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Li J, Zhao N, Gu M, Li D, Yang J. A study of patients' choice of medical treatment based on rational choice theory: a cross-sectional survey from China. Fam Pract 2024; 41:745-754. [PMID: 39162137 DOI: 10.1093/fampra/cmae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVE To describe how patients choose between primary care institutions (PCIs) and non-PCIs using rational choice theory from the perspective of survival rationality, economic rationality, and social rationality. METHODS Multi-stage stratified sampling and convenience sampling were applied to select 1723 patients to conduct the questionnaire survey. Chi-square test and binary logistic regression were performed to analyze the factors associated with patients' choice of PCIs. RESULTS In total 55.83% of 1723 patients would attend a PCIs for healthcare. The results of the univariate analysis revealed that patients who are female (58.46%, P = .015), suffering from chronic diseases (56.26%, P = .047), inpatients (67.58%, P < .001), Beijing (59.62%, P = .002), partial understanding of the family doctor contracting system (62.30%, P < .001), and not understanding of the medical alliance policy (58.04%, P = .031) had significantly higher probability of choosing PCIs. Logistic regression analysis showed that females were more unwilling to attend PCIs (odds ratio (OR) = 0.822, 95%CI: 0.676-0.999). Following survival rationality, patients without chronic diseases were more likely to attend PCIs (OR = 1.834, 95%CI: 1.029-3.268), and inpatients were more unlikely to attend PCIs (OR = 0.581, 95%CI: 0.437-0.774). From an economic rationality perspective, patients from the Fujian province were more likely to attend PCIs (OR = 1.424, 95%CI: 1.081-1.876). From a social rationality perspective, patients who partial understanding of the family doctor contracting system were more unlikely to attend PCIs (OR = 0.701, 95%CI: 0.551-0.892), and patients who partial and complete understanding of the medical alliance policy were more likely to attend PCIs (OR = 1.340, 95%CI: 1.064-1.687; OR = 1.485, 95%CI: 1.086-2.030). CONCLUSIONS Survival, economic, and social rationality are involved in patients' choice to attend PCIs. Compared to survival rationality and social rationality, economic rationality showed a lower association with patients' choice to attend PCIs. Medical institutions are recommended to adopt a "patient health-centered" approach when providing medical services and further optimize the family doctor contracting system and construction of medical alliances.
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Affiliation(s)
- Jin Li
- Hospital Office, Shenzhen Traditional Chinese Medicine Hospital, Guangdong, 518033, China
| | - Ning Zhao
- School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Mei Gu
- School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Danhui Li
- Medical Department, Shaanxi Provincial People's Hospital, Shaanxi, 710068, China
| | - Jia Yang
- School of Public Health, Capital Medical University, Beijing, 100069, China
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Ma X, Wang Y, Chen Y, Lian Y, Zhao X, He X, Qiu Y, Han S, Liu L, Wang C. Association between medication complexity and follow-up care attendance: insights from a retrospective multicenter cohort study across 1,223 Chinese hospitals. Front Pharmacol 2024; 15:1448986. [PMID: 39135802 PMCID: PMC11317271 DOI: 10.3389/fphar.2024.1448986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 07/08/2024] [Indexed: 08/15/2024] Open
Abstract
Background Patients with Chronic Obstructive Pulmonary Disease (COPD) frequently face substantial medication burdens. Follow-up care on medication management is critical in achieving disease control. This study aimed to analyze the complexity of COPD-specific medication and determine how it impacted patients' attendance on follow-up care. Methods This multicenter study includes patients with COPD from 1,223 hospitals across 29 provinces in China from January 2021 to November 2022. The medication Regimen Complexity Index (MRCI) score was used to measure COPD-specific medication complexity. The association between medication complexity and follow-up care attendance was evaluated using the Cox Proportional Hazard Model. Results Among 16,684 patients, only 2,306 (13.8%) returned for follow-up medication management. 20.3% of the patients had high complex medication regimen (MRCI score >15.0). The analysis revealed that compared to those with less complex regimens, patients with more complex medication regimens were significantly less likely to attend the follow-up medication care, with a Hazard Ratio (HR) of 0.82 (95% Confidence Interval [CI], 0.74-0.91). Specifically, patients with more complex dosage forms were 51% less likely to attend the follow-up care (95% CI, 0.43-0.57). This pattern was especially marked among male patients, patients younger than 65 years, and those without comorbid conditions. Conclusion Higher medication complexity was associated with a decreased likelihood of attending follow-up care. To promote care continuity in chronic disease management, individuals with complex medication regimens should be prioritized for enhanced education. Furthermore, pharmacists collaborating with respiratory physicians to deprescribe and simplify dosage forms should be considered in the disease management process.
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Affiliation(s)
- Xuedi Ma
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Department of Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongwu Chen
- Department of Pharmacy, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Yufei Lian
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Xiaoyu Zhao
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xuan He
- Department of Pharmacy, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Qiu
- Institute for Hospital Management, Tsinghua University, Beijing, China
| | - Sheng Han
- International Research Center for Medicinal Administration, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Lihong Liu
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
| | - Chen Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Beijing, China
- Center of Respiratory Medicine, China-Japan Friendship Hospital, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
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von Weinrich P, Kong Q, Liu Y. Would you zoom with your doctor? A discrete choice experiment to identify patient preferences for video and in-clinic consultations in German primary care. J Telemed Telecare 2024; 30:969-992. [PMID: 35915997 DOI: 10.1177/1357633x221111975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The popularity of video consultations in healthcare has accelerated during the COVID-19 pandemic. Despite increased availability and obvious benefits, many patients remain hesitant to use video consultations. This study investigates the relative importance of the consultation mode compared to other attributes in patients' appointment choices in Germany. METHODS A discrete choice experiment was conducted to examine the influence of appointment attributes on preferences for video over in-clinic consultations. A total of 350 participants were included in the analysis. RESULTS The level of continuity of care (46%) and the waiting time until the next available appointment (22%) were shown to have higher relative importance than consultation mode (18%) and other attributes. Participants with fewer data privacy concerns, higher technology proficiency, and more fear of COVID-19 tended to prefer video over in-clinic consultations. The predicted choice probability of a video over a typical in-clinic consultation and opting out increased from <1% to 40% when the video consultation was improved from the worst-case to the best-case scenario. CONCLUSION This study provides insight into the effect of the consultation mode on appointment choice at a time when telemedicine gains momentum. The results suggest that participants preferred in-clinic over video consultations. Policymakers and service providers should focus on increasing the level of continuity of care and decreasing the time until the next available appointment to prompt the adoption of video consultations. Although participants preferred to talk to their physician in person over consulting via video per se, the demand for video consultations can be increased significantly by improving the other appointment attributes of video consultations such as the level of continuity of care.
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Affiliation(s)
| | - Qingxia Kong
- Rotterdam School of Management, Erasmus University Rotterdam, The Netherlands
| | - Yun Liu
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
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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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Ong RHS, Nurjono M, Oh HC, Lien CTC, Jumala J, Teo RCC, Gan P, Kan KLM, Rosle LF, Wee MK, Low SL. Factors Influencing the Implementation of a Fall Prevention Exercise Program for Community-Dwelling Older Adults: A Qualitative Study Guided by the PRECEDE-PROCEED Model. Clin Interv Aging 2024; 19:857-871. [PMID: 38770185 PMCID: PMC11104366 DOI: 10.2147/cia.s454043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/27/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose Multiple falls preventions exercise programs have been rolled out globally, however, few studies have explored the factors necessary for their implementation. This study aimed to investigate the factors influencing the implementation of "Steady Feet" (SF), a 12-week community fall prevention exercise intervention, for older adults living in Singapore. Material and Methods This study utilized purposive sampling to recruit two participant groups: (i) older adults who declined or withdrew from the program and (ii) providers of the program (eg, instructors). We conducted 22 semi-structured interviews, recordings were transcribed and translated, followed by thematic analysis. Data collection and analysis were informed by the PRECEDE-PROCEED framework, focusing on predisposing, enabling, and reinforcing factors. Results Findings revealed two predisposing, four enabling, and two reinforcing themes. Predisposing themes encompassed (i) knowledge, attitudes, and practices of older adults towards exercises and falls prevention, and (ii) perceptions and attitudes of providers towards SF. Both older adults and providers identified several enabling elements in implementing SF, emphasizing the significance of (i) accessibility, availability, and affordability. Providers highlighted (ii) tools and structural support for continual engagement, (iii) minimizing variations in capabilities through a competency development program, and (iv) fostering synergistic partnerships. Positive reinforcement included (i) the role of providers in engaging and promoting participation, (ii) family support, social networks, and (iii) incentives for older adults. Conversely, both groups highlighted negative reinforcements, including (iv) communication issues and (v) repetitive exercises, while providers specifically identified (vi) labor constraints as a deterrent for implementation. Conclusion Findings indicate that effective implementation necessitates a multifaceted approach. Promoting participation involves engaging instructors, emphasizing social bonds and family involvement, offering incentives, and providing subsidized or free classes. A competency development program proved effective in reducing variations in providers' capabilities. Strengthening community partnerships, with management support, was crucial for ensuring the availability and accessibility of falls prevention programs.
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Affiliation(s)
| | | | - Hong Choon Oh
- Health Services Research, Changi General Hospital, Singapore
- Centre for Population Health Research and Implementation, Singapore Health Services, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | | | - Junisha Jumala
- Rehabilitative Services, Changi General Hospital, Singapore
| | | | - Peiying Gan
- Community Nursing, Changi General Hospital, Singapore
| | | | | | - Moi Kim Wee
- Community and Mental Health, Changi General Hospital, Singapore
| | - Shou Lin Low
- Geriatric Medicine, Changi General Hospital, Singapore
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Wang T, Wen K, Gao Q, Sun R. Small money, big change: The distributional impact of differentiated doctor's visit fee on healthcare utilization. Soc Sci Med 2023; 339:116355. [PMID: 37984180 DOI: 10.1016/j.socscimed.2023.116355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 09/01/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023]
Abstract
A prominent issue in China's healthcare sector is the overcrowding of high-tier hospitals, whereas low-tier hospitals and community health centers are severely underutilized. This study aims to examine whether doctor's visit fee and copay differentiated by the level of healthcare providers can change the distribution of outpatient visits across different levels of healthcare providers. By leveraging the exogeneity of the policy change implemented in a megacity in China in 2017, we apply a parametric discontinuity regression model to study the causal impact of differentiated pricing on patients' health-seeking behavior, using a large-scale insurance claim database. We find that the reform of differentiated doctor's visit fee schedule effectively increases the proportion of visits to primary care facilities among all outpatient visits. This effect is driven by a decline in visits to the highest-tier hospitals and an increase in visits to community healthcare centers. Furthermore, the policy effects are more pronounced among the elderly and people with chronic diseases. Our results suggest that shifting the focus of pricing policies from coinsurance to copays while continuing to improve the capacity of primary care facilities is an effective way to facilitate triaging patients into different levels of care without triggering moral hazard.
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Affiliation(s)
- Tianyu Wang
- School of Labor and Human Resources, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872, China
| | - Ke Wen
- School of Labor and Human Resources, Renmin University of China, 59 Zhongguancun Avenue, Beijing, 100872, China
| | - Qiuming Gao
- Business School, China University of Political Science and Law, 25 Xitucheng Road, Beijing, 100088, China.
| | - Ruochen Sun
- Wharton School of Business, University of Pennsylvania, PA, 19104, United States
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Nguyen HTT, Vo TQ, Tran HTB, Nguyen BT, Nguyen HT, Nguyen TD, Anuratpanich L. The heterogeneity of public preferences for the first healthcare visit: A discrete choice experiment in the context of Vietnam. Int J Health Plann Manage 2023; 38:473-493. [PMID: 36447363 DOI: 10.1002/hpm.3597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022] Open
Abstract
Primary healthcare is critical in addressing the main health problems of communities. In Vietnam, the increasing healthcare demands cause major challenges, especially overcrowding. This study identified public preferences regarding the selection of healthcare facilities for first visit. A discrete choice online survey was generated from five attributes including visit duration, travel time, personal connection with medical staff, doctors' experience, and health insurance. A Dz -efficient design constructed 36 choice sets, divided into three blocks of 12 choice sets. Each block formed one version of the questionnaire, which was randomly distributed to the participants. Heterogeneity in participant preferences was analysed by a latent class model with socio demographic characteristics and experiences of the last visit. 822 participants valued doctors' experience for both minor and severe symptoms. Preference heterogeneity for minor symptoms was quick service provision, highly experienced doctors, and payment through health insurance for the first (44.18%), second (32.17%), and third classes (23.66%), respectively. Regarding severe symptoms, they favoured all five attributes, quick health service, and reduced travel time for the first, second, and third classes, respectively (heterogeneities of 58.16%, 27.79%, and 14.05%, respectively). Predictions of choice from the worst to optimal healthcare facility scenario were 8.91%-61.91% and 10.16%-69.83% for minor and severe symptoms, respectively. Knowledge regarding public preference heterogeneity supports policymakers increase public acceptance in choosing primary healthcare facilities. Visit duration and doctors' experience should be considered a priority in decision making.
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Affiliation(s)
- Hieu Thi Thanh Nguyen
- Faculty of Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Trung Quang Vo
- Faculty of Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Hien Thi Bich Tran
- Faculty of Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | | | - Hiep Thanh Nguyen
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Thoai Dang Nguyen
- Faculty of Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Luerat Anuratpanich
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
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Zhang W, Zhou F, Fei Y. Repetitions in online doctor-patient communication: Frequency, functions, and reasons. PATIENT EDUCATION AND COUNSELING 2023; 107:107565. [PMID: 36428169 DOI: 10.1016/j.pec.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/23/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To attain insights into language repetition during online doctor-patient communication (DPC), understand why doctors and patients use repetition, and improve the current deficiencies in online medical platforms. METHODS The study performed a content analysis of 72 sets of textual doctor-patient conversations on the Chinese online medical consultation platform Chunyu Doctor. RESULTS Repetitions occurred 1412 times in the 72 sets of online DPC. Patient self-repetitions were the most prevalent (30.7 %), while patient repetitions of doctors were the least common (17.1 %). Doctors used repetitions for explanations and affirmations. Patients used repetition for emphasis, verification, and turn-taking. The repetition frequencies of doctors and patients were primarily influenced by personal factors. However, doctor-dimension factors exerted a greater impact on the frequency of patient repetitions. CONCLUSIONS The reasons for repetitions in online DPC differ from those offline. Online DPC increases patient initiative and reduces doctor authority. Nevertheless, it could be affected by gender stereotypes generated during offline consultations. Doctors still dominated the conversations but attended sufficiently to the patient discourse. Online DPC is gradually attempting to fulfill the expectations of a new patient-centered healthcare pattern. PRACTICAL IMPLICATIONS The findings yield suggestions for healthcare providers and the designers of online healthcare platforms.
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Affiliation(s)
- Wen Zhang
- School of Journalism and Culture Communication, Zhongnan University of Economics and Law, Wuhan 430073, PR China.
| | - Fangzhou Zhou
- Institute of Communication Studies, Communication University of China, Beijing 100024, PR China.
| | - Yifeng Fei
- School of Computer Science and Technology, Dalian University of Technology, Dalian 116024, PR China.
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Ma H, Jia E, Ma H, Pan Y, Jiang S, Xiong J. Preferences for public long-term care insurance among middle-aged and elderly residents: A discrete choice experiment in Hubei Province, China. Front Public Health 2023; 11:1050407. [PMID: 36778541 PMCID: PMC9909219 DOI: 10.3389/fpubh.2023.1050407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Objective It is critical to incorporate residents' preferences into the design of long-term care insurance (LTCI). However, little is known about middle-aged and elderly residents' preferences for personalized need-related attributes of LTCI in China. Through a discrete choice experiment (DCE), we aimed to focus on the direct beneficiaries of LTCI and then elicit their preferences for LTCI under a hypothetical scenario of dysfunction. Methods Attributes and levels were defined through a literature review and two rounds of expert consultations (n = 8). A D-optimal fractional factorial design was used to generate the DCE questionnaire. Face-to-face interviews with middle-aged and elderly residents were conducted in two cities in Hubei Province, China, between November and December 2020. A mixed logit model was utilized for estimation. Results Five attributes were identified and incorporated into the DCE questionnaire. A total of 390 participants completed DCE questionnaires. Care facilities, care content, reimbursement rate, caregivers, and annual premium per person all had a significant impact on residents' preferences. Residents had significantly higher preferences for the LTCI scheme with home and community-based care centers (β = 1.40, p < 0.01), multi-level services (β = 0.44, p < 0.01), 90% reimbursement rate (β = 0.37, p < 0.01), and sufficiently trained caregivers (β = 0.26, p < 0.01). Individual characteristics, such as gender, employment, and education level were the factors that drove heterogeneity in preferences for LTCI. Conclusion This study provides new evidence on the preferences of middle-aged and elderly residents for personalized need-related public LTCI features. The design of the LTCI scheme in China needs to take these findings into account to maximize the utility for direct beneficiaries of LTCI and enhance their enrollment.
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Affiliation(s)
- He Ma
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Erping Jia
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huimin Ma
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanzhi Pan
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shan Jiang
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Juyang Xiong
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,*Correspondence: Juyang Xiong ✉
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Peng B, Ling L. Health service behaviors of migrants: A conceptual framework. Front Public Health 2023; 11:1043135. [PMID: 37124818 PMCID: PMC10140430 DOI: 10.3389/fpubh.2023.1043135] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
Universal health coverage is vital to the World Health Organization's (WHO's) efforts to ensure access to health as a human right. However, it has been reported that migrants, including both international immigrants and internal migrants, underuse health services. Establishing a conceptual framework to facilitate research on the health service behaviors (HSB) of migrants is particularly important. Many theoretical frameworks explaining the general population's HSB have been published; however, most theoretical frameworks on migrants' HSB only focus on international immigrants without the inclusion of internal migrants. Of note, internal migrants are much more abundant than immigrants, and this group faces similar barriers to HSB as immigrants do. Based on theoretical frameworks of immigrants' HSB and Anderson's behavior model, the author proposes a new conceptual framework of migrants' HSB that includes both immigrants and internal migrants. The new conceptual framework divides the determinants into macro-structural or contextual factors, health delivery system characteristics, and characteristics of the population at risk and describes subgroup-specific factors. The author added some variables and reclassified variables in some dimensions, including characteristics of health delivery systems and access to healthcare. The characteristics of health delivery systems comprise the volume, organization, quality, and cost of the health delivery system, while the characteristics of access to healthcare include time accessibility, geographic accessibility, and information accessibility. The outcomes of HSB have been expanded, and relationships between them have been reported. The mediating effects of some variables have also been described. This conceptual framework can facilitate a deep and comprehensive understanding of the HSB determination process for migrants, including internal migrants.
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Affiliation(s)
- Boli Peng
- Department of Actuarial Science, School of Insurance, Guangdong University of Finance, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Li Ling,
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Lendado TA, Bitew S, Elias F, Samuel S, Assele DD, Asefa M. Effect of hospital attributes on patient preference among outpatient attendants in Wolaita Zone, Southern Ethiopia: discrete choice experiment study. BMC Health Serv Res 2022; 22:661. [PMID: 35581592 PMCID: PMC9110630 DOI: 10.1186/s12913-022-07874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient preference has preceded the use of health care services, and it has been affected by different hospital attributes. Meanwhile, the number of patients receiving vital health intervention is particularly low in Ethiopia. Therefore, this study aimed to determine the effect of hospital attributes on patient preference for outpatients in the Wolaita area in September 2020. METHODS A discrete choice experimental study was applied to determine the effect of hospital attributes on patient preference with a sample size of 1077. The experimental survey was conducted among outpatient attendants selected through a systematic random sampling approach. Six key attributes (competence of healthcare providers; availability of medical equipment and supplies; cost of service; wait time; distance; and hospital reputation) deduced from various hospital attributes were used to elicit the patient preferences. The data was collected from participants through the Open Data Kit application. A random effect probit model with marginal willingness to pay measure and partially log-likelihood analysis was applied to extract important attributes. We used STATA version 15 software for analysis, and the fitness of the model was verified by the calculated p-value for the Wald chi-square with a cut-point value of 0.05. RESULT One thousand forty-five patients who received outpatient care participated in the study. The random effect probit results have shown that all hospital attributes included in the study were significantly valued by patients while choosing the hospital (p-value < 0.001). Meanwhile, based on marginal willingness to pay and partial log-likelihood analysis, the competence of health care providers was identified as the most important attribute followed by the availability of medical equipment and supplies in hospitals. CONCLUSION AND RECOMMENDATION The results suggested that the quality of health care providers and availability of medical equipment and supply in hospitals would be primary interventional points for improving the patient preference of hospitals. Assessment, education, and training are recommended for enhancing the quality of health care providers. And stock balance checks, inspections, and accreditation are believed to be valuable for improving the availability of equipment and supply in hospitals.
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Affiliation(s)
- Tigabu Addisu Lendado
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, Ethiopia.
| | - Shimelash Bitew
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, Ethiopia
| | - Fikadu Elias
- Department of Reproductive Health and Nutrition, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, Ethiopia
| | - Serawit Samuel
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, Ethiopia
| | - Desalegn Dawit Assele
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, Ethiopia
| | - Merid Asefa
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, Ethiopia
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12
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Li J, Zhao N, Zhang H, Yang H, Yang J. Patients' Willingness of First Visit in Primary Medical Institutions and Policy Implications: A National Cross-Sectional Survey in China. Front Public Health 2022; 10:842950. [PMID: 35433566 PMCID: PMC9010779 DOI: 10.3389/fpubh.2022.842950] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background The Chinese hierarchical treatment system expects patients to first visit primary medical institutions (PMIs), and patients' willingness determined their utilization of primary health care. The aim of this study was to explore the factors associated with patients' willingness to make their first visit to PMIs. Methods We employed multistage stratified sampling and convenience sampling to administer questionnaires to 1,507 patients in Beijing, Qinghai, and Fujian. Patients' willingness of first visit in PMIs was analyzed using Chi-square test and binary logistic regression. Results Of the 1,507 participants in the survey, 55.1% were willing to make their first visit in PMIs. Fewer patients in Beijing (17.6%) are willing to make their first visit in PMIs than those in Qinghai (71.9%) and Fujian provinces (72.0%). Binary logistic regression analysis revealed that higher recognition of the community first visit policy and higher satisfaction with the medical technology of PMIs are associated with patients' willingness of first visit in PMIs. Conclusions Due to differences in local economic conditions, medical resources, and policy formulation, there are differences among provinces in patients' willingness of first visit in PMIs. To increase patients' rate of visits in PMIs, it is important to improve service capacity and quality of PMIs and change residents' attitudes for PMIs.
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Affiliation(s)
- Jin Li
- School of Public Health, Capital Medical University, Beijing, China
| | - Ning Zhao
- School of Public Health, Capital Medical University, Beijing, China
| | - Haiyan Zhang
- Department of Health Education, Beijing Huairou Hospital of University of Chinese Academy of Sciences, Beijing, China
| | - Hui Yang
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jia Yang
- School of Public Health, Capital Medical University, Beijing, China
- *Correspondence: Jia Yang
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13
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Ruan Y, Luo J, Lin H. Why Do Patients Seek Diagnose Dis-accordance With Hierarchical Medical System Related Policies in Tertiary Hospitals? A Qualitative Study in Shanghai From the Perspective of Physicians. Front Public Health 2022; 10:841196. [PMID: 35400060 PMCID: PMC8990090 DOI: 10.3389/fpubh.2022.841196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAlthough the Hierarchical Medical System has been utilized in China for many years, it is inadequate for guiding patients in adopting appropriate diagnose-seeking behaviors in accordance with related policies. This study examined how patients' diagnose-seeking behavior in tertiary hospitals that is dis-accordance with Hierarchical Medical System related policy (“DSB-dis-accordance”) arise and ways to guide patients away from such behaviors, both from the perspective of physicians.MethodsA qualitative study based on a mixed method including in-depth interviews and grounded theory. Twenty-seven physicians with more than 2 years of experience serving in tertiary hospitals of Shanghai were involved after reviewing the related purposes and requirements. Patients' “DSB-dis-accordance” was studied from the perspective of physicians.ResultsPatient-related factors (habits, trust, and knowledge), physician-related factors (conservative preference, risk avoidance), and system-related factors (accessibility, operability) affected patients' diagnose-seeking behavior.ConclusionsPatient-related, physician-related, and system-related factors affecting patients' diagnose-seeking behaviors in tertiary hospitals should be addressed by investing more health resources in lower-level hospitals, enhancing dissemination of health-related and policy-related knowledge, refining the classification of diseases, incentivizing physicians, and developing appropriate follow-up measures. Physicians could then become more involved in guiding patients' “DSB-dis-accordance,” thereby benefitting development of the Hierarchical Medical System in China.
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Affiliation(s)
- Yuhui Ruan
- School of Politics and Public Administration, Soochow University, Suzhou, China
- Institute of Public Health, Soochow University, Suzhou, China
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
- Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Yuhui Ruan
| | - Jin Luo
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
- Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
- Jin Luo
| | - Hong Lin
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Medical Science Popularization, Fudan University, Shanghai, China
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14
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Wang C, Gu Y, Zhao L, Zhang Y, Zhou R, Gu M, Wang L. Stated preferences for family doctor contract services: a survey of the rural elderly in Anhui Province, China. BMJ Open 2022; 12:e053277. [PMID: 35241465 PMCID: PMC8896044 DOI: 10.1136/bmjopen-2021-053277] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE A number of factors contribute to the utilisation of family doctor contract services (FDCS) in China. This study aims to measure the preferences of the elderly for the FDCS and identify the key factors (and their relative importance) that may guide policymakers in more accurately providing the FDCS. PARTICIPANTS AND METHODS A discrete choice experiment was performed to elicit the preferences for FDCS among the rural elderly in China. Attributes and levels were established based on qualitative methods. Four attributes were included: service type, service package, physician's reputation and annual contract costs. A D-efficient design was used to create a set of profiles that represented FDCS. The survey was conducted face to face using a sample of participants aged 60 and above in rural areas of Anhui Province. The data were analysed using a latent class logit (LCL) model. RESULTS A total of 545 valid questionnaires were included in the analysis. The average age of the participants was 69.44 (SD 5.80). Two latent classes were identified with the LCL model. All four attributes proved statistically significant at the level of both the population mean and the two classes. The rural elderly showed a preference for FDCS with a relatively good reputation, lower annual contract costs, the basic service with the add-on of chronic disease service and home visit. Age, gender, education, self-reported health status and the number of chronic diseases were found to be associated with latent class membership. CONCLUSION In this study, the physician's reputation had the largest impact on the rural elderly's choice of FDCS. Policy recommendations included the need to strengthen family doctor team training, devote greater attention to improving the family doctor's medical skills and service approaches, and increased FDCS efficiency for the care of the rural elderly.
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Affiliation(s)
- Cuilian Wang
- School of Health Service and Management, Anhui Medical University, Hefei, Anhui, China
- Stomatologic Hospital and College, Anhui Medical University, Hefei, Anhui, China
| | - Yuanyuan Gu
- Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Linhai Zhao
- School of Health Service and Management, Anhui Medical University, Hefei, Anhui, China
| | - Youran Zhang
- School of Health Service and Management, Anhui Medical University, Hefei, Anhui, China
| | - Rui Zhou
- School of Health Service and Management, Anhui Medical University, Hefei, Anhui, China
| | - Megan Gu
- Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Lidan Wang
- School of Health Service and Management, Anhui Medical University, Hefei, Anhui, China
- Center for Health Policy Research, Anhui Medical University, Hefei, Anhui, China
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15
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Huang S, Yin A, Liu Q, Sun X. Can the implementation of family doctor contracted service enable the elderly to utilize primary health care services more equally? empirical evidence from Shandong, China. BMC PRIMARY CARE 2022; 23:31. [PMID: 35189808 PMCID: PMC8862204 DOI: 10.1186/s12875-022-01630-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND While the elderly are facing greater health risks, they also face more serious inequalities in utilization of medical services. The family doctor contracted service is the core policy of the Chinese government to cope with aging and to achieve the outcome that everyone has the right to primary health care. However, previous research has neither revealed the degree of inequality in the use of contracted services among the elderly in China, nor has it revealed what factors are related to the inequality in the use of services. OBJECTIVE Assess and decompose the inequality in the use of family doctors contracted services in the elderly population in China. METHODS A cross-sectional study of 1037 elderly people was conducted in Shandong Province, China. According to the first consultation rate of family doctors, the physical examination rate, the healthy lifestyle guidance rate and the chronic disease management rate, the situation of elderly people's utilization of family doctor contracted service was investigated. The concentration index is used to measure the degree of inequality in the use of family doctors contracted services by the elderly. In order to test the contribution of different factors to the inequality of utilization of family doctors contracted services, the concentration index was also decomposed. RESULTS The first consultation rate of family doctors for the elderly in Shandong Province was 24.6%, the physical examination rate was 65.8%, the healthy lifestyle guidance rate was 13.7%, and the chronic disease management rate was 52.2%. The horizontal inequality index of the healthy lifestyle guidance rate and the chronic disease management rate were 0.451 and 0.573, respectively, indicating that there is an inequality of pro-wealth. The concentration index of physical examination rate and chronic disease management rate is negative (- 0.260, - 0.518), which means inequality to the poor. Education level is the most important factor affecting the unequal utilization of health services for the elderly, followed by income. CONCLUSION The family doctor contracted service has had a positive impact on alleviating the health inequality in the utilization of basic medical and health services for the elderly. Although there is still inequality in terms of pro-wealth for the elderly, the utilization of family doctor contracted service has weakened the inequality of service utilization brought about by income. Enhancing the health literacy of the elderly, narrowing the gap between the rich and the poor, bridging the gap between urban and rural areas, and building a harmonious family relationship can promote the realization of basic medical and health care services for every elderly.
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Affiliation(s)
- Shusheng Huang
- Center of Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Lixia District, Jinan, 250012, Shandong, China
| | - Aitian Yin
- Center of Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Lixia District, Jinan, 250012, Shandong, China.
| | - Qianqian Liu
- Student Counseling Center, Shandong University, Jinan, 250012, China
| | - Xihong Sun
- Center of Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Lixia District, Jinan, 250012, Shandong, China
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16
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Woo M, Jafarifiroozabadi R, MacNaughton P, Mihandoust S, Kennedy S, Joseph A. Using Discrete Choice Methodology to Explore the Impact of Patient Room Window Design on Hospital Choice. J Patient Exp 2022; 9:23743735221107240. [PMID: 35734469 PMCID: PMC9208038 DOI: 10.1177/23743735221107240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Evidence-based design has been fundamental to designing healthcare environments for patient outcomes and experience, yet few studies have studied how design factors drive patient choice. 652 patients who recently received care at hospitals across the United States were administered an online discrete choice survey to investigate the factors playing into their choice between hypothetical hospitals. Discrete choice models are widely used to model patient preferences among treatment alternatives, but few studies have utilized this approach to investigate healthcare design alternatives. In the current study, respondents were asked to choose between hypothetical hospitals that differed in patient room design, window features of the room, appointment availability, distance from home, insurance coverage, and HCAHPS ratings. The results demonstrate that patient room design that allowed unobscured access to daylight and views through windows, in-network insurance coverage, closer distance from home, and one-star higher patient experience rating increased the likelihood of a patient's hospital choice. The study broadly explores discrete choice model's applicability to healthcare design and its ability to quantify patient perceptions with a metric meaningful for hospital administrators.
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Affiliation(s)
- May Woo
- View Inc., Milpitas, CA, USA
| | | | - Piers MacNaughton
- View Inc., Milpitas, CA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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17
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Zhou T, Li X, Lu Y, Murugiah K, Bai X, Hu S, Gao Y, Masoudi FA, Krumholz HM, Li J. Changes in ST segment elevation myocardial infarction hospitalisations in China from 2011 to 2015. Open Heart 2021; 8:openhrt-2021-001666. [PMID: 34599073 PMCID: PMC8488733 DOI: 10.1136/openhrt-2021-001666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Access to acute cardiovascular care has improved and health services capacity has increased over the past decades. We assessed national changes in (1) patient characteristics, (2) in-hospital management and (3) patient outcomes among patients presenting with ST segment elevation myocardial infarction (STEMI) in 2011–2015 in China. Methods In a nationally representative sample of hospitals in China, we created two random cohorts of patients in 2011 and 2015 separately. We weighted our findings to estimate nationally representative numbers and assessed changes from 2011 to 2015. Data were abstracted from medical charts centrally using standardised definitions. Results While the proportion of patients with STEMI among all patients with acute myocardial infarction decreased over time from 82.5% (95% CI 81.7 to 83.3) in 2011 to 68.5% (95% CI 67.7 to 69.3) in 2015 (p<0.0001), the weighted national estimate of patients with STEMI increased from 210 000 to 380 000. The rate of reperfusion eligibility among patients with STEMI decreased from 49.3% (95% CI 48.1 to 50.5) to 42.2% (95% CI 41.1 to 43.4) in 2015 (p<0.0001); ineligibility was principally driven by larger proportions with prehospital delay exceeding 12 hours (67.4%–76.7%, p<0.0001). Among eligible patients, the proportion receiving reperfusion therapies increased from 54% (95% CI 52.3 to 55.7) to 59.7% (95% CI 57.9 to 61.4) (p<0.0001). Crude and risk-adjusted rates of in-hospital death did not differ significantly between 2011 and 2015. Conclusions In this most recent nationally representative study of STEMI in China, the use of acute reperfusion increased, but no significant improvement occurred in outcomes. There is a need to continue efforts to prevent cardiovascular diseases, to monitor changes in in-hospital treatments and outcomes, and to reduce prehospital delay.
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Affiliation(s)
- Tianna Zhou
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Xi Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, People's Republic of China .,Central China Subcenter of the National Center for Cardiovascular Diseases, Zhengzhou, People's Republic of China
| | - Yuan Lu
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Xueke Bai
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, People's Republic of China
| | - Shuang Hu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, People's Republic of China
| | - Yan Gao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, People's Republic of China
| | - Frederick A Masoudi
- Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA.,Research and Analytics, MO, Ascension Health, St. Louis, Missouri, USA
| | | | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, People's Republic of China
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Ma AC, Meng Z, Ding X. Performance Review of Intelligent Guidance Robot at the Outpatient Clinic Setting. Cureus 2021; 13:e16840. [PMID: 34522486 PMCID: PMC8425029 DOI: 10.7759/cureus.16840] [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] [Accepted: 08/02/2021] [Indexed: 11/24/2022] Open
Abstract
This study analyzes the implementation of a mobile intelligent guidance robot to roam hospital outpatient services and discusses the application’s effect and experience. The data consist of human-robot verbal communications in November 2019 to analyze and evaluate the application according to the service volume, accuracy, and functions. Statistically, the accuracy of correct output by the intelligent guidance robot when answering related questions in outpatient services was significantly lower than the manufacturer’s claimed expected accuracy. Furthermore, the utilization review of the intelligent guidance robot was surprisingly unexpected. Therefore, applying an intelligent guidance robot is not limited to merely providing directions and navigation functions but can be valuable in improving public health literacy. Nevertheless, the hospital should meet patients’ needs by expanding intelligent guidance robots’ service functions and increasing patient experience to finetune the application through further experiments and design.
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Affiliation(s)
- Alfred C Ma
- Anesthesiology, Mansfield International College, Fullerton, USA
| | - Zuowei Meng
- Surgery, Peking University Shenzhen Hospital, Shenzhen, CHN
| | - Xiaorong Ding
- Internal Medicine, Peking University Shenzhen Hospital, Shenzhen, CHN
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19
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Wan G, Wei X, Yin H, Qian Z, Wang T, Wang L. The trend in primary health care preference in China: a cohort study of 12,508 residents from 2012 to 2018. BMC Health Serv Res 2021; 21:768. [PMID: 34344362 PMCID: PMC8336283 DOI: 10.1186/s12913-021-06790-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Residents’ preference for primary health care (PHC) determined their utilization of PHC. This study aimed to assess the determinants of PHC service preference among the residents and the trend in PHC service preference over time in China. Methods We employed the nationally representative longitudinal data from 2012 to 2018 based on the China Family Panel Studies. The analysis framework was guided by the Andersen model of health service utilization. We included a total of 12,508 individuals who have been successfully followed up in the surveys of 2012, 2014, 2016, and 2018 without any missing data. Logistic regressions were performed to analyze potential predictors of PHC preference behavior. Results The results indicated that individuals’ socio-economic circumstances and their health status factors were statistically significant determinants of PHC preference. Notably, over time, the residents’ likelihood of choosing PHC service represented a decreasing trend. Compare to 2012, the likelihood of PHC service preference decreased by 18.6% (OR, 0.814; 95% CI, 0.764–0.867) in 2014, 30.0% (OR, 0.700; 95% CI, 0.657–0.745) in 2016, and 34.9% (OR, 0.651; 95% CI, 0.611–0.694) in 2018. The decrease was significantly associated with the changes in residents’ health status. Conclusions The residents’ likelihood of choosing PHC service represented a decreasing trend, which was contrary to the objective of China’s National Health Reform in 2009. We recommend that policymakers adjust the primary service items in PHC facilities and strengthen the coordination of service between PHC institutions and higher-level hospitals. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06790-w.
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Affiliation(s)
- Guangsheng Wan
- School of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China.
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T3M6, Canada.
| | - Hui Yin
- School of Health Management, Harbin Medical University, Harbin, 150081, Heilongjiang, China
| | - Zhiwang Qian
- School of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China
| | - Tingting Wang
- School of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China
| | - Lina Wang
- Foreign Language Faculty, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China
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20
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Su Y, Sharma S, Ozdemir S, Chow WL, Oh HC, Tiah L. Nonurgent Patients' Preferences for Emergency Department Versus General Practitioner and Effects of Incentives: A Discrete Choice Experiment. MDM Policy Pract 2021; 6:23814683211027552. [PMID: 34291173 PMCID: PMC8274117 DOI: 10.1177/23814683211027552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/14/2021] [Indexed: 12/04/2022] Open
Abstract
Objective. This study investigates potential of a new financial incentive policy, the GP-referral discount scheme introduced in Singapore, in reducing nonurgent emergency department (ED) visits, and compares it with alternative interventions. Methods. A discrete choice experiment (DCE) was designed to elicit patients’ preferences for ED and general practitioner (GP) under hypothetical nonurgent medical conditions. Through latent class multinomial logistic regression, choice models were estimated to quantify how patients’ choices are influenced by GP-referral discount, other ED/GP attributes (waiting time, test facilities, and payment), patient demographics, and their perception of severity. The choice models were used to predict uptake of the GP-referral discount scheme and other countermeasures suggested by these models. Results. Survey responses from 849 respondents recruited from a public hospital in Singapore were included in the study. The choice model identified two prominent classes of patients, one of which was highly sensitive to GP-referral discount and the other to test-facility-availability. Patients’ perceptions of severity (“critical” v. “not critical” enough to go to ED directly) were highly significant in influencing preference heterogeneity. Predictive analysis based on the choice model showed that GP-referral discount is more effective when patients visit ED expecting “shorter” waits, as opposed to test-facility provision at GPs and perception-correction measures that showed stronger effects under “longer” expected waits. Conclusions. The new GP-referral financial incentive introduced in Singapore can be effective in reducing nonurgent ED visits, if it reasonably covers the (extra) cost of visiting a GP. It may serve as a complement to test-facility provision at GPs or perception-correction measures, as the financial incentive and the latter two measures appear to influence distinct classes (discount-sensitive and facility-sensitive) of patients.
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Affiliation(s)
- Yuliu Su
- Engineering Systems and Design, Singapore University of Technology and Design, Singapore
| | - Shrutivandana Sharma
- Engineering Systems and Design, Singapore University of Technology and Design, Singapore
| | - Semra Ozdemir
- Health Services and Systems Research Program, Duke-NUS Medical School, Singapore
| | - Wai Leng Chow
- Health Services Research Department, Changi General Hospital, Singapore
| | - Hong-Choon Oh
- Health Services Research Department, Changi General Hospital, Singapore
| | - Ling Tiah
- Accident & Emergency Department, Changi General Hospital, Singapore
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21
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Zhou Z, Zhao Y, Shen C, Lai S, Nawaz R, Gao J. Evaluating the effect of hierarchical medical system on health seeking behavior: A difference-in-differences analysis in China. Soc Sci Med 2020; 268:113372. [PMID: 32979776 DOI: 10.1016/j.socscimed.2020.113372] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 12/15/2022]
Abstract
The unbalanced allocation of healthcare resources and the underutilization of primary care facilities are the core problems that restrict the current healthcare reforms in China. In order to encourage residents to go to primary care facilities, China implemented the Hierarchical Medical System (HMS) in 2015. This study aims to evaluate the effect of HMS on health seeking behavior in China using panel data. Statistics for the study were derived from China Family Panel Studies (CFPS) 2012, 2014, 2016 and 2018, and China health and family planning statistical yearbook 2012, 2014, 2016 and 2018. We employed the difference-in-differences (DID) model with multiple periods. In total, 61,932 residents were incorporated for a final sample covered 25 provinces. The results indicated that the implementation of HMS had a significantly positive effect on the probability of urban residents going to primary care facilities for contact. However, the effect of HMS was not significant for rural residents. Basic health insurance was a significant factor for directing residents to primary care facilities. Self-assessed health, chronic disease, economic level and educational status were also found to be focal factors of health seeking behavior. In conclusion, the introduction of HMS has led to improved health seeking behavior and is worth putting more effort into. For policy makers, basic medical insurance is still an important health policy that enables systematic health seeking behavior. Initiatives to continue to expand the adjustment range of economic incentives should be adopted to promote the implementation of HMS. However, the effect of HMS in chronic disease is poor and efforts to formulate chronic disease as a breakthrough to HMS should be carried out. Moreover, the government should increase the publicity of HMS.
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Affiliation(s)
- Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Yaxin Zhao
- School of Public Health, Health Science Center, Xi'an Jiaotong University, No.76 West Yanta Road, Xi'an, 710061, Shaanxi, China.
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Rashed Nawaz
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Jianmin Gao
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
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Bauer J, Klingelhöfer D, Maier W, Schwettmann L, Groneberg DA. Prediction of hospital visits for the general inpatient care using floating catchment area methods: a reconceptualization of spatial accessibility. Int J Health Geogr 2020; 19:29. [PMID: 32718317 PMCID: PMC7384227 DOI: 10.1186/s12942-020-00223-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/16/2020] [Indexed: 11/28/2022] Open
Abstract
Background The adequate allocation of inpatient care resources requires assumptions about the need for health care and how this need will be met. However, in current practice, these assumptions are often based on outdated methods (e.g. Hill-Burton Formula). This study evaluated floating catchment area (FCA) methods, which have been applied as measures of spatial accessibility, focusing on their ability to predict the need for health care in the inpatient sector in Germany. Methods We tested three FCA methods (enhanced (E2SFCA), modified (M2SFCA) and integrated (iFCA)) for their accuracy in predicting hospital visits regarding six medical diagnoses (atrial flutter/fibrillation, heart failure, femoral fracture, gonarthrosis, stroke, and epilepsy) on national level in Germany. We further used the closest provider approach for benchmark purposes. The predicted visits were compared with the actual visits for all six diagnoses using a correlation analysis and a maximum error from the actual visits of ± 5%, ± 10% and ± 15%. Results The analysis of 229 million distances between hospitals and population locations revealed a high and significant correlation of predicted with actual visits for all three FCA methods across all six diagnoses up to ρ = 0.79 (p < 0.001). Overall, all FCA methods showed a substantially higher correlation with actual hospital visits compared to the closest provider approach (up to ρ = 0.51; p < 0.001). Allowing a 5% error of the absolute values, the analysis revealed up to 13.4% correctly predicted hospital visits using the FCA methods (15% error: up to 32.5% correctly predicted hospital). Finally, the potential of the FCA methods could be revealed by using the actual hospital visits as the measure of hospital attractiveness, which returned very strong correlations with the actual hospital visits up to ρ = 0.99 (p < 0.001). Conclusion We were able to demonstrate the impact of FCA measures regarding the prediction of hospital visits in non-emergency settings, and their superiority over commonly used methods (i.e. closest provider). However, hospital beds were inadequate as the measure of hospital attractiveness resulting in low accuracy of predicted hospital visits. More reliable measures must be integrated within the proposed methods. Still, this study strengthens the possibilities of FCA methods in health care planning beyond their original application in measuring spatial accessibility.
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Affiliation(s)
- J Bauer
- Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany.
| | - D Klingelhöfer
- Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - W Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - L Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Department of Economics, Martin Luther University Halle-Wittenberg, 06099, Halle an der Saale, Germany
| | - D A Groneberg
- Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
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