Cross-Sectional Study on the Management and Control of Hypertension Among Migrants in Primary Care: What Is the Impact of Segmented Health Insurance Schemes?

Barriers to community healthcare delivery in urban China: a nurse perspective

PURPOSE

There is considerable research on China's community healthcare, but little examining its delivery from a nurse perspective. This article, set in the context of Shenzhen, elicits community nurses' views on barriers to healthcare delivery, providing an initial evidence framework to improve community nursing practice at organizational and policy levels.

METHODS

We used qualitative methods. Data from semi-structured interviews with 42 community nurses in Shenzhen underwent inductive content analysis. Consolidated criteria for reporting qualitative research were consulted to structure our reporting.

RESULTS

Our analysis suggests four elements discouraging community nurses in care delivery: lack of equipment, stressful work environments, staff incompetence, and patient distrust. Centralized means of procurement, management indifference to nurses' well-being, unsystematic training and reluctance to enter the community healthcare sector, and public prejudices against nursing contributed to these constraints, preventing community nurses from performing patient-centred care, devoting energy to caring, freeing themselves from heavy workloads, and building trust-based care relationships.

CONCLUSIONS

Delivery barriers devalued community health services systematically and undermined nurses' professional advancement and psychological well-being. Targeted management and policy inputs are necessary to reduce caring barriers and enhance the ability of community nursing to safeguard population health.

Community nursing delivery in urban China: A social power perspective

Community nurses remain understudied in research on interactional power, especially in China where community healthcare is an emerging practice. Grounded in French & Raven's typology of social power, this article conceptualises the power of community nurses in a Chinese urban context. Through thematic analysis of textual data from 26 semi-structured interviews and two additional focus group discussions with community nurses in Shenzhen, we identified six power varieties, i.e. indirect reward, indirect coercion, legitimate position, peer reference, field expertise, and caring information. We classified these powers trichotomously, as nurse-to-doctor, nurse-to-nurse, and nurse-to-patient, to show the potential influences nurses bring to healthcare relationships. Our analysis indicated nurses' exercise of some powers was constrained by two elements, i.e. doctor-nurse power polarity and patient prejudices against nursing, which together contributed to nurses' adverse power loss. These power adversities permeated the community health environment, contributing to healthcare delivery dysfunctions by undermining nurses' self-improvement, self-assurance, enthusiasm, and cooperation in care. Our analysis, using the insights of social power, develops a novel reading of community nursing delivery in urban China. We argue that nurse empowerment could promote community healthcare delivery. Role enhancement and pro-nursing policy development would reduce adverse power scenarios for community nurses and help convert their potential power resources into practical powers in support of patients' needs.

Barriers to Community-Based Primary Health Care Delivery in Urban China: A Systematic Mapping Review

Providing access to a range of basic health services, community-based primary health care (CB-PHC) plays a vital role in achieving the goal of health for all. Driven by a strong political commitment, China's CB-PHC progress in the past decade has been swift and impressive. However, a well-functioning delivery system for care has yet to be established. This systematic mapping review synthesizes selected evidence on barriers to CB-PHC delivery in urban China and draws lessons for policy development. We performed searches on five electronic databases: CINAHL, MEDLINE, Scopus, Web of Science, and China National Knowledge Infrastructure, and included studies published between 2012 and 2021. The Downs and Black and Critical Appraisal Skills Program checklists were used to assess the quality of eligible papers. We conducted our searches and syntheses following the framework set out in the Primary Health Care Performance Initiative (PHCPI). We synthesized the results of the included studies using a thematic narrative approach and reported according to PRISMA guidelines. Six salient barriers arose from our syntheses of 67 papers: lack of comprehensive health insurance schemes, lack of public awareness, superficial care relationships, gaps in communication, staff shortages and poor training, and second-rate equipment. These barriers are grouped into three subdomains following the PHCPI framework: access, people-centered care, and organization and management. A host of negative impacts of these barriers on community-based health care were also identified. It was not possible to determine clear causes of these barriers from the contributing evidence because of the lack of conceptual frameworks and research methods constraints. Non-eastern regions of China and access-related barriers require further exploration. It follows that, at the national level, the problems are likely more severe than the research suggests.

The positive association between internal migration and hospitalization among the older adults in China: Regional heterogeneity and chronic disease management

Background

Post-retirement migrants are rapidly increasing in China, but the impact of internal migration on hospitalization among older adults remains under-researched. Understanding this impact is essential for health policies development and improvement. This study aims to identify the most vulnerable population, evaluate the association between migration and hospitalization, and discuss potential causes of the association.

Methods

14,478 older adults were extracted from the 2018 to 2019 Chinese Longitudinal Healthy Longevity Survey (CLHLS) database and divided into four groups according to migration experience and age at migration: non-migrants, pre-adulthood migrants, pre-retirement migrants, and post-retirement migrants. Post-retirement migrants were key research subjects. We employed Pearson's chi-square test to compare group differences in outcome and covariates, and multivariate logistic regression analysis to examine the association between migration and hospitalization by regions and chronic conditions.

Results

Significant intergroup differences were observed in demographic characteristics, socioeconomic factors, health habits, and health-related factors. Post-retirement migrants displayed following characteristics: female predominance (61.6%; 1,472/2,391), tending toward urban areas (80.9%; 1,935/2,391), and the highest prevalence rate of chronic disease (46.7%; 1,116/2,391). Urban migrants in eastern China were more likely to be hospitalized (OR = 1.65; 95% CI: 1.27-2.15), especially those who were diagnosed with chronic disease (OR = 1.51; 95% CI: 1.04-2.19) or with unconfirmed chronic conditions (OR = 1.98; 95% CI: 1.36-2.89).

Conclusions

Internal migration is associated with the hospitalization of post-retirement migrants moving to eastern China. Improved chronic disease management and early interventions might lower the hospitalization. Effective policies should be formulated to reduce the disparity in primary care services across China, thereby facilitating the access of migrants to these services.

Impact of urbanisation on the gaps of hypertension prevalence, awareness and treatment among older age in China: a cross-sectional study

OBJECTIVES

To examine the impact of urbanisation on the prevalence, awareness and treatment of hypertension among elderly in China.

DESIGN

This cross-sectional study used data from the most recent nationally representative Chinese Longitudinal Healthy Longevity Survey, 2018.

SETTING

People in urban and rural communities from 500 sample areas in 22 Chinese provinces.

PARTICIPANTS

After exclusion, this study surveyed 9859 participants in the final analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

The main dependent variables were prevalence, awareness and treatment of hypertension defined as (1) systolic blood pressure (BP)≥140 mm Hg, diastolic BP≥90 mm Hg or (2) taking antihypertensive drugs. Hypertension awareness was defined as a previous diagnosis of hypertension by a health professional, and hypertension treatment was defined as undergoing BP treatment.

RESULTS

The prevalence of hypertension was lower among semiurbanised adults than among non-urbanised rural adults (OR=0.94, 95% CI=0.90 to 0.99; p<0.05). The probabilities of awareness (OR=1.10, 95% CI=1.01 to 1.20; p<0.05) and treatment (OR=1.17, 95% CI=1.08 to 1.26; p<0.001) of hypertension were significantly lower among non-urbanised adults than among urban-born adults. Urbanisation in eastern (OR=0.93, 95% CI=0.88 to 0.99; p<0.05) and western China (OR=1.11, 95% CI=1.01 to 1.23; p<0.05) was associated with the prevalence of hypertension. The urbanisation level was also associated with hypertension awareness and treatment in eastern (OR=1.17, 95% CI=1.04 to 1.32; p<0.01; OR=1.26, 95% CI=1.14 to 1.40; p<0.001), central (OR=1.31, 95% CI=1.05 to 1.63; p<0.05; OR=1.29, 95% CI=1.08 to 1.55; p<0.01) and western China (OR=1.28, 95% CI=1.07 to 1.53; p<0.01; OR=1.34, 95% CI=1.15 to 1.57; p<0.001). The Blinder-Oaxaca decomposition suggested that approximately 42% and 39% of the urban-rural gap in hypertension awareness and treatment, respectively, could be attributed to coefficient difference.

CONCLUSIONS

Public health programmes and policies for chronic diseases should adjust with urbanisation and combine individual-centred strategies.

Cross-Sectional Study on the Management and Control of Hypertension Among Migrants in Primary Care: What Is the Impact of Segmented Health Insurance Schemes?

Background Information is scarce regarding the impact of fragmented health insurance schemes on the management and control of hypertension among migrants in primary care. This study aimed to investigate the relationship between insurance status and management and control of hypertension among migrants in primary care and to examine whether social capital could facilitate migrants' participation in local health insurance schemes. Methods and Results A site-based, cross-sectional, face-to-face patient survey was administered in Shenzhen, China. Hypertensive primary care users who were migrants were selected using a systematic sampling design. The participants covered by local health insurance schemes were more likely than those without coverage to be managed by primary care facilities (82.6% versus 62.0%; odds ratio=2.63, 95% CI 1.41-4.89) and to take antihypertensive medications (87.9% versus 76.4%; odds ratio=2.38, 95% CI 1.34-4.24), and they had higher scores in first contact use (3.49 versus 3.23; β=0.17, 95% CI 0.05-0.29) and continuity of care (3.17 versus 3.02; β=0.11, 95% CI 0.01-0.21). The participants covered by local insurance schemes had higher scores in perceived generalized trust than their counterparts (4.23 versus 3.95; β=0.16, 95% CI 0.09-0.40). The hypertension control rate was also higher among the participants with local health insurance coverage (48.8% versus 42.2%; odds ratio=1.38, 95% CI 1.02-2.12). Conclusions In conclusion, local health insurance schemes are associated with optimal control of hypertension for migrants compared with social health insurance schemes. Our study implies that one form of social capital, namely perceived general trust, contributes to migrant hypertensive patients' participation in local health insurance schemes.