1
|
Wu J, Chen D, Li C, Wang Y. Effect of community-based public health service on health-related quality of life among middle-aged and older adults with chronic diseases in China. BMC Public Health 2024; 24:2039. [PMID: 39080595 PMCID: PMC11290236 DOI: 10.1186/s12889-024-19556-w] [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: 04/27/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The growing prevalence of non-communicable chronic diseases poses a significant public health challenge globally, particularly impacting the well-being of aging populations. This study aims to assess the impact of community-based public health service (PHS) on the health-related quality of life (HRQoL) among middle-aged and older adults with chronic diseases in China. METHODS Utilizing data from the China Health and Retirement Longitudinal Study, we constructed a novel scale based on the 36-Item Short Form Health Survey (SF-36) to measure the HRQoL of middle-aged and older patients with hypertension and/or type-2 diabetes. Multivariate linear regression models with Instrument Variables and Propensity Score Matching techniques were applied to examine the effect of PHS on the HRQoL of identified chronic disease patients. RESULTS Among 8,403 hypertensive and/or diabetic patients, only 10.98% had received PHS. After adjusting for covariates, PHS exhibited a significant association with an elevated overall SF-36 score (β = 3.539, p < 0.001). Similar effects were observed in the physical and mental component summary scores, with increases of 1.982 (p < 0.001) and 5.095 (p < 0.001), respectively. Sensitive analysis affirmed the robustness of these findings. Heterogeneity analysis revealed significant HRQoL improvements among males, females, those aged 70 and older, patients with comorbidities, and urban residents, while the effect was less pronounced in the middle-aged, those without comorbidities, or rural dwellers. CONCLUSION Community-based PHS has exerted a positive impact on both the physiological and psychological aspects of HRQoL among middle-aged and older chronic disease patients, with effects varying among individuals with different characteristics. Our findings advocate for enhancing the delivery and utilization of government-funded PHS, increasing health literacy, and promoting early prevention strategies for chronic diseases. Furthermore, targeted health management initiatives for patients with comorbidities and enhancements in the quality of community healthcare services, particularly in rural areas, are deemed necessary.
Collapse
Affiliation(s)
- Jingxian Wu
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.
| | - Danlei Chen
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
| | - Cong Li
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
| | - Yingwen Wang
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
| |
Collapse
|
2
|
Li M, Zhang X, Tang H, Zheng H, Long R, Cheng X, Cheng H, Dong J, Wang X, Zhang X, Geldsetzer P, Liu X. Quality of primary health care for chronic diseases in low-resource settings: Evidence from a comprehensive study in rural China. PLoS One 2024; 19:e0304294. [PMID: 39052549 PMCID: PMC11271947 DOI: 10.1371/journal.pone.0304294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND There is a paucity of evidence regarding the definition of the quality of primary health care (PHC) in China. This study aims to evaluate the PHC quality for chronic diseases in rural areas based on a modified conceptual framework tailored to the context of rural China. METHODS This comprehensive study, involving a patient survey, a provider survey and chart abstraction, and second-hand registered data, was set in three low-resource counties in rural China from 2021 to 2022. Rural patients with hypertension or type 2 diabetes, and health care workers providing care on hypertension or diabetes were involved. The modified PHC quality framework encompasses three core domains: a competent PHC system (comprehensiveness, accessibility, continuity, and coordination), effective clinical care (assessment, diagnosis, treatment, disease management, and provider competence), and positive user experience (information sharing, shared decision-making, respect for patient's preferences, and family-centeredness). Standardized PHC quality score was generated by arithmetic means or Rasch models of Item Response Theory. RESULTS This study included 1355 patients, 333 health care providers and 2203 medical records. Ranging from 0 (the worst) to 1 (the best), the average quality score for the PHC system was 0.718, with 0.887 for comprehensiveness, 0.781 for accessibility, 0.489 for continuity, and 0.714 for coordination. For clinical care, average quality was 0.773 for disease assessment, 0.768 for diagnosis, 0.677 for treatment, 0.777 for disease management, and 0.314 for provider competence. The average quality for user experience was 0.727, with 0.933 for information sharing, 0.657 for shared decision-making, 0.936 for respect for patients' preferences, and 0.382 for family-centeredness. The differences in quality among population subgroups, although statistically significant, were small. CONCLUSION The PHC quality in rural China has shown strengths and limitations. We identified large gaps in continuity of care, treatment, provider competence, family-centeredness, and shared decision-making. Policymakers should invest more effort in addressing these gaps to improve PHC quality.
Collapse
Affiliation(s)
- Mingyue Li
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Xiaotian Zhang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
| | - Haoqing Tang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Huixian Zheng
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Ren Long
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xiaoran Cheng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Haozhe Cheng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Jiajia Dong
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Xiaohui Wang
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Xiaoyan Zhang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, New York, United States of America
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
- Chan Zuckerberg Biohub, San Francisco, San Francisco, California, United States of America
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University, Beijing, China
| |
Collapse
|
3
|
Liu R, Zhao Q, Dong W, Guo D, Shen Z, Li Y, Zhang W, Zhu D, Zhang J, Bai J, Ren R, Zhen M, Zhang J, Cui J, Li X, Miao Y. Assessing public health service capability of primary healthcare personnel: a large-scale survey in Henan Province, China. BMC Health Serv Res 2024; 24:627. [PMID: 38745226 PMCID: PMC11094852 DOI: 10.1186/s12913-024-11070-4] [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: 12/05/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The public health service capability of primary healthcare personnel directly affects the utilization and delivery of health services, and is influenced by various factors. This study aimed to examine the status, factors, and urban-rural differences of public health service capability among primary healthcare personnel, and provided suggestions for improvement. METHODS We used cluster sampling to survey 11,925 primary healthcare personnel in 18 regions of Henan Province from 20th to March 31, 2023. Data encompassing demographics and public health service capabilities, including health lifestyle guidance, chronic disease management, health management of special populations, and vaccination services. Multivariable regression analysis was employed to investigate influencing factors. Propensity Score Matching (PSM) quantified urban-rural differences. RESULTS The total score of public health service capability was 80.17 points. Chronic disease management capability scored the lowest, only 19.60. Gender, education level, average monthly salary, professional title, health status, employment form, work unit type, category of practicing (assistant) physician significantly influenced the public health service capability (all P < 0.05). PSM analysis revealed rural primary healthcare personnel had higher public health service capability scores than urban ones. CONCLUSIONS The public health service capability of primary healthcare personnel in Henan Province was relatively high, but chronic disease management required improvement. Additionally, implementing effective training methods for different subgroups, and improving the service capability of primary medical and health institutions were positive measures.
Collapse
Affiliation(s)
- Rongmei Liu
- Henan Key Laboratory for Health Management of Chronic Diseases, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qiuping Zhao
- Henan Key Laboratory for Health Management of Chronic Diseases, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wenyong Dong
- Department of Hypertension, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, China
| | - Dan Guo
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, China
| | - Zhanlei Shen
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Yi Li
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Wanliang Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Dongfang Zhu
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Jingbao Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Junwen Bai
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Ruizhe Ren
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Mingyue Zhen
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Jiajia Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Jinxin Cui
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Xinran Li
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Yudong Miao
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China.
| |
Collapse
|
4
|
Dong C, Wu G, Li H, Qiao Y, Gao S. Type 1 and type 2 diabetes mortality burden: Predictions for 2030 based on Bayesian age-period-cohort analysis of China and global mortality burden from 1990 to 2019. J Diabetes Investig 2024; 15:623-633. [PMID: 38265170 PMCID: PMC11060160 DOI: 10.1111/jdi.14146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/07/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
AIMS This study assessed diabetes (type 1 and type 2) mortality in China and globally from 1990 to 2019, predicting the next decade's trends. MATERIALS AND METHODS Data came from the Global Burden of Disease (GBD) database. The annual percentage change (AAPC) in age-standardized mortality rates (ASMR) for diabetes (type 1 and type 2) during 1990-2019 was calculated. A Bayesian age-period-cohort (BAPC) model predicted diabetes (type 1 and type 2) mortality from 2020 to 2030. RESULTS In China, type 1 diabetes deaths declined from 6,005 to 4,504 cases (AAPC -2.827), while type 2 diabetes deaths rose from 64,084 to 168,388 cases (AAPC -0.763) from 1990 to 2019. Globally, type 1 diabetes deaths increased from 55,417 to 78,236 cases (AAPC 0.223), and type 2 diabetes deaths increased from 606,407 to 1,472,934 cases (AAPC 0.365). Both China and global trends showed declining type 1 diabetes ASMR. However, female type 2 diabetes ASMR in China initially increased and then decreased, while males had a rebound trend. Peak type 1 diabetes deaths were in the 40-44 age group, and type 2 diabetes peaked in those over 70. BAPC predicted declining diabetes (type 1 and type 2) mortality burden in China and globally over the next 10 years. CONCLUSIONS Type 2 diabetes mortality remained high in China and globally despite decreasing type 1 diabetes mortality over 30 years. Predictions suggest a gradual decrease in diabetes mortality over the next decade, highlighting the need for continued focus on type 2 diabetes prevention and treatment.
Collapse
Affiliation(s)
- Chunping Dong
- Department of EndocrinologyShaanxi Provincial People's HospitalXi'an CityChina
| | - Guifu Wu
- Department of EndocrinologyShaanxi Provincial People's HospitalXi'an CityChina
| | - Hui Li
- Department of EndocrinologyShaanxi Provincial People's HospitalXi'an CityChina
| | - Yuan Qiao
- Department of EndocrinologyShaanxi Provincial People's HospitalXi'an CityChina
| | - Shan Gao
- Department of EndocrinologyShaanxi Provincial People's HospitalXi'an CityChina
| |
Collapse
|
5
|
Wang J, Bai L, Xu X. Disparities in awareness and utilisation of National Essential Public Health Services between the floating population and the registered residents: a cross-sectional study in China. BMJ Open 2024; 14:e080756. [PMID: 38569712 PMCID: PMC11146392 DOI: 10.1136/bmjopen-2023-080756] [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] [Received: 10/10/2023] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE There are differences between the floating population and the registered population in the awareness and use of the National Essential Public Health Services (NEPHS) due to the influence of China's household registration system. The Equalization of Basic Public Health and Family Planning Services (EBPHFPS) policy aims to reduce disparities among populations by enhancing the migrant population's access to basic public health services. The aim of this study is to examine the relationship between the EBPHFPS targeted at the floating population and the disparities in access to and utilisation of NEPHS between registered residents and the floating population. DESIGN A cross-sectional study. SETTING 8 cities (regions, autonomous prefectures) in China. PARTICIPANTS 13 998 floating population and 14 000 registered residents in eight cities (regions, autonomous prefectures) were included in the analysis. OUTCOME MEASURES Three binomial variables, including awareness of NEPHS, acceptance of health education and establishment of health records, were used as outcome indicators to examine the relationship between the EBPHFPS and the disparities between the floating and registered populations. METHODS A linear regression model, fairness gap calculation and propensity score matching were used to explore the associations. RESULTS The areas that implemented EBPHFPS exhibited an 8.3% increase in awareness of the NEPHS (p<0.01) and a 4.0% increase (p<0.05) in the likelihood of individuals having received health education within the previous year compared with the areas without the policy implementation. In contrast to registered residents, however, the floating population still faces significant disparities in NEPHS awareness and utilisation. Compared with areas without the equalisation policy, the inequality of opportunity in health education of the floating population in implementation areas is significantly lower (p<0.01), whereas no significant difference is observed in the inequality of opportunity regarding NEPHS awareness among the floating population (p>0.1). The floating population in the pilot areas of the policy encountered greater disparities in the establishment of health records (p<0.01). CONCLUSIONS Positive associations between the EBPHFPS policy and NEPHS awareness and utilisation among the floating population were demonstrated to some extent; however, the floating population was still confronted with a degree of inequality of opportunity. The government needs to develop target-oriented policies and a guaranteed mechanism to ensure access to NEPHS among the floating population.
Collapse
Affiliation(s)
- Jin Wang
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, Jiangsu, China
- Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Lan Bai
- Department of Public Management, School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Xinpeng Xu
- School of Public Health, Nanjing Medical University, Nanjing, China
| |
Collapse
|
6
|
Zou C, Deng L, Luo J, Dai H, Zhang Y, Guo R, Luo X, Yang R, Song H, Spicer J, Zhao Q, Liao X. The impact of communication training on the clinical care of hypertension in general practice: a cluster randomized controlled trial in China. BMC PRIMARY CARE 2024; 25:98. [PMID: 38532356 DOI: 10.1186/s12875-024-02344-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Hypertension is one of the most common chronic diseases with a low control rate globally. The effect of communication skills training contributing to hypertension control remains uncertain. The aim of the present study was to assess the effectiveness of an educational intervention based on the Calgary-Cambridge guide in improving hypertensive management. METHODS A cluster randomized controlled trial enrolled 27 general practitioners (GPs) and 540 uncontrolled hypertensive patients attending 6 community health centers in Chengdu, China. GPs allocated to the intervention group were trained by an online communication course and two face-to-face workshops based on Calgary-Cambridge guides. The primary outcome was blood pressure (BP) control rates and reductions in systolic and diastolic BP from baseline to 3 months. The secondary outcome was changes in GPs' communication skills after one month, patients' knowledge and satisfaction after 3 months. Bivariate analysis and the regression model assessed whether the health provider training improved outcomes. RESULTS After the communication training, the BP control rate was significantly higher (57.2% vs. 37.4%, p < 0.001) in the intervention groups. Compared to the control group, there was a significant improvement in GP's communication skills (13.0 vs 17.5, p < 0.001), hypertensive patients' knowledge (18.0 vs 20.0, p < 0.001), and systolic blood pressure (139.1 vs 134.7, p < 0.001) after 3 months of follow-up. Random effects least squares regression models showed significant interactions between the intervention group and time period in the change of GP's communication skills (Parameter Estimated (PE): 0.612, CI:0.310,0.907, p = 0.006), hypertensive patient's knowledge (PE:0.233, CI: 0.098, 0.514, p < 0.001), satisfaction (PE:0.495, CI: 0.116, 0.706, p = 0.004), SBP (PE:-0.803, CI: -1.327, -0.389, p < 0.001) and DBP (PE:-0.918, CI: -1.694, -0.634, p < 0.001), from baseline to follow-up. CONCLUSION Communication training based on the Calgary-Cambridge guide for GPs has shown to be an efficient way in the short term to improve patient-provider communication skills and hypertension outcomes among patients with uncontrolled BPs. TRIAL REGISTRATION The trial was registered on Chinese Clinical Trials Registry on 2019-04-03. (ChiCTR1900022278).
Collapse
Affiliation(s)
- Chuan Zou
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, NO.37 Guoxue Lane, Wuhou District, Chengdu, 611130, China
- The Department of General Practice, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu City, China
- Teaching&Research Section, General Practice Medical Center, West China Hospital,Sichuan University, Chengdu, China
| | - Lili Deng
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, NO.37 Guoxue Lane, Wuhou District, Chengdu, 611130, China
| | - Jianzhao Luo
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, NO.37 Guoxue Lane, Wuhou District, Chengdu, 611130, China
| | - Hua Dai
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, NO.37 Guoxue Lane, Wuhou District, Chengdu, 611130, China
| | - Yu Zhang
- The Department of Gastroenterology, The First Affiliated Hospital of Chengdu Medical College, Chengdu City, China
| | - Ru Guo
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, NO.37 Guoxue Lane, Wuhou District, Chengdu, 611130, China
| | - Xiaolu Luo
- The Department of General Practice, Community Health Center of South Railway Station, Chengdu City, China
| | - Rong Yang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, NO.37 Guoxue Lane, Wuhou District, Chengdu, 611130, China
| | - Haiqi Song
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, NO.37 Guoxue Lane, Wuhou District, Chengdu, 611130, China
| | - John Spicer
- Fellow of the Royal College of General Practitioners, Country Park Practice, London, UK
| | - Qian Zhao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, NO.37 Guoxue Lane, Wuhou District, Chengdu, 611130, China.
- Teaching&Research Section, General Practice Medical Center, West China Hospital,Sichuan University, Chengdu, China.
| | - Xiaoyang Liao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, NO.37 Guoxue Lane, Wuhou District, Chengdu, 611130, China.
- Teaching&Research Section, General Practice Medical Center, West China Hospital,Sichuan University, Chengdu, China.
| |
Collapse
|
7
|
Tao X, Mao L, Zhang P, Ma X, Liang Z, Sun K, Peiris D. Barriers and facilitators to primary care management of type 2 diabetes in Shijiazhuang City, China: a mixed methods study. BMC PRIMARY CARE 2024; 25:84. [PMID: 38481166 PMCID: PMC10935988 DOI: 10.1186/s12875-024-02330-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The prevalence of type 2 diabetes (T2DM) in China is over 10%, affecting around 114 million people. Despite the inclusion of T2DM in the National Basic Public Health Service Program (NBPHSP), most people with T2DM experience challenges in achieving optimal management targets. This study aimed to identify barriers and facilitators of diabetes management from the perspectives of primary health care (PHC) service providers and recipients. METHODS This mixed-methods study was conducted in Shijiazhuang City, Hebei Province, China. A quantitative PHC facility assessment survey was conducted in all administrative districts and qualitative in-depth interviews were conducted in one district to government officials, medical staff, patients with T2DM, and their family members. Interviews were thematically analyzed, and all findings were synthesized using Michie's COM-B theory. RESULTS A total of 197 village/community level PHC facilities and 66 township/street level PHC facilities answered the survey, and 42 in-depth interviews were conducted. The key facilitators stemmed from the NBPHSP policy, which standardized the basic infrastructure, medical equipment, and medication for the PHC facilities, provided training on NCD prevention and control, and compensated the PHC workers. However, we identified a detrimental cycle among PHC providers characterized by inadequate capacity, overwhelming workloads, insufficient income, limited career development opportunities, and challenges in attracting young talents. Although patients were covered by the national medical insurance schemes, they experienced capability constraints primarily driven by low education levels, advanced age, low health literacy, and a proliferation of misinformation. These factors influenced patients' motivation to be actively engaged in care and contributed to inertia to intensify treatment and achieve their clinical management goals. CONCLUSION This study identifies several major facilitators and barriers from the perspectives of both PHC providers and patients with T2DM. Our findings suggest there are substantial opportunities to strengthen the NBPHSP, including improving the capacity and the income level of the PHC providers, attracting and retaining skilled health workers in rural areas, supporting patients to improve their health literacy and take a more active role in their health care, and improving access to high-quality care through digital health approaches. TRIAL REGISTRATION ClinicalTrials.gov (record NCT02726100, 03/22/2016).
Collapse
Affiliation(s)
- Xuanchen Tao
- The George Institute for Global Health, Beijing, China
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Limin Mao
- Center for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Puhong Zhang
- The George Institute for Global Health, Beijing, China.
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
| | - Xinyan Ma
- Shijiazhuang Center for Disease Control, Shijiazhuang, Hebei Province, China.
| | - Zhenyu Liang
- Shijiazhuang Center for Disease Control, Shijiazhuang, Hebei Province, China
| | - Kaige Sun
- The George Institute for Global Health, Beijing, China
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
8
|
Li M, Raven J, Liu X. Feminization of the health workforce in China: exploring gendered composition from 2002 to 2020. HUMAN RESOURCES FOR HEALTH 2024; 22:15. [PMID: 38373975 PMCID: PMC10877893 DOI: 10.1186/s12960-024-00898-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Feminization of health workforce has been globally documented, but it has not been investigated in China. This study aims to analyze changes in the gendered composition of health workforce and explore the trend in different types of health workforce, health organizations and majors within China's health system. METHODS The data were collected from China Health Statistical Yearbook from 2002 to 2020. We focused on health professionals including doctors, nurses, and pharmacists in health organizations. Trend analysis was employed to examine the change in the ratio of female health workforce over 18 years. The estimated average annual percent change (AAPC) was estimated, and the reciprocals of variances for the female ratios were used as weights. RESULTS In China, health professionals increased from 4.7 million in 2002 to 10.68 million in 2020. Health professionals per 1000 population increased from 3.41 in 2002 to 7.57 in 2020. The ratio of female health professionals significantly increased from 63.85% in 2002 to 72.4% in 2020 (AAPC = 1.04%, 95% CI 0.96-1.11%, P < 0.001). Female doctors and pharmacists increased 4.7 and 7.9 percentage points from 2002 to 2020. Female health workers at township health centers, village clinics, centers for disease control and prevention had higher annual increase rate (AAPC = 1.67%, 2.25% and 1.33%, respectively) than those at hospital (0.70%) and community health center (0.5%). Female doctors in traditional Chinese medicine, dentistry and public health had higher annual increase rate (AAPC = 1.82%, 1.53% and 1.91%, respectively) than female clinical doctor (0.64%). CONCLUSIONS More women are participating in the healthcare sector in China. However, socially lower-ranked positions have been feminizing faster, which could be due to the inherent and structural gender norms restricting women's career. More collective and comprehensive system-level actions will be needed to foster a gender-equitable environment for health workforce at all levels.
Collapse
Affiliation(s)
- Mingyue Li
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, People's Republic of China
- China Center for Health Development Studies, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Joanna Raven
- Department of Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China.
| |
Collapse
|
9
|
Peng K, Cai W, Liu X, Liu Y, Ouyang M, Gong J, Wang Z, Wang Y, Hao J, Wang W, Zhao H, Lin K, Han G, Shi Y, Xie Y, Xie Y, Lei L, Si L. Trends of mean systolic and diastolic blood pressure among adults in Shenzhen, China, 1997-2018: findings from three rounds of the population-based survey. BMJ Open 2024; 14:e074575. [PMID: 38341201 PMCID: PMC10862306 DOI: 10.1136/bmjopen-2023-074575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE To quantify the trends in systolic and diastolic blood pressure (BP) among adults in Shenzhen from 1997 to 2018. DESIGN Cross-sectional study. SETTINGS The data were collected from all districts in Shenzhen, China in the years of 1997, 2009 and 2018 by multistage cluster sampling procedure. PARTICIPANTS Participants were residents aged 18-69 years in Shenzhen, China. A total of 26 621 people were included: 8266 people in 1997, 8599 people in 2009 and 9756 people in 2018. PRIMARY AND SECONDARY OUTCOME MEASURES All participants were surveyed about their sociodemographic and lifestyle information. BP was measured by trained physicians using a mercury sphygmomanometer. Hypertension was defined as systolic BP of at least 140 mm Hg and diastolic BP of at least 90 mm Hg, self-reported use of antihypertensive medications or both. Hypertension control was defined as systolic BP values of less than 140 mm Hg and diastolic BP values of less than 90 mm Hg. RESULT Age-adjusted mean systolic BP increased from 117±16 mm Hg to 123±15 mm Hg (p<0.001) in males, and from 113±18 mm Hg to 115±16 mm Hg (p<0.001) in females from 1997 to 2018. Diastolic BP among males increased from 75 mm Hg (SD=11) to 79 mm Hg (SD=11) and increased from 71 mm Hg (SD=10) to 73 mm Hg (SD=10) among females between 1997 and 2018 (p<0.001). Rate of hypertension rose rapidly from 17.71% (95% CI: 16.60% to 18.90%) in 2009 to 24.01% (95% CI: 22.84% to 25.22%) in 2018 among males (p<0.001), whereas the prevalence among females remained stable at around 13.5% (p=0.98). Both awareness and treatment rates of hypertension among males and females showed a decreased trend between 2009 and 2018, while no significant changes were observed for control rates. CONCLUSIONS The mean systolic BP and diastolic BP among adults in Shenzhen increased from 1997 to 2018, and no improvements in hypertension awareness, treatment and control rates were found.
Collapse
Affiliation(s)
- Ke Peng
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China
| | - Weicong Cai
- Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
- University of New South Wales, Sydney, New South Wales, Australia
| | - Xiaoying Liu
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China
| | - Yishu Liu
- The George Institute for Global Health, Beijing, China
| | - Menglu Ouyang
- The George Institute for Global Health, Newtown, New South Wales, Australia
- George Institute for China at Peking University Health Science Center, Beijing, China
| | | | - Zhihui Wang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yunfeng Wang
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China
- National Center for Cardiovascular Diseases, Beijing, China
| | - Jing Hao
- Shenzhen Mindray Bio-Medical Electronic Co, Shenzhen, China
| | - Wei Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Honglei Zhao
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China
| | - Kaihao Lin
- Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Guiyuan Han
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China
| | - Yu Shi
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China
| | - Yinghao Xie
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China
- University of South China, Hengyang, China
| | - Yuxin Xie
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China
- University of South China, Hengyang, China
| | - Lin Lei
- Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Lei Si
- Western Sydney University, Penrith South, New South Wales, Australia
| |
Collapse
|
10
|
Zhang L, Sun L. Life expectancy inequalities between regions of China 2004-2020: contribution of age- and cause-specific mortality. Front Public Health 2023; 11:1271469. [PMID: 38174074 PMCID: PMC10764032 DOI: 10.3389/fpubh.2023.1271469] [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: 08/02/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Background China's rapid economic and social development since the early 2000s has caused significant shifts in its epidemiological transition, potentially leading to health disparities across regions. Objectives This study employs Life Expectancy (LE) to assess health disparities and trends among China's eastern, central, and western regions. It also examines the pace of LE gains relative to empirical trends and investigates age and causes of death mortality improvement contributing to regional LE gaps. Data and methods Using a log-quadratic model, the study estimates LE in China and its regions from 2004 to 2020, using census and death cause surveillance data. It also utilizes the Human Mortality Database (HMD) and the LE gains by LE level approach to analyze China and its regions' LE gains in comparison to empirical trend of developed countries. The study investigates changes in LE gaps due to age and causes of death mortality improvements during two periods, 2004-2012 and 2012-2020, through the LE factor decomposition method. Results From 2000 to 2020, China's LE exhibited faster pace of gains compared to developed countries. While men's LE growth gradually aligns with empirical trends, women experience slightly higher growth rates. Regional LE disparities significantly reduced from 2004 to 2012, with a marginal reduction from 2012 to 2020. In the latter period, the changing LE gap aligns with expected trends in developed countries, with all Chinese regions surpassing empirical estimates. Cardiovascular diseases and malignant neoplasms emerged as the primary contributors to expanding regional LE gaps, with neurological disorders and diabetes playing an increasingly negative role. Conclusion LE disparities in China have consistently decreased, although at a slower pace in recent years, mirroring empirical trends. To further reduce regional LE disparities, targeted efforts should focus on improving mortality rates related to cardiovascular diseases, neoplasms, neurological disorders and diabetes, especially in the western region. Effective health interventions should prioritize equalizing basic public health services nationwide.
Collapse
Affiliation(s)
- Leyi Zhang
- School of Insurance, University of International Business and Economics, Beijing, China
- School of Mathematics, Baotou Teachers' College, Baotou, China
| | - Lijuan Sun
- School of Insurance, University of International Business and Economics, Beijing, China
| |
Collapse
|
11
|
Ma X, Fan W, Zhang X, Zhang S, Feng X, Song S, Wang H. The urban-rural disparities and factors associated with the utilization of public health services among diabetes patients in China. BMC Public Health 2023; 23:2290. [PMID: 37985982 PMCID: PMC10662638 DOI: 10.1186/s12889-023-17198-y] [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: 07/14/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Basic public health services for diabetes play an essential role in controlling glycemia in patients with diabetes. This study was conducted to understand the urban-rural disparities in the utilization of basic public health services for people with diabetes and the factors influencing them. METHODS The data were obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS) with 2976 diabetes patients. Chi-square tests were used to examine the disparities in the utilization of diabetes physical examination and health education between urban and rural areas. Logistic regression was performed to explore the factors associated with the utilization of diabetes public health services. RESULTS Among all participants, 8.4% used diabetes physical examination in the past year, and 28.4% used diabetes health education services. A significant association with age (OR = 0.64, 95% CI:0.49-0.85; P < 0.05) was found between patients' use of health education services. Compared with diabetes patients living in an urban area, diabetes patients living in a rural area used less diabetes health education. (χ2= 92.39, P < 0.05). Patients' self-reported health status (OR = 2.04, CI:1.24-3.35; P < 0.05) and the use of glucose control (OR = 9.33, CI:6.61-13.16; P < 0.05) were significantly positively associated with the utilization of diabetes physical examination. Patients with higher education levels were more likely to use various kinds of health education services than their peers with lower education levels (OR = 1.64, CI:1.21-2.22; P < 0.05). CONCLUSION Overall, urban-rural disparities in the utilization of public health services existed. Vulnerable with diabetes, such as those in rural areas, are less available to use diabetes public health services. Providing convenient health service infrastructure facilitates the utilization of basic public health services for diabetes in older patients with diabetes, especially in rural areas.
Collapse
Affiliation(s)
- Xingli Ma
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research(Shandong University), Shandong University, Jinan, China
| | - Wenyu Fan
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research(Shandong University), Shandong University, Jinan, China
| | - Xindan Zhang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research(Shandong University), Shandong University, Jinan, China
| | - Shilong Zhang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research(Shandong University), Shandong University, Jinan, China
| | - Xia Feng
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research(Shandong University), Shandong University, Jinan, China
| | - Suhang Song
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA.
| | - Haipeng Wang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
- NHC Key Laboratory of Health Economics and Policy Research(Shandong University), Shandong University, Jinan, China.
| |
Collapse
|
12
|
Li M, Tang H, Zheng H, Tian Y, Cheng X, Cheng H, Zhang X, Hu D, Liu X. Supporting and retaining competent primary care workforce in low-resource settings: lessons learned from a prospective cohort study. Fam Med Community Health 2023; 11:e002421. [PMID: 37931977 PMCID: PMC10632899 DOI: 10.1136/fmch-2023-002421] [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] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVE Assess whether local health facilities can adequately support the performance of general practitioners (GPs) trained by China's national compulsory services programme (CSP). DESIGN Prospective cohort study. SETTING Health facilities in middle and western rural areas in China, 2015-2022. PARTICIPANTS Cohorts of CSP graduates from 2015 to 2019 in four major medical universities. MAIN OUTCOMES Job performance measured by a 12-item Job Performance Scale; productivity measured by outpatient volume per day; turnover measured by ever changing jobs within the past year. RESULTS 91.2%, 92.0% and 90.5% GPs working in township health centres reported inadequate medication, equipment and external assistance from higher level hospitals, while CSP graduates working in secondary or tertiary hospitals reported a lower rate of less than 60%. The top three tests reported as lacking were blood gases (67.7%), microbiology (61.6%) and cancer biomarkers (49.7%); the top three lacked procedures were CT scan (64.8%), MRI scan (58.1%) and ambulatory BP monitoring (55.8%); and the top three lacked drugs were drugs for cardiovascular diseases (23.3%), systematic hormonal preparations (17.7%) and traditional Chinese medicines (13.0%). Multivariable analysis showed that facility support was positively associated with job performance-adequate medication increased job performance by 2.2 points (95% CI 0.7 to 3.8), and adequate external assistance increased job performance by 3.3 points (95% CI 1.8 to 4.8). Facility support was also positively associated with productivity-adequate medication increased outpatients seen per day by 20% (95% CI 0.1 to 0.3), and adequate equipment increased outpatients seen per day by 12% (95% CI 0.0 to 0.2). Facility support did not have significant impact on turnover, but GPs who changed jobs in the past year were 1.9-2.3 times more likely to report adequate facility support. CONCLUSION GPs in township health centres experienced a high prevalence of shortage in facility support. The identification of a positive association between facility support and performance and productivity has implications for future research and resources deployment in primary healthcare.
Collapse
Affiliation(s)
- Mingyue Li
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Haoqing Tang
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Huixian Zheng
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yiran Tian
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xiaoran Cheng
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Haozhe Cheng
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xiaotian Zhang
- China Center for Health Development Studies, Peking University, Beijing, China
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Dan Hu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University, Beijing, China
| |
Collapse
|
13
|
Wang Y, Salamanca LF, Sanchez CS, Fang H. Evaluating smoking cessation interventions in China's primary care facility networks for hypertensive patients aged 45 years and older: A retrospective cohort study. Tob Induc Dis 2023; 21:119. [PMID: 37772271 PMCID: PMC10523951 DOI: 10.18332/tid/169975] [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: 06/26/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION In China's aging population, hypertension, aggravated by smoking, constitutes a substantial health concern. However, the effectiveness of the national public health interventions for smoking cessation under the Essential Public Health Services remains unverified. Our aim was to examine smoking prevalence, the proportion of individuals receiving smoking cessation advice, its impact on successful cessation among Chinese hypertensive patients aged ≥45 years, and to discern disparities in the coverage and efficacy of smoking cessation interventions between primary care facilities and hospitals. METHODS Employing a longitudinal cohort approach, we examined four waves (2011-2018) of the China Health and Retirement Longitudinal Study (CHARLS). We surveyed a nationally representative cohort of hypertensive individuals, accounting for smoking status, cessation advice, healthcare preferences, and 11 pertinent covariates. RESULTS Among the 4269 hypertensive patients, smokers were predominantly male, aged <65 years, with lower education and lower wealth. Smoking prevalence decreased from 25.2% in 2011 to 21.1% in 2018. The incidence of physician-provided smoking cessation advice reached a peak of 60.3% in 2015, decreasing to 54.8% in 2018. Visitors to primary care facilities reported the highest rate of advice reception. While patients receiving advice exhibited a higher smoking prevalence, instrumental variable regression and subgroup analyses found no significant correlation between advice receipt and successful cessation. CONCLUSIONS We observed a substantial smoking prevalence among older hypertensive Chinese individuals and limited effectiveness of existing cessation programs. This underscores the necessity for augmenting primary care and devising a comprehensive health policy for more successful smoking cessation interventions, particularly considering China's rapidly aging population.
Collapse
Affiliation(s)
- Yang Wang
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Ludwing F. Salamanca
- Department of Psychiatry, Columbia University, New York, United States
- New York State Psychiatric Institute, New York, United States
| | - Carmen S. Sanchez
- Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
| |
Collapse
|
14
|
Chen Y, Huang F, Zhou Q. Equality of public health service and family doctor contract service utilisation among migrants in China. Soc Sci Med 2023; 333:116148. [PMID: 37567016 DOI: 10.1016/j.socscimed.2023.116148] [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: 12/26/2022] [Revised: 06/15/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023]
Abstract
China initiated the equalisation of an essential public health service programme in 2009 with the goal of developing a more equitable and effective public health system for all people. This study employs data from the China Migrants Dynamic Survey to examine regional-level and household-level income-related inequalities in public health service utilisation and its determinants. Wagstaff concentration indices indicate that essential public health services and family doctor contract services are concentrated among less developed prefectures and poorer households. Decomposition analysis based on recentered influence function regression shows that education contributes to pro-poor inequality in health records and health education utilisation. China's policies of essential public health services and family doctor contract services reduce income-related inequalities in health service utilisation, which has important implications for developing countries striving to achieve universal health service coverage and equal health outcomes.
Collapse
Affiliation(s)
- Yu Chen
- School of Economics, Shanghai University of Finance and Economics, 777 Guoding Rd., Yangpu District, Shanghai, China.
| | - Feng Huang
- School of Economics, Shanghai University of Finance and Economics, 777 Guoding Rd., Yangpu District, Shanghai, China.
| | - Qin Zhou
- School of Public Administration and Policy, Renmin University of China, 59 Zhongguancun Street, Haidian District, Beijing, China.
| |
Collapse
|
15
|
Wu N, Xie X, Cai M, Han Y, Wu S. Trends in health service needs, utilization, and non-communicable chronic diseases burden of older adults in China: evidence from the 1993 to 2018 National Health Service Survey. Int J Equity Health 2023; 22:169. [PMID: 37649033 PMCID: PMC10466757 DOI: 10.1186/s12939-023-01983-7] [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: 12/01/2022] [Accepted: 08/09/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Aging is associated with an increased prevalence of non-communicable chronic diseases (NCDs), functional impairments, and diverse demands for health services. This study analyzed the trends in older adults' needs and utilization of health services from 1993 to 2018 in China, as well as chronic disease-related economic burdens. METHODS The research data were collected from the six cross-sectional National Health Service Survey (NHSS), implemented every 5 years from 1993 to 2018. A multi-stage stratified random cluster sampling method has been adopted in the NHSS. The data on the older population's socio-economic characteristics, health service needs, and utilization were collected from the 6 waves National Health Service Survey (NHSS) 1993-2018. In the 2013 and 2018 NHSSs, EQ-5D-3L and visual analogue scale were used to evaluate the health condition. And the prevalence of NCDs and related Out-of-pocket (OOP) expenditures were collected. Functional dependency and impairment were collected in 2018. The Katz Activities of Daily Living scale was used to evaluate six functions, including self-feeding, dressing, bathing, transferring, toilet hygiene, and controlling bowel movements. RESULTS The two-week morbidity rate and prevalence of NCDs showed a rapid upward trend in older adults. With the development of health system reform and universal health insurance coverage, older adults' two-week medical consultation rate increased from 25.6% in 1993 to 40.1% in 2018, and the hospitalization rate rose from 6.1% to 24.9%. The difference in health service needs and utilization between urban and rural areas decreased, and the hospitalization rate in rural areas (26.3%) exceeded that in urban areas (23.6%) for the first time in 2018. Functional independence become more severe as aged. The proportion of severe functional impairment was 6.9% and 2% in the group aged 80 or over and group 70-79 years, respectively. Regarding disability status, 32.5% had hearing problems and 31.4% had visual impairment. The highest prevalence rates of NCDs in older adults were found in hypertension (36.9%), followed by diabetes (10.6%), cerebrovascular disease (5.4%), ischemic heart disease (4.5%), and intervertebral disc disease (4.2%). The average annual OOP expenditures attributed to NCDs increased from ¥2481.8 RMB in 2013 to ¥8255.9 RMB in 2018 for older adults. About 90.7% of older adults prefer to live in the residential community, leading to the demands for preventive healthcare (30.4%), medical treatment (14.1%), and elderly education (8.6%). CONCLUSION The elevated risks of age-related impairments and chronic morbidities, and increased demands for preventive healthcare are critical public health issues. Policymakers should strengthen primary healthcare and move towards integrated delivery to improve access and quality of care for older adults. The integration of healthcare and social security constitutes an adaptive trend in meeting the multi-level demands of an aging society.
Collapse
Affiliation(s)
- Nina Wu
- Department of Health Management and Policy, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China
| | - Xueqin Xie
- Centre for Health Statistics Information, National Health Commission of the People's Republic of China, No. 1, Xizhimenwai South Road, Xicheng District, Beijing, 100044, China
| | - Min Cai
- Centre for Health Statistics Information, National Health Commission of the People's Republic of China, No. 1, Xizhimenwai South Road, Xicheng District, Beijing, 100044, China
| | - Youli Han
- Department of Health Management and Policy, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China.
| | - Shiyong Wu
- Centre for Health Statistics Information, National Health Commission of the People's Republic of China, No. 1, Xizhimenwai South Road, Xicheng District, Beijing, 100044, China.
| |
Collapse
|
16
|
Xu J. Rethinking Performance Measurement of Primary Care in China Comment on "Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China". Int J Health Policy Manag 2023; 12:7825. [PMID: 38618814 PMCID: PMC10590229 DOI: 10.34172/ijhpm.2023.7825] [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: 11/21/2022] [Accepted: 06/19/2023] [Indexed: 04/16/2024] Open
Abstract
Increased political commitment and financial input to primary care have led to a growing role of performance measurement. Rasooly et al studied the implementation of performance measurement for primary care for people with diabetes in China. This is an important topic that has received little attention from previous literature. In light of the findings from the article, this paper argues for rethinking the current use of performance measurement. It also suggests potential ways to improve primary care performance measurement, in order to avoid some of the pitfalls of top-down performance measurement and to create an enabling environment for primary care strengthening.
Collapse
Affiliation(s)
- Jin Xu
- China Center for Health Development Studies, Peking University, Beijing China
| |
Collapse
|
17
|
Hou X, Wang L, Zhu D, Guo L, Weng J, Zhang M, Zhou Z, Zou D, Ji Q, Guo X, Wu Q, Chen S, Yu R, Chen H, Huang Z, Zhang X, Wu J, Wu J, Jia W. Prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy in adults with diabetes in China. Nat Commun 2023; 14:4296. [PMID: 37463878 DOI: 10.1038/s41467-023-39864-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
The current epidemic status of diabetic retinopathy in China is unclear. A national prevalence survey of diabetic complications was conducted. 50,564 participants with gradable non-mydriatic fundus photographs were enrolled. The prevalence rates (95% confidence intervals) of diabetic retinopathy and vision-threatening diabetic retinopathy were 16.3% (15.3%-17.2%) and 3.2% (2.9%-3.5%), significantly higher in the northern than in the southern regions. The differences in prevalence between those who had not attained a given metabolic goal and those who had were more pronounced for Hemoglobin A1c than for blood pressure and low-density lipoprotein cholesterol. The participants with vision-threatening diabetic retinopathy had significantly higher proportions of visual impairment and blindness than those with non-vision-threatening diabetic retinopathy. The likelihoods of diabetic retinopathy and vision-threatening diabetic retinopathy were also associated with education levels, household income, and multiple dietary intakes. Here, we show multi-level factors associated with the presence and the severity of diabetic retinopathy.
Collapse
Affiliation(s)
- Xuhong Hou
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Limin Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dalong Zhu
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, Beijing, China
| | - Jianping Weng
- Department of Endocrinology, the First Affiliated Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China
| | - Mei Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhiguang Zhou
- Institute of Metabolism and Endocrinology, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, the Second Xiangya Hospital and the Diabetes Center, Central South University, Changsha, Hunan Province, China
| | - Dajin Zou
- Department of Endocrinology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qiuhe Ji
- Department of Endocrinology, Xijing Hospital, Xi'an, Shaanxi Province, China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Qiang Wu
- Department of Ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Siyu Chen
- Department of Endocrinology and Metabolism, Suzhou Dushu Lake Hospital (Dushu Lake Hospital Affiliated to Soochow University), Suzhou, Jiangsu Province, China
| | - Rong Yu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Hongli Chen
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Zhengjing Huang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiarui Wu
- Key Laboratory of Systems Health Science of Zhejiang Province, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, Zhejiang Province, China
- Center for Excellence in Molecular Science, Chinese Academy of Sciences, Shanghai, China
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China.
| |
Collapse
|
18
|
Wu M, Huang J, Fu H, Xie X, Wu S. Changes of equality of medical service utilization in China between 1993 and 2018: findings from six waves of nationwide household interview survey. Int J Equity Health 2023; 22:98. [PMID: 37217952 DOI: 10.1186/s12939-023-01909-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 05/06/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Changes in China's health care system in the last three decades was remarkable. The current study aims on examine the change of equality of health care utilization in mainland China based on a nationwide household interview survey. METHODS We used household interview data extracted from six waves of National Health Service Survey between 1993 and 2018. Changes of health care utilization were descripted. Equality of the utilization were examined with univariate meta-regression across urban and rural areas, socioeconomic development regions and income groups. RESULTS The proportion of outpatient visits within last two weeks experienced a decrease from 17.0% in 1993 to 13.0% in 2013 and bounced back to 24.0% in 2018. The age-standardized trend remained unchanged. Hospitalization in the last 12 month increased from 2.6% in 1998 to 13.8% in 2018. The perceived unmet need of hospital admission fell from 35.9% in 1998 to 21.5% in 2018. The gaps in health care utilization between urban and rural areas, across regions and by income groups have been narrowed, implying improved equality of using medical services in the last two and a half decades. CONCLUSION China has experienced significant increases in health care utilization over the past 25 years. Meanwhile, the unmet needs for health care decreased remarkably and the equality of health care utilization improved significantly. These results imply significant achievements in health service accessibility in China.
Collapse
Affiliation(s)
- Ming Wu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, P.R. China
| | - Ju Huang
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Hongqiao Fu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, P.R. China
| | - Xueqin Xie
- Center of Health Statistics Information, National Health Commission of the People's Republic of China, No. 38 Beilishi Road, Beijing, 100044, P.R. China
| | - Shiyong Wu
- Center of Health Statistics Information, National Health Commission of the People's Republic of China, No. 38 Beilishi Road, Beijing, 100044, P.R. China.
| |
Collapse
|
19
|
Xie P, Shi X, Zhu B, Zhao W, Li X, Zou X, Liu G, Han X. COVID-19 vaccine uptake, reasons, and associated factors among older adults in Shenzhen, China. Hum Vaccin Immunother 2023; 19:2196914. [PMID: 37096742 PMCID: PMC10142320 DOI: 10.1080/21645515.2023.2196914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
Evidence is limited on the actual uptake of the coronavirus disease 2019 (COVID-19) vaccine among older adults, especially those with chronic diseases, during the pandemic. To examine COVID-19 vaccine uptake, reasons, and associated factor among older adults, a cross-sectional survey was conducted between September 24 and October 20, 2021 among older adults aged 60 and above in Shenzhen, China. Logistic regression analysis was used to examine associations of COVID-19 vaccine uptake with sociodemographic characteristics, pneumonia vaccination history, and participation in health education activities among older adults and among those with chronic diseases. Of the 951 participants, 82.8% reported being vaccinated against COVID-19 during the study period, but this proportion was relatively lower among adults aged 80 and above (62.7%) and those with chronic diseases (77.9%). The top-rated reasons for not being vaccinated included doctors not recommending it due to underlying diseases (34.1%), not being ready for it (18.3%), and failure to make an appointment (9.1%). General older adults who were aged below 70, had a high school and above education, were permanent residents of Shenzhen, were with good health and had pneumonia vaccination history were more likely to take the COVID-19 vaccination. Yet, among older adults with chronic diseases, other than age and permanent residency status, health status was the only significant indicator of COVID-19 vaccine uptake. Our study added to evidence that health condition is the critical barrier to the actual uptake of the COVID-19 vaccine among Chinese older adults, especially those aged 80 and above and those with chronic diseases.
Collapse
Affiliation(s)
- Pei Xie
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - XiuYuan Shi
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Bin Zhu
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Wenjing Zhao
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Xiaoheng Li
- Shenzhen Center for Disease Prevention and Control, Shenzhen, China
| | - Xuan Zou
- Shenzhen Center for Disease Prevention and Control, Shenzhen, China
| | - Gang Liu
- Shenzhen Center for Disease Prevention and Control, Shenzhen, China
| | - Xinxin Han
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| |
Collapse
|
20
|
Zhou Q, Zhao R, Shen X, Zhang H, Zhai Y, Gu Y, Shen Q, Xu H. Experience of the homecare of children on automatic peritoneal dialysis during the COVID-19 outbreak: A qualitative descriptive study. Nurs Open 2023; 10:2203-2212. [PMID: 36397267 PMCID: PMC10006596 DOI: 10.1002/nop2.1469] [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: 11/18/2021] [Revised: 05/24/2022] [Accepted: 10/22/2022] [Indexed: 11/19/2022] Open
Abstract
AIMS To describe the home care experience, challenges and coping strategies of caregivers with children on automatic peritoneal dialysis (PD) in mainland China during the early stage of the COVID-19 outbreak. DESIGN A qualitative descriptive approach was adopted. Semi-structured telephone interviews were conducted among 14 families with children on automatic peritoneal dialysis from February 2nd to 10th, 2020. The care routine, stress and coping strategies of caregivers of children on peritoneal dialysis were collected. The data were analysed using thematic analysis. METHODS Four key themes were defined: (1) concerns about PD treatment intertwined with worries about COVID-19; (2) retaining a sense of normality in the middle of the challenges; (3) staying safe; and (4) staying positive and carrying on. RESULTS Families with children on automatic PD addressed the stress from COVID-19 and its containment measures by closely adhering to COVID-19 preventative measures, actively adjusting mentality and maintaining a sense of normality during the outbreak. This implies that healthcare staff need to be more aware of the complex medical needs of families with children on automatic PD, advocate for them and facilitate their navigation through the repurposed healthcare system.
Collapse
Affiliation(s)
- Qing Zhou
- Department of Nephrology, Children's Hospital, Fudan University, Shanghai, China
| | - Rui Zhao
- Department of Nephrology, Children's Hospital, Fudan University, Shanghai, China
| | - Xia Shen
- Department of Nephrology, Children's Hospital, Fudan University, Shanghai, China
| | - Hui Zhang
- Department of Nephrology, Children's Hospital, Fudan University, Shanghai, China
| | - Yihui Zhai
- Department of Nephrology, Children's Hospital, Fudan University, Shanghai, China
| | - Ying Gu
- Department of Nursing, Children's Hospital, Fudan University, Shanghai, China
| | - Qian Shen
- Department of Nephrology, Children's Hospital, Fudan University, Shanghai, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital, Fudan University, Shanghai, China
| |
Collapse
|
21
|
Han Y, Zhu X, Hu Y, Yu C, Guo Y, Hang D, Pang Y, Pei P, Ma H, Sun D, Yang L, Chen Y, Du H, Yu M, Chen J, Chen Z, Huo D, Jin G, Lv J, Hu Z, Shen H, Li L. Electronic Health Record-Based Absolute Risk Prediction Model for Esophageal Cancer in the Chinese Population: Model Development and External Validation. JMIR Public Health Surveill 2023; 9:e43725. [PMID: 36781293 PMCID: PMC10132027 DOI: 10.2196/43725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/09/2023] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND China has the largest burden of esophageal cancer (EC). Prediction models can be used to identify high-risk individuals for intensive lifestyle interventions and endoscopy screening. However, the current prediction models are limited by small sample size and a lack of external validation, and none of them can be embedded into the booming electronic health records (EHRs) in China. OBJECTIVE This study aims to develop and validate absolute risk prediction models for EC in the Chinese population. In particular, we assessed whether models that contain only EHR-available predictors performed well. METHODS A prospective cohort recruiting 510,145 participants free of cancer from both high EC-risk and low EC-risk areas in China was used to develop EC models. Another prospective cohort of 18,441 participants was used for validation. A flexible parametric model was used to develop a 10-year absolute risk model by considering the competing risks (full model). The full model was then abbreviated by keeping only EHR-available predictors. We internally and externally validated the models by using the area under the receiver operating characteristic curve (AUC) and calibration plots and compared them based on classification measures. RESULTS During a median of 11.1 years of follow-up, we observed 2550 EC incident cases. The models consisted of age, sex, regional EC-risk level (high-risk areas: 2 study regions; low-risk areas: 8 regions), education, family history of cancer (simple model), smoking, alcohol use, BMI (intermediate model), physical activity, hot tea consumption, and fresh fruit consumption (full model). The performance was only slightly compromised after the abbreviation. The simple and intermediate models showed good calibration and excellent discriminating ability with AUCs (95% CIs) of 0.822 (0.783-0.861) and 0.830 (0.792-0.867) in the external validation and 0.871 (0.858-0.884) and 0.879 (0.867-0.892) in the internal validation, respectively. CONCLUSIONS Three nested 10-year EC absolute risk prediction models for Chinese adults aged 30-79 years were developed and validated, which may be particularly useful for populations in low EC-risk areas. Even the simple model with only 5 predictors available from EHRs had excellent discrimination and good calibration, indicating its potential for broader use in tailored EC prevention. The simple and intermediate models have the potential to be widely used for both primary and secondary prevention of EC.
Collapse
Affiliation(s)
- Yuting Han
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Xia Zhu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
| | - Yizhen Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Dong Hang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
| | - Yuanjie Pang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing, China
| | - Hongxia Ma
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
| | - Dianjianyi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
| | - Ling Yang
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yiping Chen
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Huaidong Du
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Min Yu
- Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Dezheng Huo
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, United States
| | - Guangfu Jin
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
| | - Zhibin Hu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
| | - Hongbing Shen
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
| |
Collapse
|
22
|
Wang Y, Wu Y, Chu H, Xu Z, Sun X, Fang H. Association between Health-Related Quality of Life and Access to Chronic Disease Management by Primary Care Facilities in Mainland China: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4288. [PMID: 36901304 PMCID: PMC10001723 DOI: 10.3390/ijerph20054288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
The integration of chronic disease management (CDM) services into the essential public health services offered by primary care facilities has been a major strategy in China's healthcare reform since 2009. We aimed to measure the percentage of patients with chronic diseases in China who believed that they could easily obtain CDM services at a nearby primary care facility in mainland China and determine its association with the EQ visual analog scale (EQ-VAS) score and the utility index of the 5-level EQ-5D version (EQ-5D-5L). A cross-sectional survey was conducted nationwide between 20 June 2022 and 31 August 2022, involving 5525 patients with chronic diseases from 32 provincial-level administrative divisions, of which 48.1% (n = 2659) were female with a median age of 55.0 years. The median EQ-VAS score was 73.0 and the utility index of the EQ-5D-5L was 0.942. A majority of patients reported definite (24.3%) or mostly (45.9%) easy access to CDM services from nearby primary care facilities. Multivariable logistic regression analysis revealed that easy access to CDM services in primary care facilities was positively associated with higher HRQoL. Our findings indicate that, as of 2022, approximately 70% of patients with chronic diseases in mainland China had easy access to CDM services provided by primary care facilities, which was significantly and positively associated with their health status.
Collapse
Affiliation(s)
- Yang Wang
- School of Public Health, Peking University, Beijing 100191, China
- China Center for Health Development Studies, Peking University, Beijing 100191, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing 100191, China
| | - Hongling Chu
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
| | - Zhijie Xu
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xinying Sun
- School of Public Health, Peking University, Beijing 100191, China
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing 100191, China
| |
Collapse
|
23
|
Zou H, Xiao H, Xu H. Does China's Equalization of Basic Public Health Services policy improve delivery care for migrant women? BMC Public Health 2023; 23:74. [PMID: 36627595 PMCID: PMC9832805 DOI: 10.1186/s12889-022-14950-8] [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: 03/15/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND As of 2020, 1 in 4 people in China is a domestic migrant. However, their lack of access to health care in destination cities has been largely neglected by the Chinese government until recently. METHODS Drawing on data from the 2010-2016 China Migrants Dynamic Survey, this study evaluated the impact of a pilot program of the Equalization of Basic Public Health Services launched in 2014 and focused on place of childbirth, an important indicator of delivery care. A difference-in-differences design was employed for statistical inference. RESULTS The migrant pilot program increased the likelihood of a migrant childbirth at a migration destination by about 4 to 8 percentage points, depending on the model specification. Further analyses revealed that this positive effect was short-term and benefited relatively better-off migrant families. CONCLUSION The migrant pilot program improved delivery care for migrant women. The Chinese government needs to expand this pilot program to more cities and improve its benefits to better serve the massive migrant population.
Collapse
Affiliation(s)
- Hong Zou
- grid.443347.30000 0004 1761 2353School of Economics, Southwestern University of Finance and Economics, 555 Liutai Ave, Wenjiang District, Chengdu, China
| | - Han Xiao
- grid.443347.30000 0004 1761 2353School of Economics, Southwestern University of Finance and Economics, 555 Liutai Ave, Wenjiang District, Chengdu, China
| | - Hongwei Xu
- grid.262273.00000 0001 2188 3760Department of Sociology, Queens College, Powdermaker Hall 252, 65-30 Kissena Blvd, 11367 Queens, NY USA
| |
Collapse
|
24
|
Lu J, Yang H, Shi L, Sheng X, Huo Y, Liu R, Hu R. Associations between Primary Healthcare Experiences and Glycemic Control Status in Patients with Diabetes: Results from the Greater Bay Area Study, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1120. [PMID: 36673874 PMCID: PMC9859184 DOI: 10.3390/ijerph20021120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/29/2022] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Primary healthcare (PHC) plays an important role in diabetes management; community health centers (CHCs) serve as the main providers of PHC. However, few studies have discussed the association between the service quality of PHC and the effects of diabetes management. In this study, we explored the associations between experiences of PHC in CHCs and glycemic control status in patients with diabetes mellitus. This study was conducted in six CHCs in the Greater Bay Area of China. In total, 418 patients with diabetes mellitus (44% males and 56% females) were recruited between August and October 2019. We evaluated their PHC experiences using the Primary Care Assessment Tool (PCAT) developed by Johns Hopkins and assessed their glycemic control status by measuring their fasting plasma glucose levels. Binary logistic regression analyses were conducted to assess the associations between the patients’ PHC experiences and glycemic control status, adjusting for covariates. The patients with good glycemic control had significantly higher total and dimensional PCAT scores compared with those with poor glycemic control (p < 0.05). Higher PCAT scores were significantly associated with a greater adjusted odds ratios (aORs) of good glycemic control for total and dimensional PCAT scores. For example, compared to those with poor glycemic control, the aORs for those with good glycemic control was 8.82 (95% CI = 4.38−17.76) per total PCAT score increasing. Especially, the aORs for those with good glycemic control were 3.92 (95% CI = 2.38−6.44) and 4.73 (95% CI = 2.73−8.20) per dimensional PCAT score of family-centeredness and community orientation increasing, respectively. Better PHC experiences were associated with better diabetes management. In particular, family-centered and community-oriented CHCs may help improve diabetes management in China and other low- and middle-income countries.
Collapse
Affiliation(s)
- Junfeng Lu
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Hui Yang
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
| | - Leiyu Shi
- John Hopkins School of Public Health, Baltimore, MD 21205, USA
| | - Xia Sheng
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yongjun Huo
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ruqing Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ruwei Hu
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| |
Collapse
|
25
|
Feng W, Yuan H. The impact of medical infrastructure on regional innovation: An empirical analysis of China's prefecture-level cities. TECHNOLOGICAL FORECASTING AND SOCIAL CHANGE 2023; 186:122125. [PMID: 36348982 PMCID: PMC9635316 DOI: 10.1016/j.techfore.2022.122125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/01/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Because of public health emergencies, such as the COVID-19 pandemic, having an optimal medical infrastructure is an important way to maintain the normal operation of society and stimulate vitality in regional innovation. Based on the data on 260 cities at the prefecture level and above in China from 2001 to 2018, this paper investigates the characteristics and mechanisms of medical infrastructure on regional innovation. After a series of regressions, we robustly find that medical infrastructure has a significantly positive impact on regional innovation. In addition, based on the mediating effect model, the mechanism test shows that medical infrastructure can promote regional innovation through the channels of the natural population growth rate, educational level, and the environmental greening level. Finally, considering the urban heterogeneity, we find that the positive impact of medical infrastructure on regional innovation is reflected mainly in eastern and central cities, non-sub-provincial cities, and non-resource-based cities. These conclusions not only enrich the theoretical research on regional innovation from the perspective of medical infrastructure but also shed light on how to better promote regional innovation for China or even other countries.
Collapse
Affiliation(s)
- Wei Feng
- School of Economics and Management, Southeast University, PR China
| | - Hang Yuan
- School of Economics and Management, Southeast University, PR China
| |
Collapse
|
26
|
Wu Y, Ye R, Sun C, Meng S, Cai Z, Li L, Sylvia S, Zhou H, Pappas L, Rozelle S. Using standardized patients to assess the quality of type 2 diabetes care among primary care providers and the health system: Evidence from rural areas of western China. Front Public Health 2022; 10:1081239. [PMID: 36620284 PMCID: PMC9815030 DOI: 10.3389/fpubh.2022.1081239] [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: 10/27/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background Improving type 2 diabetes (T2D) care is key to managing and reducing disease burden due to the growing prevalence of diabetes worldwide, but research on this topic, specifically from rural areas, is limited. This study uses standardized patients (SPs) to assess T2D care quality among primary care providers to access the healthcare system in rural China. Methods Using multi-stage random sampling, health facilities, providers, and households were selected. SPs were used to evaluate providers' T2D care quality and a questionnaire survey was used to collect patient sorting behaviors from households. Logistic regression was used to explore factors correlated with T2D care quality. Provider referral and treatment rates were combined with patient sorting behaviors to assess the overall quality of T2D management by rural China's healthcare system. Results A total of 126 providers, 106 facilities, and 750 households were enrolled into this study. During SP interactions, 20% of rural providers followed the national guidelines for T2D consultation, 32.5% gave correct treatment, and 54.7% provided lifestyle suggestions. Multi-variable regression results showed that providers who had earned practicing certificates (β = 1.56, 95% CI: 0.44, 2.69) and saw more patients (β = 0.77, 95%: 0.25, 1.28) were more likely to use a higher number of recommended questions and perform better examinations, whereas providers who participated in online training were less likely to practice these behaviors (β = -1.03, 95%: -1.95, -0.11). The number of recommended questions and examination (NRQE) was the only significant correlated factor with correct treatment (marginal effect = 0.05, 95%: 0.01, 0.08). Throughout the rural healthcare system, 23.7% of T2D patients were treated correctly. Conclusion The quality of T2D care in rural western China, especially throughout the consultation and treatment process during a patient's first visit, is poor. Online training may not improve T2D care quality and low patient volume was likely to indicate poor care quality. Further research is needed to explore interventions for improving T2D care quality in rural China's healthcare system.
Collapse
Affiliation(s)
- Yuju Wu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruixue Ye
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chang Sun
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sha Meng
- Department of Operation Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhengjie Cai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Linhua Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Huan Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China,*Correspondence: Huan Zhou ✉
| | - Lucy Pappas
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| |
Collapse
|
27
|
Jia P, Wang Y, Yang M, Wang L, Yang X, Shi X, Yang L, Wen J, Liu Y, Yang M, Xin J, Zhang F, Jiang L, Chi C, Zhang L, Ma X, Ma X, Zhao L, Li W. Inequalities of spatial primary healthcare accessibility in China. Soc Sci Med 2022; 314:115458. [PMID: 36279792 DOI: 10.1016/j.socscimed.2022.115458] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 07/15/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
Abstract
A key step to the establishment of a tiered healthcare system is equitable access to basic primary healthcare services for all. However, no quantitative research on the national status quo of primary healthcare accessibility in China exists. We filled this gap by estimating spatial accessibility to primary healthcare centers (PHCs) and mapping its inequality across the mainland China. Four national datasets during 2015-2018, including administrative boundaries, residential communities, points-of-interest (including PHCs), and road networks, were collected to calculate the distance to the nearest PHC for each community. Five other national datasets including census, elevation, land use, vegetation, and nightlight, were collected to model 100m × 100 m population grids, based on which geographical modeling was used to calculate PHC accessibility of each community. Inequalities in PHC accessibility across China were described with concentration indices. About 44% of communities across China representing approximately 30% of the overall population had no access to PHCs within their 6-km catchment areas; about 78% of communities across China representing approximately 68.4% of the overall population had no access to PHCs within their 1.5-km catchment areas. Some municipalities/provinces like Shanghai, Beijing, Tianjin, Jiangsu, Shandong, and Zhejiang generally had higher proximity to the nearest PHCs, while others like Tibet, Guizhou, and Guangxi had lower proximity to the nearest PHCs. However, assuming similar basic service capacity across all PHCs, Shanghai, Tianjin, and Chongqing showed the lowest PHC accessibility due to high population density. Variations in PHC accessibility existed, with more inequalities observed in the north and northeastern provinces and less inequalities in southwestern and south-central provinces. This study demonstrates primary healthcare accessibility and inequality at province and city levels, and identifies communities with lower proximity and accessibility to PHCs in China. It would serve as a starting point to facilitate precise healthcare planning and preparedness for health emergencies in China.
Collapse
Affiliation(s)
- Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, Hubei, China; School of Public Health, Wuhan University, Wuhan, Hubei, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, Hubei, China.
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Min Yang
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Limin Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xuchao Yang
- Ocean College, Zhejiang University, Zhoushan, Zhejiang, China
| | - Xinyu Shi
- University College Twente, University of Twente, Enschede, the Netherlands
| | - Lijian Yang
- Center for Statistical Science, Tsinghua University, Beijing, China
| | - Jin Wen
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Liu
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Maokang Yang
- Division of Rural Health, Sichuan Hospital Association, Chengdu, Sichuan, China
| | - Junguo Xin
- School of Public Health, Chengdu Medical College, Chengdu, Sichuan, China
| | - Fengying Zhang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lihua Jiang
- Department of Health-Related Social and Behavioral Sciences, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunhua Chi
- Department of General Practice, Peking University Health Sciences Center, Beijing, China; Health Management Center, Peking University First Hospital, Beijing, China
| | - Luxia Zhang
- National Institute of Health Data Science, Peking University, Beijing, China; Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Xudong Ma
- Bureau of Medical Administration, National Health Commission of the People's Republic of China, Beijing, China
| | - Xiao Ma
- Department of Health-Related Social and Behavioral Sciences, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Weimin Li
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
28
|
Jia H. The impact of basic public health services on migrants' settlement intentions. PLoS One 2022; 17:e0276188. [PMID: 36251698 PMCID: PMC9576043 DOI: 10.1371/journal.pone.0276188] [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: 06/14/2022] [Accepted: 10/01/2022] [Indexed: 11/07/2022] Open
Abstract
An important task in the urbanization process of developing countries is to promote and support migrants’ settlement in cities. Based on the China Migrants Dynamic Survey of 2018, this paper analyzes how basic public health services (BPHSs) impact migrants’ settlement intentions. This study shows that establishing health records and access to health-related knowledge significantly and positively impact migrants’ intentions to settle permanently in inflow areas by increasing their health status and degree of social integration. Yet, this paper discusses how the trends are heterogeneous, finding that BPHSs more significantly impact the settlement intentions of female, less-educated and rural migrants. The findings of this paper provide new factual evidence that may support government policymaking to further improve migrants’ utilization of medical and health resources and their intention to settle down.
Collapse
Affiliation(s)
- Haowen Jia
- Research Institute of Economics and Management, Southwestern University of Finance and Economics, Chengdu, Sichuan, China
- * E-mail:
| |
Collapse
|
29
|
Guo L, Guo Y, Booth J, Wei M, Wang L, Zhu Y, He Y, Liu Y. Experiences of health management among people at high risk of stroke in China: A qualitative study. Nurs Open 2022; 10:613-622. [PMID: 36054680 PMCID: PMC9834500 DOI: 10.1002/nop2.1327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 12/28/2021] [Accepted: 07/29/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Effective health management of people at high risk of stroke in China is challenging. AIM To explore and identify the experiences of health management among people at high risk of stroke in order to provide a foundation for a targeted health management strategy for this special group. DESIGN A qualitative, descriptive study based on interviews. METHODS Semistructured interviews were conducted with 31 people at high risk of stroke. The interviews were collated and analysed using Colaizzi's seven-step method. RESULTS A total of 31 people at high risk of stroke were included, and the ages ranged from 40 to 86, with an average age of 60.71 (SD = 11.55). The experiences of health management were categorized into three themes. Theme 1: Facing many ongoing problems in health management, limited knowledge, lack of confidence and poor compliance. Theme 2: Accumulated some value experiences of coping with problems of health management, becoming active learners, promoting social interaction and enhancing self-health management. Theme 3: Sensitivity to multiple influencing factors, the severity of disease and complexity of disease management, family income and economic burden and the value of social support. CONCLUSIONS This study explored the experiences of health management among people at high risk of stroke, and these findings are of great significance in the primary prevention of stroke.
Collapse
Affiliation(s)
- Lina Guo
- Department of Neurology, National Advanced Stroke CenterThe first Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Yuanli Guo
- Department of Neurology, National Advanced Stroke CenterThe first Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Jo Booth
- Centre for Living, School of Health & Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Miao Wei
- Department of Neurology, National Advanced Stroke CenterThe first Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Lin Wang
- College of Medicine & AgricultureHenan Radio & Television UniversityZhengzhouChina
| | - Yiru Zhu
- Department of Neurology, National Advanced Stroke CenterThe first Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Yu He
- Department of Neurology, National Advanced Stroke CenterThe first Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Yanjin Liu
- Department of NursingThe first Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| |
Collapse
|
30
|
Zhao D, Zhou Z, Shen C, Zhai X, Zhao Y, Cao D, Deng Q, Liu G, Lim JFY. The Effect of Health Check-Ups on Health Among the Elderly in China: Evidence From 2011–2018 Longitudinal Data. Int J Public Health 2022; 67:1604597. [PMID: 35990189 PMCID: PMC9389946 DOI: 10.3389/ijph.2022.1604597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 07/13/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives: To assess the effect of health check-ups on health among the elderly Chinese. Methods: The first dataset was panel data extracted from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Health Longevity Survey (CLHLS). The second dataset was cross-sectional data come from CLHLS 2018 linked with the lagged term of health check-ups in CLHLS 2011. Health check-ups were measured by a binary variable annual health check-up (AHC). Health was assessed by a binary variable self-rated health (SRH). A coarsened exact matching method and individual fixed-effects models, as well as logistic regressions were employed. Results: AHC attendance among the elderly increased from 2011 to 2018, with higher utilization of AHC also detected in the rural group. AHC had positive effects on SRH among rural respondents (short-term effect: OR = 1.567, p < 0.05; long-term effect: OR = 3.385, p < 0.001). Conclusion: This study highlights a higher utilization of AHC in rural area, and the effectiveness of AHC in SRH improvement among rural participants. It indicates enhanced access to public healthcare services in rural area and underlying implications of health check-ups for reducing urban–rural health inequalities.
Collapse
Affiliation(s)
- Dantong Zhao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Zhongliang Zhou,
| | - Chi Shen
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Xiaohui Zhai
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Yaxin Zhao
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Dan Cao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Qiwei Deng
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Guanping Liu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Jeremy Fung Yen Lim
- Saw Swee Hock School of Public Health, Leadership Institute for Global Health Transformation, National University of Singapore, Singapore, Singapore
| |
Collapse
|
31
|
Ye P, Jin Y, Er Y, Yin X, Yao Y, Li B, Zhang J, Ivers R, Keay L, Duan L, Tian M. Perceptions of Facilitators and Barriers to Implementation of Falls Prevention Programs in Primary Health Care Settings in China. JAMA Netw Open 2022; 5:e2228960. [PMID: 36018587 PMCID: PMC9419020 DOI: 10.1001/jamanetworkopen.2022.28960] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
IMPORTANCE Falls have become a major public health issue in China with population aging. Although falls prevention for older community-dwelling people has been included in the National Essential Public Health Service Package since 2009, there is limited understanding of the implementation of this program. OBJECTIVE To identify the associated factors and provide recommendations to inform the better implementation of falls prevention in the Chinese primary health care system. DESIGN, SETTING, AND PARTICIPANTS This qualitative study was conducted in 3 purposively selected cities in China from March 1 to June 7, 2021. Health administrators from the local health commission or bureau, staff members from local Centers for Disease Control and Prevention and primary health care facilities and community-dwelling older people were recruited, using a combination of purposive sampling and snowball sampling. MAIN OUTCOMES AND MEASURES In-depth interviews were conducted with health administrators and focus groups with other participants. Data analysis followed the guidance of the Consolidated Framework for Implementation Research. Study outcomes included facilitators and barriers of implementing falls prevention for older people in the Chinese primary health care settings. A framework with recommendations was developed to inform the future intervention implementation. RESULTS Among a total of 130 participants interviewed, 77 (59.2%) were female and the mean (SD) age was 47.4 (16.7) years. Clear recognition of the challenges and benefits of falls prevention, adaptive regionally tailored guidance plans, and continuous governmental policy and financial support were the major facilitators, whereas the major barriers consisted of insufficient confidence in delivering interventions and poor understanding of the falls burden, low recognition of the importance of falls prevention, limited multisectoral collaboration, and weak financial incentives. A 7-strategy embedded framework-including data-driven surveillance, audit and feedback, implementation strategy, workforce strengthening, community empowerment, internal services integration, and external enabling environment-was developed to foster successful implementation. CONCLUSIONS AND RELEVANCE This qualitative study identified major facilitators and barriers to the implementation of falls prevention for older people at the primary care level, which have the potential to contribute to better implementation of falls prevention for older people in the Chinese primary health care system.
Collapse
Affiliation(s)
- Pengpeng Ye
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Ye Jin
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Yuliang Er
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Xuejun Yin
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Yao Yao
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Bingqin Li
- Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Jing Zhang
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Lisa Keay
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Leilei Duan
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| |
Collapse
|
32
|
Tan X, Wong C. Anatomy of intergovernmental finance for essential public health services in China. BMC Public Health 2022; 22:914. [PMID: 35534861 PMCID: PMC9080974 DOI: 10.1186/s12889-022-13300-y] [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: 07/16/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Chinese government launched health care reforms in 2009 and introduced a national list of essential public health services (EPHS) as an integral part of the plan to deliver health care for all. EPHS was also built into the national plan to promote the equalisation of public services across the country. A national standard was set for financial input to EPHS. As the services are co-funded by the central and local governments, a robust intergovernmental fiscal system is essential to guarantee that the hundreds of thousands of service providers have adequate financing to meet the service commitment. METHODS We examined the flow of funds through China's complex intergovernmental fiscal system to see whether the promise of equal funding for EPHS was implemented, and how the costs were distributed across levels of government. Information was collated from funding documents issued by all levels of governments involved, for a sample that includes the central government, 12 provincial governments, eight prefectural governments and 11 county-level governments. For each level of government, we examined: (i) when and how much funding they disbursed or received from higher levels; (ii) when and how much matching funds were made; and (iii) the allocation rules adopted. RESULTS Overall, we found the central government met its commitments for the program on time and in full, and good compliance from local governments in passing through funding from higher levels and as well as meeting their own financial responsibilities. However, we also found the following problems: (i) the involvement of so many levels of government resulted in delays in the disbursement of funds; (ii) the use of outdated population data in calculating required funding resulted in some under-allocation; and (iii) localities that needed funding the most were not well targeted by the distribution of funds. CONCLUSION This study traces how the 2018 subsidy for EPHS was disbursed from the central government to service providers, focusing on the roles played by intermediate levels of subnational governments-provinces, prefectures and counties. In this way, it identifies gaps in the current intergovernmental financing of EPHS and points to areas for further improvement.
Collapse
Affiliation(s)
- Xiao Tan
- Centre for Contemporary Chinese Studies, The University of Melbourne, 761 Swanston Street, Parkville, VIC3010, Australia.
| | - Christine Wong
- East Asian Institute, National University of Singapore, 469A Bukit Timah Road, Tower Block #06-01, Singapore, 259770, Singapore
| |
Collapse
|
33
|
Hu X, Wang P. Has China's Healthcare Reform Reduced the Number of Patients in Large General Hospitals? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5428. [PMID: 35564824 PMCID: PMC9104654 DOI: 10.3390/ijerph19095428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/14/2022] [Accepted: 04/28/2022] [Indexed: 02/01/2023]
Abstract
Many studies have shown that the new round of healthcare reform launched by the Chinese government in 2009 has not effectively solved the problem in which patients more readily choose large general hospitals. We aimed to find out if this situation exists in every department of a large general hospital. This study collected the outpatient data of 24 departments for a large general hospital in Beijing. By calculating the average growth rate of outpatients in each department from 2014 to 2019, and the utilization rate of outpatient appointments in different departments in 2020, we found that the average growth rate of outpatients in 4 departments (16.6%) was negative, and the utilization rate of outpatient appointments in 13 departments (54.16%) was less than 80%. This shows that the number of patients in some departments is declining, and that there is an inefficient use of doctor resources. Obviously, this is inconsistent with people's current beliefs. Therefore, it is not entirely true that China's healthcare reform has not reduced the number of patients in large general hospitals. At the same time, the inefficient use of outpatient doctor resources is a phenomenon worthy of attention; if it persists, it will result in significant waste in the healthcare system. We suggest that policy makers and hospital managers in China, and countries similar to China, can attract attention and take measures.
Collapse
Affiliation(s)
| | - Ping Wang
- Medical Affairs Department, Peking University First Hospital, Beijing 100034, China;
| |
Collapse
|
34
|
Factors Associated with Free Medicine Use in Patients with Hypertension and Diabetes: A 4-Year Longitudinal Study on Full Coverage Policy for Essential Medicines in Taizhou, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211966. [PMID: 34831722 PMCID: PMC8620273 DOI: 10.3390/ijerph182211966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 12/03/2022]
Abstract
Full coverage policies for medicines have been implemented worldwide to alleviate medicine cost burden and promote access to medicines. However, few studies have explored the factors associated with free medicine use in patients with chronic diseases. This study aimed to analyze the utilization of free medicines by patients with hypertension and diabetes after the implementation of the full coverage policy for essential medicines (FCPEM) in Taizhou, China, and to explore the factors associated with free medicine use. We conducted a descriptive analysis of characteristics of patients with and without free medicine use and performed a panel logit model to examine factors associated with free medicine use, based on an electronic health record database in Taizhou from the baseline year (12 months in priori) to three years after FCPEM implementation. After FCPEM implementation, the proportion of patients without any free medicine use decreased from 31.1% in the baseline year to 28.9% in the third year, while that of patients taking free medicines rose from 11.0% to 22.8%. Patients with lower income or education level, those with agricultural hukou, patients aged 65 and above, married patients, and patients in the Huangyan district were more likely to take free medicines. In conclusion, FCPEM contributed to improved medicine access, especially in vulnerable populations. Local policy makers should consider expanding the coverage of FCPEM to other types of medicines and cultivate the potential of social supports for patients to enhance the effectiveness of FCPEM policies.
Collapse
|
35
|
Yuan B, Yu Y, Zhang H, Li H, Kong C, Zhang W. Satisfaction of Township Hospitals Health Workers on How They Are Paid in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211978. [PMID: 34831735 PMCID: PMC8618711 DOI: 10.3390/ijerph182211978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Township Hospitals (THs) are crucial providers in China's primary health delivery system. Low job satisfaction of THs health workers has been one of biggest challenges to strengthening the health system in China. Even huge amounts of studies confirmed low remuneration level as a key demotivating factor though few studies have explored the feelings of health workers on how they were paid. OBJECTIVE To analyze how the key design of Performance-based Salary System (PBS) influences the satisfaction of health workers on the payment system in China's THs. METHOD A cross-sectional study was conducted in 47 THs in Shandong China, and a total of 1136 participants were recruited. Expectancy theory was applied to design the measurements on designs of PBS. The associations between PBS design and satisfaction of health workers were analyzed by logistic regression. RESULTS Three key components of PBS design were all related to the satisfaction of health workers. Those health workers who were aware of assessment methods were more likely to be satisfied with how they were paid (OR = 2.44, p < 0.001) compared with those being not aware of the methods. The knowledge on personal performance was also associated with being satisfied (OR = 3.34, p < 0.001). The percentage of floating income in total income was negatively associated with the satisfaction, and one percentage point increase in floating income proportion could result in the possibility of being satisfied decreasing by 2.82% (95%CI -4.9 to -0.7, p = 0.01). Subgroup analysis found that only in those with lower value on monetary income, the negative influence of more floating income was significant. CONCLUSIONS When policymakers or managers apply performance-related payment to incentivize certain work behavior, they should pay attention to the design details, including keeping transparency in the performance assessment criteria, clear performance feedback, and setting the proportion of the performance-related part based on the preference of health workers in certain cultural settings.
Collapse
Affiliation(s)
- Beibei Yuan
- China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
- Correspondence: ; Tel.: +86-186-1829-5166
| | - Yahang Yu
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (Y.Y.); (C.K.); (W.Z.)
| | - Hongni Zhang
- School of College Industry & Commerce, Shandong Management University, 3500 Dingxiang Road, Changqing District, Jinan 250357, China;
| | - Huiwen Li
- China Population and Development Research Center, Beijing 100191, China;
| | - Chen Kong
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (Y.Y.); (C.K.); (W.Z.)
| | - Wei Zhang
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (Y.Y.); (C.K.); (W.Z.)
| |
Collapse
|
36
|
Effectiveness of quality of care for patients with type 2 diabetes in China: findings from the Shanghai Integration Model (SIM). Front Med 2021; 16:126-138. [PMID: 34705246 DOI: 10.1007/s11684-021-0897-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/23/2021] [Indexed: 12/23/2022]
Abstract
This cross-sectional study aimed to investigate the quality of care of diabetes in Shanghai, China. A total of 173 235 patients with type 2 diabetes in 2017 were included in the analysis. Profiles of risk factors and intermediate outcomes were determined. The patients had a mean age of 66.43 ± 8.12 (standard deviation (SD)) years and a mean diabetes duration of 7.95 ± 5.53 (SD) years. The percentage of patients who achieved the target level for HbA1c (< 7.0%) was 48.6%. Patients who achieved the target levels for blood pressure (BP) < 130/80 mmHg and low-density lipoprotein-cholesterol (LDL-c) < 2.6 mmol/L reached 17.5% and 34.0%, respectively. A total of 3.8% achieved all three target levels, and the value increased to 6.8% with an adaptation of the BP target level (< 140/90 mmHg) for those over 65 years. Multivariable analysis identified the factors associated with a great likelihood of achieving all three target levels: male, young age, short diabetes duration, low body mass index, macrovascular complications, no microvascular complications, prescribed with lipid-lowering medication, and no prescription of antihypertensive medication. In conclusion, nearly 50% and one-third of the patients with diabetes met the target levels for HbA1c and LDL-c, respectively, with a low percentage achieving the BP target level. The percentage of patients who achieved all three target levels needs significant improvement.
Collapse
|
37
|
Yao D, Yu L, He W, Hu Y, Xu H, Yuan Y, Dai H. Antineoplastic prescription among patients with colorectal cancer in eight major cities of China, 2015-2019: an observational retrospective database analysis. BMJ Open 2021; 11:e046166. [PMID: 34706945 PMCID: PMC8552170 DOI: 10.1136/bmjopen-2020-046166] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES It is unclear what is driving rising colorectal cancer (CRC) treatment costs in China, whether an adjustment in drug prices changes use and total cost. This study aims to estimate trends in drug use, prescribing patterns and spending for antineoplastic drug therapies for CRC in major cities of China. METHODS Information from 128 811 antineoplastic drug prescriptions in CRC was retrospectively collected from the Hospital Prescription Analysis Cooperative Project. The prescriptions extracted included demographic information of patients, the generic name and the price of antineoplastic drugs. The Mann-Kendall and Cochran-Armitage trend test was used to estimate the trends of antineoplastic agent usage. RESULTS The number of antineoplastic prescriptions ranged from 18 966 in 2015 to 34 219 in 2019. Among the prescriptions collected in this study, the annual cost of antineoplastic drugs increased by 117.2%, and average prescription cost increased by 20%. Throughout the study period, the most prescribed antineoplastic drugs were capecitabine, oxaliplatin, fluorouracil and irinotecan, representing 49%, 27%, 21% and 9% of (per cent of visits (PV)). The PV of bevacizumab and cetuximab increased by 494% and 338% (from 1.8% and 1.3% in 2015 to 10.7% and 5.7% in 2019). In prescribing patterns of antineoplastic agents, monotherapy gradually decreased, while combination therapy, especially three-drug combination, increased significantly from 1.35% to 7.31%. CONCLUSION This study estimated recent trends of antineoplastic drug use and expenditure for Chinese patients with CRC. These results would inform CRC treatment decisions, including health insurance negotiation, precision therapy access, allocation of research funding and evaluation of the financial burden of CRC drug treatment.
Collapse
Affiliation(s)
- Difei Yao
- Pharmacy, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lingyan Yu
- Pharmacy, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wei He
- Pharmacy, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yangmin Hu
- Pharmacy, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Huimin Xu
- Pharmacy, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ying Yuan
- Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, Ministry of Education), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Haibin Dai
- Pharmacy, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| |
Collapse
|
38
|
Yu X, Zhang W, Liang J. Physician distribution across China's cities: regional variations. Int J Equity Health 2021; 20:162. [PMID: 34256753 PMCID: PMC8276398 DOI: 10.1186/s12939-021-01503-5] [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: 12/10/2020] [Accepted: 06/29/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Distribution of physicians is a key component of access to health care. Although there is extensive research on urban-rural disparities in physician distribution, limited attention has been directed to the heterogeneity across urban areas. This research depicts variations in physician density across over 600 cities in the context of China's rapid urbanization. METHODS Data came from National Census Surveys and China statistical yearbooks, 2000-2003, and 2010-2013. Cities were characterized in terms of not only administrative level but also geographic regions and urban agglomerations. We analyzed variations in physician supply by applying generalized estimating equations with an ordinal logistic linking function. RESULTS Although overall physician density increased between 2003 and 2013, with population and socioeconomic attributes adjusted, physician density declined in urban China. On average, urban districts had a higher physician density than county-level cities, but there were regional variations. Cities in urban agglomerations and those outsides did not differ in physician density. CONCLUSION Despite the reduced inequality between 2003 and 2013, the growth in physician density did not appear to be commensurate with the changes in population health demand. Assessment in physician distribution needs to take into account heterogeneity in population and socioeconomic characteristics.
Collapse
Affiliation(s)
- Xuexin Yu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610040, Sichuan, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610040, Sichuan, China.
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
| |
Collapse
|
39
|
Özgül E, Dinçer H, Yüksel S. HoQ-based evaluation of UHC competencies using an extension of interval-valued spherical fuzzy and hesitant 2-tuple linguistic term sets. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2021. [DOI: 10.3233/jifs-202818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Healthy life is recognized as one of the most fundamental human rights. However, even today, millions of people around the world are forced to choose between their basic needs and fundamental rights. Half of the world’s population does not have access to the healthcare they need. Universal Health Coverage (UHC) aims to ensure that all individuals receive the quality health services they need without incurring a financial burden, and to protect them from risk factors that threaten their health. The aim of this study is to identify the significant factors to improve UHC in the countries. For this purpose, house of quality (HoQ) approach is used in the analysis process so that both customer expectations and technical requirements are considered. Within this framework, a novel hybrid model has been proposed which has three different stages. Firstly, 3 groups of diseases and 4 clinical services for each group are determined regarding the customer needs. Secondly, these factors are weighted by using interval-valued intuitionistic hesitant 2-tuple fuzzy decision making and trial evaluation laboratory (DEMATEL). In the final stage, 9 different technical requirements are ranked by using interval-valued intuitionistic hesitant 2-tuple fuzzy technique for order preference by similarity to ideal solution (TOPSIS). Additionally, another evaluation has also been conducted by considering Spherical fuzzy sets. Similarly, a comparative analysis has also been performed with VIKOR while ranking the alternatives. It is concluded that analysis results of both evaluations are quite similar. This situation gives an information about the coherency and consistency of the analysis results. The findings indicate that treatment services in noncommunicable diseases play the most significant role in this respect. Moreover, according to the ranking results, it is concluded that strategic policies should be related to improving the social security and special physician capacity as well as decreasing the out-of-pocket payment.
Collapse
Affiliation(s)
- Ercan Özgül
- School of Business, Istanbul Medipol University, South Campus, Istanbul, Turkey
| | - Hasan Dinçer
- School of Business, Istanbul Medipol University, South Campus, Istanbul, Turkey
| | - Serhat Yüksel
- School of Business, Istanbul Medipol University, South Campus, Istanbul, Turkey
| |
Collapse
|
40
|
Fang G, Yang D, Wang L, Wang Z, Liang Y, Yang J. Towards Universal Healthcare Coverage: Experience form the Implementation of the National Basic Public Health Service Program in China (Preprint). JMIR Public Health Surveill 2021; 8:e31289. [PMID: 35867386 PMCID: PMC9356336 DOI: 10.2196/31289] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 02/05/2022] [Accepted: 04/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Public health service is an important component and pathway to achieve universal health coverage (UHC), a major direction goal of many countries. China’s National Basic Public Health Service Program (the Program) is highly consistent with this direction. Objective The aim of this study was to analyze the key experience and challenges of the Program so as to present China’s approach to UHC, help other countries understand and learn from China’s experience, and promote UHC across the world. Methods A literature review was performed across five main electronic databases and other sources. Some data were obtained from the Department of Primary Health, National Health Commission, China. Data obtained included the financing share of the national/provincial/prefectural government among the total investment of the program in 32 provinces in 2016, their respective per capita funding levels, and some indicators related to program implementation from 2009 to 2016. The Joinpoint regression model was adopted to test the time trend of changes in program implementation indicators. Face-to-face individual interviews and group discussions were conducted with 48 key insiders. Results The program provided full life cycle service to the whole population with an equitable and affordable financing system, enhanced the capability and quality of the health workforce, and facilitated integration of the public health service delivery system. Meanwhile, there were also some shortcomings, including lack of selection and an exit mechanism of service items, inadequate system integration, shortage of qualified professionals, limited role played by actors outside the health sector, and a large gap between the subsidy standard and the actual service cost. The Joinpoint regression analysis demonstrated that 13 indicators related to program implementation showed a significant upward trend (P<.05) from 2009 to 2016, with average annual percent change values above 10% for 6 indicators and below 6% for 7 indicators. Three indicators (coverage of health records, electronic health records, and health management among the elderly) rose rapidly with annual percent change values above 30% between 2009 and 2011, but rose slowly or remained stable between 2011 and 2016. In 2016, the subsidy standard per capita in the eastern, central, and western regions was equivalent to US $7.43, $7.15, and $6.57, respectively, of which the national-level subsidy accounted for 25.50%, 60.57%, and 79.52%, respectively. Conclusions The Program has made a significant contribution to China’s efforts in achieving UHC. The Program focuses on a key population and provides full life cycle services for the whole population. The financing system completely supported by the government makes the services more equitable and affordable. However, there are a few challenges to implementing the Program in China, especially to increase the public investment, optimize service items, enhance quality of the services, and evaluate the health outcomes.
Collapse
Affiliation(s)
- Guixia Fang
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Diling Yang
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Li Wang
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Zhihao Wang
- The First Affiliated Hospital, University of Science and Technology of China, Hefei, China
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yuanyuan Liang
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Jinxia Yang
- School of Health Service Management, Anhui Medical University, Hefei, China
| |
Collapse
|
41
|
Yan LL, Gong E, Gu W, Turner EL, Gallis JA, Zhou Y, Li Z, McCormack KE, Xu LQ, Bettger JP, Tang S, Wang Y, Oldenburg B. Effectiveness of a primary care-based integrated mobile health intervention for stroke management in rural China (SINEMA): A cluster-randomized controlled trial. PLoS Med 2021; 18:e1003582. [PMID: 33909607 PMCID: PMC8115798 DOI: 10.1371/journal.pmed.1003582] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/12/2021] [Accepted: 03/11/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Managing noncommunicable diseases through primary healthcare has been identified as the key strategy to achieve universal health coverage but is challenging in most low- and middle-income countries. Stroke is the leading cause of death and disability in rural China. This study aims to determine whether a primary care-based integrated mobile health intervention (SINEMA intervention) could improve stroke management in rural China. METHODS AND FINDINGS Based on extensive barrier analyses, contextual research, and feasibility studies, we conducted a community-based, two-arm cluster-randomized controlled trial with blinded outcome assessment in Hebei Province, rural Northern China including 1,299 stroke patients (mean age: 65.7 [SD:8.2], 42.6% females, 71.2% received education below primary school) recruited from 50 villages between June 23 and July 21, 2017. Villages were randomly assigned (1:1) to either the intervention or control arm (usual care). In the intervention arm, village doctors who were government-sponsored primary healthcare providers received training, conducted monthly follow-up visits supported by an Android-based mobile application, and received performance-based payments. Participants received monthly doctor visits and automatically dispatched daily voice messages. The primary outcome was the 12-month change in systolic blood pressure (BP). Secondary outcomes were predefined, including diastolic BP, health-related quality of life, physical activity level, self-reported medication adherence (antiplatelet, statin, and antihypertensive), and performance in "timed up and go" test. Analyses were conducted in the intention-to-treat framework at the individual level with clusters and stratified design accounted for by following the prepublished statistical analysis plan. All villages completed the 12-month follow-up, and 611 (intervention) and 615 (control) patients were successfully followed (3.4% lost to follow-up among survivors). The program was implemented with high fidelity, and the annual program delivery cost per capita was US$24.3. There was a significant reduction in systolic BP in the intervention as compared with the control group with an adjusted mean difference: -2.8 mm Hg (95% CI -4.8, -0.9; p = 0.005). The intervention was significantly associated with improvements in 6 out of 7 secondary outcomes in diastolic BP reduction (p < 0.001), health-related quality of life (p = 0.008), physical activity level (p < 0.001), adherence in statin (p = 0.003) and antihypertensive medicines (p = 0.039), and performance in "timed up and go" test (p = 0.022). We observed reductions in all exploratory outcomes, including stroke recurrence (4.4% versus 9.3%; risk ratio [RR] = 0.46, 95% CI 0.32, 0.66; risk difference [RD] = 4.9 percentage points [pp]), hospitalization (4.4% versus 9.3%; RR = 0.45, 95% CI 0.32, 0.62; RD = 4.9 pp), disability (20.9% versus 30.2%; RR = 0.65, 95% CI 0.53, 0.79; RD = 9.3 pp), and death (1.8% versus 3.1%; RR = 0.52, 95% CI 0.28, 0.96; RD = 1.3 pp). Limitations include the relatively short study duration of only 1 year and the generalizability of our findings beyond the study setting. CONCLUSIONS In this study, a primary care-based mobile health intervention integrating provider-centered and patient-facing technology was effective in reducing BP and improving stroke secondary prevention in a resource-limited rural setting in China. TRIAL REGISTRATION ClinicalTrials.gov NCT03185858.
Collapse
Affiliation(s)
- Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, Jiangsu, China
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- The George Institute for Global Health, Beijing, China
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China
- Peking University School of Global Health and Development, Beijing, China
- * E-mail:
| | - Enying Gong
- Global Health Research Center, Duke Kunshan University, Jiangsu, China
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Wanbing Gu
- Global Health Research Center, Duke Kunshan University, Jiangsu, China
- Vital Strategies, Jinan Representative Office, Beijing, China
| | - Elizabeth L. Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Biostatistics & Bioinformatics, Duke University, Durham North Carolina, United States
| | - John A. Gallis
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Biostatistics & Bioinformatics, Duke University, Durham North Carolina, United States
| | - Yun Zhou
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zixiao Li
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kara E. McCormack
- Department of Biostatistics & Bioinformatics, Duke University, Durham North Carolina, United States
| | - Li-Qun Xu
- China Mobile Industry Institute, Chengdu, China
| | - Janet P. Bettger
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Orthopedic Surgery, Duke University, Durham North Carolina, United States of America
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Yilong Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| |
Collapse
|
42
|
Ghanbari MK, Behzadifar M, Doshmangir L, Martini M, Bakhtiari A, Alikhani M, Bragazzi NL. Mapping Research Trends of Universal Health Coverage From 1990 to 2019: Bibliometric Analysis. JMIR Public Health Surveill 2021; 7:e24569. [PMID: 33427687 PMCID: PMC7834945 DOI: 10.2196/24569] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/15/2020] [Accepted: 12/02/2020] [Indexed: 12/19/2022] Open
Abstract
Background Universal health coverage (UHC) is one of many ambitious, health-related, sustainable development goals. Sharing various experiences of achieving UHC, in terms of challenges, pitfalls, and future prospects, can help policy and decision-makers reduce the likelihood of committing errors. As such, scholarly articles and technical reports are of paramount importance in shedding light on the determinants that make it possible to achieve UHC. Objective The purpose of this study is to conduct a comprehensive analysis of UHC-related scientific literature from 1990 to 2019. Methods We carried out a bibliometric analysis of papers related to UHC published from January 1990 to September 2019 and indexed in Scopus via VOSviewer (version 1.6.13; CWTS). Relevant information was extracted: the number of papers published, the 20 authors with the highest number of publications in the field of UHC, the 20 journals with the highest number of publications related to UHC, the 20 most active funding sources for UHC-related research, the 20 institutes and research centers that have produced the highest number of UHC-related research papers, the 20 countries that contributed the most to the research field of UHC, the 20 most cited papers, and the latest available impact factors of journals in 2018 that included the UHC-related items under investigation. Results In our analysis, 7224 articles were included. The publication trend was increasing, showing high interest in the scientific community. Most researchers were from the United States, the United Kingdom, and Canada, with Thailand being a notable exception. The Lancet accounted for 3.95% of published UHC-related research. Among the top 20 funding sources, the World Health Organization (WHO), the Bill and Melinda Gates Foundation, and the National Institutes of Health (NIH) accounted for 1.41%, 1.34%, and 1.02% of published UHC-related research, respectively. The highest number of citations was found for articles published in The Lancet, the American Journal of Psychiatry, and the Journal of the American Medical Association (JAMA). The top keywords were “health insurance,” “insurance,” “healthcare policy,” “healthcare delivery,” “economics,” “priority,” “healthcare cost,” “organization and management,” “health services accessibility,” “reform,” “public health,” and “health policy.” Conclusions The findings of our study showed an increasing scholarly interest in UHC and related issues. However, most research concentrated in middle- and high-income regions and countries. Therefore, research in low-income countries should be promoted and supported, as this could enable a better understanding of the determinants of the barriers and obstacles to UHC achievement and improve global health.
Collapse
Affiliation(s)
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Leila Doshmangir
- Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mariano Martini
- Department of Health Sciences, School of Public Health, University of Genoa, Genoa, Italy
| | - Ahad Bakhtiari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Mahtab Alikhani
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Nicola Luigi Bragazzi
- Department of Health Sciences, School of Public Health, University of Genoa, Genoa, Italy
| |
Collapse
|
43
|
Lu S, Zhang L, Klazinga N, Kringos D. More public health service providers are experiencing job burnout than clinical care providers in primary care facilities in China. HUMAN RESOURCES FOR HEALTH 2020; 18:95. [PMID: 33272284 PMCID: PMC7711271 DOI: 10.1186/s12960-020-00538-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/20/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND Health workers are at high risk of job burnout. Primary care in China has recently expanded its scope of services to a broader range of public health services in addition to clinical care. This study aims to measure the prevalence of burnout and identify its associated factors among clinical care and public health service providers at primary care facilities. METHODS A cross-sectional survey (2018) was conducted among 17,816 clinical care and public health service providers at 701 primary care facilities from six provinces. Burnout was measured by the Chinese version of the Maslach Burnout Inventory-General Scale, and multilevel linear regression analysis was conducted to identify burnout's association with demographics, as well as occupational and organisational factors. RESULTS Overall, half of the providers (50.09%) suffered from burnout. Both the presence of burnout and the proportion of severe burnout among public health service providers (58.06% and 5.25%) were higher than among clinical care providers (47.55% and 2.26%, respectively). Similar factors were associated with burnout between clinical care and public health service providers. Younger, male, lower-educated providers and providers with intermediate professional title, permanent contract or higher working hours were related to a higher level of burnout. Organisational environment, such as the presence of a performance-based salary system, affected job burnout. CONCLUSIONS Job burnout is prevalent among different types of primary care providers in China, indicating the need for actions that encompass the entirety of primary care. We recommend strengthening the synergy between clinical care and public health services and transforming the performance-based salary system into a more quality-based system that includes teamwork incentives.
Collapse
Affiliation(s)
- Shan Lu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Research Centre for Rural Health Service, Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, 430030, China
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Liang Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Research Centre for Rural Health Service, Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, 430030, China.
| | - Niek Klazinga
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Dionne Kringos
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
44
|
Zhao X, Wang H, Li J, Yuan B. Training primary healthcare workers in China's township hospitals: a mixed methods study. BMC FAMILY PRACTICE 2020; 21:249. [PMID: 33267821 PMCID: PMC7713157 DOI: 10.1186/s12875-020-01333-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022]
Abstract
Background Primary health care (PHC) was a keystone toward achieving universal health coverage and Sustainable Development Goals (SDGs). China has made efforts to strengthen its PHC institutions. As part of such efforts, regular in-service training is crucial for primary healthcare workers (PHWs) to strengthen their knowledge and keep their skills up to date. Objective To investigate if and how the existing training arrangements influenced the competence and job satisfaction of PHWs in township hospitals (THs). Methods A mixed method approach was employed. We analyzed the associations between in-service training and competence, as well as between in-service training and job satisfaction of PHWs using logistic regression. Interviews were recorded, transcribed, and analyzed using NVivo12 to better understand the trainings and the impacts on PHWs. Results The study found that training was associated with competence for all the types of PHWs except nurses. The odds of higher competence for physicians who received long-term training were 3.60 (p < 0.01) and that of those who received both types of training was 2.40 (p < 0.01). PHWs who received short-term training had odds of higher competence significantly (OR = 1.710, p < 0.05). PHWs who received training were more satisfied than their untrained colleagues in general (OR = 1.638, p < 0.01). Specifically, physicians who received short-term training (OR = 1.916, p < 0.01) and who received both types of training (OR = 1.941, p < 0.05) had greater odds of general job satisfaction. The odds ratios (ORs) of general job satisfaction for nurses who received short-term training was 2.697 (p < 0.01), but this association was not significant for public health workers. The interview data supported these results, and revealed how training influenced competence and satisfaction. Conclusions Considering existing evidence that competence and satisfaction serve as two major determinants of health workers’ performance, to further improve PHWs’ performance, it is necessary to provide sufficient training opportunities and improve the quality of training.
Collapse
Affiliation(s)
- Xuan Zhao
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Haipeng Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Juan Li
- Shandong Provincial Hospital, Jinan, Shandong, China
| | - Beibei Yuan
- China Center for Health Development Studies, Peking University, Beijing, China.
| |
Collapse
|
45
|
Demographic variations and temporal trends in prenatal use of multiple micronutrient supplements in Beijing, 2013-2017. Public Health Nutr 2020; 24:826-833. [PMID: 33261684 DOI: 10.1017/s1368980020004905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To provide updated information about demographic variations and temporal trends in the prenatal use of multiple micronutrient (MMN) supplements in the metropolitan areas of China. DESIGN Descriptive analysis of routine prenatal healthcare data between 2013 and 2017. SETTING Chaoyang District, Beijing, China. PARTICIPANTS A total of 197 346 pregnant women who attended their first prenatal care visit and provided information about MMN supplementation during the periconceptional period. RESULTS Of these pregnant women, 60·6 % reported consuming prenatal MMN supplements. In multivariate-adjusted models, there were significant gradients of age, education and parity in prenatal MMN supplementation, with the highest likelihood of MMN use among the oldest, the most highly educated and nulliparous women (Pfor trend < 0·001). Compared with that among unemployed women, prenatal MMN supplementation was more common among the employed, especially those engaged in business (adjusted relative risks (95 % CI): 1·08 (1·06, 1·10)) and management (1·10 (1·08, 1·12)). The proportion of prenatal MMN supplementation was 57·0 % in 2013, which increased to 63·5 % in 2017 (Pfor trend < 0·001). The trends varied by age, education and parity (Pfor heterogeneity < 0·001), whereas no significant difference was observed in trends across subgroups of ethnicity or occupation. The greatest magnitude increase in MMN supplement use occurred in women of age < 25 years (annual percent change: 5·7 %), less than high school education (9·6 %), parity ≥ 2 (6·8 %) or unemployment (6·1 %). CONCLUSION Approximately two-thirds of women consumed prenatal MMN supplements during the periconceptional period in the central area of Beijing and the proportion increased over time, indicating a need to evaluate the effectiveness and safety and to develop a guideline for relatively well-nourished women.
Collapse
|
46
|
Abstract
BACKGROUND To address the neglect of depression in multimorbidity measurement and the lack of focus on rural population in previous literature about China, this paper aimed to estimate the prevalence of multimorbidity (including depressive disorders) among the country's rural and urban population. METHODS We used a cross-sectional design and data from a nationally representative survey conducted in 2015-2016 among Chinese people aged 45 years or older involving 19 656 participants. Multimorbidity was measured with a cut-off point of having two or more among 14 chronic illnesses. In that 13 of them were based on self-reported physician diagnosis. In addition, depressive disorders were assessed with the 10-item Centre for Epidemiologic Studies Depression Scale. The weighted prevalence of multimorbidity was calculated, with a non-response adjustment. Multivariate logistic regression was applied to analyse the relation between covariates and multimorbidity. FINDINGS Multimorbidity was highly prevalent (54.3%) among the studied population. Contrary to previous studies, we found the prevalence of multimorbidity to be higher among the rural dwellers (58.3%) than among the urban population (50.4%). After adjustment for covariates, rural residents had 7.5% higher odds (95% CI of OR (1.003 to 1.151)) of having multimorbidity than their urban counterparts. Above 70% of patients with any of the 14 chronic illnesses above 45 years old had multimorbidity, while 80.6%-97.9% of chronic patients had multimorbidity. INTERPRETATION Future health system development in China should transform from preventing and controlling non-communicable diseases as individual diseases to addressing people's comprehensive health needs under multimorbidity. The rural population should be prioritised as they suffered more from multimorbidity than the urban population.
Collapse
Affiliation(s)
- Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yu He
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jin Xu
- China Center for Health Development Studies, Peking University, Beijing, China
| |
Collapse
|
47
|
Feng S, Cheng A, Luo Z, Xiao Y, Zhang L. Effect of family doctor contract services on patient perceived quality of primary care in southern China. BMC FAMILY PRACTICE 2020; 21:218. [PMID: 33099322 PMCID: PMC7585687 DOI: 10.1186/s12875-020-01287-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 10/15/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Family doctor contract service is an important service item in China's primary care reform. This research was designed to evaluate the impact of the provision of family doctor contract services on the patient-perceived quality of primary care, and therefore give evidence-based policy suggestions. METHODS This cross-sectional study of family doctor contract service policy was conducted in three pilot cities in the Pearl River Delta, South China, using a multistage stratified sampling method. The validated Primary Care Assessment Tool-Adult Edition (PCAT-AS) was used to measure the quality of primary care services. PCAT-AS assesses each of the unique characteristics of primary care including first contact, continuity, comprehensiveness, coordination, family-centeredness, community orientation, culture orientation. Data was collected through face-to-face interviews held from July to November, 2015. Covariate analysis and multivariate Linear Regression were adopted to explore the effect of contract on the quality of primary care by controlling for the socio-demographic status and health care service utilization factors. RESULTS A total of 828 valid questionnaires were collected. Among the interviewees, 453 patients signed the contract (54.7%) and 375 did not (45.3%). Multivariate linear regression showed that contracted patients reported higher scores in dimensions of PCAT total score (β = - 8.98, P < 0.000), first contact-utilization(β = - 0.71,P < 0.001), first contact-accessibility(β = - 1.49, P < 0.001), continuity (β = 1.27, P < 0.001), coordination (referral) (β = - 1.42, P < 0.001), comprehensiveness (utilization) (β = - 1.70, P < 0.001), comprehensiveness (provision) (β = - 0.99, P < 0.001),family-centeredness(β = - 0.52, P < 0.01), community orientation(β = - 1.78, P < 0.001), than un- contracted after controlling socio-demographic and service utilization factors. There were no statistically significant differences in the dimensions of coordination (information system) (β = - 0.25, P = 0.137) and culture orientation (β = - 0.264, P = 0.056) between the two both groups. CONCLUSIONS This study demonstrates that the pilot implementation of family doctor contract services has significantly improved patients' perceived primary care quality in the pilot cities, and could help solve the quality problem of primary care. It needs further promotion across the province.
Collapse
Affiliation(s)
- Shanshan Feng
- School of Health Management, Guangzhou Medical University, Xinzao Town, Panyu District, Guangzhou, 5111436, Guangdong, People's Republic of China.
| | - Aiyun Cheng
- School of Health Management, Guangzhou Medical University, Xinzao Town, Panyu District, Guangzhou, 5111436, Guangdong, People's Republic of China
| | - Zhenni Luo
- School of Health Management, Guangzhou Medical University, Xinzao Town, Panyu District, Guangzhou, 5111436, Guangdong, People's Republic of China
| | - Yao Xiao
- School of Health Management, Guangzhou Medical University, Xinzao Town, Panyu District, Guangzhou, 5111436, Guangdong, People's Republic of China
| | - Luwen Zhang
- School of Health Management, Southern Medical University, No. 1023-1063, South Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong Province, People's Republic of China
| |
Collapse
|
48
|
Huang J, Gong X, Gu Q, Liu R, Shi J, Yu W, Zu P, Ma X, Lin J, Sun J, Yang Y, Wang Z. The effect of family doctor policy practice on primary health-care workers' health in Hongkou District of Shanghai, China: varied by occupational divisions? BMC FAMILY PRACTICE 2020; 21:205. [PMID: 32998704 PMCID: PMC7529512 DOI: 10.1186/s12875-020-01275-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 09/23/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND A key component of the 2009 medical reform in China was the change to family doctor (FD) policy practice. However, this led to an increased workload for primary health-care workers (PHCWs) at community health service centres. Their increasing workload may play a significant role in affecting PHCWs' health. METHODS A questionnaire survey was conducted in Hongkou district of Shanghai amongst PHCWs including family doctors (FDs), family nurses (FNs), public health doctors (PHDs), and other PHCWs in early 2019. Ordered logistic regression models (Models 1 to 3) were performed to explore the differing health status amongst PHCWs, and their respective influential factors were also tested (Models 4 to 7). RESULTS Five hundred sixty-two valid questionnaires were collected with a response rate of 96.4%. Other PHCWs' (OR = 2.03; 95% CI: 1.163-3.560) and FNs' (OR = 1.98; 95% CI: 1.136-3.452) self-rated health (SRH) were significantly better than that of FDs. In terms of FNs, the OR of SRH for those who strongly perceived the extra workload brought by FD-contracted services was only 12.0% (95% CI: 0.018-0.815) of that of the no-pressure group. Similarly, FNs with stronger work pressure had worse SRH, i.e., compared with "no" pressure, the SRH ORs for "neutral," "strong," and "very strong" evaluations of work pressure were 0.002 (95% CI: 0.000-0.055), 0.001 (95% CI: 0.000-0.033), and 0.000 (95% CI: 0.000-0.006), respectively. Information technology (IT) systems and performance incentives were suggested to improve SRH for FNs, while the former was found to be negatively correlated with other PHCWs. After one unit increase in the PHDs' team/department support, their OR was 10.7 times (95% CI: 1.700-67.352) higher. In addition, policy support had a negative effect on SRH for PHDs. The OR of "good" assessments of cultural environments was 25.98 times (95% CI: 1.391-485.186) higher than that of "very poor" for Other PHCWs. CONCLUSIONS The influences of FD policy practice on FNs' SRH were the most significant amongst PHCWs, rather than FDs' as expected. The significant factors of SRH were varied over different occupational categories, that is team/department support and policy support (though negative) for PHDs, IT system and incentive for FNs, facility and equipment for FDs, and culture environment for other PHCWs respectively.
Collapse
Affiliation(s)
- Jiaoling Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.,Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200003, China
| | - Xin Gong
- Shanghai East Hospital affiliated to Tongji University School of Medicine, Shanghai, 200120, China
| | - Qing Gu
- Beiwaitan Community Health Service Center of Hongkou Area, Shanghai, 200082, China
| | - Rui Liu
- Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200003, China
| | - Jianwei Shi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Wenya Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ping Zu
- Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, 200336, China
| | - Xiaojun Ma
- Beiwaitan Community Health Service Center of Hongkou Area, Shanghai, 200082, China
| | - Jie Lin
- Beiwaitan Community Health Service Center of Hongkou Area, Shanghai, 200082, China
| | - Jin Sun
- Beiwaitan Community Health Service Center of Hongkou Area, Shanghai, 200082, China
| | - Yonghua Yang
- Beiwaitan Community Health Service Center of Hongkou Area, Shanghai, 200082, China.
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.,General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, 528244, Guangdong, China
| |
Collapse
|
49
|
Yao H, Zhan C, Sha X. Current situation and distribution equality of public health resource in China. ACTA ACUST UNITED AC 2020; 78:86. [PMID: 32983449 PMCID: PMC7507592 DOI: 10.1186/s13690-020-00474-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/15/2020] [Indexed: 12/13/2022]
Abstract
Background The public health system has been developed in China for several years while no research explores its distribution. This research aims to describe the variation and equality of public health allocation from 2013 to 2018 and explore the source of inequality. Methods Data in this research was obtained from the China Health Statistics Yearbook 2014 to 2019 and the China Statistical Yearbook 2019. Four indicators were chosen in describing the development and current situation of the public health system. Three of them were used to evaluate allocation equality. 31 provinces were categorized into western, middle, and eastern groups based on geographical and economic conditions. Total allocation equality, inter- and intra-difference were all measured by the Theil index. Results All indicators showed a stably upwards trend except for the number of public health institutions. The allocation gap of the public health institution per km2 was larger than that per 10,000 capita. Theil index of three indicators continually rose from 2013 to 2018 and the inequality of public health institutions allocation was the highest one. The western region had the highest Theil index in technical personnel and beds allocation. Among the three regions, the western region contributed most to inequality. Conclusions The public health workforces and institutions are still under the requirement of the National Medical and Health Service System Plan. From 2013 to 2018, the equality of public health resources stably decreases, which is mainly contributed by the internal difference within the western region. Further research should be done to explore the possible cause of the results. Problems founded in this research should be solved by multisectoral cooperation.
Collapse
Affiliation(s)
- Honghui Yao
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, 171 77 Stockholm, Sweden
| | - Chaohong Zhan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008 Hunan Province China
| | - Xinping Sha
- Department of infectious disease, Xiangya Hospital, Central South University, Changsha, 410008 Hunan Province China.,Xinagya Changde Hospital, Changde, 415000 Hunan Province China
| |
Collapse
|
50
|
Mao Y, Hu Y, Feng Z, Wang R, Chen X, Zhang W, Yang G. Job burnout and correlated factors of three-tiered public health workers: A cross-sectional study in China. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1241-1251. [PMID: 32128900 DOI: 10.1111/hsc.12957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/15/2020] [Accepted: 01/25/2020] [Indexed: 05/22/2023]
Abstract
This study aimed to reveal burnout levels and its potential influencing factors among three-tiered public health workers in China. A total of 1,328 public health workers from cities, counties and townships in Henan and Hubei provinces participated. Cumulative logistic regressions were used to determine job burnout predictors. Township workers (β = 0.276, p = .046) showed higher levels of emotional exhaustion (EE) than city workers. Municipal workers showed higher levels of depersonalisation (DP) (β = -0.439, p = .004) and lack of personal accomplishment (LPA) (β = -0.343, p = .005) than township workers. Compared with those who had better results, township workers with average levels of interpersonal relationships (β = 0.703, p = .014) exhibited higher EE degrees. Municipal (β = 1.050, p < .001) and county (β = 1.359, p < .001) workers with moderate training satisfaction had higher levels of burnout than those with a high degree of training satisfaction. Municipal (β = 3.933, p < .001) and county (β = 1.218, p = .018) workers earning 2,000 RMB and below every month were more likely to have higher burnout levels than those earning 4,001 RMB and above. Township respondents exhibited high EE levels, given the low-level education of their services' target audience. Similarly affected by interpersonal relationships, township workers require interpersonal and emotional intervention programmes. City respondents showed a high level of DP and LPA, which was attributed to considerable differences between public health workers and medical workers in cities. Hence, apart from narrowing the reward gap between clinicians and public health workers, improving public health workers' social cognition and status by various channels was found necessary. The burnout of municipal and county respondents were influenced by income and training. Improving the role of income as incentive and reforming trainings programmes would be necessary.
Collapse
Affiliation(s)
- Yiqing Mao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yue Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoyu Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weiping Zhang
- Health Commission of Henan Province, Zhengzhou, Henan, China
| | - Gaiying Yang
- Center for Disease Control and Prevention in Henan Province, Zhengzhou, Henan, China
| |
Collapse
|