People-centered primary care measures in health equity: a perspective of urban-rural comparison in Beijing, China

Person-centered primary care measures (PCPCM) facilitate high-quality and culturally appropriate primary care. Access to PCPCM remains unequal between rural and urban areas, and the available evidence on rural PCPCM is still lacking. A cross-sectional survey was conducted with stratified sampling by regions, and four districts (Xicheng, Fengtai, Huairou, and Daxing) in Beijing were selected to test the performance of PCPCM in both urban and rural areas. Descriptive statistical methods were used to compare the urban-rural differences in the demographic characteristics of PCPCM. Correlation and regression analyses were performed to determine the associations between PCPCM in demographics and utilization of primary care. The PCPCM showed good reliability and validity in both urban and rural areas (P < .001), slightly lower in rural areas, but scores of rural PCPCM (R-PCPCM) in all items were lower than urban PCPCM (U-PCPCM). Patients in either the preferred urban or rural health centers all showed the highest PCPCM scores, with U-PCPCM= 3.31 for CHCs and R-PCPCM= 3.10 for RHCs, respectively. Patients in urban areas were more likely to receive higher-quality primary care than in rural areas (P < .001). Patients who preferred hospitals (β = 2.61, P < .001) or CHCs (β = 0.71, P = .003) as providers was a significant positive predictor of U-PCPCM but it was the preference for hospitals (β = 2.95, P < .001) for R-PCPCM. Urban-rural differences existed in the performance of PCPCM, with rural areas typically more difficult to access better PCPCM. To promote health equity in rural areas, healthcare providers should strive to minimize urban-rural differences in the quality and utilization of primary care services as much as feasible.

Does the community service environment affect the willingness of older adults people to socialize for older adults care?

Population ageing is a significant trend in social development and will remain a fundamental national condition in China for the foreseeable future. Socialized older adults care has become a crucial strategy for China to address population ageing. However, the current levels of acceptance and willingness to seek socialized older adults care among older adults are relatively low. This study focuses on examining how the community environment and services influence older adults people's willingness to engage in social activities related to older adults care. Using data from the China Longitudinal Ageing Social Survey (CLASS) (N = 9,657), this study investigated the impact of the community service environment on older adults people's willingness to participate in social activities related to older adults care through a logit model. The study revealed that 9.15% of older adults (N = 9,657) in China are willing to engage in social activities related to older adults care. Furthermore, the individual characteristics and family support of older adults play a significant role in shaping their willingness to engage in older adults care. The provision of medical services, daily care services, and entertainment venues by the community positively influence older adults people's willingness to participate in social activities related to older adults care (p < 0.01), whereas psychological counselling services have a negative impact (p < 0.01). The impact of community services on older adults people's willingness to engage in social activities related to older adults care varies due to factors such as smoking and chronic diseases. These findings provide valuable insights for improving older adults' social engagement in China.

Research on care preferences for the elderly and influencing factors in Zhejiang Province: A statistical and geographical approach

The aging of the population is becoming an increasingly severe issue. How can we develop caring services for the elderly and promote healthy aging? Investigating care preferences is an essential step in addressing this issue. A self-designed questionnaire was employed to collect data online. The impact of personal circumstances on care preferences was ascertained using the chi-squared test and multivariate logistic regression. An optimal parameters-based geographical detector was introduced to examine the influence of spatially heterogeneous regional factors on care preferences. The online survey produced 1178 valid questionnaires. Home-based elderly care was the preference of 91.9% of respondents, followed by community-based care and medical-nursing care; institutional care was the least preferred alternative. Age, education, living style, and health states of the elderly significantly influenced the preferred care option. When compared to home-based elderly care, older respondents (odds ratio [OR] = 3.776) preferred institutional care, highly educated respondents preferred community-based care (higher education: OR = 5.206; secondary education: OR = 3.049) and medical-nursing care (higher education: OR = 4.484); the elderly living alone (OR = 0.101) excluded institutional care, and the elderly living with their children excluded non-family care method of institutional care (OR = 0.031) and medical-nursing care (OR = 0.391). Regional medical resources and old-age security significantly affect the preferences of the elderly (q-statistic [q] > 0.5); local economic development significantly affects community-based care (q > 0.6); the availability of financial subsidies significantly affects home-based care and medical-nursing care (q > 0.9); and the availability of institutional resources significantly affects the preference for institutional care (q > 0.8). We found that it is necessary to improve the level of medical care given by non-family members and care facilities, vigorously develop new methods of elderly care, promote humanistic care in non-family care settings, and increase available regional medical resources, financial subsidies, and social security. This study integrates economic and social perspectives to examine and analyze retirement willingness, thereby broadening the scope of social surveys and research methodologies, and offering valuable insights with potential directive implications.

Association of Sensory Impairment With Institutional Care Willingness Among Older Adults in Urban and Rural China: An Observational Study

Background and Objectives

An aging population has contributed to increasing rates of sensory impairment (SI) among older adults and a boom in institutional elder care. However, little is known regarding the association between SI and institutional care willingness. This study identified the association between SI and institutional care willingness among older adults living both in urban and rural China.

Research Design and Methods

This was an observational study using the sixth National Health Service Survey of Shandong Province, China, in 2018. A total of 8 583 individuals aged ≥60 years were included. The primary outcome was institutional care willingness. Self-reported SI was categorized as vision impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI). We used multivariable logistic regression models to estimate the association between SI and institutional care willingness, stratified by the place of residence.

Results

The overall proportion of older adults with institutional care willingness was 7.8%. In fully adjusted models, older adults with HI only (odds ratio [OR] = 1.57, 95% confidence interval [CI]: 1.12-2.20) or DSI (OR = 1.68, 95% CI: 1.14-2.49) were more likely to show institutional care willingness than those without SI in urban areas, but no significant associations between VI only (OR = 0.95, 95% CI: 0.68-1.31), HI only (OR = 0.99, 95% CI: 0.73-1.34), or DSI (OR = 0.95, 95% CI: 0.68-1.31) and institutional care willingness were observed among rural older adults.

Discussion and Implications

Our results underscore that the relationship between SI and institutional care willingness varied by place of residence, and provide a reference for making targeted and appropriate endowment policies. Improving the quality of institutional elder care is vital for urban older adults with SI, whereas community-based care might be more appropriate for rural older adults with SI.

Utilisation willingness for institutional care by the disabled elderly and its influencing factors based on Andersen's model: a cross-sectional survey of Henan, China

OBJECTIVE

To explore the factors that influence institutional care for the disabled elderly in China and the key factors that influence individuals based on the Andersen model.

DESIGN

Cross-sectional survey.

SETTING

The research was conducted in 18 cities in Henan Province, China.

MAIN OUTCOME MEASURES

A multistage, stratified sampling design was employed. The χ² test was used to compare the differences in basic information of the disabled elderly. A binary Logit model was used to examine the factors influencing the willingness to institutionalise elderly people with disabilities. The determinants of willingness to care in an institution were also explored in a stratified study by gender, age and region to identify the key differences affecting institutionalisation. The Andersen model was used as the theoretical framework to infer the impact strength of each model.

RESULTS

Of the 2810 disabled elderly people in Henan, China, 7.4% of the elderly had a willingness for institutional care. In the binary logistic regression analysis, whether living alone (OR (95% CI)=0.596 (0.388 to 0.916)), medical payment method (basic medical insurance for urban employees: OR (95% CI)=2.185 (1.091 to 4.377)), having mental illness (OR (95% CI)=2.078 (1.044 to 4.137)) had a statistically significant difference (p<0.05) on the impact on the willingness of the disabled elderly to receive institutional care. Validation of the fitted coefficients of the model revealed that the needs factor had the most significant effect on the enabling variable, while the predisposing factor had more minerally effect.

CONCLUSIONS

Several factors influence the willingness of the disabled elderly to institutionalise. Therefore, it is recommended that relevant authorities take targeted measures to focus on the disabled elderly to identify more precise elderly care services to deal with the ageing crisis.

Nurses' Willingness and Demand for Internet +home Care Services and Its Influencing Factors in Different Levels of Hospitals in China - A Nationwide Survey

Purpose

The present study aimed to investigate nurses’ willingness and demand for Internet +home care services in different levels of hospitals in China and analyze the influencing factors.

Participants and Methods

From October 1 to December 31, 2021, 5714 nurses from 15 hospitals in five regions of China were recruited in this cross-sectional study using a two-stage random sampling method. A self-designed questionnaire with good reliability and validity was used to measure nurses’ willingness and demand for Internet +home care services. χ² test, Welch t-test, and multiple linear regression analyses were used to analyze the data.

Results

Nurses were highly willing to provide Internet +home care services. Statistical differences were found in the willingness to provide Internet +home care services and the preference for service distance, service platform, and single service fee between nurses in different levels of hospitals (both P<0.05). The willingness to provide “catheter maintenance service” and “rehabilitation nursing service” of nurses in different levels of hospitals were statistically significant (both P<0.05). Nurses’ demand for Internet +home care services increased with the level of their hospital. Multiple linear regression showed that professional title, educational level, monthly family income, and mortgage or car loan influence nurses’ demand for Internet +home care services.

Conclusion

Nurses’ willingness and demand for Internet +home care services vary with the level of their hospitals. It is recommended that government and hospitals regulate the service items, the service distance, single service fee, and other contents according to nurses’ willingness and demand and establish relevant laws and regulations to ensure the steady and orderly development of the Internet +home care services.

Factors Associated With Informational Support in Transitional Care for Older Adults With Chronic Diseases: A Cross-Sectional Study

To evaluate the current situation and associated factors of informational support for older adults with chronic diseases in transitional care. Study was conducted in five hospitals of five different cities in Jiangsu Province, China. A random cluster sample of 800 older adults with chronic diseases responded to the informational support questionnaire of transitional care survey. Descriptive analysis, t-tests, variance analysis, and stepwise multiple linear regression were used to analyze data. The STROBE statement for observational studies was applied. Total score of ISQTC for older adults with chronic diseases was (44.05 ± 17.21). Marital status, educational level, past occupation, close friends, medical insurance, complications, and exercise habits were significantly correlated with informational support. The level of informational support in transitional care for older adults with chronic diseases was low. Clinical staff should periodically and primarily assess their informational support, help find information resources for those who have low initial informational support, and identify which information they preferred to carry out accurate transitional care.

Chronic disease and medical spending of Chinese elderly in rural region

OBJECTIVE

To determine whether or not chronic disease positively impacts medical costs among the rural elderly in China and to calculate medical expenditure induced by chronic disease between different groups of the rural elderly, as well as provide insight into the factors that affect medical losses induced by chronic disease among different household registration groups and different New Rural Pension Scheme statuses.

DESIGN

To estimate the share of medical expenses induced by chronic disease, this article uses a two-part model and a four-part model to analyze the causal effect of chronic disease on medical services and then uses a counter-factual method to estimate the share of medical expenses.

SETTING

The rapid development of China has changed nearly every aspect of life for the rural elderly. Many are concerned about the increasing prevalence of physical health issues, particularly chronic diseases, among the rural elderly. Nevertheless, there are no articles using nationally representative panel datasets that report differences in the cost of chronic disease between sub-populations.

PARTICIPANTS

The panel dataset used for this study comes from the China Family Panel Studies (CFPS) data. In this study, we use the CFPS data for the years 2012, 2014 and 2016 to create a panel dataset that includes 2730 rural elderly for 3 years.

INTERVENTIONS

This article reports the representative estimate of medical expenditures attributable to chronic disease among rural elderly in China. On this basis, we estimate per capita medical spending among rural elderly under the condition of logarithmic normal distribution of different parameters between urban and rural or between groups that participate in the New Rural Pension Program and groups that do not.

MAIN OUTCOME MEASURES

This study indicates that physical health status has a significant impact on both the probability of undergoing medical care and the size of medical expenditures among the rural elderly, and the influence was significant for all patients, including outpatients and inpatients.

RESULTS

Chronic illness has significant effects on individual medical expenses, and they aggregately contribute to 63.96% of total personal expected medical expenditure. Specifically, the medical spending caused by chronic disease was part of a non-uniform distribution, with the rural, male, older, married and higher educated groups spending more money on medical costs induced by chronic disease.

CONCLUSIONS

Examining trends in the prevalence of chronic diseases and evaluating medical spending on chronic diseases can prevent and control potential medical costs among rural elderly, especially for vulnerable groups, which helps to predict future health-care needs.