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Zhong C, Huang J, Li L, Luo Z, Liang C, Zhou M, Hu N, Kuang L. Relationship between patient-perceived quality of primary care and self-reported hospital utilisation in China: A cross-sectional study. Eur J Gen Pract 2024; 30:2308740. [PMID: 38407121 PMCID: PMC10898267 DOI: 10.1080/13814788.2024.2308740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/15/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Reducing avoidable hospital admissions is a global healthcare priority, with optimal primary care recognised as pivotal for achieving this objective. However, in developing systems like China, where primary care is evolving without compulsory gatekeeping, the relationship between patient-perceived primary care quality and hospital utilisation remains underexplored. OBJECTIVES This study aimed to explore the association between patient-perceived primary care quality and self-reported hospital utilisation in China. METHODS Data were collected from 16 primary care settings. Patient-perceived quality of primary care was measured using the Assessment Survey of Primary Care scale across six domains (first-contact care, continuity, comprehensiveness, accessibility, coordination, and patient-centredness). Hospital utilisation included patient self-reported outpatient visits, hospital admissions, and emergency department (ED) visits in the last six months. Logistic regression analyses were examined associations between self-reported hospital utilisation and perceived primary care quality adjusted for potential confounders. RESULTS Of 1,185 patients recruited, 398 (33.6%) reported hospital utilisation. Logistic regression analyses showed that higher total scores for patient-perceived quality of primary care were associated with decreased odds of hospital utilisation (adjusted odds ratio(AOR): 0.417, 95% confidence interval (CI): 0.308-0.565), outpatient visits (AOR: 0.394, 95% CI: 0.275-0.566) and hospital admissions (AOR: 0.496, 95% CI: 0.276-0.891). However, continuity of care was positively associated with ED visits (AOR: 2.252, 95% CI: 1.051-4.825). CONCLUSION Enhanced patient-perceived quality of primary care in China is associated with a reduction in self-reported overall hospital utilisation, including outpatient visits and hospital admissions. However, better continuity of care may be associated with increased ED visits. Further research is warranted for precise insights and validation of these findings.
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Affiliation(s)
- Chenwen Zhong
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Junjie Huang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Lina Li
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhuojun Luo
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Cuiying Liang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Mengping Zhou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Nan Hu
- Department of Family and Preventive Medicine, and Population Health Sciences, University of UT School of Medicine, Salt Lake City, UT, USA
| | - Li Kuang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
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Maddigan K, Kowalski KL, Tawiah AK, Rushton AB. The educational pathway to Advanced Practice for the physiotherapist: Protocol for a systematic mixed studies review. PLoS One 2024; 19:e0308921. [PMID: 39331670 PMCID: PMC11432879 DOI: 10.1371/journal.pone.0308921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/31/2024] [Indexed: 09/29/2024] Open
Abstract
RATIONALE Advanced Practice Physiotherapy (APP) is a post-licensure higher level of practice that requires distinctly increased skills, clinical reasoning and experience. The four pillars that underpin APP are clinical practice, leadership, education and research. Multiple systematic reviews support that APP is beneficial to health care systems. While APP exists in over a dozen countries, it has yet to reach international recognition. A steppingstone in gaining global acknowledgement is understanding the educational pathway that physiotherapists traverse to become Advanced Practitioners. No systematic review has synthesized evidence to describe and evaluate the educational pathway for physiotherapists to APP. Therefore, the objectives of this review are 1) to describe the post-licensure educational pathways that physiotherapists engage in to advance their level of practice, 2) to evaluate the pillars of APP demonstrated by the physiotherapist after traversing a post-licensure educational pathway. MATERIALS AND METHODS A systematic mixed studies review using a data based convergent qualitative synthesis design will be conducted. MEDLINE (Ovid), Embase, CINAHL, the Cochrane Library, Web of Science, PEDro, SportDiscus, ProQuest Education databases as well as the grey literature will be searched from inception to 02/29/2024. Studies that aim to describe and or evaluate the capacity of educational pathways to influence the level of practice of the physiotherapist will be included. Two independent reviewers will screen studies, extract data and assess methodological quality (Quality Assessment of Diverse Studies). Quantitative data will be 'qualitized', and all data will be synthesized via a clustered textual description and directed content analysis. After synthesis, two reviewers will assess confidence in the cumulative evidence (GRADE-CERQual), which will inform the discussion. IMPLICATIONS The optimal pathway(s) to Advanced Practice for the physiotherapist will be evaluated to inform future high-quality research investigating the effectiveness of post-licensure education in developing Advanced Practice physiotherapists.
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Affiliation(s)
- Kaitlyn Maddigan
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Katie L Kowalski
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Andrews K Tawiah
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Alison B Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
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López García A, Barber Pérez P. [Systematic review of the primary care quality assessment instruments used in the last 10 years]. Aten Primaria 2024; 56:103046. [PMID: 39018797 PMCID: PMC11305259 DOI: 10.1016/j.aprim.2024.103046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVE There are numerous instruments in the scientific literature for the evaluation of the quality of Primary Care (PC) and to know which of them are the most used and in which countries provides more information to make a well-founded decision. The aim is to determine which, between 2013 and 2023, have been the instruments used to assess the international quality of PC, its evolution and geographical distribution. DESIGN Systematic review. DATA SOURCES PubMed and Embase. From March to December 2023. INCLUSION CRITERIA 1) Validation studies of specific assessment instruments to measure the quality of PC and/or the satisfaction of patients, providers or managers. 2) carried out in the field of PC and 3) published between 1/01/2013 and 01/02/2023. 83 full-text articles were included. DATA EXTRACTION From each publication, an instrument used to evaluate the quality of the PC, attributes of the PC it evaluates, recipient of the evaluation, user, provider or manager, year, and country. RESULTS Fifteen PC assessment instruments were found. The most widely used is the Primary Care Assessing Tool (PCAT), with wide geographical distribution, versions in several languages, is more limited in Europe, except in Spain, and is mostly used in the Primary Care Assessing Tool (PCAT). CONCLUSIONS The PCAT, due to its cultural adaptability, availability in several languages, its ability to evaluate the fundamental principles of PC enunciated by the World Health Organization and to contemplate the perspectives of all health agents, is a complete, versatile, and consistent questionnaire for the evaluation of the quality of PC.
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Affiliation(s)
- Alberto López García
- Facultad de Ciencias Económicas, Campus de Tafira, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España.
| | - Patricia Barber Pérez
- Profesora titular de universidad, Departamento de Métodos Cuantitativos, Facultad de Ciencias Económicas, Campus de Tafira, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
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Lu J, Yang H, Shi L, Sheng X, Huo Y, Liu R, Hu R. Associations between Primary Healthcare Experiences and Glycemic Control Status in Patients with Diabetes: Results from the Greater Bay Area Study, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1120. [PMID: 36673874 PMCID: PMC9859184 DOI: 10.3390/ijerph20021120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/29/2022] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Primary healthcare (PHC) plays an important role in diabetes management; community health centers (CHCs) serve as the main providers of PHC. However, few studies have discussed the association between the service quality of PHC and the effects of diabetes management. In this study, we explored the associations between experiences of PHC in CHCs and glycemic control status in patients with diabetes mellitus. This study was conducted in six CHCs in the Greater Bay Area of China. In total, 418 patients with diabetes mellitus (44% males and 56% females) were recruited between August and October 2019. We evaluated their PHC experiences using the Primary Care Assessment Tool (PCAT) developed by Johns Hopkins and assessed their glycemic control status by measuring their fasting plasma glucose levels. Binary logistic regression analyses were conducted to assess the associations between the patients’ PHC experiences and glycemic control status, adjusting for covariates. The patients with good glycemic control had significantly higher total and dimensional PCAT scores compared with those with poor glycemic control (p < 0.05). Higher PCAT scores were significantly associated with a greater adjusted odds ratios (aORs) of good glycemic control for total and dimensional PCAT scores. For example, compared to those with poor glycemic control, the aORs for those with good glycemic control was 8.82 (95% CI = 4.38−17.76) per total PCAT score increasing. Especially, the aORs for those with good glycemic control were 3.92 (95% CI = 2.38−6.44) and 4.73 (95% CI = 2.73−8.20) per dimensional PCAT score of family-centeredness and community orientation increasing, respectively. Better PHC experiences were associated with better diabetes management. In particular, family-centered and community-oriented CHCs may help improve diabetes management in China and other low- and middle-income countries.
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Affiliation(s)
- Junfeng Lu
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Hui Yang
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
| | - Leiyu Shi
- John Hopkins School of Public Health, Baltimore, MD 21205, USA
| | - Xia Sheng
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yongjun Huo
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ruqing Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ruwei Hu
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
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Continuity of Care and Healthcare Costs among Patients with Chronic Disease: Evidence from Primary Care Settings in China. Int J Integr Care 2022; 22:4. [PMID: 36310688 PMCID: PMC9562970 DOI: 10.5334/ijic.5994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Though critical to primary care, continuity of care has rarely been examined in China. This study aims to assess the relationship between continuity of care and healthcare costs among patients with chronic diseases within primary care settings in China. Methods: In this cross-sectional study, we used a social health insurance claims dataset of 1406 patients with hypertension and/or diabetes in Yuhuan City, Zhejiang Province collected in 2017–2019. We measured continuity of care using the Bice-Boxerman Continuity of Care (COC) Index, Herfindahl Index (HI), Sequential Continuity of Care (SECON) Index, Usual Provider of Care (UPC), and a binary variable indicating whether a patient’s UPC was a primary care provider. We examined the associations between continuity of care and healthcare costs in the same period and the subsequent year, using ordinary least squares regression for the outpatient costs and two-part regression for the inpatient costs. Based on the regression coefficients, we predicted costs saved if each continuity measure was set to 1 from the status quo. Results: When optimum continuity were to be achieved, 7.12–27.29% of total outpatient costs and 55.38–73.35% of total inpatient costs could be saved compared to the status quo during the two-year study period. If optimum continuity were to be achieved in the first year, 7.47%–21.78% of total outpatient costs and 8.84–40.22% of total inpatient costs could be saved in the second-year. Conclusions: Care continuity indicators were consistently associated with reduced outpatient costs and hospitalization risks. Future health reform in China should further enhance continuity of care in primary care.
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Myles SM, Wenghofer EF, Ellaway RH, Yeo MT. Ontario family physicians’ perspectives about their scope of practice: what is it, what drives it and how does it change? BMC PRIMARY CARE 2022; 23:251. [PMID: 36162984 PMCID: PMC9511454 DOI: 10.1186/s12875-022-01833-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/19/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
There is little evidence to show what scope of practice (SOP) means from the point of view of family physicians, how family physicians think about their SOP as it changes over time, or what factors shape and influence their SOP. Understanding family physician perspectives on SOP and the factors that influence it can aid our understanding of how it can constrain and enable physicians’ agency and autonomy in professional practice.
Methods
Using qualitative description and incorporating constructivist grounded theory data collection and analysis techniques, four focus groups were conducted involving twenty-four Ontario-based family physicians from different contexts, at different career stages, and with different practice experiences.
Results
Participants’ SOP was highly dynamic, changing throughout their careers due to factors both within and beyond their control. Their sense of their own SOP was the product of a continuous cycle of personal and professional transitions, exposures, and experiences throughout their careers. These family physicians sought regular and sustained mentorship, support, and engagement for their SOP throughout their careers. This was particularly the case during professional transitions and for drivers of their SOP for which they felt unprepared early in their careers, such as through the first years of independent practice, and when functioning as owner-operators of medical practices. Four descriptive themes were identified focusing on the nature of their current practice, their professional preparedness and supports, practice management dynamics, and ‘doctors are people, too’.
Conclusions
The SOP of the family physicians in this study was dynamic and unique to each individual, it emerged from interactions between their personal and professional lives and identities, and it was embedded in their lived experiences. SOP was also to some extent imposed and externally driven. This study advances understanding by exploring the ‘why’ and ‘how’ of SOP rather than focusing solely on what it is.
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Xu J, Zhou Y, Liu R, Cheng F, Liang W. Primary Health Institutions and Service Quality in China: Implications for Health Policy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12063. [PMID: 36231364 PMCID: PMC9565038 DOI: 10.3390/ijerph191912063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND To protect and improve the health of populations, the important role of primary health institutions has been strengthened through a series of health policies, especially the implementation of a national hierarchical diagnosis and treatment system. In this light, we aim to evaluate the development of primary health institutions between 2013, before the implementation of the hierarchical diagnosis and treatment system, and 2020 as well as people's perception of the quality of primary healthcare services. METHOD The national-level data (e.g., the numbers of primary health institutions, personnel, beds, visits, and hospitalizations) regarding primary health institutions were collected from the Health Statistics Yearbook, and the perceptions of the quality of primary healthcare services were collected by a web-based questionnaire survey using an internationally recognized assessment tool (i.e., PCAT-AE). In total, 10,850 persons were surveyed, and 10,419 participants were incorporated into the final analysis after removing invalid questionnaires. A descriptive statistical analysis (i.e., frequency and percentage) was used to analyze the national-level characteristics of primary health institutions and people's perceptions of the quality of primary healthcare services. Moreover, a logistic regression model was used to analyze the factors influencing the perceptions of the quality of primary healthcare services. RESULTS From the macro perspective, the number of primary health institutions, beds, and personnel per 10 thousand residents slightly increased from 2013 to 2020, especially in the eastern and central areas. However, the average number of visits and the hospitalization rate in primary health institutions showed a decrease, especially in central and eastern areas. Among participants, 92.2% (9606/10,419) of them had previously sought healthcare services in primary health institutions, and most were seeking general outpatient services (57.06-63.45%), followed by medicine purchasing (16.49-21.51%), physical examinations (9.91-11.49%), preventive health services (5.11-6.48%), and hospitalization services (3.17-5.67%). The total perception scores on the quality of primary healthcare services reported by the participants were 26.19 and 27.00 for rural and urban areas, respectively, which accounted for 65.5% and 67.5% of the total score, respectively, and 26.62, 26.86, and 25.89 for the eastern, central, and western areas, respectively, with percentages of 66.6%, 67.2%, and 64.7%. The perception score on the quality among people contracted with a family doctor (29.83, 74.58%) was much higher than those who were not (25.25, 63.13%), and the difference was statistically significant (p < 0.001). Moreover, people who were female, married, had higher incomes, and were diagnosed with various diseases had better perceptions of the primary healthcare services compared to their counterparts (p < 0.05). CONCLUSION Improvements were seen for primary health institutions, especially in terms of hardware resources such as beds and personnel. However, the service utilization in primary health institutions did not improve between 2013 and 2020. The perception score on the quality of primary healthcare was moderate to low in rural and urban as well as eastern, central, and western areas, but it was significantly higher among people contracted with a family doctor than those who were not. Therefore, it is important for policy makers to take or adjust measures focusing on quality improvement and increasing the service utilization in primary health institutions with good first contact, accessibility, continuity, comprehensiveness, and coordination, such as raising the enrollment rate of family doctors and promoting the provision of high-quality services.
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Affiliation(s)
- Junfang Xu
- Institute of Social Medicine, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Yuyin Zhou
- Institute of Social Medicine, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Ruyu Liu
- Institute of Social Medicine, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Feng Cheng
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
- Institute for Healthy China, Tsinghua University, Beijing 100084, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
- Institute for Healthy China, Tsinghua University, Beijing 100084, China
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Analysis of inequality in the distribution of general practitioners in China: evidence from 2012 to 2018. Prim Health Care Res Dev 2022; 23:e59. [PMID: 36117274 PMCID: PMC9532852 DOI: 10.1017/s1463423622000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aim: This paper aims to analyze the inequalities in general practitioner (GP) distribution in China. Background: GPs-based primary health care (PHC) has been implemented from 2011 in China, aiming to improve the accessibility and quality of basic medical and healthcare services. GPs in China, as the gatekeeper of people’s health, mainly undertake integrated health services at the grass-roots level. Methods: The number of GPs and inequality in GPs distribution from 2012 to 2018 was analyzed by the Lorenz Curve/Gini coefficient and Theil L index. Data were extracted from China Health Statistical Yearbook 2013–2019. Findings: The demographic Gini coefficient of GPs changed from 2012 (0.234) to 2018 (0.167), showing high equality in China. In contrast, the Thiel L index from 2012 (0.372) to 2018 (0.345) showed less equality. The decomposition of Thiel L index implicated the inequalities within the divisions. The number of GPs in China shows a fast growth trend since the general practice system established, and the GPs distribution becomes more demographically equitable. However, the shortage of GPs and inequality in their distribution remains severe. More incentive and supportive policies need to be made to enhance the quantity, quality, and structure of GPs in China.
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Chen K, Li Z, Liu R, Zhu Y, Yan W, Pui NAP, Chen Z. Distribution of health problems at the general outpatients' clinic of the University of Hong Kong-Shenzhen Hospital: A cross-sectional study. Front Public Health 2022; 10:889819. [PMID: 36003636 PMCID: PMC9393786 DOI: 10.3389/fpubh.2022.889819] [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: 03/04/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe study aimed to understand the distribution of health problems of a general practice clinic to provide guidance on how to develop primary care in Shenzhen, China.Study designThis is a cross-sectional study.MethodsPatients' sociodemographic data and diagnoses were recorded from the electronic medical record system of the University of Hong Kong-Shenzhen Hospital from Jan 2014 to Dec 2020 and coded using the International Classification of Primary Care-2. Descriptive statistics were used to describe the distribution of health problems.ResultsA total of 368,167 health problems were recorded. Respiratory, digestive, musculoskeletal, general, and cardiovascular were the top five categories, which accounted for 67.71% of the total in this study. Acute upper respiratory tract infection (AURTI) was the most common health problem (6.67%). Chronic diseases, including hypertension and diabetes mellitus, accounted for about 7% of all health problems. The proportion of cardiovascular problems increased significantly with age (r = 0.96, P < 0.05). The proportion of consultations for mental health problems was low in all age groups.ConclusionsThe results represent an understanding of the common health problems of patients in Shenzhen city, which can provide a reference for preventing diseases and developing primary care.
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Affiliation(s)
- Kai Chen
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Zhuo Li
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
- *Correspondence: Zhuo Li
| | - Ruihong Liu
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Yanyan Zhu
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Weihui Yan
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Ng Amy Pui Pui
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Shenzhen, China
| | - Zhiyuan Chen
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
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Searle K, Blashki G, Kakuma R, Yang H, Lu S, Li B, Xiao Y, Minas H. Adapting the depression component of WHO Mental Health Gap Intervention Guide (mhGAP-IG.v2) for primary care in Shenzhen, China: a DELPHI study. Int J Ment Health Syst 2022; 16:13. [PMID: 35168656 PMCID: PMC8845283 DOI: 10.1186/s13033-022-00523-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 01/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Primary care doctors in Shenzhen, China are increasingly expected to identify and prevent depressive disorder; however, they have received limited mental health training and community healthcare centres (CHC) do not provide standardised protocols for the diagnosis and care of depressive disorder. The World Health Organization’s mental health gap intervention guide, version 2 (mhGAP-IG.v2) is a decision support tool for non-specialists for the assessment, management and follow-up of mental, neurological and substance use disorders (including depressive disorder). Given that mhGAP-IG.v2 is a generic tool, it requires adaptation to take account of cultural differences in depression presentation and unique characteristics of China’s emergent mental health system. Methods A two-round, web-based, Delphi survey was conducted. A panel of primary care doctors from Shenzhen, were invited to score their level of agreement with 199 statements (arranged across 10 domains) proposing changes to the content and structure of mhGAP-IG.v2 for use in Shenzhen. Consensus was predefined as 80% panelists providing a rating of either “somewhat agree/definitely agree”, or “definitely disagree/somewhat disagree” on a five-point scale for agreement. Results 79% of statements received consensus with a mean score of 4.26 (i.e. “somewhat agree”). Agreed adaptations for mhGAP-IG.v2 included:- an assessment approach which considers a broader spectrum of depression symptoms and reflects the life course of disease; incorporating guidance for screening tool usage; clarifying physicians’ roles and including referral pathways for intersectorial care with strong family involvement; aligning drug treatment with national formularies; stronger emphasis of suicide prevention throughout all sections of the guide; contextualizing health education; reflecting a person-centred approach to care. Panelists chose to maintain diagnostic and treatment advice for bipolar patients experiencing a depressive episode as in the current guide. Conclusions An adapted mhGAP-IG.v2 for depression recognises China’s cultural and contextual needs for assessment guidance; unique primary healthcare system organization, priorities and treatment availability; and diverse psychosocial educational needs. An adapted mhGAP-IG.v2 could both inform the future training programs for primary care in Shenzhen and also offer an additional mental health resource for non-specialists in other countries. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00523-0.
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Affiliation(s)
- Kendall Searle
- Global and Cultural Mental Health Unit, Centre for Mental Health, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Grant Blashki
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Ritsuko Kakuma
- London School of Hygiene and Tropical Medicine, London, WC1E 7HTE, England, UK
| | - Hui Yang
- Monash Institute for Health and Clinical Education, School of Primary Health Care, Monash University, Notting Hill, VIC, 3168, Australia
| | - Shurong Lu
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Baoqi Li
- Shenzhen Guangming Hospital of the University of Chinese Academy of Sciences, Bao'an District, Shenzhen, 518107, China
| | - Yingying Xiao
- Shenzhen Guangming Hospital of the University of Chinese Academy of Sciences, Bao'an District, Shenzhen, 518107, China
| | - Harry Minas
- Global and Cultural Mental Health Unit, Centre for Mental Health, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia
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Does Internet Use Affect Medical Decisions among Older Adults in China? Evidence from CHARLS. Healthcare (Basel) 2021; 10:healthcare10010060. [PMID: 35052224 PMCID: PMC8775657 DOI: 10.3390/healthcare10010060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The rapid growth of the elderly population poses a huge challenge for people to access medical services. The key to get rid of the dilemma is for patients to go firstly to primary medical institutions. Existing studies have identified numerous factors that can affect patients’ health institution choice. However, we currently know little about the role of Internet use in the patients’ medical decisions. The objective of this study is to explore health-seeking behavior and institution choice under the background of the Internet era from the perspective of older adults, and to analyze whether the Internet could guide patients to the appropriate medical institution so as to accomplish hierarchical treatment. Methods: The dataset comprises 9416 people aged 45 or above from the China Health and Retirement Longitudinal Survey (CHARLS), which, through multistage cluster sampling, was conducted in 2011, 2013, and 2015. Logistic regression, PSM, and FE model are used to estimate the influence of Internet use on the health care decision-making behavior. Results: Internet use has a significant positive impact on the self-treatment of common diseases (β = 0.05, p < 0.05). In terms of medical institution choices, those who use Internet are more inclined to choose top-level hospitals than community health service institutions to treat common diseases (β = 0.06, p < 0.01). Conclusions: The Internet has lowered the obstacles to learning about common ailments, resulting in a substitution impact of self-treatment for hospital care. However, Internet use may aggravate older adults’ perception of the risk of disease, which exacerbates the tendency of going to higher-level medical institutions for medical treatment. The finding of the study is useful for further rational planning and utilization of the Internet in order to guide patients to appropriate medical institution, which helps to improve the efficiency of the overall medical and health services.
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Wang W, van Wijngaarden J, Wang H, Buljac-Samardzic M, Yuan S, van de Klundert J. Factors Influencing the Implementation of Foreign Innovations in Organization and Management of Health Service Delivery in China: A Systematic Review. FRONTIERS IN HEALTH SERVICES 2021; 1:766677. [PMID: 36926484 PMCID: PMC10012679 DOI: 10.3389/frhs.2021.766677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022]
Abstract
Background: China has been encouraged to learn from international innovations in the organization and management of health service delivery to achieve the national health reform objectives. However, the success and effectiveness of implementing innovations is affected by the interactions of innovations with the Chinese context. Our aim is to synthesize evidence on factors influencing the implementation of non-Chinese innovations in organization and management of health service delivery in mainland China. Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched seven databases for peer-reviewed articles published between 2009 and 2020. Data were analyzed and combined to generate a list of factors influencing the implementation of foreign innovations in China. The factors were classified in the categories context, system, organization, innovation, users, resources, and implementation process. Results: The 110 studies meeting the inclusion criteria revealed 33 factors. Most supported by evidence is the factor integration in organizational policies, followed by the factors motivation & incentives and human resources. Some factors (e.g., governmental policies & regulations) were mentioned in multiple studies with little or no evidence. Conclusion: Evidence on factors influencing the implementation of foreign innovations in organization and management of health service delivery is scarce and of limited quality. Although many factors identified in this review have also been reported in reviews primarily considering Western literature, this review suggests that extrinsic motivation, financial incentives, governmental and organizational policies & regulations are more important while decentralization was found to be less important in China compare to Western countries. In addition, introducing innovations in rural China seems more challenging than in urban China, because of a lack of human resources and the more traditional rural culture.
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Affiliation(s)
- Wenxing Wang
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jeroen van Wijngaarden
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Hujie Wang
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Martina Buljac-Samardzic
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Shasha Yuan
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Joris van de Klundert
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Mohammad Bin Salman College of Business and Entrepreneurship, King Abdullah Economic City, Saudi Arabia
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Ernawaty E, Wardhani K K, Supriyanto S, Putri NK, Husniyawati YR. Brand equity analysis to increase health care utilization. J Public Health Res 2020; 9:1821. [PMID: 32728565 PMCID: PMC7376459 DOI: 10.4081/jphr.2020.1821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Health care utilization is one of the key indicators in measuring performance of health care services. Strong brand equity suggests positive correlation with great attraction for consumers to use a product. Design and Methods: A cross-sectional study was conducted to identify the effects of brand equity to health care utilization. 381 students were selected by simple random sampling. Multiple logistic regression tests were used to analyze the influence between variables. Results: Findings showed that there was an influence between brand equity and health care utilization (P=0.001). In the three attributes, brand equity was known to have an influence to the utilization of health care. The highest influence of the three attributes was brand association (Exp (B) = 2.501). Conclusions: It can be concluded that brand equity affects patient visits to AHCC showing that the brand equity significantly influence patient visits. Promotion to create familiarity and good impression was required to enhance brand equity and increase health care utilization. Significance for public health In a study reports on the utilization of University health care center it was found that more than one-third (36.5%) of students have never used the service. One of the reasons contributing to the suboptimal utilization of health care services was the brand factor. Components of brand equity include brand awareness, brand association, and brand loyalty. The highest influence of the three attributes is brand association. Promotion to create familiarity and good impression is required to enhance brand equity and increase the University health care utilization. This paper describes the influence of brand equity to University health care utilization.
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Affiliation(s)
- Ernawaty Ernawaty
- Departement of Health Policy and Administration.,Harapan Keluarga Hospital, Mataram
| | | | | | - Nuzulul Kusuma Putri
- Departement of Health Policy and Administration.,Harapan Keluarga Hospital, Mataram
| | - Yeni Rahmah Husniyawati
- Master Program in Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Indonesia
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van de Venter R, Hodgson H. Strategies for Inclusive Medical Imaging Environments for Sexual and Gender Minority Patients and Radiographers: An Integrative Literature Review. J Med Imaging Radiat Sci 2020; 51:S99-S106. [PMID: 32622654 DOI: 10.1016/j.jmir.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Sexual and gender minority patients, and radiographers, experience several challenges that hinder realisation of their rights to equality and to a standard of living which is adequate for their well-being and health, in clinical environments. To this extent, a person-centred care approach is advocated for the medical radiation science professions so that a more inclusive medical imaging environment for patients and radiographers is provided. There is no summation of the body of knowledge available to promote all-encompassing environments for sexual and gender minority groups in medical imaging. PURPOSE The purpose of this study was to establish the current evidence available on strategies that can be and are used to foster inclusive medical imaging environments for sexual and gender minority patient groups and radiographers. KEY FINDINGS Four articles, predominantly written from a global north perspective and within the last three years, formed part of this review. The strategies that emerged from the analysed articles were categorised into three themes, namely, using inclusive language, educating radiographers, and creating affirming health care environments. CONCLUSION Limited evidence exists on the strategies used to promote more inclusive medical imaging environments for sexual and gender minority patients and radiographers. Hence, more work in this area is needed from a diagnostic radiography perspective. Recommendations for possible future research are provided.
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Affiliation(s)
- Riaan van de Venter
- Faculty of Health Sciences, School of Clinical Care Sciences, Department of Radiography, Nelson Mandela University, Port Elizabeth, Eastern Cape, South Africa.
| | - Hayley Hodgson
- Faculty of Health Sciences, School of Clinical Care Sciences, Department of Radiography, Nelson Mandela University, Port Elizabeth, Eastern Cape, South Africa
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