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Zhou J, Yuan Q, Huang Q, Wang Q, Huang H, Chen W, Wang G, Liu S, Zhang T, Zhao X, Li Y. Implementation factors of tuberculosis control program in primary healthcare settings in China: a mixed-methods using the Consolidated Framework for Implementation Research framework. Infect Dis Poverty 2024; 13:52. [PMID: 38978081 PMCID: PMC11229258 DOI: 10.1186/s40249-024-01222-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/26/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major cause of death worldwide, and Chinese TB burden ranked the second globally. Chinese primary healthcare (PHC) sectors implement the TB Control Program (TCP) to improve active case finding, referral, treatment adherence, and health education. This study aimed to identify barriers and enablers of TCP implementation in high TB burden regions of West China. METHODS We conducted a representative study using mixed-methods in 28 counties or districts in Chongqing Municipality and Guizhou Province of West China from October 2021 to May 2022. Questionnaire surveys and semi-structured in-depth interviews were conducted with 2720 TB healthcare workers (HCWs) and 20 interviewees in PHC sectors. Descriptive statistical analysis was used to investigate TB HCWs' characteristics, and path analysis model was utilized to analyze the impact of associated factors on TCP implementation. Thematic framework analysis was developed with the guide of the adapted Consolidated Framework for Implementation Research (CFIR) on factors of TCP implementation. RESULTS This study found that 84.6% and 94.1% of community and village HCWs had low professional titles. Based on the results of multiple regression analysis and correlation analysis, lower TB core knowledge scores (-0.09) were identified as barriers for TCP implementation in community PHC sectors, and low working satisfaction (-0.17) and low working willingness (-0.10) are barriers for TPC implementation in village PHC sectors. The results of in-depth interviews reported barriers in all domains and enablers in four domains of CFIR. There were identified 19 CFIR constructs associated with TCP implementation, including 22 barriers such as HCWs' heavy workload, and 12 enablers such as HCWs' passion towards TCP planning. CONCLUSIONS With the guide of the CFIR framework, complex factors (barriers and enablers) of TCP implementation in PHC sectors of West China were explored, which provided important evidences to promote TB program in high TB burden regions. Further implementation studies to translate those factors into implementation strategies are urgent needed.
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Affiliation(s)
- Jiani Zhou
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Quan Yuan
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Qingning Huang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Qingya Wang
- Chongqing Tuberculosis Prevention and Control Institute, Chongqing Municipality, China
| | - Hexiang Huang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Wei Chen
- Institute of Tuberculosis Prevention and Control, Center for Disease Control and Prevention, Guiyang, Guizhou Province, China
| | - Geng Wang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Shili Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Ting Zhang
- Chongqing Tuberculosis Prevention and Control Institute, Chongqing Municipality, China
| | - Xi Zhao
- Guiyang Center for Disease Control and Prevention, Guiyang, Guizhou Province, China
| | - Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China.
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Xie Y, Shum TT, Tian Z, Lin C, Chen L, Chen B, Huang D, Zhu L, Zou G. Diagnostic delay, treatment duration and outcomes since the implementation of integrated model of tuberculosis control and their associated factors in a county in East China. BMC Infect Dis 2023; 23:727. [PMID: 37880574 PMCID: PMC10601170 DOI: 10.1186/s12879-023-08561-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: 02/22/2022] [Accepted: 08/24/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE This study assesses the diagnostic delay, treatment duration and treatment outcomes of tuberculosis (TB) patients since the implementation of the integrated model of TB control in a county in eastern China. It further identifies factors associated with diagnostic delay and treatment duration in the integrated model. METHODS We collected data through the Chinese Tuberculosis Information Management System (TBIMS) for Cangnan County in Zhejiang Province. Chi-square and Mann-Whitney tests were adopted to identify factors associated with duration of treatment and treatment delay for TB patients within the integrated model. Multiple regression analysis was subsequently performed to confirm the identified factors. RESULTS In the integrated model from 2012 to 2018, the median health system delay was maintained at 1 day, and the median patient delay decreased from 14 to 9 days and the median total delay decreased from 15 to 11 days. In addition, the proportion of patients who experienced patient delay > 14 days and total delay > 28 days decreased from 49% to 35% and from 32% to 29% respectively. However, the proportion of patients who had health system delay > 14 days increased from 0.2% to 13% from 2012 to 2018. The median treatment duration increased from 199 to 366 days and the number of TB patients lost to follow-up showed an overall upward trend from 2012 to 2018. The multivariable regression analysis indicated that migrant TB patients and TB patients initially diagnosed in hospitals at the prefectural level and above tended to experience total delay > 28 days (p < 0.001). Linear regression analysis confirmed that new TB patients>60 years tended to have longer treatment duration (p < 0.05). CONCLUSIONS While our study may suggest the potential of the integrated model in early detection and diagnosis of TB, it also suggests the importance of strengthening supervision and management of designated hospitals to optimize the treatment duration and improve retention of patients in TB care. Enhancing health education for TB patients, especially amongst migrant patients, and training in TB identification and referral for non-TB doctors are also key for early TB detection and diagnosis in the integrated model.
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Affiliation(s)
- Yuanxiang Xie
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting Ting Shum
- Department of Social Anthropology, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Zhenming Tian
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chuanheng Lin
- Center for Public Health, Longgang County, Wenzhou, Zhejiang Province, China
| | - Lingyuan Chen
- Center for Disease Prevention and Control, Cangnan County, Wenzhou, Zhejiang Province, China
| | - Bin Chen
- Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, China
| | - Dajiang Huang
- Center for Public Health, Longgang County, Wenzhou, Zhejiang Province, China
| | - Lei Zhu
- School of Postgraduate Studies, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Guanyang Zou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Zou G, McPake B, Kielmann K. 'You say you are a TB doctor, but actually, you do not have any power': health worker (de)motivation in the context of integrated, hospital-based tuberculosis care in eastern China. HUMAN RESOURCES FOR HEALTH 2022; 20:55. [PMID: 35739586 PMCID: PMC9229519 DOI: 10.1186/s12960-022-00745-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: 01/03/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In China, tuberculosis (TB) care, traditionally provided through the Centre for Disease Control (CDC), has been integrated into 'designated' public hospitals at County level, with hospital staff taking on delivery of TB services supported by CDC staff. Little is known about the impact of this initiative on the hospital-based health workers who were delegated to manage TB. Drawing on a case study of two TB 'designated' hospitals in Zhejiang province, we explored factors influencing hospital-based health workers' motivation in the context of integrated TB service delivery. METHODS We conducted 47 in-depth interviews with health officials, TB/hospital managers, clinicians, radiologists, laboratory staff and nurses involved in the integrated model of hospital-based TB care. Thematic analysis was used to develop and refine themes, code the data and assist in interpretation. RESULTS Health workers tasked with TB care in 'designated' hospitals perceived their professional status to be low, related to their assessment of TB treatment as lacking need for professional skills, their limited opportunities for professional development, and the social stigma surrounding TB. In both sites, the integrated TB clinics were under-staffed: health workers providing TB care reported heavy workloads, and expressed dissatisfaction with a perceived gap in their salaries compared with other clinical staff. In both sites, health workers were concerned about poor infection control and weak risk management assessment systems. CONCLUSIONS Inadequate attention to workforce issues for TB control in China, specifically the professional status, welfare, and development as well as incentivization of infectious disease control workers has contributed to dissatisfaction and consequently poor motivation to serve TB patients within the integrated model of TB care. It is important to address the failure to motivate health workers and maximize public good-oriented TB service provision through improved government funding and attention to the professional welfare of health workers providing TB care in hospitals.
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Affiliation(s)
- Guanyang Zou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Karina Kielmann
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Chen Y, Zhou Q, Yang X, Shi P, Shen Q, Zhang Z, Chen Z, Pu C, Xu L, Hu Z, Ma A, Gong Z, Xu T, Wang P, Wang H, Hao C, Li C, Hao M. Influence of Public Health Services on the Goal of Ending Tuberculosis: Evidence From Panel Data in China. Front Public Health 2022; 10:826800. [PMID: 35309188 PMCID: PMC8931334 DOI: 10.3389/fpubh.2022.826800] [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: 12/01/2021] [Accepted: 02/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background The World Health Organization has proposed an initiative to “end tuberculosis (TB).” Unfortunately, TB continues to endanger the health of people worldwide. We investigated the impact of public health services (PHS) in China on TB incidence. In this way, we provided policy ideas for preventing the TB epidemic. Methods We used the “New Public Management Theory” to develop two indicators to quantify policy documents: multisector participation (MP) and the Assessable Public Health Service Coverage Rate (ASCR). The panel data from 31 provinces in Chinese mainland were collected from 2005 to 2019 based on 1,129 policy documents and the China Statistical Yearbook. A fixed-effect model was used to determine the impact of MP and the ASCR on TB incidence. Results From 2005 to 2019, the average MP increased from 89.25 to 97.70%, and the average ASCR increased from 53.97 to 78.40% in Chinese mainland. However, the development of ASCR between regions was not balanced, and the average level in the western region was lower than that in the eastern coastal provinces. With an increase in MP and the ASCR, the TB incidence had been decreasing gradually in recent years. The panel analysis results showed that MP (β = −0.76, p < 0.05). and ASCR (β = −0.40, p < 0.01) had a negative effect on TB incidence, respectively. Even if the control variables were added, the negative effects of MP (β = −0.86, p < 0.05) and ASCR (β = −0.35, p < 0.01) were still statistically significant. Conclusions Promoting the participation of multiple departments, as well as emphasizing the quality of PHS delivery, are important ways to alleviate the TB epidemic. The settings of evaluation indices for PHS provision should be strengthened in the future.
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Affiliation(s)
- Yang Chen
- Research Institute of Health Development Strategies, Fudan University, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China
| | - Qingyu Zhou
- Research Institute of Health Development Strategies, Fudan University, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China
| | - Xinmei Yang
- Research Institute of Health Development Strategies, Fudan University, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China
| | - Peiwu Shi
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- Zhejiang Academy of Medical Sciences, Hangzhou, China
| | - Qunhong Shen
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- School of Public Policy and Management, Tsinghua University, Beijing, China
| | - Zhaoyang Zhang
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- Project Supervision Center of National Health Commission of the People's Republic of China, Beijing, China
| | - Zheng Chen
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- Department of Grassroots Public Health Management Group, Public Health Management Branch of Chinese Preventive Medicine Association, Shanghai, China
| | - Chuan Pu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Lingzhong Xu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- School of Public Health, Shandong University, Jinan, China
| | - Zhi Hu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Anning Ma
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- School of Management, Weifang Medical University, Weifang, China
| | - Zhaohui Gong
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- Committee on Medicine and Health of Central Committee of China Zhi Gong Party, Beijing, China
| | - Tianqiang Xu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- Institute of Inspection and Supervision, Shanghai Municipal Health Commission, Shanghai, China
| | - Panshi Wang
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- Shanghai Municipal Health Commission, Shanghai, China
| | - Hua Wang
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- Jiangsu Preventive Medicine Association, Nanjing, China
| | - Chao Hao
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- Changzhou Center for Disease Control and Prevention, Changzhou, China
| | - Chengyue Li
- Research Institute of Health Development Strategies, Fudan University, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China
- *Correspondence: Chengyue Li
| | - Mo Hao
- Research Institute of Health Development Strategies, Fudan University, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China
- Mo Hao
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Zhang R, Pu J, Zhou J, Wang Q, Zhang T, Liu S, Wang G, Chen Y, Liu J, Hu D, Li Y. Factors predicting self-report adherence (SRA) behaviours among DS-TB patients under the "Integrated model": a survey in Southwest China. BMC Infect Dis 2022; 22:201. [PMID: 35232384 PMCID: PMC8889779 DOI: 10.1186/s12879-022-07208-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China is one of 30 countries with a high tuberculosis (TB) burden, and poor adherence to TB treatment is one of the biggest challenges for TB control. We aimed to explore the barriers and facilitators of treatment adherence among drug-sensitive tuberculosis (DS-TB) patients under the "Integrated model" in Western China, to provide evidence-based treatment and control regimens for DS-TB patients to improve adherence behaviours. METHODS Both qualitative and quantitative research methods were used to explore the factors associated with self-reported adherence (SRA) behaviours. Questionnaire surveys with DS-TB patients and in-depth interviews with leaders from the Centers for Disease Control and Prevention (CDC) and community health sectors (CHCs), healthcare workers (HCWs) from CHCs, and DS-TB patients were conducted. RESULTS A total of 459 eligible patients were included in the quantitative survey, and two patients and 13 healthcare providers were included in the in-depth interviews. The percentage of patients who experienced a missed dose, lack of follow-up sputum examination, and interrupted treatment were 19.0%, 11.3%, and 9.2%, respectively. Patients aged 20-39 had a higher risk of missed dose [OR (95% CI): 2.302 (1.001-5.305)] and a lower risk of interrupted treatment [OR (95% CI): 0.278 (0.077-0.982)] than patients more than 60 years. Patients who were of Han ethnicity (OR [95% CI]: 0.524 [0.301-0.912]) received psychological support (OR [95% CI]: 0.379 [0.144-0.998]) from their family and had a lower risk of missed doses. Patients who had drug side effects had a higher risk of interrupted treatment (OR [95% CI]: 2.587 [1.237-5.412]). Patients who possessed higher knowledge had a lower risk of lack of follow-up sputum examination [OR (95% CI): 0.817 (0.673-0.991)]. The results of the qualitative study also reported that patients' poor TB knowledge was the main reason for their non-SRA behaviours. CONCLUSIONS Patient-centred strategies should be implemented to improve health literacy and strengthen psychological support. More effective case management should be designed and implemented based on different patient characteristics to improve adherence behaviours in further studies.
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Affiliation(s)
- Rui Zhang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Pu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiani Zhou
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qingya Wang
- Department of Districts and Counties, Chongqing Institute of TB Prevention and Treatment, Jiulongpo District, Chongqing, China
| | - Ting Zhang
- Department of Districts and Counties, Chongqing Institute of TB Prevention and Treatment, Jiulongpo District, Chongqing, China
| | - Shili Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Geng Wang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yong Chen
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiaqing Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Daiyu Hu
- Department of Districts and Counties, Chongqing Institute of TB Prevention and Treatment, Jiulongpo District, Chongqing, China.
| | - Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China.
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Xing W, Zhang R, Jiang W, Zhang T, Pender M, Zhou J, Pu J, Liu S, Wang G, Chen Y, Li J, Hu D, Tang S, Li Y. Adherence to Multidrug Resistant Tuberculosis Treatment and Case Management in Chongqing, China - A Mixed Method Research Study. Infect Drug Resist 2021; 14:999-1012. [PMID: 33758516 PMCID: PMC7979342 DOI: 10.2147/idr.s293583] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
Aim This paper evaluated the treatment adherence for multidrug-resistant tuberculosis (MDR-TB) and MDR-TB case management (MTCM) in Chongqing, China in order to identify factors associated with poor treatment adherence and case management. Methods Surveys with 132 MDR-TB patients and six in-depth interviews with health care workers (HCWs) from primary health centers (PHC), doctors from MDR-TB designated hospitals and MDR-TB patients were conducted. Surveys collected demographic and socio-economic characteristics, as well as factors associated with treatment and case management. In-depth interviews gathered information on treatment and case management experience and adherence behaviors. Results Patient surveys found the two main reasons for poor adherence were negative side-effects from the treatment and busy work schedules. In-depth interviews with key stakeholders found that self-perceived symptom improvement, negative side-effects from treatment and financial difficulties were the main reasons for poor adherence. MDR-TB patients from urban areas, who were unmarried, were female, had migrant status, and whose treatments were supervised by health care workers from primary health clinics, had poorer treatment adherence (P<0.05). Among the MDR-TB patients surveyed, 86.7% received any type of MTCM in general (received any kind of MTCM from HCWs in PHC, MDR-TB designated hospital and centers of disease control/TB dispensaries and 62.50% received MTCM from HCWs in PHC sectors). Patients from suburban areas were more likely to receive both MTCM in general (OR=6.70) and MTCM from HCWs in MDR-TB designated hospitals (OR=2.77), but female patients (OR=0.26) were less likely to receive MTCM from HCWs in PHC sectors, and patients who were not educated about MTCM by TB doctors in designated hospitals were less likely to receive MTCM in general (OR=0.14). Patients who had not been hospitalized were less likely to receive MTCM from HCWs in MDR-TB designated hospitals (OR=0.21). Conclusion Stronger MTCM by HCWs in PHC sectors would improve treatment adherence among MDR-TB patients. Community-based patient-centered models of MTCM in PHC sectors and the use of digital health technology could help to improve case management and thereby improve adherence.
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Affiliation(s)
- Wei Xing
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Rui Zhang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Weixi Jiang
- Duke Kunshan University, Kunshan, Jiangsu, People's Republic of China
| | - Ting Zhang
- Department of Districts and Counties, Chongqing Institute of TB Prevention and Treatment, Chongqing, People's Republic of China
| | - Michelle Pender
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jiani Zhou
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Jie Pu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Shili Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Geng Wang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Yong Chen
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Jin Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Daiyu Hu
- Chongqing Institute of TB Prevention and Treatment, Chongqing, People's Republic of China
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
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Exploiting Inter-Organizational Relationships in Health Care: A Bibliometric Analysis and Literature Review. ADMINISTRATIVE SCIENCES 2020. [DOI: 10.3390/admsci10030057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inter-organizational relationships are high on the health policy agenda. Scholars and practitioners have provided heterogeneous views about the triggers of collaborative practices and the success factors that underpin the sustainability of inter-organizational relationships in the health care domain. The article proposes a literature review aimed at systematizing current scientific research that contextualizes inter-organizational relationships to health care. A mixed approach was undertaken, which consisted of a bibliometric analysis followed by a narrative literature review. A tailored search strategy on Elsevier’s Scopus yielded 411 relevant records, which were carefully screened for inclusion in this study. After screening, 105 papers were found to be consistent with the study purposes and included in this literature review. The findings emphasize that the establishment and implementation of inter-organizational relationships in health care are affected by several ambiguities, which concern both the governance and the structuring of collaborative relationships. The viability and the success of inter-organizational relationships depend on the ability of both central and peripheral partners to acknowledge and address such ambiguities. Failure to do so involves an opportunistic participation to inter-organizational relationships. This endangers conflicting behaviors rather than collaboration among partners.
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Zhang L, Xing W, Zhou J, Zhang R, Cheng Y, Li J, Wang G, Liu S, Li Y. Characteristics of tuberculosis patients in the integrated tuberculosis control model in Chongqing, China: a retrospective study. BMC Infect Dis 2020; 20:576. [PMID: 32758169 PMCID: PMC7404911 DOI: 10.1186/s12879-020-05304-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 07/27/2020] [Indexed: 12/25/2022] Open
Abstract
Background China ranks second in the world in terms of numbers of tuberculosis (TB) cases and is one of the top three countries with the largest number of multidrug-resistant and rifampicin-resistant TB (MDR/RR-TB). It also has high mortality and low cure rates of human immunodeficiency virus (HIV)-positive TB patients. This study aimed to analyse, under the integrated TB control model, the characteristics of TB patients seeking healthcare in the largest designated TB hospital in Chongqing. Methods This was a retrospective study of TB registers in a health facility. Record data of 1827 TB patients who had attended the Chongqing Public Health Medical Center (CPHMC) from 1 January to 31 December 2018 were included. The Statistical Package for Social Science (SPSS 18.0; IBM Corporation, Armonk, NY, USA) was used to analyse the data. Counting data were compared using the chi-square test or Fisher’ s exact test. Among the results of the univariate analysis, the variables with statistical significance were included in the binomial stepwise logistic regression, with odds ratio and 95% confidence interval calculated. A two-tailed probability level of P < 0.05 was considered statistically significant. Results The majority of registered patients were men (1197), of Han ethnicity (1670), aged 21–60 years (1331), farmer/unemployed (1075), and living in county/district (1207). Approximately 24.9% of patients (455/1827) contracted DR-TB, 6% (110/1827) were co-infected with HIV, and 41.0% (749/1827) had drug-related hepatotoxicity. Among those patients, DR-TB was more likely to develop among farmers who received retreatment and had drug-related hepatotoxicity (P < 0.05). Women who received retreatment and lived in county/district were less likely to be HIV positive (P < 0.05). Compared with farmers, patients who were unemployed were more likely to be HIV positive, and those aged 21–60 years had a higher risk of being tested as HIV positive (P < 0.05). Conclusion Farmers who received retreatment and had drug-related hepatotoxicity are more susceptible to DR-TB; young unemployed men have a higher risk of contracting HIV-positive TB. The demographic and clinical characteristics of TB patients should be taken into consideration in DR-TB and HIV-positive TB screening in the future.
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Affiliation(s)
- Liwen Zhang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China.,Chongqing Public Health Medical Center (CPHMC), Chongqing, China
| | - Wei Xing
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Jiani Zhou
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Rui Zhang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Yong Cheng
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Jin Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Geng Wang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Shili Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China.
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Wu S, Khan M, Legido-Quigley H. What steps can researchers take to increase research uptake by policymakers? A case study in China. Health Policy Plan 2020; 35:665-675. [PMID: 32386212 DOI: 10.1093/heapol/czaa025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2020] [Indexed: 11/14/2022] Open
Abstract
Empirical analysis of the connections between research and health policymaking is scarce in middle-income countries. In this study, we focused on a national multidrug-resistant tuberculosis (TB) healthcare provider training programme in China as a case study to examine the role that research plays in influencing health policy. We specifically focused on the factors that influence research uptake within the complex Chinese policymaking process. Qualitative data were collected from 34 participants working at multilateral organizations, funding agencies, academia, government agencies and hospitals through 14 in-depth interviews and 2 focus group discussions with 10 participants each. Themes were derived inductively from data and grouped based on the 'Research and Policy in Developing countries' framework developed by the Overseas Development Institute. We further classified how actors derive their power to influence policy decisions following the six sources of power identified by Sriram et al. We found that research uptake by policymakers in China is influenced by perceived importance of the health issues addressed in the research, relevance of the research to policymakers' information needs and government's priorities, the research quality and the composition of the research team. Our analysis identified that international donors are influential in the TB policy process through their financial power. Furthermore, the dual roles of two government agencies as both evidence providers and actors who have the power to influence policy decisions through their technical expertise make them natural intermediaries in the TB policy process. We concluded that resolving the conflict of interests between researchers and policymakers, as suggested in the 'two-communities theory', is not enough to improve evidence use by policymakers. Strategies such as framing research to accommodate the fast-changing policy environment and making alliances with key policy actors can be effective to improve the communication of research findings into the policy process, particularly in countries undergoing rapid economic and political development.
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Affiliation(s)
- Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore 117549, Singapore
| | - Mishal Khan
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel St., London WC1E 7HT, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore 117549, Singapore.,Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel St., London WC1E 7HT, UK
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10
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Wang Z, Jiang W, Liu Y, Zhang L, Zhu A, Tang S, Liu X. Transforming tuberculosis (TB) service delivery model in China: issues and challenges for health workforce. HUMAN RESOURCES FOR HEALTH 2019; 17:83. [PMID: 31718682 PMCID: PMC6852749 DOI: 10.1186/s12960-019-0420-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/20/2019] [Indexed: 05/20/2023]
Abstract
BACKGROUND China's TB control system has been transforming its service delivery model from CDC (Centers for Disease Control and Prevention)-led model to the designated hospital-led model to combat the high disease burden of TB. The implications of the new service model on TB health workforce development remained unclear. This study aims to identify implications of the new service model on TB health workforce development and to analyze whether the new service model has been well equipped with appropriate health workforce. METHODS The study applied mixed methods in Zhejiang, Jilin, and Ningxia provinces of China. Institutional survey on designated hospitals and CDC was conducted to measure the number of TB health workers. Individual questionnaire survey was conducted to measure the composition, income, and knowledge of health workers. Key informant interviews and focus group discussions were organized to explore policies in terms of recruitment, training, and motivation. RESULTS Zhejiang, Jilin, and Ningxia provinces had 0.33, 0.95, and 0.47 TB health professionals per 10 000 population respectively. They met the national staffing standard at the provincial level but with great variety at the county level. County-designated hospitals recruited TB health professionals from other departments of the same hospital, existing TB health professionals who used to work in CDC, and from township health centers. County-designated hospitals recruited new TB health professionals from three different sources: other departments of the same hospital, CDC, and township health centers. Most newly recruited professionals had limited competence and put on fixed posts to only provide outpatient services. TB doctors got 67/100 scores from a TB knowledge test, while public health doctors got 77/100. TB professionals had an average monthly income of 4587 RMB (667 USD). Although the designated hospital had special financial incentives to support, they still had lower income than other health professionals due to their limited capacity to generate revenue through service provision. CONCLUSIONS The financing mechanism in designated hospitals and the job design need to be improved to provide sufficient incentive to attract qualified health professionals and motivate them to provide high-quality TB services.
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Affiliation(s)
- Ziyue Wang
- China Center for Health Development Studies, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191 China
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, No.38 Xueyuan Road, Haidian District, Beijing, 100191 China
| | - Weixi Jiang
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316 Jiangsu Province China
| | - Yuhong Liu
- Beijing Chest Hospital, Capital Medical University, No. 97 Ma Chang, Tongzhou District, Beijing, 101149 China
- Clinical Centre on Tuberculosis, Chinese Center for Disease Control and Prevention, No. 97 Ma Chang, Tongzhou District, Beijing, 101149 China
| | - Lijie Zhang
- Beijing Chest Hospital, Capital Medical University, No. 97 Ma Chang, Tongzhou District, Beijing, 101149 China
- Clinical Centre on Tuberculosis, Chinese Center for Disease Control and Prevention, No. 97 Ma Chang, Tongzhou District, Beijing, 101149 China
| | - Anna Zhu
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316 Jiangsu Province China
| | - Shenglan Tang
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316 Jiangsu Province China
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191 China
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11
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Wang XX, Chen JY, Jiang H, Zhu AN, Long Q, Ji JS. Utilization and expenses of outpatient services among tuberculosis patients in three Chinese counties: an observational comparison study. Infect Dis Poverty 2019; 8:79. [PMID: 31581953 PMCID: PMC6777024 DOI: 10.1186/s40249-019-0590-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 08/22/2019] [Indexed: 11/19/2022] Open
Abstract
Background The China-Gates TB project Phase II implemented case-based payment reform in three Chinese counties in 2014, designed specifically for patients diagnosed with Tuberculosis (TB). This study aimed to examine the changes in utilization and expenses of outpatient services before and after the reform implementation, among TB patients in the three counties in China. Methods We collected quantitative data using surveys in 2013 (baseline year) and 2015 (final year). We used outpatient hospital records to measure service utilization and medical expenses of TB patients. We conducted qualitative interviews with local health authorities, officers of health insurance agencies, and hospital managers (n = 18). We utilized three focus group discussions with hospital staff and TB doctors and nurses. The χ2 tests and Mann-Whitney U tests were used to analyse quantitative data, and the thematic analysis using a framework approach was applied to analyse qualitative data. Results Dantu and Yangzhong counties enacted TB-specific case-based payment method in 2014. Jurong County maintained global budget payment but raised the reimbursement rate for TB care. Compared to the baseline, the percentage of TB patients in Dantu and Yangzhong with eight or above outpatient visits increased from 7.5 to 55.1% and from 22.1 to 53.1% in the final survey, respectively. Jurong experienced the opposite trend, decreasing from 63.0 to 9.8%. In the final survey, the total outpatient expenses per patient during a full treatment course in Dantu (RMB 2939.7) and Yangzhong (RMB 2520.6) were significantly higher than those in the baseline (RMB 690.4 and RMB 1001.5, respectively), while the total outpatient expenses in Jurong decreased significantly (RMB 1976.0 in the baseline and RMB 660.8 in the final survey). Health insurance agencies in Dantu and Yangzhong did not approve the original design with outpatient and inpatient expenses packaged together, revealed by qualitative interviews. Furthermore, staff at designated hospitals misunderstood that health insurance agencies would only reimburse actual expenses. Many TB doctors complained about their reduced salary, which might be due to decreased hospital revenue generated from TB care after the payment method reform. Conclusions The intended effect on cost containment of case-based payment was not evident in Dantu and Yangzhong. In Jurong, where the global budget payment system maintained with the reimbursement rate enhanced, we found an effect on cost containment, but the quality of TB care might be compromised. The TB-specific case-based payment method could be redesigned to combine payment on outpatient and inpatient expenses and to set an appropriate payment standard for TB care during a full treatment course. Local health insurance agencies have to provide explicit explanations on the payment method. TB care providers should be provided with proper incentives. Monitoring and evluaiton on the quality of TB care should be undertaken at regular intervals. Electronic supplementary material The online version of this article (10.1186/s40249-019-0590-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xuan-Xuan Wang
- School of Health Policy and Management, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166, Jiangsu Province, China
| | - Jia-Ying Chen
- Center for Health Policy Studies, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166, Jiangsu Province, China. .,Creative Health Policy Research Group, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166, Jiangsu Province, China.
| | - Hui Jiang
- Zhenjiang Center for Disease Control and Prevention, No. 9 Huangshan South Road, Zhenjiang, 212004, Jiangsu Province, China
| | - An-Na Zhu
- Environmental Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu Province, China
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu Province, China
| | - John S Ji
- Environmental Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu Province, China.,Nicholas School of the Environment, Duke University, Durham, NC, 27708, USA
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12
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Pu J, Chen W, Jiang WX, Xing W, Liang SX, Wang G, Liu SL, Wu H, Li Y, Tang SL. Is tuberculosis patients management improved in the integrated TB control model in West China? A survey in Guizhou Province, China. Infect Dis Poverty 2019; 8:55. [PMID: 31262368 PMCID: PMC6604227 DOI: 10.1186/s40249-019-0563-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) patient management (TPM) is crucial to improve patient compliance to treatment. The coverage of TPM delivered by TB dispensaries or Centers for Disease Control and Prevention (CDC) was not high under the previous CDC model of TB control in China. In the integrated TB control model in China, TB patient management (TPM) was mainly delivered by lay health workers (LHWs) in primary health care (PHC) sectors. This study aims to investigate TPM delivery in resource-limited western China and to identify factors affecting TPM delivery by LHWs under the integrated TB control model. Methods A stratified random sampling was used to select study sites. Pulmonary TB (PTB) patients ≥15 years old from selected counties/districts in Guizhou Province were surveyed from August 2015 to May 2016. Structured questionnaires were used to collect data. A χ2 test and logistic regression were used to identify factors associated with self-administered treatment (non-TPM). Results In total, 638 PTB patients were included in the final analysis. Close to 30% of patients were ethnic minorities. More than 30% of patients were from counties with high TB burden, and 24.9% of patients had poor compliance to treatment. Only 37.1% of patients received TPM delivered by LHWs under the integrated TB control model throughout the treatment period. The main reasons for unwillingness to manage reported by patients included social stigma and no perceived need. Being ethnic minorities (OR = 3.35) was a main factor associated with lower likelihood of receiving TPM, while living in areas with middle or high TB burden may increase the likelihood of receiving TPM (OR = 0.17 and 0.25, respectively). Among current management approaches, more than 85% of patients chose phone reminder as their preferred TPM by LHWs. Conclusions TPM under the integrated model in West China is still low and need further improvement, and the impeding factors of TPM need to be addressed. Strengthening patient-centered and community-based TPM and developing more feasible approaches of TPM delivery should be explored in future research in this region. Electronic supplementary material The online version of this article (10.1186/s40249-019-0563-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jie Pu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China.,Second Affiliated Hospital, Army Medical University (Third Military Medical University), No. 83 Xinqiao Road, Shapingba District, Chongqing, 400037, China
| | - Wei Chen
- Department of TB Control, Center of Disease Control and Prevention, Guiyang, 550004, Guizhou Province, China
| | | | - Wei Xing
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Sheng-Xiang Liang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Geng Wang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Shi-Li Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Hao Wu
- Second Affiliated Hospital, Army Medical University (Third Military Medical University), No. 83 Xinqiao Road, Shapingba District, Chongqing, 400037, China.
| | - Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China.
| | - Sheng-Lan Tang
- Duke Global Health Institute, Duke University, Durham, NC, 27708-0065, USA
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13
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Raus K, Mortier E, Eeckloo K. Organizing Health Care Networks: Balancing Markets, Government and Civil Society. Int J Integr Care 2018; 18:6. [PMID: 30093844 PMCID: PMC6078116 DOI: 10.5334/ijic.3960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 07/03/2018] [Indexed: 11/20/2022] Open
Abstract
Much is changing in health care organization today. A perspective or paradigm that is gaining ever increasing momentum is that of translational, extramural and integrated care. Current research suggests many potential benefits for integrated care and health care networks but the ethical issues are less frequently emphasized. Showing that integrated care can be beneficial, does not mean it is automatically ethically justified. We will argue for three ethical requirements such health care networks should meet. Subsequently we will look at the mechanisms driving the formation of networks and examine how these can cause networks to meet or fail to meet these ethical requirements or obligations. The three mechanisms we will examine are government, civil society and market mechanisms, which, we argue, should be balanced properly. Each mechanism is able to provide a relevant ethical perspective to health care networks. However, when the balance is skewed towards a single mechanism, health care networks might fail to promote one or more of the ethical requirements.
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Affiliation(s)
- Kasper Raus
- Ghent University Hospital, Ghent, BE
- Department of Philosophy and Moral Sciences, Ghent University, Ghent, BE
| | - Eric Mortier
- Ghent University Hospital, Ghent, BE
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, BE
| | - Kristof Eeckloo
- Ghent University Hospital, Ghent, BE
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, BE
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14
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Yin J, Wang X, Zhou L, Wei X. The relationship between social support, treatment interruption and treatment outcome in patients with multidrug-resistant tuberculosis in China: a mixed-methods study. Trop Med Int Health 2018; 23:668-677. [PMID: 29691959 DOI: 10.1111/tmi.13066] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Multidrug-resistant tuberculosis (MDR-TB) has been a major threat for successful TB control. We examined the relationship between social support and treatment outcomes in MDR-TB patients and evaluated barriers to social support. METHODS Retrospective cohort study with MDR-TB patients enrolled in the Global Fund programme between 1 January 2009 and 30 June 2014 in Zhejiang, China. We reviewed all MDR-TB patients' diagnoses and treatment outcomes. In-depth interviews were conducted with 10 community health workers and 10 patients. Pathway analysis was employed to examine the association between social support and treatment outcomes, and the mediating effect of medication adherence on their relationship. RESULTS Of 218 participants, 144 (66%) were successfully treated and 59 (27%) had poor treatment adherence. Directly observed therapy (DOT) had an indirect positive effect on treatment success, mediating through medication adherence (β = 0.541, P = 0.008; β = 0.538, P < 0.001). Financial support had both a direct (β = 0.769, P < 0.001) and an indirect positive effect on treatment success, which was mediated by a self-reported social support scale (β = 0.541, P = 0.008; β = 0.538, P < 0.001). The interviews indicated poor performance of DOT. Patients often suffered from substantial stigma, but were not provided with psychological support. CONCLUSION DOT and financial support were effective strategies for improving successful treatment outcomes in MDR-TB patients, but they were delivered not considering patients' perspectives. There is an urgent need for consistent and specific psychological support for MDR-TB patients in their communities.
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Affiliation(s)
- Jia Yin
- School of Health Care Management, Shandong University, Shandong, China.,Key Laboratory of Health Economics and Policy Research, NHFPC, Shandong University, Shandong, China.,Center for Health Management and Policy Research, Shandong University, Shandong, China
| | - Xiaomeng Wang
- TB Department, Zhejiang Centre for Disease Control and Prevention, Hangzhou, China
| | - Lin Zhou
- TB Department, Zhejiang Centre for Disease Control and Prevention, Hangzhou, China
| | - Xiaolin Wei
- Division of Clinical Public Health and Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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15
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Auschra C. Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review. Int J Integr Care 2018; 18:5. [PMID: 29632455 PMCID: PMC5887071 DOI: 10.5334/ijic.3068] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 10/31/2017] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION In recent years, inter-organisational collaboration between healthcare organisations has become of increasingly vital importance in order to improve the integration of health service delivery. However, different barriers reported in academic literature seem to hinder the formation and development of such collaboration. THEORY AND METHODS This systematic literature review of forty studies summarises and categorises the barriers to integrated care in inter-organisational settings as reported in previous studies. It analyses how these barriers operate. RESULTS Within these studies, twenty types of barriers have been identified and then categorised in six groups (barriers related to administration and regulation, barriers related to funding, barriers related to the inter-organisational domain, barriers related to the organisational domain, barriers related to service delivery, and barriers related to clinical practices). Not all of these barriers emerge passively, some are set up intentionally. They are not only context-specific, but are also often related and influence each other. DISCUSSION AND CONCLUSION The compilation of these results allows for a better understanding of the characteristics and reasons for the occurrence of barriers that impede collaboration aiming for the integration of care, not only for researchers but also for practitioners. It can help to explain and counteract the slow progress and limited efficiency and effectiveness of some of the inter-organisational collaboration in healthcare settings.
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Affiliation(s)
- Carolin Auschra
- Freie Universität Berlin, Department of Management, Boltzmannstr. 20, 14195 Berlin, DE
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16
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Gebreweld FH, Kifle MM, Gebremicheal FE, Simel LL, Gezae MM, Ghebreyesus SS, Mengsteab YT, Wahd NG. Factors influencing adherence to tuberculosis treatment in Asmara, Eritrea: a qualitative study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:1. [PMID: 29304840 PMCID: PMC5756387 DOI: 10.1186/s41043-017-0132-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/14/2017] [Indexed: 05/02/2023]
Abstract
BACKGROUND Non-adherence to tuberculosis (TB) treatment is an important barrier for TB prevention and control. Poor adherence may result in prolonged disease infectiousness, drug resistance, relapse and death. The aim of this study was to assess factors influencing adherence to tuberculosis treatment in selected health facilities in Asmara, Eritrea. METHODS A qualitative study which included in-depth interviews with 12 TB patients, three focus group discussions in selected health facilities in which one group comprised eight patients and key informant interviews with three health workers. Data analysis was done by translating and transcribing the verbatim of the interviews and focus group discussions. Transcribed data was then analysed using thematic framework procedure. RESULTS This study found that patients lacked knowledge about the cause, transmission and duration of treatment of TB. The most common reason mentioned for discontinuing treatment was the patient "felt cured". Almost half of the respondents did not know the standard treatment duration and the consequences they face if they halt treatment. Patients reported losing their job when their diagnosis was known, were too ill to continue working or unable to find daily work due to time-consuming treatment arrangements. With few exceptions, the majority of patients reported that the short distance to the clinic encouraged them to attend regular treatment follow-up. Most of the respondents were unable to get enough food, leading to stress and feelings of hopelessness. Lack of social support for most of the patients was a critical factor for adherence as were stigma, medication side effects and long treatment duration. Recognized as an enabler to treatment adherence, health workers had good communication and positive attitude towards their patients. CONCLUSION Lack of knowledge, loss of income, stigma and lack of social support, drug side effects and long treatment duration emerged as important barriers for treatment adherence. Short distances to health facilities, good communication and accepting attitude of health care providers emerged as enablers for treatment adherence. For better treatment adherence, comprehensive health education at treatment sites, patient's family members and the community at large and strengthening of social support structures need to be addressed.
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Affiliation(s)
| | - Meron Mehari Kifle
- Department of Epidemiology and Biostatistics, School of Public Health, Asmara College of Health Sciences, Asmara, Eritrea
| | | | - Leban Lebahati Simel
- Department of Epidemiology and Biostatistics, School of Public Health, Asmara College of Health Sciences, Asmara, Eritrea
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17
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Zhu Y, Wu J, Feng X, Chen H, Lu H, Chen L, Luo L, Rui C. Patient characteristics and perceived health status of individuals with HIV and tuberculosis coinfection in Guangxi, China. Medicine (Baltimore) 2017; 96:e6475. [PMID: 28383411 PMCID: PMC5411195 DOI: 10.1097/md.0000000000006475] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To explore demographics, clinical and medication profiles, patients' social support, and perceived health status in HIV/TB coinfected patients in Guangxi, China.We performed a cross-sectional study in the HIV clinic of the Guigang City People's Hospital (N = 150). Health professionals conducted face-to-face interviews and collected data from patients' electronic medical records regarding patients' demographic, clinical, and medication information, as well as their social support and perceived health status. We classified all HIV/AIDS patients into HIV monoinfected and TB coinfected, at a ratio of 2:1.Compared with the HIV monoinfected, patients with HIV/TB coinfection were more likely to be older, male, less educated, unemployed, carrying health insurance, having advanced stage of HIV infection, longer history with HIV, and other opportunistic infections. Patients coinfected with TB were also more likely to hold a negative belief that their HIV treatment could prevent exacerbations, and reported significantly worse emotional/informational support, social interaction, and perceived health status. Better social support and better self-efficacy to the HIV treatment adherence was significantly associated with better perceived health status among patients with HIV and TB coinfection.Having HIV/TB coinfection was associated with poorer perceived general well-being and mental health, particularly in those undergoing TB therapy. Our findings suggest the need for mental health referrals and medication management for coinfected individuals, as well as further efforts and policies to improve coordinated care.
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Affiliation(s)
- Yujia Zhu
- Department of Infection, Eighth Affiliated Hospital of Guangxi Medical University, Guigang City People's Hospital, Guigang
| | - Jizhou Wu
- Department of Infection, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xue Feng
- School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Huanhuan Chen
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning
| | - Huaxiang Lu
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning
| | - Li Chen
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning
| | - Liuhong Luo
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning
| | - Chao Rui
- Department of Infection, Eighth Affiliated Hospital of Guangxi Medical University, Guigang City People's Hospital, Guigang
- Guangxi University of Chinese Medicine, Nanning, Guangxi, China
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18
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Zhong J, Yin J, Zou G, Hu Y, Walley J, Wang X, Chen S, Wei X. Experience of implementing the integrated TB model in Zhejiang, China: a retrospective observational study. Trans R Soc Trop Med Hyg 2016; 110:246-51. [PMID: 26850456 DOI: 10.1093/trstmh/trw001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/23/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aims to assess the implementation of the TB control program under the integrated model in China where TB diagnosis and treatment is provided in TB designated hospitals. METHODS Six counties under the integrated model in Zhejiang were randomly selected. TB referral and tracing was analyzed based on routine TB reporting data between January and December 2009 from county TB dispensaries. Regarding treatment and community management, we conducted face-to-face surveys with 50 new TB patients randomly selected from each county, and reviewed their medical charts. RESULTS A total of 7090 persons with presumptive TB were reported in 2009, of whom, 66.7% (4732/7090) were referred by other health facilities to TB designated hospitals, while 80.2% (3795/4732) were successfully referred. In total, 301 patients were surveyed and had a median medical expenditure of US$192. Ten percent (31/301) missed at least one dose during their treatment, and 64.5% (194/301) received direct observation, mostly by family members. CONCLUSIONS The integrated model performed better on case referral and community management, but higher medical expenditures than those reported by studies under the dispensary model in China. Clear guidelines should be issued on supervising TB treatment in designated hospitals.
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Affiliation(s)
- Jieming Zhong
- TB department, Zhejiang Centre for Disease Control and Prevention, Hangzhou, 310051, China
| | - Jia Yin
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, N.T., China
| | - Guanyang Zou
- China Global Health Research and Development, Hong Kong SAR, and Shenzhen, 250012, China
| | - Yanhong Hu
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, N.T., China
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, LS2 9JT, UK
| | - Xiaomeng Wang
- TB department, Zhejiang Centre for Disease Control and Prevention, Hangzhou, 310051, China
| | - Songhua Chen
- TB department, Zhejiang Centre for Disease Control and Prevention, Hangzhou, 310051, China
| | - Xiaolin Wei
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, N.T., China Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada
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Huang F, Zhang H, Lv Q, Sato KD, Qu Y, Huan S, Cheng J, Zhao F, Wang L. Use of anti-tuberculosis drugs among newly diagnosed pulmonary tuberculosis inpatients in China: a retrospective study. Infect Dis Poverty 2016; 5:2. [PMID: 26792535 PMCID: PMC4720996 DOI: 10.1186/s40249-016-0098-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/04/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND China's national tuberculosis control program (NTP) provides free, first-line anti-tuberculosis (TB) drugs to pulmonary TB patients. This treatment regimen follows the World Health Organization's (WHO) guideline. The objective of this paper is to evaluate the current status of anti-TB drug use for newly diagnosed pulmonary TB inpatients treated in prefecture- and county-level designated hospitals. METHODS Three prefecture-level hospitals and nine county-level hospitals were selected for the study. All newly diagnosed pulmonary TB inpatient medical records from 2012 were reviewed and doubly examined by two national senior physicians. The rational use of anti-TB drugs was evaluated based on criteria in line with WHO's guideline. RESULTS Of the 2,060 total treatment regimens for TB, 53.1 % were found to be rational (1093/2060). The percentages in prefecture-level and county-level hospitals were 50.3 % (761/1513) and 60.7 % (332/547), respectively. The difference between the two levels of hospitals was statistically significant (Chi-square value = 17.44, P < 0.01). The percentages of rational treatment regimens for first-time hospitalizations and for two or more hospitalizations were 59.5 % (983/1653) and 27.0 % (110/407), respectively, with a statistically significant difference (Chi-square value = 138.00, P < 0.01). The overall use of second-line drugs (SLD) was 54.9 % (1131/2060). The percentages for prefecture-level and county-level hospitals were 50.6 % (766/1513) and 66.7 % (365/547), respectively. A statistically significant difference was found (Chi-square value = 42.06, P < 0.01). The use of SLD for inpatients hospitalized once and inpatients hospitalized twice or more was 58.4 % (966/1653) and 40.5 % (165/407), respectively, with a statistically significant difference (Chi-square value = 42.26, P < 0.01). CONCLUSIONS Half of inpatients might be treated with irrational regimens, and the use of SLD was more appropriately dispensed in city-level hospitals than in county-level hospitals. Trainings and guidelines for health personnel, supervision led by health authorities and increased investment to designated hospitals may help to improve the rational use of anti-TB drugs.
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Affiliation(s)
- Fei Huang
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Hui Zhang
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Qing Lv
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | | | - Yan Qu
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Shitong Huan
- Bill & Melinda Gates Foundation, Beijing office, Beijing, China.
| | - Jun Cheng
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Fei Zhao
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Lixia Wang
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
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Tuberculosis Hospitalization Fees and Bed Utilization in China from 1999 to 2009: The Results of a National Survey of Tuberculosis Specialized Hospitals. PLoS One 2015; 10:e0139901. [PMID: 26457980 PMCID: PMC4601762 DOI: 10.1371/journal.pone.0139901] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 09/19/2015] [Indexed: 11/19/2022] Open
Abstract
Background China is transitioning towards concentrating tuberculosis (TB) diagnostic and treatment services in hospitals, while the Centers of Disease Control and Prevention (CDC) system will retain important public health functions. Patient expenditure incurred through hospitalization may lead to barriers to TB care or interruption of treatment. Methodology/Principal Findings We conducted a national survey of TB specialized hospitals to determine hospitalization fees and hospital bed utilization in 1999, 2004, and 2009. Hospitalization of TB patients increased 185.3% from 1999 to 2009. While the average hospitalization fees also increased, the proportion of those fees in relation to GDP per capita decreased. Hospitalization fees differed across the three regions (eastern, central, and western). Using a least standard difference (LSD) paired analysis, in 2004, the difference in hospitalization fees was significant when comparing eastern and central provinces (p<0.001) as well as to western provinces (p<0.001). In 2009, the difference remained statistically significant when comparing eastern province hospitalization fees with central provinces (p<0.001) and western provinces (p = 0.008). In 2004 and 2009, the cost associated with hospitalization as a proportion of GDP per capita was highest in the western region. The average in-patient stay decreased from 33 days in 1999 to 26 and 27 days in 2004 and 2009 respectively. Finally, hospital bed utilization in all three regions increased over this period. Conclusions/Significance Our findings show that both the total number of in-patients and hospitalization fees increased from 1999 to 2009, though the proportion of hospitalization fees to GDP per capita decreased. As diagnostic services move to hospitals, regulatory and monitoring mechanisms should be established, and hospitals should make use of the experience garnered by the CDC system through continued strong collaborations. Infrastructure and social protection mechanisms in high burden areas, such as in the western region, should be strengthened.
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Zou G, King R, Walley J, Yin J, Sun Q, Wei X. Barriers to hospital and tuberculosis programme collaboration in China: context matters. Glob Health Action 2015; 8:27067. [PMID: 26408404 PMCID: PMC4583609 DOI: 10.3402/gha.v8.27067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 07/17/2015] [Accepted: 08/24/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In many developing countries, programmes for 'diseases of social importance', such as tuberculosis (TB), have traditionally been organised as vertical services. In most of China, general hospitals are required to report and refer suspected TB cases to the TB programme for standardised diagnosis and treatment. General hospitals are the major contacts of health services for the TB patients. Despite the implementation of public-public/private mix, directly observed treatment, short-course, TB reporting and referral still remain a challenge. OBJECTIVE This study aims to identify barriers to the collaboration between the TB programme and general hospitals in China. DESIGN This is a qualitative study conducted in two purposefully selected counties in China: one in Zhejiang, a more affluent eastern province, and another in Guangxi, a poorer southwest province. Sixteen in-depth interviews were conducted and triangulated with document review and field notes. An open systems perspective, which views organisations as social systems, was adopted. RESULTS The most perceived problem appeared to be untimely reporting and referral associated with non-standardised prescriptions and hospitalisation by the general hospitals. These problems could be due to the financial incentives of the general hospitals, poor supervision from the TB programme to general hospitals, and lack of technical support from the TB programme to the general hospitals. However, contextual factors, such as different funding natures of different organisations, the prevalent medical and relationship cultures, and limited TB funding, could constrain the processes of collaboration between the TB programme and the general hospitals. CONCLUSIONS The challenges in the TB programme and general hospital collaboration are rooted in the context. Improving collaboration should reduce the potential mistrust of the two organisations by aligning their interests, improving training, and improving supervision of TB control in the hospitals. In particular, effective regulatory mechanisms are crucial to alleviate the negative impact of the contextual factors and ensure smooth collaboration.
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Affiliation(s)
- Guanyang Zou
- China Programme, COMDIS Health Services Delivery Research Consortium, University of Leeds, Shenzhen, China
- Institute for International Health and Development, Queen Margaret University, Edinburgh, UK
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Jia Yin
- Devision of Health System, Policy and Management, School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Qiang Sun
- Centre for Health Policy and Management, School of Public Health, Shandong University, Jinan, China
| | - Xiaolin Wei
- Devision of Health System, Policy and Management, School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China;
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Valentijn PP, Boesveld IC, van der Klauw DM, Ruwaard D, Struijs JN, Molema JJW, Bruijnzeels MA, Vrijhoef HJ. Towards a taxonomy for integrated care: a mixed-methods study. Int J Integr Care 2015; 15:e003. [PMID: 25759607 PMCID: PMC4353214 DOI: 10.5334/ijic.1513] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/09/2015] [Accepted: 01/20/2015] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Building integrated services in a primary care setting is considered an essential important strategy for establishing a high-quality and affordable health care system. The theoretical foundations of such integrated service models are described by the Rainbow Model of Integrated Care, which distinguishes six integration dimensions (clinical, professional, organisational, system, functional and normative integration). The aim of the present study is to refine the Rainbow Model of Integrated Care by developing a taxonomy that specifies the underlying key features of the six dimensions. METHODS First, a literature review was conducted to identify features for achieving integrated service delivery. Second, a thematic analysis method was used to develop a taxonomy of key features organised into the dimensions of the Rainbow Model of Integrated Care. Finally, the appropriateness of the key features was tested in a Delphi study among Dutch experts. RESULTS The taxonomy consists of 59 key features distributed across the six integration dimensions of the Rainbow Model of Integrated Care. Key features associated with the clinical, professional, organisational and normative dimensions were considered appropriate by the experts. Key features linked to the functional and system dimensions were considered less appropriate. DISCUSSION This study contributes to the ongoing debate of defining the concept and typology of integrated care. This taxonomy provides a development agenda for establishing an accepted scientific framework of integrated care from an end-user, professional, managerial and policy perspective.
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Affiliation(s)
- Pim P Valentijn
- Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg, The Netherlands
| | - Inge C Boesveld
- The Netherlands Expert Centre Integrated Primary Care, Jan van Es Institute, Almere, The Netherlands
| | | | - Dirk Ruwaard
- Public Health and Health Care Innovation, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Marc A Bruijnzeels
- The Netherlands Expert Centre Integrated Primary Care, Jan van Es Institute, Almere, The Netherlands
| | - Hubertus Jm Vrijhoef
- Chronic Care, Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg, The Netherlands
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Wei X, Zou G, Yin J, Walley J, Zhang X, Li R, Sun Q. Effective reimbursement rates of the rural health insurance among uncomplicated tuberculosis patients in China. Trop Med Int Health 2014; 20:304-11. [PMID: 25430477 DOI: 10.1111/tmi.12438] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE China has established universal health coverage for 830 million rural residents through the rapid expansion of the New Cooperative Medical Scheme (NCMS). This study accesses the effective reimbursement rates of NCMS among patients with tuberculosis (TB) who lived in counties where their schemes covered costs within TB dispensaries and those who did not. METHODS We randomly selected 50 patients with uncomplicated TB from each of the eight counties in two provinces. We reviewed all patient clinical charts and conducted face-to-face surveys. Effective reimbursement was measured as the proportion of patients who received reimbursement from NCMS and the average reimbursement rate of total medical costs. RESULTS A total of 393 patients with TB were included with 186 from Zhejiang and 206 from Sichuan. In the covered group, only 41% of patients with TB received reimbursements for medical costs in TB dispensary in Zhejiang as compared to 84% in Sichuan, because patients in Zhejiang needed to keep their bills and claim later, while Sichuan had patient medical costs automatically deducted at the point of care. Patients in the covered group had a significantly higher average reimbursement rate compared with those in the uncovered group (13% vs. 8% in Zhejiang and 17% vs. 12% in Sichuan). For all patients, the biggest cost was due to hospitalisation, and their overall reimbursement rates were low. CONCLUSION New Cooperative Medical Scheme has not relieved the financial burden of TB-related medical costs. NCMS should cover costs in TB dispensaries. Measures are also needed to minimise unnecessary hospitalisation, and lower the barriers to claims.
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Affiliation(s)
- Xiaolin Wei
- The Chinese University of Hong Kong, Hong Kong, China
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Wei X, Zou G, Walley J, Yin J, Lonnroth K, Uplekar M, Wang W, Sun Q. China tuberculosis policy at crucial crossroads: comparing the practice of different hospital and tuberculosis control collaboration models using survey data. PLoS One 2014; 9:e90596. [PMID: 24621996 PMCID: PMC3951218 DOI: 10.1371/journal.pone.0090596] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/30/2014] [Indexed: 11/28/2022] Open
Abstract
Background Currently three hospital and tuberculosis (TB) collaboration models exist in China: the dispensary model where TB has to be diagnosed and treated in TB dispensaries, the specialist model where TB specialist hospital also treat TB patients, and the integrated model where TB diagnosis and treatment is integrated into a general hospital. The study compared effects of the three models through exploring patient experience in TB diagnosis and treatment. Methods We selected two sites in each model of TB service in four provinces of China. In each site, 50 patients were selected from TB patient registries for a structured questionnaire survey, with a total of 293 patients recruited. All participants were newly registered uncomplicated TB cases without any major complications or resistance to first-line anti-TB drugs, and having successfully completed treatment. Diagnostic and treatment procedures were reviewed from medical charts of the surveyed patients to compare with national guidelines. Results Specialist sites had the highest patient expenditure, hospitalization rates and mostly used second-line anti-TB drugs, while the integrated model reported the opposite. The median health expenditure was USD 1,499 for the specialist sites and USD 306 for the integrated sites, with 83% and 15% patients respectively having unnecessary hospitalization. 74% of the specialist sites and 19% of the integrated sites used second-line anti-TB drugs. Mixed results were identified in the two dispensary sites. One site had median health expenditure of USD 138 with 12% of patients hospitalized, while the other had USD 912 and 65% respectively. Conclusion The study observed prohibitive financial expenditure and a high level of deviation from national guidelines in all sites, which may be related to the profit-seeking behavior of public hospitals. The study supports the integrated model as the better policy option for future TB health reform in China.
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Affiliation(s)
- Xiaolin Wei
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Guanyang Zou
- China HSD Program, Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Jia Yin
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Knut Lonnroth
- Global TB Programme, the World Health Organization, Geneva, Switzerland
| | - Mukund Uplekar
- Global TB Programme, the World Health Organization, Geneva, Switzerland
| | - Weibing Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Qiang Sun
- Center for Health Management and Policy, Shandong University, Jinan, China
- * E-mail:
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Wei X, Yin J, Zou G, Walley J, Zhong J, Chen S, Sun Q, Wang X. Patient care pathways under the model of integrating tuberculosis service with general hospitals in China. Trop Med Int Health 2013; 18:1392-9. [PMID: 24107010 DOI: 10.1111/tmi.12197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report care pathways of tuberculosis (TB) patients under the integrated model, where TB clinical service is provided by a general hospital instead of the TB dispensary, with the aim of providing policy recommendations for TB care reforms in China. METHODS Six counties implementing the integrated model were randomly selected, and 50 TB patients in each county participated in a questionnaire survey. RESULTS Of the 301 participants, 82 visited only the TB designated hospital. A patient visited a median of two health providers in total. The median external provider delay and internal provider delay were 1 and 0 day, respectively. The median out-of-pocket medical costs were US$379 in total; US$293 in the TB units and US$0 in other health units in the TB designated hospital. Logistic regression analyses suggested that patients who visited the primary care facilities first tended to have longer external delays (OR = 5.71) than patients who visited the other hospitals (OR = 10.16). CONCLUSION The integrated model is promising as it reported relatively fewer patient pathways and shorter delays than the dispensary model. However, the integrated model did not reduce patient out-of-pocket costs.
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Affiliation(s)
- Xiaolin Wei
- The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Municipal Key Laboratory for Health Risk Analysis, Shenzhen Research Institute of The Chinese University of Hong Kong, Shenzhen, Guangdong Province, China
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Wei X, Zou G, Yin J, Walley J, Sun Q. Comparing patient care seeking pathways in three models of hospital and TB programme collaboration in China. BMC Infect Dis 2013; 13:93. [PMID: 23425261 PMCID: PMC3598790 DOI: 10.1186/1471-2334-13-93] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 02/06/2013] [Indexed: 11/10/2022] Open
Abstract
Background Public hospitals in China play an important role in tuberculosis (TB) control. Three models of hospital and TB control exist in China. The dispensary model is the most common one in which a TB dispensary provides both clinical and public health care. The specialist model is similar to the former except that a specialist TB hospital is located in the same area. The specialist hospital should treat only complicated TB cases but it also treats simple cases in practice. The integrated model is a new development to integrate TB service in public hospitals. Patients were diagnosed, treated and followed up in this public hospital in this model while the TB dispensary provides public health service as case reporting and mass education. This study aims to compare patient care seeking pathways under the three models, and to provide policy recommendation for the TB control system reform in China. Methods Six sites, two in each model, were selected across four provinces, with 293 newly treated uncomplicated TB patients being randomly selected. Results The majority (68%) of TB patients were diagnosed in hospitals. Patients in the integrated model presented the simplest care seeking pathways, with the least number of providers visited (2.2), shortest treatment delays (2 days) and the least medical expenditure (2729RMB/401USD). On the contrary, patients in the specialist model had the highest number of provider visits (4), longest treatment delays (23 days) and the highest medical expenditure (11626RMB/1710USD). Logistic regression suggested that patients who were hospitalised tended to have longer treatment delays and higher medical expenditure. Conclusion Specialist hospital treating uncomplicated cases not using the standard regimens posed a threat to TB control. The integrated model has shortened patient treatment pathways, and reduced patient costs; therefore, it could be considered as the direction for future reform of China’s TB control system.
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Affiliation(s)
- Xiaolin Wei
- School of Public Health and Primary Care, The Chinese University of Hong Kong, 2/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, Hong Kong, N.T, China
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Soomro MH, Qadeer E, Mørkve O. Barriers in the management of tuberculosis in rawalpindi, pakistan: a qualitative study. TANAFFOS 2013; 12:28-34. [PMID: 25191481 PMCID: PMC4153264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 12/22/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Tuberculosis (TB) is a contagious, airborne disease and remains a major global public health hazard. TB is a major cause of mortality and is affecting millions of people in low-income and middle-income countries. Worldwide, one person out of three is infected with the Mycobacterium tuberculosis. Timely diagnosis and treatment are the two key factors for better outcomes. Non-adherence to TB treatment is an important barrier for TB control programs. This study was designed to understand the barriers encountered by TB patients when seeking health care. MATERIALS AND METHODS A qualitative study was conducted during the months of August and December 2010 on 15 health facilities. In-depth interviews were conducted with 23 TB patients (13 males and 10 females) aged 15-65 years. In addition, 15 health personnel were also interviewed. RESULTS Most patients were found to be well informed about the idea of taking TB medications under direct supervision and its overall importance. However, many of them were not convinced with either drugs or treatment protocols. We found that limited knowledge of patients, loss of employment, financial burden, social stigma and long distance from health facility were the main barriers for TB adherence. CONCLUSION More patient-centred interventions and attention to the barriers are required to improve the treatment adherence. Direct observation of patients and regular home visits by health workers can reduce the risk of non-adherence.
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Affiliation(s)
- Munawar Hussain Soomro
- Department of Community Medicine, Al-Nafees Medical College, Isra University-Islamabad Campus, Pakistan ; Centre for International Health, University of Bergen, Norway
| | | | - Odd Mørkve
- Centre for International Health, University of Bergen, Norway
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