resources are always more limited compared with demand, but better matching supply with demand can improve overall resource efficiency. In countries like China where patients are free to choose healthcare facilities, over-utilization and under-utilization of healthcare resources co-exist because of unreasonable healthcare seeking behavior. However, scholarship regarding the spatial distribution of utilization for healthcare resources, resulting from unreasonable spatial tendencies in healthcare seeking, is rare. Methods In this article, we propose a new External Patient Healthcare Index (EPHI) to simulate the spatial distribution of utilization for healthcare resources, based on the Two-Step Floating Catchment Area (2SFCA) method, which is widely used to assess potential spatial accessibility. Instead of using individual-level healthcare utilization data which is difficult to obtain, the EPHI uses institution-level aggregated data, including numbers of inpatient/outpatient visits. By comparing the estimated utilization (based on local healthcare institution services provision) with the expected utilization (based on local population morbidity), guest patients (e.g., patients flowing in for treatment) and bypass patients (patients flowing out) can be identified. To test the applicability of this index, a case study was carried out on China's Hainan Island. The spatial tendencies of patients for inpatient and outpatient services were simulated, then incorporated with spatial access to healthcare resources to evaluate overall resource allocation efficiency, thus guiding future resource allocations and investment for policy makers and healthcare providers. Results The EPHI revealed that bypass activities widely exist on Hainan Island in both inpatient and outpatient care, with patients tending to travel from less developed regions with fewer healthcare resources to more highly developed regions with more healthcare resources to receive healthcare. Comparison with spatial accessibility demonstrated how bypass activities on Hainan produced an under-utilization of doctors in less developed regions and over-utilization of doctors in more developed coastal regions. Conclusions This case study on Hainan Island demonstrates that this new index can very clearly identify both the sources and sinks of patient spatial tendencies. Combining these results with spatial accessibility of healthcare resources, how efficiently the available supply matches the utilization can be revealed, indicating wide-ranging applicability for local governments and policymakers.
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Affiliation(s)
- Jay Pan
- Healthcare Evaluation and Organizational Analysis Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.,Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Duan Wei
- People's Government of Jinkouhe District, Leshan, China
| | | | - Chao Song
- Healthcare Evaluation and Organizational Analysis Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.,Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Xiuli Wang
- Healthcare Evaluation and Organizational Analysis Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.,Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
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14
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Liu S, Lin J, He Y, Xu J. The Service Capability of Primary Health Institutions under the Hierarchical Medical System. Healthcare (Basel) 2022; 10:healthcare10020335. [PMID: 35206949 PMCID: PMC8872352 DOI: 10.3390/healthcare10020335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/29/2022] [Accepted: 02/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Primary health institutions (PHIs) are the foundation of the whole health system and the basic link to achieve the goal of all people enjoying primary health care. However, the service capability of primary health institutions is not under the hierarchical medical system. Method: Data were collected from the China Health Statistics Yearbook between 2014 and 2020. PHIs included community health centres, community health stations, and township hospitals in our study. The service capability of primary health institutions was analysed from the perspective of structure, process, and results. Structure capability was evaluated using the number of beds, number of personnel, number of health technicians, and proportion of the number of personnel in PHIs accounting for the total number of health personnel. Process capability was evaluated using the number of general practitioners. The number of outpatients and inpatients, medical income, the proportion of drug income, and the average number of patients and beds served by physicians in PHIs per day were employed to evaluate the resulting capability. Results: From 2014 to 2020, the number of community health service centres/stations increased, while the number of township health centres decreased. In the aspect of structure capability, the total number of personnel and health technicians in community health centres/stations and township hospitals both increased during 2014 and 2020. However, the increasing rate in PHIs was a little bit less than that of general medical institutions. The proportion of male health technicians in community health centres and township hospitals both decreased, while the proportion of female technicians in both increased. From 2014 to 2020, the number of beds in PHIs also increased from 138.12 × 104 to 164.94 × 104. However, the proportion of beds in PHIs accounting for the total number of beds in medical institutions decreased. For the resulting capability, from 2014 to 2019, the proportion of diagnosis and treatment times in PHIs decreased from 57.41% to 51.96%, although it increased in 2020. The proportion of inpatients in PHIs decreased from 20.03% to 16.11%. From 2014 to 2020, the utilisation rate of hospital beds in PHIs decreased (from 55.6% to 34% for community health centres and 60.5% to 53.6% for township hospitals). The average daily bed days of doctors in township hospitals was higher than that of doctors in community health service centres. However, the average medical cost of outpatients and the per capita medical cost of inpatients in community health service centres were higher than in township hospitals. Conclusion: In recent years, although the service capability showed an increasing trend in PHIs, the growth rate was lower than the general health institutions. The utilisation rates of PHIs, including beds and physicians, were decreased. Among PHIs, the utilisation in township hospitals was higher than in community health centres with a relatively low price. Under the hierarchical medical system and normalisation period of the COVID-19 epidemic, it is important to improve the service capability to achieve its goal of increasing PHI utilisation and decreasing secondary and tertiary hospital utilisation.
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15
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Wang Y, Wu XY, Wang HHX, Li YT, Fu Y, Wang JJ, Hernandez J, Wong MCS. Body Constitution and Unhealthy Lifestyles in a Primary Care Population at High Cardiovascular Risk: New Insights for Health Management. Int J Gen Med 2021; 14:6991-7001. [PMID: 34707390 PMCID: PMC8544129 DOI: 10.2147/ijgm.s329321] [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] [Received: 07/15/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background Adherence to lifestyle recommendations remains insufficient in cardiovascular (CV) health management globally. Body constitution, from the perspective of traditional Chinese medicine, is primarily influenced by an individual's internal metabolism and susceptibility to external pathogenic factors. Nevertheless, less is known about whether body constitutions may play a role in the presence of unhealthy lifestyles. We aimed to explore the associations between body constitutions and unhealthy lifestyles among Chinese individuals at high CV risk. Methods Computerised data were retrieved from a primary care population-based health record for all 1739 eligible individuals at high CV risk who attended routine check-up in an urbanised, medium-size district in Guangzhou, China. Unhealthy lifestyles were determined in accordance with guideline recommendations. The body constitution was assessed on the basis of physical signs, personality, body symptoms, and the susceptibility to environmental changes, following nationally standard procedure. Binary logistic regression analyses were performed using marginal standardisation method. Results The participants ranged in age from 20 to 96 years, with a mean age of 69.55 years. There were slightly more females than males (52.3% vs 47.7%). Current smoking, regular drinking, and physical inactivity were most common. Participants with a body constitution of phlegm-and-dampness type (adjusted odds ratio [aOR]=1.999, 95% confidence interval [CI]=1.003-3.984; p=0.049) tended to be current smokers, and those assessed with special diathesis type (aOR=2.166, 95% CI=1.029-4.559; p=0.042) had a higher likelihood of being regular drinkers. Having a body constitution type of blood stasis (aOR=1.375, 95% CI=1.029-1.838; p=0.031) or qi deficient (aOR=1.711, 95% CI=1.080-2.709; p=0.022) was associated with physical inactivity. Conclusion Our findings add to current evidence suggesting that an individual's body constitution is closely related to the presence of unhealthy lifestyles. This offers new insights for health management through body constitution-based strategies to target those at high CV risk who need tailor-made attention in lifestyle modifications during routine primary care.
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Affiliation(s)
- Yi Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xiao-Ya Wu
- Shipai Community Health Centre, Tianhe District, Guangzhou, People's Republic of China
| | - Harry H X Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China.,JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong Special Administrative Region
| | - Yu-Ting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yu Fu
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jia-Ji Wang
- Guangdong-Provincial Primary Healthcare Association, Guangdong, People's Republic of China.,School of Public Health, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Jose Hernandez
- Faculty of Medicine and Health, EDU, Digital Education Holdings Ltd., Kalkara, Malta.,Green Templeton College, University of Oxford, Oxford, UK
| | - Martin C S Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong Special Administrative Region.,School of Public Health, Peking University, Beijing, People's Republic of China.,School of Public Health, The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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16
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Yang L, Wang L, Di X, Dai X. Utilisation of community care services and self-rated health among elderly population in China: a survey-based analysis with propensity score matching method. BMC Public Health 2021; 21:1936. [PMID: 34696767 PMCID: PMC8546940 DOI: 10.1186/s12889-021-11989-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Elderly care and elderly health are the enormous challenges in such an aging society as China. Community care services have been developing rapidly in recent years in China as an increasingly mainstream care resource to promote elderly health. The purpose of this study is to examine the association between using community care services and self-rated health among Chinese elderly. Methods A cross-sectional survey was conducted in 2019 and 612 elderly people from China’s Shaanxi province were enrolled. The binary logistic regression was first employed to explore the association between community care services utilisation and elderly health. Given the potential selection bias issue, the propensity score matching method was hired to generate comparable samples between participants who used these services and participants who didn’t, and further examine the health benefits of using four types of services. Results The results of the binary logistic regression showed that the use of community care services predicted a better health status of elderly individuals. Overall, the results of the propensity score matching method showed the similar results. Specifically, with the nearest neighbors matching algorithm, using daily care services was significantly associated with a 0.246 increase in the self-rated health of the elderly (T = 1.83). For medical care services, the mean of self-rated health of elderly individuals who used these services was 3.542, significantly higher than those who didn’t (T = 2.15). For spiritual comfort services, elderly individuals using these services showed a significant increase by 0.280 in the self-rated health (T = 1.82). For social and recreational services, the result of the nearest neighbor matching method was not statistically significant, while the results of kernel matching method and the mahalanobis matching method showed a significant increase in the self-rated health among elderly individuals using these services (T = 2.03, T = 2.03, respectively). All the estimated results passed the Rosenbaum bounds analysis and were not sensitive to hidden bias. Conclusions Using community care services improved the self-rated health of the elderly. More effective measures may be implemented to increase access to care resources for senior citizens, and further improve their health status. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11989-x.
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Affiliation(s)
- Liu Yang
- School of Public Policy and Administration, Xi'an Jiaotong University, People's Republic of China, No 28 West Road, Xi'an, Xianning, 710049, Shaanxi, China
| | - Lijian Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, People's Republic of China, No 28 West Road, Xi'an, Xianning, 710049, Shaanxi, China.
| | - Xiaodong Di
- School of Public Policy and Administration, Xi'an Jiaotong University, People's Republic of China, No 28 West Road, Xi'an, Xianning, 710049, Shaanxi, China
| | - Xiuliang Dai
- School of Public Policy and Administration, Xi'an Jiaotong University, People's Republic of China, No 28 West Road, Xi'an, Xianning, 710049, Shaanxi, China
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17
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Wei Y, Wang F, Pan Z, Wang M, Jin G, Liu Y, Lu X. Development of a competency model for general practitioners after standardized residency training in China by a modified Delphi method. BMC FAMILY PRACTICE 2021; 22:171. [PMID: 34433420 PMCID: PMC8390270 DOI: 10.1186/s12875-021-01508-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The "5 + 3" residency training is the main stream general practitioner training program in China. However, a competency model is absent for evaluating the clinical competence attained by general practitioners after training. This study was conducted to develop a consensus set of competencies for general practitioners after standardized residency training in China. METHODS A modified Delphi process was deployed to develop the competency model, including two stages: (1) generation of an initial set of competencies derived from literature review, behavioral observation of GP-patient consultations, and critical incidents interview of GPs; (2) a 2-round, web-based Delphi survey of experts in general practice, selected using purposive sampling, to prioritize and gain consensus on the essential competencies of GPs. RESULTS From literature review, behavioral observation, and critical incidents interview, 46 competencies in 7 domains were identified. After two rounds of Delphi survey of 28 participants (the mean age was 47.9 [9.3] years and 64.3% were women) representing a range of health professionals (GPs, managers, and researchers), a consensus was reached on 50 competencies categorized into 7 domains. CONCLUSION A consensus-based competency model for general practitioners in China has been identified which may be used to evaluate the general practitioners' clinical competence after standardized training.
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Affiliation(s)
- Yun Wei
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing, 100069, China
| | - Feiyue Wang
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing, 100069, China
| | - Zhaolu Pan
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing, 100069, China
| | - Meirong Wang
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing, 100069, China
| | - Guanghui Jin
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing, 100069, China
| | - Yanli Liu
- Department of General Practice, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoqin Lu
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing, 100069, China.
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18
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Liao R, Liu Y, Peng S, Feng XL. Factors affecting health care users' first contact with primary health care facilities in north eastern China, 2008-2018. BMJ Glob Health 2021; 6:bmjgh-2020-003907. [PMID: 33597277 PMCID: PMC7893657 DOI: 10.1136/bmjgh-2020-003907] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/03/2021] [Accepted: 01/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background China set out the vision to establishing a hierarchical medical system, with primary health care (PHC) facilities serving health care users’ first contact. Common ailments were listed, supported by a series of auxiliary policy measures. We aim to assess whether these policies were effective to prompt users’ preference to PHCs within these contexts. Methods Using data from three waves of National Health Service Survey, we examined trends in care users’ first contact with PHC facilities in Jilin, a north eastern province, during 2008–2018. We analysed trends and factors affecting care users’ choices, stratified by type of diseases and urban–rural settings. Results From 38 823 respondents, the survey identified 3302 health care users who sought outpatient care. 54.92% and 82.49% with diseases recommended to PHC, in urban and rural Jilin, respectively, contacted PHC facilities first. While 33.51% and 61.19% with diseases not recommended to PHC did so. Care users’ first contact with PHC facilities followed an inverse U shape during 2008–2018. Such trends were more profound among care users with hypertension and/or diabetes. Neither social health insurance coverage nor contracting with family doctors was associated with care users’ first contacts. Only 1.25% care users had referral experiences. Low perceived quality was the main barrier to choose PHC facilities. Conclusion Health care users sought PHC in a chaotic manner in Jilin. None of the recent efforts seemed effective in prompting their preference to PHC facilities. Without levering quality of PHC, an effective hierarchical medical system could be hardly forged in China.
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Affiliation(s)
- Ran Liao
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Yaqian Liu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Shunzhuang Peng
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Xing Lin Feng
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
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Yang C, Hui Z, Zeng D, Zhu S, Wang X, Lee DTF, Chair SY. A community-based nurse-led medication self-management intervention in the improvement of medication adherence in older patients with multimorbidity: protocol for a randomised controlled trial. BMC Geriatr 2021; 21:152. [PMID: 33653300 PMCID: PMC7923480 DOI: 10.1186/s12877-021-02097-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Older patients suffering from multimorbidity are at high risk of medication nonadherence. It has been well established that self-management support is an effective strategy to enhance medication adherence for patients with chronic conditions. However, little is known about the effect of the medication self-management intervention in older patients with multimorbidity. This paper presents the protocol for a study that aims to evaluate the effectiveness of a nurse-led medication self-management intervention in improving medication adherence and health outcomes for community-dwelling older patients with multimorbidity. Methods The study protocol follows the recommendations of the Standard Protocol Items: Recommendations for Interventional Trials 2013 statement. This study is a multicentre, single-blind, two-arm randomised controlled trial. Older patients with multimorbidity will be recruited from three community health centres in Changsha, China. A total of 136 participants will be randomly allocated to receive usual care or usual care plus the medication self-management intervention. The intervention will be delivered by community nurses. The 6-week intervention includes three face-to-face education sessions and two weekly follow-up phone calls. Participants in the control group continue to receive all respects of usual care offered by community healthcare providers, including chronic disease management, drug prescription, referral to hospital specialists, health education and consultations regarding patients’ diseases and treatments during centre visits. The primary outcome is medication adherence as measured by the 5-item Medication Adherence Report Scale. Secondary outcomes include medication self-management capacity (medication knowledge, medication beliefs, medication social support, medication skills, and medication self-efficacy), treatment experiences (medication treatment satisfaction and treatment burden), quality of life, and utilisation of healthcare services. All outcomes will be measured at baseline, immediately post-intervention, and at 3-month post-intervention. Discussion This study will provide evidence about the effectiveness of a medication self-management intervention, delivered by nurses, for older patients with multimorbidity and adherence problems. It is expected that the results of the study, if proven effective in improving patients’ adherence and health outcomes, will provide evidence-based self-management support strategies for healthcare providers in routine chronic disease management in community settings. Trial registration The trial is registered at ChiCTR.org.cn (ChiCTR2000030011; date February 19, 2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02097-x.
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Affiliation(s)
- Chen Yang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6/F, Esther Lee Building, Shatin, Hong Kong SAR, China.
| | - Zhaozhao Hui
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6/F, Esther Lee Building, Shatin, Hong Kong SAR, China
| | - Dejian Zeng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6/F, Esther Lee Building, Shatin, Hong Kong SAR, China
| | - Song Zhu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiuhua Wang
- Xiang Ya Nursing School, Central South University, Changsha, China
| | - Diana Tze Fan Lee
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6/F, Esther Lee Building, Shatin, Hong Kong SAR, China
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6/F, Esther Lee Building, Shatin, Hong Kong SAR, China
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Wang X, Seyler BC, Han W, Pan J. An integrated analysis of spatial access to the three-tier healthcare delivery system in China: a case study of Hainan Island. Int J Equity Health 2021; 20:60. [PMID: 33579289 PMCID: PMC7881625 DOI: 10.1186/s12939-021-01401-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/03/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Access to healthcare is critical for the implementation of Universal Health Coverage. With the development of healthcare insurance systems around the world, spatial impedance to healthcare institutions has attracted increasing attention. However, most spatial access methodologies have been developed in Western countries, whose healthcare systems are different from those in Low- and Middle-Income Countries (LMICs). METHODS Hainan Island was taken as an example to explore the utilization of modern spatial access techniques under China's specialized Three-Tier Health Care Delivery System. Healthcare institutions were first classified according to the three tiers. Then shortest travel time was calculated for each institution's tier, overlapped to identify eight types of multilevel healthcare access zones. Spatial access to doctors based on the Enhanced Two-Step Floating Catchment Area Method was also calculated. RESULTS On Hainan Island, about 90% of the population lived within a 60-min service range for Tier 3 (hospital) healthcare institutions, 80% lived within 30 min of Tier 2 (health centers), and 75% lived within 15 min of Tier 1 (clinics). Based on local policy, 76.36% of the population living in 48.52% of the area were able to receive timely services at all tiers of healthcare institutions. The weighted average access to doctors was 2.31 per thousand residents, but the regional disparity was large, with 64.66% being contributed by Tier 3 healthcare institutions. CONCLUSION Spatial access to healthcare institutions on Hainan Island was generally good according to travel time and general abundance of doctors, but inequity between regions and imbalance between different healthcare institution tiers exist. Primary healthcare institutions, especially in Tier 2, should be strengthened.
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Affiliation(s)
- Xiuli Wang
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17 People’s South Road, Chengdu, 610041 China
- Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No.17 People’s South Road, Chengdu, China
| | - Barnabas C. Seyler
- Department of Environment, Sichuan University, No.24 South Section 1, Yihuan Road, Chengdu, 610065 China
| | - Wei Han
- Health, Nutrition and Population Global Practice, World Bank, No.1 Jianguomenwai Street, Chaoyang district, Beijing, 100020 China
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17 People’s South Road, Chengdu, 610041 China
- Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No.17 People’s South Road, Chengdu, China
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Nagel DA, Keeping-Burke L, Shamputa IC. Concept Analysis and Proposed Definition of Community Health Center. J Prim Care Community Health 2021; 12:21501327211046436. [PMID: 34541950 PMCID: PMC8460964 DOI: 10.1177/21501327211046436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Community health centers (CHCs) have been used for delivery of health services since the 1920s and originally were intended to provide care to underserved populations. CHCs have become an integral part of healthcare systems in many countries; however, the term CHC is used synonymously with other concepts and there is no clear definition for CHC. The purpose of our concept analysis was to determine how CHCs are described in the literature and to develop a concept definition for CHC. Methods: Informed by the 8-step process described by Walker and Avant, we searched for literature spanning disciplines within health, business, and policy. We used a systematic review process to identify a range of peer-reviewed articles that help illustrate the attributes, antecedents, and consequences of CHCs. A total of 102 articles from 7 databases were included in our concept analysis. Results: We distinguished 6 attributes of a CHC: primary care; accessibility; preventative care; defined population; health promotion; and comprehensive and integrated care. About 4 antecedents fundamental to a CHC included: secure funding; vision and support; adequate human resources; and governance structure. Consequences of CHCs are improved health outcomes, efficiency, and cost-effective provision of healthcare services. Conclusions: Our concept analysis revealed core characteristics of CHCs that assisted us in synthesizing a concept definition for CHC. These characteristics and our proposed definition will help provide clarity on the concept of CHC to benefit evaluation, research, and policy development of CHCs.
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Ghaffari R, Taghizadieh A, Behshid M, Somi MH, Mirzazadeh A, Baradaran HR, Huntington M, Emami Razavi SH, Baghban Rezvan F, Salek Ranjbarzadeh F. Accountability in medical education from theory to practice Tabriz 2018 statement: A step towards the implementation of this social necessity. Med J Islam Repub Iran 2020; 34:93. [PMID: 33315967 PMCID: PMC7722974 DOI: 10.34171/mjiri.34.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background: To implement the education reform package on accountability in medical education, the Education Development Center (EDC) of Tabriz University of Medical Sciences has held the first national conference on accountability in medical education, and the present statement is the result of scientific interactions and exchanges in the conference.
Methods: For implementation of the accountability in medical education, there was a need to inform faculty members and other stakeholders about their responsibility in education and health care needs. The provision of such platform was provided by holding a specialized conference on accountability in medical education by Tabriz University of Medical Sciences. Steps of preparing the draft version of the Tabriz 2018 Statement were as follow: Formation the scientific committee; Division of the responsibility for drafting the statement between various workgroups; and Preparation and primary approval of the draft of Tabriz 2018 Statement.
Results: Steps of preparing the draft version of the Tabriz 2018 Statement were: Formation of the scientific committee, Division of the responsibility for drafting the statement between the various workgroups and Preparation and primary approval of the draft of Tabriz 2018 Statement.
Conclusion: Establishing an educational accreditation model and reviewing accreditation standards based on social accountability can be an effective step to strengthen accountability towards community needs.
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Affiliation(s)
- Reza Ghaffari
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Taghizadieh
- Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mozhgan Behshid
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Husein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azim Mirzazadeh
- Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Mark Huntington
- Department of Family Medicine, School of Medicine, University of South Dakota Sanford, 414 E. Clark Street, Vermillion, SD 57069, United States
| | - Seyed Hasan Emami Razavi
- Neuroscience Institute, Brain and Spinal Cord Injury Research Center (BASIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Flora Baghban Rezvan
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Salek Ranjbarzadeh
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Jones MM. Coronary care in China: starting from the tip of the iceberg? Heart 2020; 106:1454-1455. [PMID: 32748798 DOI: 10.1136/heartjnl-2020-317223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Melvyn M Jones
- Research Department of Primary Care and Population Health, UCL, London, UK .,Institution of Biomedical Education, St George's University of London, London, UK
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24
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Chen S, Lei Y, Dai H, Wu J, Yang Z, Liao X. Community-based rehabilitation service in Chengdu, Southwest China: a cross-sectional general survey. BMC Health Serv Res 2020; 20:625. [PMID: 32641049 PMCID: PMC7346348 DOI: 10.1186/s12913-020-05480-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 06/28/2020] [Indexed: 02/05/2023] Open
Abstract
Background World Health Organization initiated community-based rehabilitation (CBR) in 1978, and by now, it has been an essential process of medical services worldwide. China had strengthened primary health care on building more than 35,000 community health centers (CHCs) in cities, and more than 34,000 township health centers (THCs) in the rural area. Nevertheless, it remains unclear that if these primary health centers could provide optional rehabilitation services for disabilities. And this study aims at evaluating the supply capacity of rehabilitation service in primary health centers of Chengdu, a regional center city of southwest China. Method We conducted a general investigation of primary health centers in Chengdu, a city located in southwest China with more than 15 million population. Our investigation covered all of Chengdu’s 390 primary health centers from October to November 2016. We researched these primary health centers on basic rehabilitation services, diseases, and rehabilitation equipment quantity and quality, and traditional Chinese medicine (TCM) physiotherapy. Result Rehabilitation therapy is available in 88.9% (337 of 379) of all primary health centers. Meanwhile, CHCs slightly surpass THCs with an available rate of 92.2% (106 of 115) and 87.5% (231 of 264), respectively. Traditional Chinese Medicine (TCM) physiotherapy is available in 97.1% (368 of 379) of all primary health centers, 97.3% (112 of 115) of CHCs and 97.0% (256 of 264) of THCs. Quantitative analysis showed that substantial factors which could make an impact on the number of patients per year contain: categories of rehabilitation disease (P < 0.001, 95% confidence interval (CI) [− 1.571, − 0.702]),number of rehabilitation bed (P < 0.001, 95%CI [− 1.249, − 0.290]). Conclusion CBR and TCM physiotherapy has become accessible for disabilities in most basic health centers of Chengdu City, whereas, available rate of CBR in THCs is lesser than in CHCs, which suggests an imbalance in primary health service development between rural and urban area. Categories of rehabilitation diseases, and the number of rehabilitation beds constitute co-factors that make an impact on the CBR capacity of basic health centers.
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Affiliation(s)
- Siliang Chen
- West China School of Medicine, Sichuan University, Chengdu, 610041, Sichuan, PR China
| | - Yi Lei
- International medical center/center of general practice, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, PR China.
| | - Hua Dai
- International medical center/center of general practice, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, PR China
| | - Jia Wu
- International medical center/center of general practice, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, PR China
| | - Ziyu Yang
- International medical center/center of general practice, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, PR China
| | - Xiaoyang Liao
- International medical center/center of general practice, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, PR China.
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Evolution of the Output-Workforce Relationship in Primary Care Facilities in China from 2009 to 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093043. [PMID: 32349373 PMCID: PMC7246558 DOI: 10.3390/ijerph17093043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022]
Abstract
This study evaluates trends in workforce supply compared with those in the volume of service delivery (output) for basic clinical care (CC) and public health (PH) services from 2009 to 2017 in China. A cross-sectional survey (2018) was combined with retrospective data (2009–2017) from 785 primary care (PC) facilities in six provinces. Measures for the output of clinical care and of public health services were aggregated into a single (weighted) index for both service profiles. The output–workforce relationship was measured by its ratio. Latent class growth analysis and logistic regression analysis were applied to classify trajectories and determine associations with facility-level, geographic, and economic characteristics. From 2009 to 2017, the proportion of PC to overall healthcare workforce decreased from 24.25% to 18.57%; the proportion of PH to PC providers at PC facilities increased from 23.6% to 29.5%, while the proportion of PH output increased from 44.3% to 65.9%. Four trajectories of the output–workforce relationship were identified for CC, and five trajectories for PH services of which 85.3% of the facilities showed initially increasing and then slightly decreasing trends. Geographic characteristics impacted different trajectories. The PC workforce falls behind hospital workforce. The expansion in workload of PH services is unbalanced with that of workforce.
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Yang C, Hui Z, Zeng D, Liu L, Lee DTF. Examining and adapting the information-motivation-behavioural skills model of medication adherence among community-dwelling older patients with multimorbidity: protocol for a cross-sectional study. BMJ Open 2020; 10:e033431. [PMID: 32209623 PMCID: PMC7202708 DOI: 10.1136/bmjopen-2019-033431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Multimorbidity is highly prevalent among older patients and has been shown to be associated with poor health outcomes and lower quality of life. Adherence to medication treatments is essential in order to maximise the efficacy of treatments and improve health outcomes. However, nearly half of the older patients with multimorbidity fail to adhere to their medications, which can result in an increased risk of adverse health events, lower quality of life and higher healthcare cost. Only a few studies have explored the underlying mechanism and influencing factors of medication adherence among older patients with multimorbidity, which are inadequate to provide robust evidence for the development and evaluation of the medication adherence interventions. This study aims to examine and adapt the information-motivation-behavioural skills (IMB) model, a widely used social behaviour theory, to explain the medication adherence behaviour among community-dwelling older patients with multimorbidity. METHODS AND ANALYSIS A cross-sectional study will be conducted in community settings in China. Around 309 older patients with multimorbidity will be recruited to complete questionnaires on adherence knowledge, adherence motivation, adherence self-efficacy, medication adherence, medication treatment satisfaction, depressive symptoms, treatment burden, disease burden and basic demographic information. Structural equation modelling will be used to analyse and validate the relationships among variables in the IMB model. ETHICS AND DISSEMINATION This study has been approved by the Survey and Behavioral Research Ethics Committee of the Chinese University of Hong Kong (reference number SBRE-18-675). The study results will be published in peer-reviewed journals and presented in academic conferences and workshops. TRIAL REGISTRATION NUMBER ChiCTR1900024804.
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Affiliation(s)
- Chen Yang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zhaozhao Hui
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dejian Zeng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Li Liu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Diana Tze Fan Lee
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Zeng Y, Xu W, Chen L, Chen F, Fang Y. The Influencing Factors of Health-Seeking Preference and Community Health Service Utilization Among Patients in Primary Care Reform in Xiamen, China. Patient Prefer Adherence 2020; 14:653-662. [PMID: 32280202 PMCID: PMC7125321 DOI: 10.2147/ppa.s242141] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/15/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Patients often seek healthcare at general hospitals rather than at community healthcare centres (CHCs) which leads to inefficiency of health services. The primary healthcare reform developed by Xiamen has proven to break through the barriers of hierarchical diagnosis and treatment. The influencing factors of health-seeking behaviours of patients in the Xiamen reform, however, are unclear. OBJECTIVE This study aimed to assess patients' healthcare-seeking preferences and CHCs utilization, and identify influencing factors among patients affected by the Xiamen reform. METHODS A cross-sectional study composed of 2200 individuals with hypertension or diabetes was conducted in association with Xiamen's reform. The choice of health institutions was used to measure health-seeking preference. The probability and frequency of outpatient service use were used to measure CHC utilization. The social ecological model and two-part model were employed to examine influencing factors. RESULTS As high as 72.5% of the subjects, including those who were under 60 years old, had low education level, with long disease duration, good self-report health and low household income expressed a preference for CHC (P<0.05). Also, participants who had good-condition CHCs (χ2=6.736, P=0.010), joined in three-in-one chronic disease management (χ2=81.615, P<0.01) and were insured by medical insurance (χ2=21.142, P<0.01) significantly preferred to visit CHCs for treatment. In addition, patients who had a preference for CHC utilized many more CHCs (P<0.01). Analysis of influencing factors found that education, self-reported health, smoking, household income, condition of the CHC, whether the patient had joined the healthcare reform and whether the patient had medical insurance were important factors affecting health-seeking preference and CHC utilization (P<0.05). CONCLUSION The Xiamen healthcare reform made some achievements in improving CHC utilization. However, certain challenges remain. The government should further strengthen CHCs, deepen and expand healthcare reform, and make efforts to guide reasonable healthcare-seeking behaviour and improve the efficiency of primary health systems.
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Affiliation(s)
- Yanbing Zeng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, People’s Republic of China
| | - Weiqian Xu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, People’s Republic of China
| | - Lele Chen
- School of Social and Behavioral Sciences, Nanjing University, Nanjing, Jiangsu, People’s Republic of China
| | - Fan Chen
- Xiang’An Hospital of Xiamen University, Xiamen, Fujian, People’s Republic of China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, People’s Republic of China
- Correspondence: Ya Fang School of Public Health, Xiamen University, Xiang’an Nan Road, Xiang’an District, Xiamen, Fujian361102, People’s Republic of ChinaTel +86 592-2880636Fax +86 592-2880639 Email
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Liu L, Liu C, Duan Z, Pan J, Yang M. Factors associated with the inter-facility transfer of inpatients in Sichuan province, China. BMC Health Serv Res 2019; 19:329. [PMID: 31122226 PMCID: PMC6533730 DOI: 10.1186/s12913-019-4153-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/08/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The overuse of tertiary hospitals and underuse of primary care facilities has been one of the key reasons leading to fast health expenditure increase and health service utilization inequity in China. Recent health care reform in China tries to enforce a patient transfer system to make the health services utilization more efficient. This study examined the pattern and associated factors of inter-facility transfer of inpatients in Sichuan province of Western China. METHODS Patient discharge records (n = 1,490,695) from 604 general hospitals during the period of April to June 2015 in Sichuan were extracted from the front page of the medical records system with individual information on demographics, insurance coverage, diagnoses, hospitals admitted and discharge type. We calculated the percentage of inpatients transferring to other health facilities, the Inter-Facility Transfer Rate (IFTR) with adjustment for Charlson Comorbidity Index (CCI). Multi-level logistic regression models were established to identify factors associated with IFTRs. RESULTS A small number of tertiary hospitals (n = 75, 12.41%) shared 51.71% (n = 770,823) of all admitted cases while a large number of primary/unrated hospitals (n = 321, 53.15%) shared only 8.15%. The overall CCI-adjusted IFTR was 2.08% with 3.73% among secondary hospitals, 1.87% among tertiary hospitals and 1.30% among primary/unrated hospitals. Uninsured patients (OR = 1.13) and those with a lower level of insurance entitlements (OR = 1.12 for the New Rural Cooperative Medical Scheme and the Basic Medical Insurance for Urban Residents) were more likely to experience inter-facility transfer than those with a higher level of insurance entitlements (the Basic Medical Insurance for Urban Employees). CONCLUSION The level of IFTR in general hospitals in Sichuan is low, which is associated with the level of hospitals and insurance entitlements. Further studies are needed to better understand how patients and health care providers respond to different insurance policies and make decisions on inter-facility transfer.
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Affiliation(s)
- Linxin Liu
- West China School of Public Health, Sichuan University, Chengdu, Sichuan People’s Republic of China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086 Australia
| | - Zhanqi Duan
- Health and Family Planning Information Centre of Sichuan Province, Chengdu, Sichuan People’s Republic of China
| | - Jingping Pan
- Health and Family Planning Information Centre of Sichuan Province, Chengdu, Sichuan People’s Republic of China
| | - Min Yang
- West China School of Public Health, West China Research Center for Rural Health Development, Sichuan University, Chengdu, 610041 Sichuan People’s Republic of China
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
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Sun X, Meng H, Ye Z, Conner KO, Duan Z, Liu D. Factors associated with the choice of primary care facilities for initial treatment among rural and urban residents in Southwestern China. PLoS One 2019; 14:e0211984. [PMID: 30730967 PMCID: PMC6366770 DOI: 10.1371/journal.pone.0211984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/23/2019] [Indexed: 01/04/2023] Open
Abstract
Objective To explore influential factors contributing to the choice of primary care facilities (PCFs) for the initial treatment among rural and urban residents in Southwestern China. Methods A face-to-face survey was conducted on a multistage stratified random sample of 456 rural and 459 urban residents in Sichuan Province from January to August in 2014. A structured questionnaire was used to collect data on residents’ characteristics, provider of initial treatment and principal reason for the choice. Multivariate logistic regression was performed to identify factors associated with choosing PCFs for the initial treatment. Results The result showed that 65.4% of the rural residents and 50.5% of the urban residents chose PCFs as their initial contact for medical care. Among both rural and urban residents, the principal reason for choosing medical institutions for the initial treatment was convenience (42.3% versus 40.5%, respectively), followed by high quality of medical care (26.5% versus 29.4%, respectively). Compared to rural residents, urban residents were more likely to value trust in doctors and high quality of medical care but were less likely to value the insurance designation status of the facilities. Logistic regression analysis showed that both rural and urban residents were less likely to choose PCFs for the initial treatment if they lived more than 15 minutes (by walk) from the nearest facilities (rural: OR = 0.15, 95%CI = 0.09–0.26; urban: OR = 0.19, 95%CI = 0.10–0.36), had fair (rural: OR = 0.49, 95%CI = 0.26–0.92; urban: OR = 0.31, 95%CI = 0.15–0.64) or poor (rural: OR = 0.14, 95%CI = 0.07–0.30; urban: OR = 0.22, 95%CI = 0.11–0.44) self-reported health status. Among rural residents, attending college or higher education (OR = 0.21, 95%CI = 0.08–0.59), being retired (OR = 0.90, 95%CI = 0.44–1.84) and earning a per capita annual income of household of 10,000–29,999 (OR = 0.24, 95%CI = 0.11–0.52) and 30,000–49,999 (OR = 0.26, 95%CI = 0.07–0.92) were associated with lower rates of seeking care at PCFs. Conclusion Efforts should be made to improve the accessibility of PCFs and to upgrade the services capability of PCFs both in rural and urban areas in China. At the same time, resources should be prioritized to residents with poorer self-reported health status, and rural residents who retire or have better education and higher income levels should be taken into account.
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Affiliation(s)
- Xiaxia Sun
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
| | - Hongdao Meng
- School of Aging Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, United States of America
| | - Zhiqiu Ye
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Kyaien O. Conner
- Department of Mental Health Law & Policy, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, United States of America
| | - Zhanqi Duan
- Health and Family Planning Information Centre of Sichuan Province, Chengdu, China
| | - Danping Liu
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
- * E-mail:
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Niu Y, Zhang L, Ye T, Yan Y, Zhang Y. Can unsuccessful treatment in primary medical institutions influence patients' choice? A retrospective cluster sample study from China. BMJ Open 2019; 9:e022304. [PMID: 30647031 PMCID: PMC6340440 DOI: 10.1136/bmjopen-2018-022304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE China has been attempting to control the patients' choice of high-level medical institutions through series measures of first point of contact at primary medical institutions, but the outcome is considered poor. We aim to analyse whether unsuccessful treatment in primary medical institutions can lead to the patients' choice of high-level medical institutions. DESIGN A retrospective cluster sample study. SETTING The study setting was in Macheng city, Hubei province. PARTICIPANTS The respondents are township-county (TC) patients (patients who first went to township hospitals and then county hospitals within 30 days for the same disease) who experienced unsuccessful treatment in primary medical institutions. A total of 2090 TC patients were screened out based on the New Rural Cooperative Medical System database in 2013. MAIN OUTCOME MEASURES The choice of patients between township hospitals (primary medical institutions) and county hospitals was observed. We compared TC patients' ratio of choosing county hospitals (RoCC) before TC experience with after TC experience. Thereafter, we compared RoCC of TC patients and non-TC patients (patients who did not experience TC) based on coarsened exact matching. RESULTS The ratio of TC for outpatient in township hospitals is 0.68% and that of TC for inpatient in township hospitals is 3.37%. RoCC for TC disease increased from 20.8% to 35.5% (p<0.001), RoCC for other disease increased from 35% to 37.3% (p=0.01). TC patients had significantly higher RoCC than non-TC patients (p<0.001). CONCLUSIONS Patients' choice of high-level medical institutions is highly associated with the experience of unsuccessful treatment in primary medical institutions. Moreover, people likely select high-level medical institutions thereafter regardless of conditions in rural China. Unsuccessful treatment in primary medical institutions is inevitable for patients. Thus, additional measures should be considered in lowering the potential risks for patients when treatments fail. TRIAL REGISTRATION NUMBER ChiCTR-OOR-14005563.
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Affiliation(s)
- Yadong Niu
- School of Health and Medicine Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, China
| | - Liang Zhang
- School of Health and Medicine Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, China
| | - Ting Ye
- School of Health and Medicine Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, China
| | - Yan Yan
- School of Health and Medicine Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, China
| | - Yan Zhang
- School of Health and Medicine Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, China
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Spatial Organization of Hierarchical Medical Services within the City Proper of Tianjin, China: Towards Efficient Medical Alliances. SUSTAINABILITY 2019. [DOI: 10.3390/su11010229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
To address the low performance of health care service delivery in the half-market system, the Chinese government has begun to advocate the medical alliance (MA) recently. Instead of strict regulations on the procedure of diagnosis and treatment, flexible resource sharing among medical institutions of different grades inside each MA is encouraged. By now, many attempts have been made for MA establishment from different perspectives, but there is no effective model maturely developed. For the promotion of the spatial accessibility to medical services at different levels, it is important to organize the hierarchial medial services according to the distributions of different grades of health care facilities in a city. With the city proper of Tianjin as the study case, we explored the optimal establishment of MAs using the geographic information system (GIS). By means of the Voronoi Diagrams, the service regions of different medical institutions were precisely defined and the organizational structure of hierarchical medical services in MAs was determined. Through interpolation analysis, accessibility to different levels of medical services was measured, and on this basis, discussions were conducted on the service efficiency of the MAs. According to the results from Tianjin, (1) under the proposed organizational model for MAs, the fit of the service regions of the first grade and the other two higher grades of medical institutions was good. but the fit of the second and the third grade medical institutions was insufficient. (2) Although the overall service efficiency was excellent, there were still deficiencies in a number of the MAs. (3) Increasing the number of second and third grade medical institutions in specific regions near the city’s edge, as well as the number of first grade institutions, could further improve the performance of hierarchical medical services.
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Huang J, Liu S, He R, Fang S, Lu W, Wu J, Liang H, Zhang Y. Factors associated with residents' contract behavior with family doctors in community health service centers: A longitudinal survey from China. PLoS One 2018; 13:e0208200. [PMID: 30496254 PMCID: PMC6264849 DOI: 10.1371/journal.pone.0208200] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/13/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND China adopted family doctor (FD) to help achieve "Healthy China 2030" through providing continuous, comprehensive, and life-cycle contract services. However, there is a disparity between actual and targeted FD use, as residents continue to visit specialists in large hospitals. The government implemented initiatives to improve residents' willingness to sign up with and visit their FDs. Factors that influence contract behavior are therefore significant for frontier policy research. METHODS Two survey waves were conducted in Shanghai (2013 and 2016). The first wave included 2754 people and the second 1995 people. Exploratory factor analysis was used to synthesize "satisfaction" as a predictor of contract behavior. Pearson's chi-square, pooled and logistic regression models were used to estimate associations between influencing factors and contract behavior, and clarify variations in factors across the two waves. RESULTS Four factors were extracted from 15 satisfaction items: "Treatment Environment," "Medical Technology," "Service Specification" and "Service Attitude". Consistent with descriptive analysis, longitudinal analysis showed sociodemographic characteristics (age, education, marital status, and hukou) were significant predictors of contract behavior. The odds ratio of non-communicable diseases (NCD) patients for contract behavior was 2.218 times that of residents without NCD. Contract behavior was positively correlated with awareness of FD services (OR = 21.674, 95%CI = 15.043-31.229), satisfaction with Service Attitude (OR = 1.210, 95%CI = 1.009-1.451), and visit compliance (OR = 1.959, 95%CI = 1.564-2.452). Over time, the odds ratios of the married, Shanghai hukou, NCD, and awareness of FD services declined from 0.456, 1.795, 2.492, 28.690 to 0.443, 1.678, 1.910 and 14.031 respectively, while those of age, and visit compliance increased from 1.027, 1.521 to 1.041 and 2.305 respectively. In 2016, an education-contract gradient had formed (the higher the education level, the higher probability of signing with a FD), whereas high school education had the highest odds ratio (OR = 1.163,95%CI = 0.740-1.827) in 2013. Service Attitude was the only significant satisfaction-related predictor (OR = 1.358, 95%CI = 1.001-1.842) in 2016, compared with "Treatment Environment" (OR = 1.224, 95%CI = 1.001-1.496) and "Service Specification" in 2013(OR = 1.270, 95%CI = 1.040-1.552). CONCLUSIONS Except for the socio-demographic variables, NCD, awareness of FD services, satisfaction and visit compliance were significant predictors of contract behavior with FDs. The effect of visit compliance had increased over time while NCD and awareness of FD services were losing impact over time. Significant satisfaction factors had also changed from "Treatment Environment" and "Service Specification" to "Service Attitude".
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Affiliation(s)
- Jiaoling Huang
- School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Shanshan Liu
- Pudong Institute for Health Development, Shanghai, China
| | - Rongrong He
- Shanghai Pudong Gongli Hospital, Shanghai, China
| | - Shuai Fang
- School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Wei Lu
- School of Economics and Management, Hainan Normal University, Hainan, China
| | - Jun Wu
- Health and Family Planning Commission of Pudong New District, Shanghai, China
| | - Hong Liang
- School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Yimin Zhang
- Pudong Institute for Health Development, Shanghai, China
- * E-mail:
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Zhu E, Fors U, Smedberg Å. Exploring the needs and possibilities of physicians' continuing professional development - An explorative qualitative study in a Chinese primary care context. PLoS One 2018; 13:e0202635. [PMID: 30114295 PMCID: PMC6095581 DOI: 10.1371/journal.pone.0202635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 08/07/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND One component of the 2009 Chinese health care reform plan is to train general practitioners to improve the delivery of primary care services. This continuing professional development is expected to further improve the physicians' competencies to be general practitioners in primary care. Augmented reality-a combination of virtual information and the real environment-may enhance general practitioners' continuing professional development by allowing their learning experiences to overlap with their workplace practice. OBJECTIVE To explore the needs, opportunities, and challenges involved in continuing professional development for Chinese physicians becoming competent general practitioners within primary care, with a special focus on the possibilities of applying augmented reality. METHODS This study used a qualitative approach with semi-structured face-to-face interviews. Two managers and thirteen physicians (from four community health centers and stations) participated. The data were analyzed using a thematic inductive analysis approach. RESULTS Based on our interviews, most of the physicians were not fully trained as general practitioners but still assumed the duties of that position; they were supposed to eventually become fully trained in line with the reforms of the Chinese primary care system. However, they reported a lack of in-service training opportunities to fulfill this goal. Even those who said that they had such opportunities perceived the efficacy of that training as being poor. The managers and most of the physicians reacted positively to the idea of using augmented reality in continuing professional development, and they suggested antibiotics treatment, surgery, and emergency care as learning areas in which augmented reality could be applied. CONCLUSIONS Due to the Chinese reforms of the primary care system, both managers and the physicians themselves expect general practitioners to become qualified by engaging in continuing professional development. Both groups also regarded augmented reality as a potentially useful tool.
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Affiliation(s)
- Egui Zhu
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Uno Fors
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - Åsa Smedberg
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
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Yang J, Siri JG, Remais JV, Cheng Q, Zhang H, Chan KKY, Sun Z, Zhao Y, Cong N, Li X, Zhang W, Bai Y, Bi J, Cai W, Chan EYY, Chen W, Fan W, Fu H, He J, Huang H, Ji JS, Jia P, Jiang X, Kwan MP, Li T, Li X, Liang S, Liang X, Liang L, Liu Q, Lu Y, Luo Y, Ma X, Schwartländer B, Shen Z, Shi P, Su J, Wu T, Yang C, Yin Y, Zhang Q, Zhang Y, Zhang Y, Xu B, Gong P. The Tsinghua-Lancet Commission on Healthy Cities in China: unlocking the power of cities for a healthy China. Lancet 2018; 391:2140-2184. [PMID: 29678340 PMCID: PMC7159272 DOI: 10.1016/s0140-6736(18)30486-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Jun Yang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China; Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China
| | - José G Siri
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Justin V Remais
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Qu Cheng
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Han Zhang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Karen K Y Chan
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Zhe Sun
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Yuanyuan Zhao
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Na Cong
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Xueyan Li
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Wei Zhang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Yuqi Bai
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China; Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China
| | - Jun Bi
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, China
| | - Wenjia Cai
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China; Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China
| | - Emily Y Y Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wanqing Chen
- National Office for Cancer Prevention and Control, National Central Cancer Registry Cancer Institute/Hospital, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College National Cancer Center, Beijing, China
| | - Weicheng Fan
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, China
| | - Hua Fu
- Fudan Health Communication Institute, School of Public Health, Fudan University, Shanghai, China
| | - Jianqing He
- China National Engineering Research Center for Human Settlements, Beijing, China
| | - Hong Huang
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, China
| | - John S Ji
- Environmental Research Center, Duke Kunshan University, Kunshan, China; Nicholas School of the Environment, Duke University, Durham, NC, USA; Harvard Center Shanghai, Asia-Pacific Research Center, Harvard Business School, Boston, MA, USA
| | - Peng Jia
- Department of Earth Observation Science, Faculty of Geo-information Science and Earth Observation (ITC), University of Twente, Enschede, Netherlands
| | | | - Mei-Po Kwan
- Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, Netherlands
| | - Tianhong Li
- Department of Internal Medicine, Division of Hematology & Oncology, University of California Davis School of Medicine, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Xiguang Li
- School of Journalism and Communication, Tsinghua University, Beijing, China
| | - Song Liang
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lu Liang
- Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China; Arkansas Forest Resources Center, University of Arkansas Division of Agriculture, School of Forestry and Natural Resources, University of Arkansas at Monticello, Monticello, AR, USA
| | - Qiyong Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yongmei Lu
- Department of Geography, Texas State University, San Marcos, TX, USA
| | - Yong Luo
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China
| | - Xiulian Ma
- Chinese Academy of Governance, Beijing, China
| | | | | | - Peijun Shi
- Joint Center for Global Change Studies (JCGCS), Beijing, China; State Key Laboratory of Earth Surface Processes and Resource Ecology/Academy of Disaster Reduction and Emergency Management, Beijing Normal University, Beijing, China
| | - Jing Su
- School of Medicine, Tsinghua University, Beijing, China
| | - Tinghai Wu
- School of Architecture, Tsinghua University, Beijing, China
| | - Changhong Yang
- Institute for Public Health Information, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Yongyuan Yin
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Qiang Zhang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China
| | - Yinping Zhang
- Bureau of Disease Prevention and Control, National Health and Family Planning Commission, Beijing, China
| | - Yong Zhang
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Department of Building Science, Tsinghua University, Beijing, China
| | - Bing Xu
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China; Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China.
| | - Peng Gong
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China; Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China.
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Han TS, Wang HHX, Wei L, Pan Y, Ma Y, Wang Y, Wang J, Hu Z, Sharma P, Chen R. Impacts of undetected and inadequately treated hypertension on incident stroke in China. BMJ Open 2017; 7:e016581. [PMID: 28993383 PMCID: PMC5640060 DOI: 10.1136/bmjopen-2017-016581] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/11/2017] [Accepted: 08/21/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES China carries the greatest burden of stroke given its largest volume of people with hypertension. This study assessed the impacts of suboptimal controls of hypertension on incident stroke and projected the number of patients with stroke saved after the control of blood pressure improved in population. SETTING Anhui, China. PARTICIPANTS We examined data from the Anhui cohort of 2001-2011, consisting of 3336 participants aged ≥60 years who were randomly recruited from the urban and rural Anhui. 2852 participants (89.2%) had hypertensive status measured and no stroke at baseline, and were followed up until 2011 in three surveys using a standard method of interview. RESULTS At baseline, 1646 participants (57.7%) were identified to have hypertension, among whom 912 (55.4%) were previously undetected, 115 (7.0%) detected but not treated, 452 (27.5%) treated but not controlled and only 127 (7.7%) controlled. During the 10-year follow-up, 211 incident stroke cases (12.8/1000 person-years) occurred. Compared with normotensive individuals at baseline, multivariate adjusted HR for having stroke increased in those with undetected hypertension by 1.63 (95%CI 1.15 to 2.32), untreated by 2.21 (1.26-3.85) and uncontrolled hypertension by 3.34 (2.28-4.88), but did not differ from those with controlled hypertension (1.34; 0.60-2.99). Based on a two-fold increase in the detection and management of current levels of hypertension and algorithms on the current situation in China, approximately 250 000 incident stroke cases could be prevented annually. CONCLUSIONS In China, hypertension is frequently undetected or inadequately treated. With appropriate management of hypertension, a substantial number of people could be saved form stroke.
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Affiliation(s)
- Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, UK
- Department of Endocrinology, Ashford and St Peter’s NHS Foundation Trust, Surrey, UK
| | - Harry Hao-Xiang Wang
- School of Public Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- General Practice and Primary Care, Institute of Health and Wellbeing, Glasgow University, Glasglow, UK
| | - Li Wei
- Department of Practice and Policy, University College London, London, UK
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Ma
- School of Health Administration, Anhui Medical University, Hefei, China
| | - Yu Wang
- Pojen General Hospital, Taipei, China
| | - Jiaji Wang
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Zhi Hu
- School of Health Administration, Anhui Medical University, Hefei, China
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, UK
- Department of Endocrinology, Ashford and St Peter’s NHS Foundation Trust, Surrey, UK
- Department of Medicine, Imperial College London NHS Trust, London, UK
| | - Ruoling Chen
- Centre for Health and Social Care Improvement, Faculty of Education, Health and Wellbeing, Wolverhampton University, Wolverhampton, UK
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Liu D, Meng H, Dobbs D, Conner KO, Hyer K, Li N, Ren X, Gao B. Cross-sectional study of factors associated with community health centre use in a recently urbanised community in Chengdu, China. BMJ Open 2017; 7:e014510. [PMID: 28600364 PMCID: PMC5541612 DOI: 10.1136/bmjopen-2016-014510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Public investment in community health centres (CHCs) has been increasing as a response to rapid urbanisation in China. The objectives of this study were: (1) to examine factors associated with CHC use among residents from a recently urbanised community in western China and (2) to describe satisfaction with CHC among users. DESIGN Cross-sectional design. SETTING A community recently converted to urban status with a newly constructed CHC in Southwest China. PARTICIPANTS A random sample of 2259 adults in the Hezuo community in Chengdu, China, completed the survey in 2013. OUTCOME MEASURES Trained staff interviewed study participants in their homes using structured questionnaires. The survey included questions regarding sociodemographics, health status, access to and usage of healthcare, health behaviours and CHC use. The Andersen's behavioural model of health service use was used to guide multivariable logistic regression modelling in identifying predisposing, enabling and need factors associated with the likelihood of using CHC. Descriptive statistics were used to describe residents' satisfaction with the CHC. RESULTS A total of 71.8% of the respondents reported using the CHC during the past year. Factors influencing adults' CHC use included: gender, marital status, education level and knowledge of one's blood pressure (predisposing factors); annual household per capita income and walking time to the CHC (enabling factors) and self-rated health as well as physical activities (need factors). CHC users reported modest satisfaction across various aspects of the CHC. CONCLUSIONS Neighbourhood CHC in urban areas provides important services to these residents living in a recently urbanised community. All three categories of factors in the Andersen model help explain the likelihood of CHC use. There is much room for improvement in CHC to enhance customer satisfaction. Future research is needed to improve access to CHCs and promote their use in urbanised populations with low to modest education.
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Affiliation(s)
- Danping Liu
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
| | - Hongdao Meng
- School of Aging Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Debra Dobbs
- School of Aging Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Kyaien O Conner
- Department of Mental Health Law & Policy, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Kathryn Hyer
- School of Aging Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Ningxiu Li
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
| | - Xiaohui Ren
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
| | - Bo Gao
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
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Chen D, Liu S, Tan X, Zhao Q. Assessment of hospital length of stay and direct costs of type 2 diabetes in Hubei Province, China. BMC Health Serv Res 2017; 17:199. [PMID: 28288623 PMCID: PMC5348848 DOI: 10.1186/s12913-017-2140-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 03/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of type 2 diabetes is increasing, creating a huge burden for China's social healthcare system. This study aimed to evaluate hospital length of stay (LOS) based on admission characteristics and direct costs correlated with various types of complications for type 2 diabetic inpatients in Hubei Province, China. METHODS A total of 1528 inpatients diagnosed with type 2 diabetes discharged between April 1, 2013, and March 31, 2014, were included in this study. Information regarding patients' admission and hospitalization were obtained from the hospital information system. The relationship between admission characteristics and LOS, distribution of total costs, and types of complications were described and analysed. RESULTS (1) The mean LOS was 11.65 days (median: 10 days). Multiple linear regression analysis demonstrated that inpatients with New Cooperative Medical Scheme (NCMS), aged 80 and above, had longer LOS than the reference group, and inpatients with chronic or acute + chronic complications had shorter LOS than those without. (2) Mean total costs per patient were US$159.72 ± 130.83 (median: US$135.33), US$240.60 ± 166.58 (median: US$192.09), and US$247.98 ± 166.22 (median: US$200.99) for inpatients with no complications, chronic complications, and acute + chronic complications, respectively. Total and individual costs were significantly less for patients without complications than for those with the two types of complications (p < 0.001). (3) Mean total costs per patient were US$225.40 ± 115.32 (median: US$200.34), US$221.25 ± 177.64 (median: US$170.05), and US$275.18 ± 193.14 (median: US$217.91) for inpatients with microvascular complications, macrovascular complications, and microvascular + macrovascular complications, respectively. Total costs were significantly higher for patients with microvascular + macrovascular complications than for those with other types of chronic complications (p < 0.001). (4) Drugs were the greatest expense for patients, and the least expensive treatment was nursing care. CONCLUSIONS Medical insurance status, age, and type of complication may help to predict LOS for patients with type 2 diabetes in Hubei Province, China. The total and individual costs for patients with complications were higher than for those without, and hospitalization expenses posed a heavy burden. Efforts should be made to reduce the financial impact on patients by integrating the medical insurance system of urban and rural areas, and by reducing the risk of complications, especially microvascular complications.
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Affiliation(s)
- Dajie Chen
- Wuhan University, 115# Donghu Road, Wuhan, 430071, China
| | - Shuai Liu
- Wuhan University, 115# Donghu Road, Wuhan, 430071, China
| | - Xiaodong Tan
- Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Qihan Zhao
- Wuhan University, 115# Donghu Road, Wuhan, 430071, China
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Tutino GE, Yang WY, Li X, Li WH, Zhang YY, Guo XH, Luk AO, Yeung ROP, Yin JM, Ozaki R, So WY, Ma RCW, Ji LN, Kong APS, Weng JP, Ko GTC, Jia WP, Chan JCN. A multicentre demonstration project to evaluate the effectiveness and acceptability of the web-based Joint Asia Diabetes Evaluation (JADE) programme with or without nurse support in Chinese patients with Type 2 diabetes. Diabet Med 2017; 34:440-450. [PMID: 27278933 PMCID: PMC5324581 DOI: 10.1111/dme.13164] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 02/06/2023]
Abstract
AIMS To test the hypothesis that delivery of integrated care augmented by a web-based disease management programme and nurse coordinator would improve treatment target attainment and health-related behaviour. METHODS The web-based Joint Asia Diabetes Evaluation (JADE) and Diabetes Monitoring Database (DIAMOND) portals contain identical built-in protocols to integrate structured assessment, risk stratification, personalized reporting and decision support. The JADE portal contains an additional module to facilitate structured follow-up visits. Between January 2009 and September 2010, 3586 Chinese patients with Type 2 diabetes from six sites in China were randomized to DIAMOND (n = 1728) or JADE, plus nurse-coordinated follow-up visits (n = 1858) with comprehensive assessments at baseline and 12 months. The primary outcome was proportion of patients achieving ≥ 2 treatment targets (HbA1c < 53 mmol/mol (7%), blood pressure < 130/80 mmHg and LDL cholesterol < 2.6 mmol/l). RESULTS Of 3586 participants enrolled (mean age 57 years, 54% men, median disease duration 5 years), 2559 returned for repeat assessment after a median (interquartile range) follow-up of 12.5 (4.6) months. The proportion of participants attaining ≥ 2 treatment targets increased in both groups (JADE 40.6 to 50.0%; DIAMOND 38.2 to 50.8%) and there were similar absolute reductions in HbA1c [DIAMOND -8 mmol/mol vs JADE -7 mmol/mol (-0.69 vs -0.62%)] and LDL cholesterol (DIAMOND -0.32 mmol/l vs JADE -0.28 mmol/l), with no between-group difference. The JADE group was more likely to self-monitor blood glucose (50.5 vs 44.2%; P = 0.005) and had fewer defaulters (25.6 vs 32.0%; P < 0.001). CONCLUSIONS Integrated care augmented by information technology improved cardiometabolic control, with additional nurse contacts reducing the default rate and enhancing self-care. (Clinical trials registry no.: NCT01274364).
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Affiliation(s)
- G. E. Tutino
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - W. Y. Yang
- China‐Japan Friendship HospitalBeijingChina
| | - X. Li
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Asia Diabetes FoundationPrince of Wales HospitalHong Kong SARChina
| | - W. H. Li
- Peking Union HospitalBeijingChina
| | - Y. Y. Zhang
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Asia Diabetes FoundationPrince of Wales HospitalHong Kong SARChina
| | - X. H. Guo
- First HospitalPeking University HospitalBeijingChina
| | - A. O. Luk
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Asia Diabetes FoundationPrince of Wales HospitalHong Kong SARChina
| | - R. O. P. Yeung
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Asia Diabetes FoundationPrince of Wales HospitalHong Kong SARChina
| | - J. M. Yin
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Asia Diabetes FoundationPrince of Wales HospitalHong Kong SARChina
| | - R. Ozaki
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - W. Y. So
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - R. C. W. Ma
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - L. N. Ji
- Beijing People's HospitalBeijingChina
| | - A. P. S. Kong
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - J. P. Weng
- Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - G. T. C. Ko
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
| | - W. P. Jia
- Shanghai Sixth People's HospitalShanghaiChina
| | - J. C. N. Chan
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongPrince of Wales HospitalHong Kong SARChina
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Prevalence of Breastfeeding: Findings from the First Health Service Household Interview in Hunan Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14020150. [PMID: 28165407 PMCID: PMC5334704 DOI: 10.3390/ijerph14020150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/16/2017] [Accepted: 01/25/2017] [Indexed: 12/12/2022]
Abstract
Background: With the development of economy and urbanization, methods of child-feeding have significantly changed in China over the past three decades. However, little is known about breastfeeding in China since 2009. This study aims to update information on the prevalence of breastfeeding in China. Methods: Data were obtained from the first Health Service Household Interview Survey of Hunan Province, China. Of 24,282 respondents, 1659 were aged five years or younger. We ran multivariable logistic regression to examine the impact of urban/rural setting, gender, age and household income per capita on the use of breastfeeding. Results: A total of 79.4% of children aged 5 years or younger had been breastfed at some point and 44.9% been breastfed exclusively in the first 6 months of life. After controlling for setting urban/rural setting, gender and child age, children from households with average family income were more likely to be breastfed than those from households with the lowest family income (adjusted odds ratio: 2.28). Children from households with higher and the highest family income were less likely to be exclusively breastfed in the first 6 months of life compared to those from households with the lowest family income (adjusted odds ratio: 0.51 and 0.68, respectively). Conclusions: It is encouraging that the prevalence of exclusive breastfeeding for infants in the first 6 months of life in Hunan Province, China is approaching the goal of 50% proposed by the World Health Organization (WHO). Nevertheless, more efforts are needed to further promote exclusive breastfeeding in the first 6 months after birth.
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Chan WY, Fung IM, Chan E. Universal Health Coverage through Community Nursing Services: China vs. Hong Kong. Rev Lat Am Enfermagem 2017; 25:e2838. [PMID: 28146178 PMCID: PMC5288864 DOI: 10.1590/1518-8345.1664.2838] [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: 06/01/2016] [Accepted: 07/05/2016] [Indexed: 12/04/2022] Open
Abstract
Objective: this article looks at how the development of community nursing services in China
and Hong Kong can enhance universal health coverage. Methods: literature and data review have been utilized in this study. Results: nursing services have evolved much since the beginning of the nursing profession.
The development of community nursing services has expanded the scope of nursing
services to those in need of, not just hospital-level nursing care, but more
holistic care to improve health and quality of life. Conclusion: despite the one-country-two-systems governance and the difference in population
and geography, Hong Kong and China both face the aging population and its
complications. Community nursing services help to pave the road to Universal
Health Coverage.
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Affiliation(s)
- Wai Yee Chan
- DHSc, Assistant Professor, School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, China
| | - Ita M Fung
- PharmD, Associate Professor, School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, China
| | - Eric Chan
- DMgt, Professor, School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, China
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What Contributes to the Regularity of Patients with Hypertension or Diabetes Seeking Health Services? A Pilot Follow-Up, Observational Study in Two Sites in Hubei Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121268. [PMID: 28009850 PMCID: PMC5201409 DOI: 10.3390/ijerph13121268] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 01/13/2023]
Abstract
Regular maintenance of non-communicable chronic diseases can constrain disease progression in diabetic and hypertensive patients. To identify the individual and social factors that are associated with positive health-seeking behaviors and regular maintenance of chronic diseases, we have conducted a follow up study in 2015 on diabetic and hypertensive patients in Hubei Province. We used binary logistic regression models to determine specific factors associated with diabetic and hypertensive patients that sought healthcare services for their conditions in accordance with current Chinese Centers for Disease Prevention and Control (CDC) guidelines. Our findings show that 42.16% of 510 people living with chronic conditions (PLCDs) sought health services in line with existing guidelines. Findings also show a higher probability (8.418 times) for PLCDs seeking healthcare services at higher-tiered hospitals (secondary and tertiary hospitals) than for PLCDs seeking care at primary hospitals (odds ratio (OR) = 8.418, 95% confidence interval (CI) = 4.82, 14.27, p < 0.001). These analyses underscore the importance of having patient advocates who can provide support, where necessary, and encourage positive health-seeking behavior. The study also shows a negative impact on regular maintenance for PLCDs in households with high financial constraints. In contrast, the study shows positive impacts for increased household income, age, and residency in rural locations. In sum, this study underscores the importance of primary hospitals as key points of care and critical players in care coordination for PLCDs. The study provides more evidence for Chinese policymakers seeking to contain costs and improve population health. The findings also underscore the need for community-based interventions, specifically interventions that link local primary hospitals, friends/family members, and PLCDs.
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Bauer J, Brueggmann D, Ohlendorf D, Groneberg DA. General practitioners in German metropolitan areas - distribution patterns and their relationship with area level measures of the socioeconomic status. BMC Health Serv Res 2016; 16:672. [PMID: 27884186 PMCID: PMC5123403 DOI: 10.1186/s12913-016-1921-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Geographical variation of the general practitioner (GP) workforce is known between rural and urban areas. However, data about the variation between and within urban areas are lacking. METHOD We analyzed distribution patterns of GP full time equivalents (FTE) in German cities with a population size of more than 500,000. We correlated their distribution with area measures of social deprivation in order to analyze preferences within neighborhood characteristics. For this purpose, we developed two area measures of deprivation: Geodemographic Index (GDI) and Cultureeconomic Index (CEI). RESULTS In total n = 9034.75 FTE were included in n = 14 cities with n = 171 districts. FTE were distributed equally on inter-city level (mean: 6.49; range: 5.12-7.20; SD: 0.51). However, on intra-city level, GP distribution was skewed (mean: 6.54; range: 1.80-43.98; SD: 3.62). Distribution patterns of FTE per 10^4 residents were significantly correlated with GDI (r = -0.49; p < 0.001) and CEI (r = -0.22; p = 0.005). Therefore, location choices of GPs were mainly positively correlated with 1) central location (r = -0.50; p < 0.001), 2) small household size of population (r = -0.50; p < 0.001) and 3) population density (r = 0.35; p < 0.001). CONCLUSION Intra-city distribution of GPs was skewed, which could affect the equality of access for the urban population. Furthermore, health services planners should be aware of GP location preferences. This could be helpful to better understand and plan delivery of health services. Within this process the presented Geodemographic Index (GDI) could be of use.
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Affiliation(s)
- Jan Bauer
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, 60329 Frankfurt/Main, Germany
| | - Doerthe Brueggmann
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, 60329 Frankfurt/Main, Germany
| | - Daniela Ohlendorf
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, 60329 Frankfurt/Main, Germany
| | - David A. Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, 60329 Frankfurt/Main, Germany
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Zhang Y, Yeager VA, Hou S. The Impact of Community-Based Supports and Services on Quality of Life Among the Elderly in China: A Longitudinal Study. J Appl Gerontol 2016; 37:1244-1269. [PMID: 27496140 DOI: 10.1177/0733464816661945] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Community-based supports and services (CBSS) have been developing rapidly in China as a new way of satisfying the needs of elderly people. However, it is not clear how pervasive these services are or whether the availability of CBSS impacts quality of life. This study examines trends in CBSS and the impact of the perceived CBSS availability on self-reported quality of life among the elderly in China. We found a significant increase in perceived CBSS availability from 2005 to 2011, but the perceived availability of CBSS varies by the type of CBSS. Multivariate analyses show that home medical visits (β = .181, p = .03), psychological support (β = .332, p = .02), social and recreation activities (β = .231, p = .02), and legal consulting services (β = .271, p = .02) were each significantly associated with a good quality of life. Results from this study provide insight that can inform CBSS strategies and the development of new services for the elderly in China.
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