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Zhong Y, Hahne J, Wang X, Wang X, Wu Y, Zhang X, Liu X. Telehealth Care Through Internet Hospitals in China: Qualitative Interview Study of Physicians' Views on Access, Expectations, and Communication. J Med Internet Res 2024; 26:e47523. [PMID: 38551618 PMCID: PMC11015369 DOI: 10.2196/47523] [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: 03/22/2023] [Revised: 09/27/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Internet hospitals in China are an emerging medical service model similar to other telehealth models used worldwide. Internet hospitals are currently in a stage of rapid development, giving rise to a series of new opportunities and challenges for patient care. Little research has examined the views of chronic disease physicians regarding internet hospitals in China. OBJECTIVE We aimed to explore the experience and views of chronic disease physicians at 3 tertiary hospitals in Changsha, China, regarding opportunities and challenges in internet hospital care. METHODS We conducted semistructured qualitative interviews with physicians (n=26) who had experience working in internet hospitals affiliated with chronic disease departments in 3 tertiary hospitals in Changsha, Hunan province, south central China. Interviews were transcribed verbatim and analyzed by content analysis using NVivo software (version 11; Lumivero). RESULTS Physicians emphasized that internet hospitals expand opportunities to conduct follow-up care and health education for patients with chronic illnesses. However, physicians described disparities in access for particular groups of patients, such as patients who are older, patients with lower education levels, patients with limited internet or technology access, and rural patients. Physicians also perceived a gap between patients' expectations and the reality of limitations regarding both physicians' availability and the scope of services offered by internet hospitals, which raised challenges for doctor-patient boundaries and trust. Physicians noted challenges in doctor-patient communication related to comprehension and informed consent in internet hospital care. CONCLUSIONS This study explored the experience and views of physicians in 3 tertiary hospitals in Changsha, China, regarding access to care, patients' expectations versus the reality of services, and doctor-patient communication in internet hospital care. Findings from this study highlight the need for physician training in telehealth communication skills, legislation regulating informed consent in telehealth care, public education clarifying the scope of internet hospital services, and design of internet hospitals that is informed by the needs of patient groups with barriers to access, such as older adults.
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Affiliation(s)
- Yuqiong Zhong
- School of Humanities, Central South University, Changsha, China
- Xiangya Hospital, Central South University, Changsha, China
| | - Jessica Hahne
- Department of Psychological & Brain Sciences, Washington University in St Louis, St Louis, MO, United States
| | - Xiaomin Wang
- Center for Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, China
- Center for Medical Ethics, Central South University, Changsha, China
| | - Xuxi Wang
- School of Humanities, Central South University, Changsha, China
| | - Ying Wu
- School of Humanities, Central South University, Changsha, China
| | - Xin Zhang
- Xiangya Hospital, Central South University, Changsha, China
- Medical Humanities Research Center, Central South University, Changsha, China
| | - Xing Liu
- Medical Humanities Research Center, Central South University, Changsha, China
- Office of International Cooperation and Exchanges, Xiangya Hospital, Central South University, Changsha, China
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Wei Q, Wang X, Zhang G, Li X, Yang X, Gu D. Internet Healthcare Policy Analysis, Evaluation, and Improvement Path: Multidimensional Perspectives. Healthcare (Basel) 2023; 11:1905. [PMID: 37444738 DOI: 10.3390/healthcare11131905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/13/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Internet healthcare is a crucial component of the healthcare industry's digital transformation and plays a vital role in achieving China's Healthy China strategy and promoting universal health. To ensure the development of internet healthcare is guided by scientifically sound policies, this study analyzes and assesses current policy texts, aiming to identify potential issues and inadequacies. By examining 134 national-level policy documents, utilizing multiple research methods, including policy bibliometrics, content analysis, and the PMC Index Model, the study investigates policy characteristics, distribution of policy instruments, and evaluation outcomes related to internet healthcare. The study findings reveal that internet healthcare policies place emphasis on enhancing service quality, driving technological innovation, and promoting management standardization. Although policy instruments align with the current stage of internet healthcare development in China, they are plagued by imbalances in implementation. While policies are generally well-formulated, there are discernible discrepancies among them, necessitating the reinforcement and refinement of certain provisions. Hence, it is imperative to strategically optimize the amalgamation and implementation of policy instruments while concurrently endeavoring to achieve a dynamic equilibrium in policy combinations. Furthermore, policymakers should diligently refine the policy content pertaining to its nature and effectiveness in order to fully maximize policy utility.
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Affiliation(s)
- Qi Wei
- School of Management, Hefei University of Technology, Hefei 230009, China
| | - Xiaoyu Wang
- The Department of Pharmacy, Anhui University of Traditional Chinese Medicine, Hefei 230009, China
| | - Gongrang Zhang
- School of Management, Hefei University of Technology, Hefei 230009, China
| | - Xingguo Li
- School of Management, Hefei University of Technology, Hefei 230009, China
| | - Xuejie Yang
- School of Management, Hefei University of Technology, Hefei 230009, China
| | - Dongxiao Gu
- School of Management, Hefei University of Technology, Hefei 230009, China
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Xu R, Wu L, Liu Y, Ye Y, Mu T, Xu C, Yuan H. Evaluation of the impact of the COVID-19 pandemic on health service utilization in China: A study using auto-regressive integrated moving average model. Front Public Health 2023; 11:1114085. [PMID: 37089481 PMCID: PMC10115989 DOI: 10.3389/fpubh.2023.1114085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/22/2023] [Indexed: 04/09/2023] Open
Abstract
BackgroundThe outbreak of COVID-19 in early 2020 presented a major challenge to the healthcare system in China. This study aimed to quantitatively evaluate the impact of COVID-19 on health services utilization in China in 2020.MethodsHealth service-related data for this study were extracted from the China Health Statistical Yearbook. The Auto-Regressive Integrated Moving Average model (ARIMA) was used to forecast the data for the year 2020 based on trends observed between 2010 and 2019. The differences between the actual 2020 values reported in the statistical yearbook and the forecast values from the ARIMA model were used to assess the impact of COVID-19 on health services utilization.ResultsIn 2020, the number of admissions and outpatient visits in China declined by 17.74 and 14.37%, respectively, compared to the ARIMA model’s forecast values. Notably, public hospitals experienced the largest decrease in outpatient visits and admissions, of 18.55 and 19.64%, respectively. Among all departments, the pediatrics department had the greatest decrease in outpatient visits (35.15%). Regarding geographical distribution, Beijing and Heilongjiang were the regions most affected by the decline in outpatient visits (29.96%) and admissions (43.20%) respectively.ConclusionThe study’s findings suggest that during the first year of the COVID-19 pandemic, one in seven outpatient services and one in six admissions were affected in China. Therefore, there is an urgent need to establish a green channel for seeking medical treatment without spatial and institutional barriers during epidemic prevention and control periods.
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Affiliation(s)
- Rixiang Xu
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lang Wu
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yulian Liu
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yaping Ye
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, China
| | - Tingyu Mu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Caiming Xu
- School of Law, Hangzhou City University, Hangzhou, China
- *Correspondence: Caiming Xu, Huiling Yuan,
| | - Huiling Yuan
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, China
- *Correspondence: Caiming Xu, Huiling Yuan,
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He J, Ning P, Schwebel DC, Yang Y, Li L, Cheng P, Rao Z, Hu G. Injury mortality and morbidity changes due to the COVID-19 pandemic in the United States. Front Public Health 2022; 10:1001567. [PMID: 36408028 PMCID: PMC9666887 DOI: 10.3389/fpubh.2022.1001567] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction The COVID-19 pandemic significantly changed society. We aimed to examine the systematic impact of the COVID-19 on injury burden in the United States. Methods We extracted mortality and morbidity data from CDC WONDER and WISQARS. We estimated age-standardized injury mortality rate ratio and morbidity rate ratio (MtRR and MbRR) with 95% confidence interval (95% CI) for all injuries, all unintentional injuries, homicide/assault by all methods, suicide/self-harm by all methods, as well as other 11 specific unintentional or intentional injury categories. Injury rate ratios were compared for 2020 vs. 2019 to those of 2019 vs. 2018 to demonstrate the influence of the COVID-19 pandemic on fatal and nonfatal injury burden. The ratio of MtRRs (RMtRR) and the ratio of MbRRs (RMbRR) with 95% CI between 2020 vs. 2019 and 2019 vs. 2018 were calculated separately. Results The COVID-19 pandemic was associated with an increase in injury mortality (RMtRR = 1.12, 95% CI: 1.11, 1.13) but injury morbidity decreased (RMbRR = 0.88, 95% CI: 0.88, 0.89) when the changes of these rates from 2019 to 2020 were compared to those from 2018 to 2019. Mortality disparities between the two time periods were primarily driven by greater mortality during the COVID-influenced 2020 vs. 2019 from road traffic crashes (particularly motorcyclist mortality), drug poisoning, and homicide by firearm. Similar patterns were not present from 2019 vs. 2018. There were morbidity reductions from road traffic crashes (particularly occupant and pedestrian morbidity from motor vehicle crashes), unintentional falls, and self-harm by suffocation from 2019 to 2020 compared to the previous period. Change patterns in sexes and age groups were generally similar, but exceptions were observed for some injury types. Conclusions The COVID-19 pandemic significantly changed specific injury burden in the United States. Some discrepancies also existed across sex and age groups, meriting attention of injury researchers and policymakers to tailor injury prevention strategies to particular populations and the environmental contexts citizens face.
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Affiliation(s)
- Jieyi He
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Peishan Ning
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - David C. Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yang Yang
- Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States
| | - Li Li
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Peixia Cheng
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhenzhen Rao
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Guoqing Hu
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Fang G, Yang D, Wang L, Wang Z, Liang Y, Yang J. Towards Universal Healthcare Coverage: Experience form the Implementation of the National Basic Public Health Service Program in China (Preprint). JMIR Public Health Surveill 2021; 8:e31289. [PMID: 35867386 PMCID: PMC9356336 DOI: 10.2196/31289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 02/05/2022] [Accepted: 04/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Public health service is an important component and pathway to achieve universal health coverage (UHC), a major direction goal of many countries. China’s National Basic Public Health Service Program (the Program) is highly consistent with this direction. Objective The aim of this study was to analyze the key experience and challenges of the Program so as to present China’s approach to UHC, help other countries understand and learn from China’s experience, and promote UHC across the world. Methods A literature review was performed across five main electronic databases and other sources. Some data were obtained from the Department of Primary Health, National Health Commission, China. Data obtained included the financing share of the national/provincial/prefectural government among the total investment of the program in 32 provinces in 2016, their respective per capita funding levels, and some indicators related to program implementation from 2009 to 2016. The Joinpoint regression model was adopted to test the time trend of changes in program implementation indicators. Face-to-face individual interviews and group discussions were conducted with 48 key insiders. Results The program provided full life cycle service to the whole population with an equitable and affordable financing system, enhanced the capability and quality of the health workforce, and facilitated integration of the public health service delivery system. Meanwhile, there were also some shortcomings, including lack of selection and an exit mechanism of service items, inadequate system integration, shortage of qualified professionals, limited role played by actors outside the health sector, and a large gap between the subsidy standard and the actual service cost. The Joinpoint regression analysis demonstrated that 13 indicators related to program implementation showed a significant upward trend (P<.05) from 2009 to 2016, with average annual percent change values above 10% for 6 indicators and below 6% for 7 indicators. Three indicators (coverage of health records, electronic health records, and health management among the elderly) rose rapidly with annual percent change values above 30% between 2009 and 2011, but rose slowly or remained stable between 2011 and 2016. In 2016, the subsidy standard per capita in the eastern, central, and western regions was equivalent to US $7.43, $7.15, and $6.57, respectively, of which the national-level subsidy accounted for 25.50%, 60.57%, and 79.52%, respectively. Conclusions The Program has made a significant contribution to China’s efforts in achieving UHC. The Program focuses on a key population and provides full life cycle services for the whole population. The financing system completely supported by the government makes the services more equitable and affordable. However, there are a few challenges to implementing the Program in China, especially to increase the public investment, optimize service items, enhance quality of the services, and evaluate the health outcomes.
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Affiliation(s)
- Guixia Fang
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Diling Yang
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Li Wang
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Zhihao Wang
- The First Affiliated Hospital, University of Science and Technology of China, Hefei, China
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yuanyuan Liang
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Jinxia Yang
- School of Health Service Management, Anhui Medical University, Hefei, China
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