Internet Hospitals in China: Cross-Sectional Survey

Medical Information Protection in Internet Hospital Apps in China: Scale Development and Content Analysis

BACKGROUND

Hospital apps are increasingly being adopted in many countries, especially since the start of the COVID-19 pandemic. Web-based hospitals can provide valuable medical services and enhanced accessibility. However, increasing concerns about personal information (PI) and strict legal compliance requirements necessitate privacy assessments for these platforms. Guided by the theory of contextual integrity, this study investigates the regulatory compliance of privacy policies for internet hospital apps in the mainland of China.

OBJECTIVE

In this paper, we aim to evaluate the regulatory compliance of privacy policies of internet hospital apps in the mainland of China and offer recommendations for improvement.

METHODS

We obtained 59 internet hospital apps on November 7, 2023, and reviewed 52 privacy policies available between November 8 and 23, 2023. We developed a 3-level indicator scale based on the information processing activities, as stipulated in relevant regulations. The scale comprised 7 level-1 indicators, 26 level-2 indicators, and 70 level-3 indicators.

RESULTS

The mean compliance score of the 52 assessed apps was 73/100 (SD 22.4%), revealing a varied spectrum of compliance. Sensitive PI protection compliance (mean 73.9%, SD 24.2%) lagged behind general PI protection (mean 90.4%, SD 14.7%), with only 12 apps requiring separate consent for processing sensitive PI (mean 73.9%, SD 24.2%). Although most apps (n=41, 79%) committed to supervising subcontractors, only a quarter (n=13, 25%) required users' explicit consent for subcontracting activities. Concerning PI storage security (mean 71.2%, SD 29.3%) and incident management (mean 71.8%, SD 36.6%), half of the assessed apps (n=27, 52%) committed to bear corresponding legal responsibility, whereas fewer than half (n=24, 46%) specified the security level obtained. Most privacy policies stated the PI retention period (n=40, 77%) and instances of PI deletion or anonymization (n=41, 79%), but fewer (n=20, 38.5%) committed to prompt third-party PI deletion. Most apps delineated various individual rights, but only a fraction addressed the rights to obtain copies (n=22, 42%) or to refuse advertisement based on automated decision-making (n=13, 25%). Significant deficiencies remained in regular compliance audits (mean 11.5%, SD 37.8%), impact assessments (mean 13.5%, SD 15.2%), and PI officer disclosure (mean 48.1%, SD 49.3%).

CONCLUSIONS

Our analysis revealed both strengths and significant shortcomings in the compliance of internet hospital apps' privacy policies with relevant regulations. As China continues to implement internet hospital apps, it should ensure the informed consent of users for PI processing activities, enhance compliance levels of relevant privacy policies, and fortify PI protection enforcement across the information processing stages.

Developing a Tailored eHealth Self-Management Intervention for Patients With Chronic Kidney Disease in China: Intervention Mapping Approach

BACKGROUND

Chronic kidney disease (CKD) is a major public health concern. Adequate self-management skills are vital to reduce CKD burden, optimize patient health outcomes, and control health care expenditures. Using eHealth to support CKD self-management has the potential to promote healthy behaviors and improve health outcomes of patients with CKD. However, knowledge of the implementation of such interventions in general, and in China specifically, is still limited.

OBJECTIVE

This study aims to develop a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) eHealth self-management intervention.

METHODS

We used an intervention mapping approach. In phase 1, a systematic review and 2 qualitative studies were conducted to examine the needs, beliefs, and perceptions of patients with CKD and health care professionals regarding CKD self-management and eHealth interventions. Afterward, key factors gathered from the aforementioned studies were categorized following the 5 domains of the Consolidated Framework for Implementation Research (CFIR). In phase 2, we specified program outcomes, performance objectives, determinants, theory-based methods, and practical strategies. Knowledge obtained from previous results was combined to complement core components of the MD self-management intervention and adapt them for Chinese patients with CKD. Additionally, the CFIR-Expert Recommendations for Implementing Change Matching Tool was pragmatically used to generate a list of potential implementation strategies to address the key factors influencing the implementation of eHealth CKD self-management interventions, and implementation strategies were discussed and finalized with the intervention monitoring group.

RESULTS

An overview of the CFIR domains showed the essential factors influencing the implementation of eHealth CKD self-management interventions in Chinese settings, including "knowledge and beliefs" in the domain "individual characteristics," "quality and advantage of eHealth intervention" in the domain "intervention characteristics," "compatibility" in the domain "inner setting," and "cultural context" in the domain "outer setting." To ensure the effectiveness of the Dutch MD-based self-management intervention, we did not change the core self-management intervention components of MD that underlie its effectiveness, such as self-monitoring. We identified surface-level cultural adaptations involving customizing intervention content, messages, and approaches to the observable cultural characteristics of the local population to enhance the intervention's appeal, receptivity, and feasibility, such as providing video or voice call options to support interactions with health care professionals. Furthermore, the adapted modules such as Knowledge Center and My Self-Monitoring were developed in a mobile health app.

CONCLUSIONS

Our study resulted in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China that has the potential to optimize patients' self-management skills and improve health status and quality of life. Moreover, our study's research approach and results can inform future research on the tailoring and translation of evidence-based, eHealth self-management interventions to various contexts.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04212923; https://classic.clinicaltrials.gov/ct2/show/NCT04212923.

Telehealth Care Through Internet Hospitals in China: Qualitative Interview Study of Physicians' Views on Access, Expectations, and Communication

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.

The Current Status and Promotional Strategies for Cloud Migration of Hospital Information Systems in China: Strengths, Weaknesses, Opportunities, and Threats Analysis

BACKGROUND

In the 21st century, Chinese hospitals have witnessed innovative medical business models, such as online diagnosis and treatment, cross-regional multidepartment consultation, and real-time sharing of medical test results, that surpass traditional hospital information systems (HISs). The introduction of cloud computing provides an excellent opportunity for hospitals to address these challenges. However, there is currently no comprehensive research assessing the cloud migration of HISs in China. This lack may hinder the widespread adoption and secure implementation of cloud computing in hospitals.

OBJECTIVE

The objective of this study is to comprehensively assess external and internal factors influencing the cloud migration of HISs in China and propose promotional strategies.

METHODS

Academic articles from January 1, 2007, to February 21, 2023, on the topic were searched in PubMed and HuiyiMd databases, and relevant documents such as national policy documents, white papers, and survey reports were collected from authoritative sources for analysis. A systematic assessment of factors influencing cloud migration of HISs in China was conducted by combining a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis and literature review methods. Then, various promotional strategies based on different combinations of external and internal factors were proposed.

RESULTS

After conducting a thorough search and review, this study included 94 academic articles and 37 relevant documents. The analysis of these documents reveals the increasing application of and research on cloud computing in Chinese hospitals, and that it has expanded to 22 disciplinary domains. However, more than half (n=49, 52%) of the documents primarily focused on task-specific cloud-based systems in hospitals, while only 22% (n=21 articles) discussed integrated cloud platforms shared across the entire hospital, medical alliance, or region. The SWOT analysis showed that cloud computing adoption in Chinese hospitals benefits from policy support, capital investment, and social demand for new technology. However, it also faces threats like loss of digital sovereignty, supplier competition, cyber risks, and insufficient supervision. Factors driving cloud migration for HISs include medical big data analytics and use, interdisciplinary collaboration, health-centered medical service provision, and successful cases. Barriers include system complexity, security threats, lack of strategic planning and resource allocation, relevant personnel shortages, and inadequate investment. This study proposes 4 promotional strategies: encouraging more hospitals to migrate, enhancing hospitals' capabilities for migration, establishing a provincial-level unified medical hybrid multi-cloud platform, strengthening legal frameworks, and providing robust technical support.

CONCLUSIONS

Cloud computing is an innovative technology that has gained significant attention from both the Chinese government and the global community. In order to effectively support the rapid growth of a novel, health-centered medical industry, it is imperative for Chinese health authorities and hospitals to seize this opportunity by implementing comprehensive strategies aimed at encouraging hospitals to migrate their HISs to the cloud.

Patterns of information literacy and their predictors among emergency department nurses: a latent profile analysis based on the person-context interaction theory

BACKGROUND

With the development of information technology, information has been an important resource in clinical medicine, particularly within the emergency department. Given its role in patient rescue, the emergency department demands a high level of information literacy from nurses to effectively collect, analyze, and apply information due to the urgency and complexity of emergency nursing work. Although prior studies have investigated the information literacy of nursing staff, little has been undertaken in examining the patterns of information literacy and their predictors among emergency department nurses.

AIM

To clarify the subtypes of information literacy among nurses in the emergency department and explore the factors affecting profile membership.

METHODS

A cross-sectional study was conducted among a convenience sample of 2490 nurses in the emergency department from April to June 2023. The clinical nurses completed the online self-report questionnaires including the general demographic questionnaire, information literacy scale, self-efficacy scale and social support scale. Data analyses involved the latent profile analysis, variance analysis, Chi-square tests and multivariate logistic regression.

RESULTS

Four latent profiles were identified: 'Low information literacy (Class 1)', 'Moderate information knowledge (Class 2)', 'High information knowledge and support (Class 3)' and 'High information literacy (Class 4)', accounting for 20.14%, 42.11%, 23.36% and 14.39%, respectively. Each profile displayed unique characteristics representative of different information literacy patterns. Age, years of work, place of residence, hospital grade, title, professional knowledge, using databases, reading medical literature, participating in information literacy training, self-efficacy, and social support significantly predicted information literacy profile membership.

CONCLUSIONS

Information literacy exhibits different classification features among emergency department nurses, and over half of the nurses surveyed were at the lower or middle level. Identifying sociodemographic and internal-external predictors of profile membership can aid in developing targeted interventions tailored to the needs of emergency department nurses. Nursing managers should actively pay attention to nurses with low information literacy and provide support to improve their information literacy level.

RELEVANCE TO CLINICAL PRACTICE

Insights from the current study of the latent profile analysis are beneficial to hospital managers in understanding the different types of emergency department nurses' information literacy. These insights serve as a reference for managers to enhance nurses' information literacy levels.

Online medical consultation in China: Demand-side analysis of obese patients' preferences and willingness-to-pay for online obesity consultations

Objective

With obesity a major health concern and call on healthcare resources in China, we explored the preferences and willingness to pay (WTP) for obesity OMC, including the influencing factors behind WTP and preferences.

Method

We recruited 400 obese participants to undertake a discrete choice experiment (DCE) and the contingent value method (CVM) survey. We used CVM to measure obese participants' WTP for one-click services (OCS) and used DCE to estimate obesity participants' preferences and WTP for OMC with different attributes.

Results

Obese participants were willing to pay more than RMB80 on average for OCS, and more than 50% of participants had a WTP over RMB50 and 5% had a WTP over RMB300, reflecting the strong willingness of Chinese obese patients to pay for OMC. Educational background, income, ethnicity, previous OMC experience and accessibility to offline hospitals with different levels impacted WTP. The relative importance score of attributes in descending order was cost, doctors' hospital level, doctors' level, online waiting time, consultation time and consultation form. Obese patients preferred lower cost, doctors from higher-level hospitals, doctors with higher expertise levels, shorter waiting time and consultation duration, and telephone consultation were preferred. 30-min waiting time, 15-min consultation duration and telephone consultation were the most economically efficient set we found.

Conclusion

To maximize health resources, provincial tertiary and municipal hospitals face different paths to developing obesity OMC platforms. We encouraged young doctors to use OMC. OMC regulators should implement consumer protection policies to optimize OMC pricing and address potential 'unfair' pricing.

Trends, Influence Factors, and Doctor-Patient Perspectives of Web-Based Visits for Thyroid Surgery Clinical Care: Cross-Sectional Study

BACKGROUND

In recent years, the new generation of telecommunication technologies has profoundly changed the traditional medical industry. To alleviate the medical difficulties faced by patients with thyroid diseases, hospitals have opened web-based visits and actively combined online-to-offline outpatient services.

OBJECTIVE

This study aims to explore differences between office and web-based outpatient services from doctors' and patients' perspectives, illustrate the effect of the COVID-19 pandemic on outpatient services, and provide clues for improving the online-to-offline mode of care for patients with thyroid diseases.

METHODS

We collected the complete web-based and office outpatient records of the Thyroid Surgery Center of West China Hospital. A total of 300,884 completed patient encounters occurred (201,840 office visits and 99,044 web-based visits) from January 1, 2019, to May 31, 2022. We performed logistic regression to evaluate the association between the chosen visit type and patients' sociodemographic characteristics.

RESULTS

The number of web-based visits rapidly increased since March 2020 and reached 45.1% (4752/10,531) of all encounters in December 2021. The COVID-19 pandemic dramatically accelerated the development of web-based visits. Web-based visits were preferred by patients 18-45 years old (odds ratio [OR] 2.043, 95% CI 1.635-2.552, P<.001), patients with relatively high-paying jobs (technical staff: OR 1.278, 95% CI 1.088-1.479, P=.003; office clerk: OR 1.25, 95% CI 1.07-1.461, P=.005; national public servant: OR:1.248, 95% CI 1.042-1.494, P=.02), and patients living in Sichuan Province (excluding Chengdu; OR 1.167, 95% CI 1.107-1.23, P<.001). The medicine cost (P<.001) and examination cost (P<.001) of office visits were significantly higher than those of web-based visits.

CONCLUSIONS

Web-based outpatient visits have increased rapidly in recent years, and the COVID-19 pandemic has boosted their development. The preference for web-based visits was influenced by the socioeconomic and demographic characteristics of both patients and doctors.

Application of Internet hospitals for first-visit patients with COVID-19 during the pandemic in China

BACKGROUND

There has been controversy over whether to carry out online medical inquiries and electronic prescription for first-visit patients. While Internet hospitals have become crucial to ensure providing online diagnosis and prescription needs for first-visit COVID-positive patients.

OBJECTIVE

We describe the results and advantages of online medical treatment during the coronavirus disease 2019 (COVID-19) outbreak and analyse the results and advantages of online medical treatment.

METHODS

Data were collected from the patients who received online medical inquiry services through the COVID-19 Special Section of our Internet hospital. The user demographic characteristics, user behaviour, clinical symptoms and medical records were collected. Baseline data of offline outpatient patients were also collected.

RESULTS

A total of 16 173 online medical inquiries were included. The daily online outpatient service volume reached a peak of 2446 person-times. The median age was 29.92 years (SD 15.59), ranging from 20-39 years (n = 8870, 54.84%). A total of 89.20% (n = 14 426/16 173) patients had epidemic-related symptoms. Moreover, 23.35% of the people were diagnosed as COVID-19-positive through antigen or nucleic acid testing. Furthermore, 86.61% (14 008/16 173) of the patients visited our hospital for the first time or had no offline physical outpatient service record within the past 3 months. The demand for medical inquiries was mainly for drug dispensing, followed by medication guidance and disease diagnosis. And 2.07% (334/16 173) of the patients needed to go to the offline hospital for further treatment.

CONCLUSION

The service model of the COVID-19 Special Section based on Internet hospitals provided the public with the necessary medical support during the COVID-19 outbreak. It provides a reference for future pandemics or public health emergencies.

Investigating Factors Influencing Medical Practitioners' Resistance to and Adoption of Internet Hospitals in China: Mixed Methods Study

BACKGROUND

The swift shift toward internet hospitals has relied on the willingness of medical practitioners to embrace new systems and workflows. Low engagement or acceptance by medical practitioners leads to difficulties in patient access. However, few investigations have focused on barriers and facilitators of adoption of internet hospitals from the perspective of medical practitioners.

OBJECTIVE

This study aims to identify both enabling and inhibiting predictors associated with resistance and behavioral intentions of medical practitioners to use internet hospitals by combining the conservation of resources theory with the Unified Theory of Acceptance and Use of Technology and technostress framework.

METHODS

A mixed methods research design was conducted to qualitatively identify the factors that enable and inhibit resistance and behavioral intention to use internet hospitals, followed by a quantitative survey-based study that empirically tested the effects of the identified factors. The qualitative phase involved conducting in-depth interviews with 16 experts in China from June to August 2022. Thematic analysis was performed using the qualitative data analysis software NVivo version 10 (QSR International). On the basis of the findings and conceptual framework gained from the qualitative interviews, a cross-sectional, anonymous, web-based survey of 593 medical practitioners in 28 provincial administrative regions of China was conducted. The data collected were analyzed using the partial least squares method, with the assistance of SPSS 27.0 (IBM Corp) and Mplus 7.0 (Muthen and Muthen), to measure and validate the proposed model.

RESULTS

On the basis of qualitative results, this study identified 4 facilitators and inhibitors, namely performance expectancy, social influence, work overload, and role ambiguity. Of the 593 medical practitioners surveyed in the quantitative research, most were female (n=364, 61.4%), had a middle title (n=211, 35.6%) or primary title (n=212, 35.8%), and had an average use experience of 6 months every year. By conducting structural equation modeling, we found that performance expectancy (β=-.55; P<.001) and work overload (β=.16; P=.005) had the most significant impact on resistance to change. Resistance to change fully mediated the influence of performance expectancy and partially mediated the influences of social influence (variance accounted for [VAF]=43.3%; P=.002), work overload (VAF=37.2%; P=.03), and role ambiguity (VAF=12.2%; P<.001) on behavioral intentions to use internet hospitals. In addition, this study found that the sex, age, professional title, and use experience of medical practitioners significantly moderated the aforementioned influencing mechanisms.

CONCLUSIONS

This study investigated the factors that facilitate or hinder medical practitioners' resistance to change and their behavioral intentions to use internet hospitals. The findings suggest that policy makers avoid the resistance and further promote the adoption of internet hospitals by ensuring performance expectancy and social influence and eliminating work overload and role ambiguity.

Internet Healthcare Policy Analysis, Evaluation, and Improvement Path: Multidimensional Perspectives

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.

The construction and operational models of internet hospitals in China: a hospital-based survey study

BACKGROUND

China has empowered and continues to empower internet hospitals, which saw an increase in their development due to the pandemic, to fight against COVID-19. The construction and operational models of internet hospitals can be categorized as self-constructed and self-managed models, self-constructed and enterprise-run models, hospital and enterprise joint-owned models, and hosted by a third-party platform. Despite the growing importance of internet hospitals, there have been few systematic summaries of their construction and operational models. The primary purpose of the study was to understand the construction and operational models of internet hospitals in China.

METHODS

Data was collected from 39 internet hospitals and 356 medical staff between September 2020 and April 2021, via internet hospital and hospital staff surveys. T-tests were used to compare the continuous variables, while Chi-square tests were employed to compare the proportions of categorical variables. The self-perception of the internet hospitals' services was assessed using a 5-point Likert scale on 16 aspects and a root cause analysis was conducted to identify the root causes and influencing factors of current deficiencies experienced by internet hospitals.

RESULTS

Among the 39 internet hospitals, 22 (56.4%) were self-constructed and self-managed. Compared to other models of Internet hospitals, self-constructed and self-managed hospitals had lower percentages of professionals providing online services (P = 0.006), numbers of doctors outside of the entity (P = 0.006), numbers of online nurses (P = 0.004), and the ratio of online nurses to offline doctors (P < 0.001). Of the 16 aspects evaluated with regards to the medical staff's self-perception of the internet hospital services, the highest scores were given for fee transparency, fee rationality, travel cost capital, patience and responsibility, and consultation behaviors. The root causes included five aspects: human, channels, prices, services, and time.

CONCLUSIONS

While the self-constructed and self-managed model was found to be the most prevalent form of internet hospital in China, the different models of internet hospitals can have an impact on both the quantity and quality of online healthcare services. This study contributes to the existing literature on internet hospitals' construction and operational models, offering additional policy implications for telemedicine management.

The effect of using internet hospitals on the physician-patient relationship: Patient perspective

BACKGROUND

Internet hospitals are rapidly developing in China. Despite many studies regarding internet hospitals, there has been little further research that evaluates the impact of using internet hospitals on the physician-patient relationship during outpatient visits.

METHODS

We developed a questionnaire based on the patient-doctor relationship questionnaire (PDRQ-9) to survey the physician-patient relationship. A sample of 505 patients who sought medical services from offline physical or internet hospitals was selected by convenience sampling. Multiple linear regression analysis was performed to determine whether the use of internet hospitals during outpatient visits was associated with the physician-patient relationship.

RESULTS

Internet hospital users gave significantly lower scores than nonusers in total physician-patient relationship scores (P =.01) and in the 5 items of "My physician helps me" (P <.001), "I trust my physician" (P =.001), "My physician understands me" (P =.002), "My physician and I agree on the nature of my medical symptoms" (P =.01), and "I can talk to (communicate with) my physician freely" (P =.005). Multiple linear regression results showed that the use of internet hospitals during outpatient visits influenced the physician-patient relationship. And after controlling for other patient characteristics, the use of internet hospitals decreased the physician-patient relationship scores by 11.9%.

CONCLUSIONS

Our findings suggest that the current use of internet hospitals could not significantly enhance the physician-patient relationship during outpatient visits. Therefore, we should work on improving physicians' online communication skills and strengthening the level of trust between physicians and their patients. Policymakers should also pay close attention to the gap of the physician-patient relationship between internet hospitals and offline physical hospitals.

Determinants Influencing the Adoption of Internet Health Care Technology Among Chinese Health Care Professionals: Extension of the Value-Based Adoption Model With Burnout Theory

BACKGROUND

The global COVID-19 pandemic has been widely regarded as a catalyst for adopting internet health care technology (IHT) in China. IHT consists of new health care technologies that are shaping health services and medical consultations. Health care professionals play a substantial role in the adoption of any IHT, but the consequences of doing so can often be challenging, particularly when employee burnout is prevalent. Few studies have explored whether employee burnout influences the adoption intention of IHT in health care professionals.

OBJECTIVE

This study aims to explain the determinants influencing the adoption of IHT from the perspective of health care professionals. To do so, the study extends the value-based adoption model (VAM) with consideration for employee burnout as a determining factor.

METHODS

A cross-sectional web-based survey using a sample of 12,031 health care professionals selected through multistage cluster sampling from 3 provinces in mainland China was conducted. The hypotheses of our research model were developed based on the VAM and employee burnout theory. Structural equation modeling was then used to test the research hypotheses.

RESULTS

The results indicate that perceived usefulness, perceived enjoyment, and perceived complexity positively correlate with perceived value (β=.131, P=.01; β=.638, P<.001; β=.198, P<.001, respectively). Perceived value had a positive direct effect on adoption intention (β=.725, P<.001), perceived risk negatively correlated with perceived value (β=-.083, P<.001), and perceived value negatively correlated with employee burnout (β=-.308, P<.001). In addition, employee burnout was negatively related to adoption intention (β=-.170, P<.001) and mediated the relationship between perceived value and adoption intention (β=.052, P<.001).

CONCLUSIONS

Perceived value, perceived enjoyment, and employee burnout were the most important determinants of IHT adoption intention by health care professionals. In addition, while employee burnout was negatively related to adoption intention, perceived value inhibited employee burnout. Therefore, this study finds that it is necessary to develop strategies to improve the perceived value and reduce employee burnout, which will benefit the promotion of the adoption intention of IHT in health care professionals. This study supports the use of the VAM and employee burnout in explaining health care professionals' adoption intention regarding IHT.

Utilization of, satisfaction toward, and challenges for Internet-based healthcare services provided by primary health institutions: Evidence from China

Background

The rapid development of "Internet plus healthcare" in China has provided new ways for the innovative development of primary healthcare. In addition, a series of favorable policies have been issued to promote Internet-based healthcare services in primary health institutions.

Objective

The aim of this study was to describe the utilization of, satisfaction toward, and challenges faced by Internet-based healthcare services provided by primary health institutions in China.

Methods

A self-designed structured questionnaire was employed to collect related data in January 2022 through Credamo. The questionnaire mainly included sociodemographic characteristics, health-related information, utilization of, satisfaction toward, and challenges faced by Internet-based healthcare services provided by primary health institutions. Descriptive analysis was used to describe the sociodemographic characteristics, utilization, satisfaction, and challenges by subgroups. The Wilcoxon rank-sum test was carried out to examine the differences in satisfaction with Internet-based healthcare services between participants who ever received these services and those who did not. A multiple logistic regression model was also used to examine the factors influencing the utilization of Internet-based healthcare services provided by primary health institutions.

Results

A total of 10,600 residents were included in the final analysis, of whom 5,754 (54.3%) were women. Overall, 51.3% (5,434) of the total participants ever used Internet-based healthcare services provided by primary health institutions. Among those who used Internet-based healthcare services, the most widely used services were procedure-related consultation services (63.7%). The satisfaction among those who ever used it was significantly higher than that among those who did not (84.7 vs. 45.4%; p-value < 0.001). One of the biggest challenges (69.3%) expressed by the residents was that it was difficult for the elderly to use Internet-based services, followed by community doctors with low capacity of providing primary care online (49.0%) and residents were worried about the information security and privacy protection (48.5%). Younger people, people with lower education levels, and people with chronic diseases were significantly more likely to use Internet-based healthcare services provided by primary health institutions (P < 0.05).

Conclusion

Among 10,600 residents surveyed in China in 2022, more than half of the people used Internet-based healthcare services provided by primary health institutions, and most of them were satisfied, although subgroups significant differences existed. The most common use was procedure-related (e.g., online registration and result query), and several challenges of using Internet-based healthcare services exist (e.g., information safety and usage among elderly people). Therefore, it is important to further improve Internet-based primary healthcare services based on the population perception of achieving healthy China in 2030.

Regional disparities and influencing factors of high quality medical resources distribution in China

BACKGROUND

With the gradual increase of residents' income and the continuous improvement of medical security system, people's demand for pursuing higher quality and better medical and health services has been released. However, so far little research has been published on China's high quality medical resources (HQMR). This study aims to understand the spatiotemporal variation trend of HQMR from 2006 to 2020, analyze regional disparity of HQMR in 2020, and further explore the main factors influencing the distribution of HQMR in China.

METHODS

The study selected Class III level A hospitals (the highest level medical institutions in China) to represent HQMR. Descriptive statistical methods were used to address the changes in the distribution of HQMR from 2006 to 2020. Lorentz curve, Gini coefficient (G), Theil index (T) and High-quality health resource density index (HHRDI) were used to calculate the degree of inequity. The geographical detector method was used to reveal the key factors influencing the distribution of HQMR.

RESULTS

The total amount of HQMR in China had increased year by year, from 647 Class III level A hospitals in 2006 to 1580 in 2020. In 2020, G for HQMR by population was 0.166, while by geographic area was 0.614. T was consistent with the results for G, and intra-regional contribution rates were higher than inter-regional contribution rates. HHRDI showed that Beijing, Shanghai, and Tianjin had the highest allocated amounts of HQMR. The results of the geographical detector showed that total health costs, government health expenditure, size of resident populations, GDP, number of medical colleges had a significant impact on the spatial distribution of HQMR and the q values were 0.813, 0.781, 0.719, 0.661, 0.492 respectively. There was an interaction between the influencing factors.

CONCLUSIONS

China's total HQMR is growing rapidly but is relatively inadequate. The distribution of HQMR by population is better than by geography, and the distribution by geography is less equitable. Population size and geographical area both need to be taken into account when formulating policies, rather than simply increasing the number of HQMR.

Developing a Capsule Clinic-A 24-Hour Institution for Improving Primary Health Care Accessibility: Evidence From China

Telehealth is an effective combination of medical service and intelligent technology. It can improve the problem of remote access to medical care. However, an imbalance in the allocation of health resources still occurs. People spend more time and money to access higher-quality services, which results in inequitable access to primary health care (PHC). At the same time, patients' usage of telehealth services is limited by the equipment and their own knowledge, and the PHC service suffers from low usage efficiency and lack of service supply. Therefore, improving PHC accessibility is crucial to narrowing the global health care coverage gap and maintaining health equity. In recent years, China has explored several new approaches to improve PHC accessibility. One such approach is the capsule clinic, an emerging institution that represents an upgraded version of the internet hospital. In coordination with the United Nations, the Yinzhou district of Ningbo city in Zhejiang, China, has been testing this new model since 2020. As of October 2022, the number of applications in Ningbo was 15, and the number of users reached 12,219. Unlike internet hospitals, the entire process-from diagnosis to prescription services-can be completed at the capsule clinic. The 24-hour telehealth service could also solve transportation problems and save time for users. Big data analysis can accurately identify regional populations' PHC service needs and improve efficiency in health resource allocation. The user-friendly, low-cost, and easily accessible telehealth model is of great significance. Installation of capsule clinics would improve PHC accessibility and resolve the uneven distribution of health resources to promote health equity.

Factors Influencing Adoption and Use of Telemedicine Services in Rural Areas of China: Mixed Methods Study

BACKGROUND

The shortage of medical resources in rural China reflects the health inequity in resource-limited settings, whereas telemedicine could provide opportunities to fill this gap. However, evidence of patient acceptance of telemedicine services from low- and middle-income countries is still lacking.

OBJECTIVE

We aimed to understand the profile of patient end-user telemedicine use and identify factors influencing telemedicine service use in rural China.

METHODS

Our study followed a mixed methods approach, with a quantitative cross-sectional survey followed by in-depth semistructured interviews to describe telemedicine use and its associated factors among rural residents in Guangdong Province, China. In the quantitative analysis, explanatory variables included environmental and context factors, household-level factors, individual sociodemographic factors, access to digital health care, and health needs and demand factors. We conducted univariate and multivariate analyses using Firth logistic regression to examine the correlations of telemedicine uptake. A thematic approach was used, guided by the Social Cognitive Theory for the qualitative analysis.

RESULTS

A total of 2101 households were recruited for the quantitative survey. With a mean age of 61.4 (SD 14.41) years, >70% (1364/2101, 72.94%) of the household respondents were male. Less than 1% (14/2101, 0.67%) of the respondents reported experience of using telemedicine. The quantitative results supported that villagers living with family members who had a fever in the past 2 weeks (adjusted odds ratio 6.96, 95% CI 2.20-21.98; P=.001) or having smartphones or computers (adjusted odds ratio 3.71, 95% CI 0.64-21.32; P=.14) had marginally higher telemedicine uptake, whereas the qualitative results endorse these findings. The results of qualitative interviews (n=27) also supplemented the potential barriers to telemedicine use from the lack of knowledge, trust, demand, low self-efficacy, and sufficient physical and social support.

CONCLUSIONS

This study found extremely low use of telemedicine in rural China and identified potential factors affecting telemedicine uptake. The main barriers to telemedicine adoption among rural residents were found, including lack of knowledge, trust, demand as well as low self-efficacy, and insufficient physical and social support. Our study also suggests strategies to facilitate telemedicine engagement in low-resource settings: improving digital literacy and self-efficacy, building trust, and strengthening telemedicine infrastructure support.

Strategic Encounters in Innovation and Regulation: Healthcare Transformation in the Era of Digital Connectivity Comment on "What Managers Find Important for Implementation of Innovations in the Healthcare Sector - Practice Through Six Management Perspectives"

Healthcare innovations emerge and develop in institutionally dense selective environments. New projects and propositions in healthcare sectoral ecosystems can be understood as product-service compacts, that is, complex solutions that dynamically integrate tangible and intangible elements in close interaction with users' needs and the evolving regulatory context under uncertainty and ambiguity. We advance the concept of "strategic encounters" to encapsulate, capitalise and extend the contribution by Palm and Fischier's on the key enabling managerial factors for healthcare innovation implementation under conditions of imperfect foresight. We intertwine creative assemblages that shape the formation of knowledge-intensive activities at the operators' level with scope of sectoral level interventions to underscore how the opportunities and constraints can enhance innovation for the common good. We use the case of digital data health regulatory agendas as illustration. We argue that this broader perspective on healthcare transformation is theoretically pertinent and practically useful, for management and policy.

Mobile Health in China: Well Integrated or a New Divide?

The application of mobile health holds promises of achieving greater accessibility in the evolving health care sector. The active engagement of private actors drives its growth, while the challenges that exist between health care privatization and equitable access are a concern. This article selects the private internet hospital in China as a case study. It indicates that a market-oriented regulatory mechanism of private mobile health will contribute little to improving health equity from the perspectives of egalitarians and libertarians. By integrating the capability approach and the right to health, it is claimed that mobile health is a means of accessing health care for everyone, where substantive accessibility should be emphasized. With this view, this article provides policy recommendations that reinforce private sector engagement for mobile health, recognizing liberty, equity, and collective responsibility in the Chinese context.

Telemedicine Is Becoming an Increasingly Popular Way to Resolve the Unequal Distribution of Healthcare Resources: Evidence From China

Background

Few studies focused on the general situation of telemedicine in China.

Objectives

The purpose of this review is to investigate telemedicine in China, from the aspects of necessity, history, scale, and operation procedure, to improve the further development and implementation of telemedicine service.

Methods

A literature search for peer-reviewed studies was conducted using the primary electronic databases. Additional documents from the official websites of Chinese government departments involved telemedicine was also collected. We extracted telemedicine related information focused on China from the final retrieved materials, and the general situation of telemedicine was drawn.

Results

In China, telemedicine offers a feasible solution to the unequal allocation of healthcare resources, which makes telemedicine increasingly become an important alternative to close the gap between rural and urban in the capability and quality of medical services. China initiated telemedicine in the late 1980s. In 2018, China's telemedicine network has covered more than 3,000 hospitals across the country. As of 2019, almost all of the 31 provinces and municipalities in mainland have established regional telemedicine centers, and the market size of telemedicine reached about USD 2.68 billion. Based on the telemedicine network, remote rural patients can apply for healthcare services of top-tier urban hospitals through local county-level medical institutions.

Conclusions

Through improving the capacity, quality, and efficiency of healthcare in underserved areas, and reducing the unequal distribution of medical resources, telemedicine can help solve the problems of the difficulty and high cost to access to medical services in China.

Digital tools/eHealth to support CKD self-management: A qualitative study of perceptions, attitudes and needs of patients and health care professionals in China

BACKGROUND

A growing body of evidence supports the potential effectiveness of electronic health (eHealth) self-management interventions in improving disease self-management skills and health outcomes of patients suffering from chronic kidney disease (CKD). However, current research on CKD eHealth self-management interventions has almost exclusively focused on high-income, western countries.

OBJECTIVE

To inform the adaptation of a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) intervention, we examined the perceptions, attitudes and needs of Chinese patients with CKD and health care professionals (HCPs) towards eHealth based (self-management) interventions in general and the Dutch MD intervention in specific.

METHODS

We conducted a basic interpretive, cross-sectional qualitative study comprising semi-structured interviews with 11 patients with CKD and 10 HCPs, and 2 focus group discussions with 9 patients with CKD. This study was conducted in the First Affiliated Hospital of Zhengzhou University in China. Data collection continued until data saturation was reached. All data were transcribed verbatim and analyzed using a framework approach.

RESULTS

Three themes emerged: (1) experience with eHealth in CKD (self-management), (2) needs for supporting CKD self-management with the use of eHealth, and (3) adaptation and implementation of the Dutch MD intervention in China. Both patients and HCPs had experience with and solely mentioned eHealth to 'inform, monitor and track' as potentially relevant interventions to support CKD self-management, not those to support 'interaction' and 'data utilization'. Factors reported to influence the implementation of CKD eHealth self-management interventions included information barriers (i.e. quality and consistency of the disease-related information obtained via eHealth), perceived trustworthiness and safety of eHealth sources, clinical compatibility and complexity of eHealth, time constraints and eHealth literacy. Moreover, patients and HCPs expressed that eHealth interventions should support CKD self-management by improving the access to reliable and relevant disease related knowledge and optimizing the timeliness and quality of patient and HCPs interactions. Finally, suggestions to adaptation and implementation of the Dutch MD intervention in China were mainly related to improving the intervention functionalities and content of MD such as addressing the complexity of the platform and compatibility with HCPs' workflows.

CONCLUSIONS

The identified perceptions, attitudes and needs towards eHealth self-management interventions in Chinese settings should be considered by researchers and intervention developers to adapt a tailored eHealth self-management intervention for patients with CKD in China. In more detail, future research needs to engage in co-creation processes with vulnerable groups during eHealth development and implementation, increase eHealth literacy and credibility of eHealth (information resource), ensure eHealth to be easy to use and well-integrated into HCPs' workflows.

China's Elder Care Policies 1994-2020: A Narrative Document Analysis

Until the 1980s, institutional elder care was virtually unknown in China. In a few decades, China had to construct a universal social safety net and assure basic elderly care. China’s government has been facing several challenges: the eroding traditional family care, the funding to assure care services for the older population, as well as the shortage of care delivery services and nursing staff. This paper examines China’s Five-Year Policy Plans from 1994 to 2020. Our narrative review analysis focuses on six main topics revealed in these policies: care infrastructure, community involvement, home-based care, filial piety, active aging and elder industry. Based on this analysis, we identified several successive and often simultaneously strategic steps that China introduced to contend with the aging challenge. In Western countries, elder care policies have been shifting to the home care approach. China introduced home care as the elder care cornerstone and encouraged the revival of the filial piety tradition. Although China has a unique approach, the care policies for the aged population in China and Western countries are converging by emphasizing home-based care, informal care and healthy aging.

Access, charge and quality of tele-dermatology e-consults in China: A standardized patients study

OBJECTIVE

Direct-to-consumer telemedicine is rapidly changing the way that patients seek medical care. This study provided the first report on access, cost and quality of text- and image-based tele-dermatology e-consults, in China.

METHODS

We adopted the Standardized Patients approach to evaluate the services of tele-dermatology e-consults in two metropolitan cities, that is, Beijing and Hangzhou, in China. We measured quality from four dimensions: service process, diagnosis accuracy, prescription and treatment comprehensiveness, based on China's national clinical guidelines. We performed logistic regressions to investigate factors that were associated with high-quality care.

RESULTS

For 114 physicians eligible for inclusion, we succeeded in 87 (76%) validated visits. The median waiting time was 100 minutes (IQR 19-243 minutes) and the median length of consultation was 636 minutes (about 10 hours, IQR 188-1528 minutes). Per visit costs varied from $0 to $38, with a median of $8 (IQR 4-9). Among all, 15% of visits showed high quality in service process, 84% arrived in the correct diagnosis, 24% provided high-quality prescriptions and 71% provided comprehensive treatment. Providing images was associated with high quality in service process (OR 7.22, 95% CI 1.49-34.88). Visits in metropolitan Beijing and on non-work days had better prescription quality than that in metropolitan Hangzhou (OR 6.05, 95% CI 1.75-20.95) and that on workdays (OR 3.75, 95%CI 1.27-11.04), respectively.

CONCLUSIONS

Tele-dermatology e-consults seem to be easy to access and less expensive in China. However, great efforts are warranted to ensure that service processes and prescriptions adhere to clinical guidelines.

Attitudes and perspectives of 534 Chinese pediatricians toward internet hospitals

BACKGROUND

Internet hospitals introduced in China have effectively reduced service time and space, promoted high-quality pediatric medical resources to grassroots areas, solved the contradiction between supply and demand of pediatric medical resources, and met patients' increasing multi-level and diversified medical service needs. However, pediatricians' attitudes toward and satisfaction with the use of internet hospitals remain unknown.

OBJECTIVE

This study aimed to investigate pediatricians' knowledge of, use of, and satisfaction with internet hospitals in order to identify major issues in internet hospital development, and to understand pediatricians' attitudes and opinions on the construction, development, and use of internet hospitals.

MATERIALS AND METHODS

A total of 625 pediatricians in 17 public tertiary hospitals in Shanghai were surveyed from November 1-30, 2021. Five hundred and thirty four pediatricians completed the survey, and the response rate was 85.44%. Pediatricians' baseline demographic data were collected and information about their use of and satisfaction with internet hospitals.

RESULTS

About 70.22% (375/534) of pediatricians knew about internet hospitals and about 54.68% (292/534) use internet hospitals for patient consultation, diagnosis, and treatment. Utilized services mainly focused on online consultation (271/292, 92.81%), online follow-up consultation (174/292, 59.59%), and health sciences (111/292, 38.01%). Online services were provided by 69.18% (202/292) of pediatricians for less than 1 h a day, and 75.00% (219/292) responded to fewer than five patient consultations online every day. Pediatricians' overall satisfaction with internet hospitals was low (3.59 ± 0.92 points), user experience, systems functions, operation processes, service prices, and performance rewards of internet hospitals were main influencing factors. Pediatricians are enthusiastic about further development of internet hospitals, with 87.83% (469/534) willing to provide services on the internet hospital platform.

CONCLUSION

Most pediatricians view internet hospitals favorably and are eager to contribute to the development of online diagnosis and treatment services. The development of internet hospitals will be more strongly supported by improving pediatricians' satisfaction and mobilizing their enthusiasm and initiative to participate in internet medical services.

Evaluation of Online Andrology Medical Services in Central Regions of China During the COVID-19 Pandemic: A Cross-Sectional Data Analysis Study

To provide an overview of the current situation, challenges, and trends in online medical services from the perspective of andrology and promote the development of online medical services. Users of the Learning Alliance of Urology, who mainly worked in central regions of China, were invited to complete the questionnaire that included information on the participants and their institutions and their involvement in and concerns for online medical services. We received 875 complete responses. The percentage of online andrology patients at most institutions was less than 30%. The most common services were online appointment registration (92.7%) and online payment (81.8%). Online chat consultation (77.7%) was the most common form of consultation. Only 1 in 5 of the institutions had constructed their Internet hospital. Factors related to the percentage of online andrology patients included specialized andrology clinics and wards, sufficient time for doctors to provide online services, more diversified services, and online clinic training. The biggest challenge for online medical services was diagnosis and treatment safety. It is essential to raise awareness of online medical services for hospitals and patients and strengthen standardized management and training of online medical services, especially applicable to central regions of China. However, online medical services cannot wholly replace offline services due to insufficient diagnosis and treatment.

Understanding "Internet Plus Healthcare" in China: Policy Text Analysis

Background

The combination of the internet and healthcare has excellent benefits and far-reaching positive effects in improving service efficiency and promoting social equity. The role of the “internet plus healthcare” (IPHC) has been recognized, especially during the COVID-19 pandemic. This new healthcare model is also familiar to people and shows a bright prospect.

Objective

This article seeks to accurately understand and fully grasp the characteristics of IPHC policies that can enlighten the formulation of future policies.

Methods

The content analysis method was used to analyze China’s IPHC policies collected from the Beida Fabao database and several official websites.

Results

We found that the development of IPHC policy has gone through 4 stages and is currently entering a phase of rapid development. IPHC policymakers are primarily health administrative departments. In addition, policy instruments are classified into either supply, environment, or demand, and policy themes can be summarized into 4 categories: facilities, technology, service, and management.

Conclusions

China’s IPHC policy has good prospects from the perspective of development trends. The health administrative departments mainly lead the development of China’s IPHC policy. It is suggested that these departments involve other stakeholders (ie, medical workers, medical industries, and technology sectors) in formulating policies. Policies prefer to use supply-based and environment-based policy instruments. The policy themes emphasize improving infrastructure construction and high-quality diagnostic and treatment services, strengthening the supporting role of information technology, and ensuring all stakeholders understand their responsibilities.

Policy Interventions, Development Trends, and Service Innovations of Internet Hospitals in China: Documentary Analysis and Qualitative Interview Study

BACKGROUND

Internet hospitals have been encouraged by the Chinese government to develop an innovative medical service model that mainly uses new internet-based technologies to increase access to health care and improve the quality and efficiency of health care delivery. However, the academic exploration of the institutional and sectoral development of internet hospitals in China is scarce in the existing literature.

OBJECTIVE

This study aimed to investigate the policy interventions, development trends, and service innovations of internet hospitals in China. It is expected that the findings from this study will contribute to the further innovation of internet hospitals in China and provide references for the international development of internet hospitals for personalized digital health and patient-centric services.

METHODS

This study analyzed official policies related to internet hospitals that were implemented by the government in China since 2005. The data of formally approved internet hospitals were collected from official websites to analyze development trends. In-depth semistructured interviews were conducted with 58 key stakeholders who represented comprehensive viewpoints about the service innovations of internet hospitals between March and November 2019.

RESULTS

In total, 25 policies that promoted the development of internet hospitals in China were identified. These policies encompassed informatization infrastructure construction, medical resource integration, development model design, service model design, and payment model design. Of the 268 internet hospitals that had received an official license from the government, 153 public internet hospitals had been built mainly by medical institutions. Public tertiary hospitals were the main actors in founding internet hospitals that were created to provide services that targeted patients with common diseases or chronic diseases or patients living in remote and rural areas. Promoting convenient access to high-quality medical resources and saving patients' and their families' time were the key values of internet hospitals.

CONCLUSIONS

The policy interventions strongly promoted the development of internet hospitals in China. Public tertiary hospitals led the development of internet hospitals. However, internet hospitals in China have mainly played roles that are complementary to those of physical medical institutions. The service model of internet hospitals needs more distinguished innovations to provide personalized digital health and patient-centric services.

Consultation Pricing of the Online Health Care Service in China: Hierarchical Linear Regression Approach

BACKGROUND

Online health care services are a possible solution to alleviate the lack of medical resources in rural areas, and further understanding of the related medical service pricing system would contribute to improvement of the online health care community (OHC). Although many studies have investigated the OHC, the impact of physicians' reputations and wage levels on consulting prices in the OHC has rarely been discussed in the literature.

OBJECTIVE

This study was designed to explore the determinants of consulting prices in the OHC. We addressed the following questions: (1) Are the prices of online health consultation services affected by wage levels at the doctor's location? (2) How does a physician's online and offline reputation affect their consulting prices?

METHODS

Employing a large-scale sample of 16,008 doctors in China, we first used descriptive statistics to investigate the determinants of consulting prices in their entirety. Hierarchical linear modeling was then used to investigate the determinants of consulting prices in the OHC.

RESULTS

The empirical results led to the conclusion that if doctors have more elevated clinic titles, work in higher-level hospitals, have better online reputations, and/or have made more past sales, their consulting prices will be higher. Additionally, the wage level in the city in which the doctor is working determines their opportunity cost and therefore also affects consulting prices.

CONCLUSIONS

The findings indicate that the characteristics of the doctor, the doctor's online reputation, and past sales affect the consulting price. In particular, the wage level in the city affects the price of the consultation. These findings highlight that the OHC is important because it can indeed break through geographical restrictions and give rural residents the opportunity to obtain medical service from doctors in big cities. However, doctors from cities often charge higher fees because of their higher opportunity cost. The results reveal that one of the most important functions of the OHC is to reduce the medical disparity between urban and rural areas; however, planners appear to ignore the possibility that rural residents with lower incomes may not be able to afford such high medical consultation costs. Therefore, the government should consider providing incentives to encourage urban doctors to provide discounts to rural residents or directly offer appropriate subsidies.

Few changes shown in cancer information-seeking behaviour among young adults in China between 2012 and 2017

BACKGROUND

The increasing incidence of cancer among young adults (18-40 years old) is of concern in China.

OBJECTIVES

This study aims to examine the influence of cancer information-seeking behaviours (CISB) on young adults' worries about cancer and participation in screening.

METHODS

This study analysed data from two probability sample surveys conducted in 2012 and 2017 in China. The questions in the questionnaire remained the same for better comparison. The sample size was 1212 in the 2012 survey, and 2178 in the 2017 survey.

RESULTS

From 2012 to 2017, among young adults, there was a decline in cancer information seeking, diversity of cancer information sought and cancer worry, while an improvement in cancer information-seeking experience was found. Also, CISB had significant associations with cancer worry and health screening over the 5 years.

DISCUSSION

The level of young adults' cancer information seeking remains low in China, and this group is not fully aware of their potential risks of getting cancer.

CONCLUSION

Although young adults find the experience of looking for cancer information easier in 2017, health campaigns may be necessary to encourage young adults to find out more about their cancer risks, and to participate more in health screening.

How Doctors Do Things with Empathy in Online Medical Consultations in China: A Discourse-analytic Approach

It is widely acknowledged that doctors' expressions of empathy are fundamental to a successful medical consultation. While extensive work has been done on empathic communication in face-to-face medical encounters, few studies explored expressions of empathy in online medical consultations. Such research is particularly scarce in Chinese contexts, even though China has recently seen substantial growth in e-healthcare activities. To gain a better understanding of clinical empathic communication in online environment, this study, using discourse-analytic tools, explores the pragmatic functions of doctors' empathic responses in text-based online medical consultations in China. The study finds that most empathic responses by doctors can be said to perform the function of facilitating the institutional task of problem-solving, and a few serve the function of self-promotion that is likely to be triggered by the e-commerce model for online medical services.

Characteristics of Online Health Care Services From China's Largest Online Medical Platform: Cross-sectional Survey Study

Background

Internet hospitals in China are in great demand due to limited and unevenly distributed health care resources, lack of family doctors, increased burdens of chronic diseases, and rapid growth of the aged population. The COVID-19 epidemic catalyzed the expansion of online health care services. In recent years, internet hospitals have been rapidly developed. Ping An Good Doctor is the largest, national online medical entry point in China and is a widely used platform providing online health care services.

Objective

This study aims to give a comprehensive description of the characteristics of the online consultations and inquisitions in Ping An Good Doctor. The analyses tried to answer the following questions: (1) What are the characteristics of the consultations in Ping An Good Doctor in terms of department and disease profiles? (2) Who uses the online health services most frequently? and (3) How is the user experience of the online consultations of Ping An Good Doctor?

Methods

A total of 35.3 million consultations and inquisitions over the course of 1 year were analyzed with respect to the distributions of departments and diseases, user profiles, and consulting behaviors.

Results

The geographical distribution of the usage of Ping An Good Doctor showed that Shandong (18.4%), Yunnan (15.6%), Shaanxi (7.2%), and Guangdong (5.5%) were the provinces that used it the most; they accounted for 46.6% of the total consultations and inquisitions. In terms of department distribution, we found that gynecology and obstetrics (19.2%), dermatology (17.0%), and pediatrics (14.4%) were the top three departments in Ping An Good Doctor. The disease distribution analysis showed that, except for nondisease-specific consultations, acute upper respiratory infection (AURI) (4.1%), pregnancy (2.8%), and dermatitis (2.4%) were the most frequently consulted diseases. In terms of user profiles, females (60.4%) from 19 to 35 years of age were most likely to seek consultations online, in general. The user behavior analyses showed that the peak times of day for online consultations occurred at 10 AM, 3 PM, and 9 PM. Regarding user experience, 93.0% of users gave full marks following their consultations. For some disease-related health problems, such as AURI, dermatitis, and eczema, the feedback scores were above average.

Conclusions

The prevalence of internet hospitals, such as Ping An Good Doctor, illustrated the great demand for online health care services that can go beyond geographical limitations. Our analyses showed that nondisease-specific issues and moderate health problems were much more frequently consulted about than severe clinical conditions. This indicated that internet hospitals played the role of the family doctor, which helped to relieve the stress placed on offline hospitals and facilitated people’s lives. In addition, good user experiences, especially regarding disease-related inquisitions, suggested that online health services can help solve health problems. With support from the government and acceptance by the public, online health care services could develop at a fast pace and greatly benefit people’s daily lives.

Talk to Your Doctors Online: An Internet-based Intervention in China

China has long faced the problem of having health care that is difficult to access. Online patient-provider communication (OPPC) may offer a new option for the delivery of affordable health services in a timely manner. However, OPPC is still novel in China, particularly among middle-aged and older adults. Thus, to promote effective use of OPPC for these population groups, the current study implemented a four-week Internet-based intervention program, with a general basis of Social Cognitive Theory. With analyses of three-wave panel data, the results offer the promise of this intervention program in increasing usage frequency, quality of users' experience, self-efficacy, behavioral capability, and awareness of OPPC. This Internet-based intervention program also provides important implications for future research, practice, and policy in promoting e-Health in China.

Comparing Smartphone Apps for Traditional Chinese Medicine and Modern Medicine in China: Systematic Search and Content Analysis

Background

Traditional Chinese medicine (TCM) is an integral part of mainstream medicine in China, with theories and practices that are completely different from modern medicine. TCM should not be ignored or confused with modern medicine in the analysis of the Chinese health care system, including the analysis of mobile health (mHealth) apps. To date, differences between TCM apps and modern medicine apps have not be systematically investigated.

Objective

The aim of this study was to systematically compare the quality of apps for TCM and modern medicine in China.

Methods

In December 2020, we searched iOS (iTunes) and Android (Tencent, Oppo, and Huawei app stores) platforms for all mHealth apps and then categorized them as TCM or modern medicine apps if they were included in the final analysis. The included apps were downloaded on smartphones and assessed by 2 reviewers on the following 4 aspects: (1) data in the app stores, including user ratings, download counts, cost, target users, and year of last update; (2) functionality; (3) quality of the app content as determined by the Mobile App Rating Scale (MARS); and (4) analysis of the app privacy and security.

Results

In total, 658 apps were analyzed, including 261 TCM medicine apps and 397 modern medicine apps. The average download count of modern medicine apps (approximately 5 million) was more than 10 times that of TCM apps (approximately 400,000). Regarding functionalities, 64.7% (257/397) of modern medicine apps provided telemedicine (74/261, 28.4% in TCM apps), 62.7% (249/397) provided registration (70/261, 26.8% in TCM apps), and 45.6% (181/397) provided communication (38/261, 14.6% in TCM apps). A larger proportion of TCM apps provided prescription and medication management (144/261, 55.2% in TCM apps versus 168/397, 42.3% in modern medicine apps). The majority of modern medicine apps (329/397, 82.9%) combined ≥3 functionalities compared with one-third of TCM apps (93/261, 34.6%). We then selected 81 top apps for quality and safety assessment (41 TCM apps and 40 modern medicine apps). Of these, the mean overall MARS score of TCM apps (2.7, SD 0.5) was significantly lower than modern medicine apps (3.6, SD 0.4). Almost all modern medicine apps (38/40, 95%) addressed privacy and security by providing a privacy policy and describing how to protect personal data, but less than half of the TCM apps (18/41, 44%) described this information (P<.001).

Conclusions

The different functionalities reflect the distinct innate characteristics of these two medical systems. Although great progress has been made and the Chinese mHealth market size is large, there still exist many opportunities for future development, especially for TCM.

Assessment of Internet Hospitals in China During the COVID-19 Pandemic: National Cross-Sectional Data Analysis Study

BACKGROUND

Internet hospitals in China are being rapidly developed as an innovative approach to providing health services. The ongoing COVID-19 pandemic has triggered the development of internet hospitals that promote outpatient service delivery to the public via internet technologies. To date, no studies have assessed China's internet hospitals during the COVID-19 pandemic.

OBJECTIVE

This study aimed to elucidate the characteristics of China's internet hospitals and assess the health service capacity of these hospitals.

METHODS

Data on 711 internet hospitals were collected from official websites, the WeChat (Tencent Inc) platform, smartphone apps, and the Baidu search engine until July 16, 2020.

RESULTS

As of July 16, 2020, 711 internet hospitals were developed in mainland China. More than half of these internet hospitals (421/711, 59.2%) were established during 2019 (206/711, 29%) and 2020 (215/711, 30.2%). Furthermore, about one-third (215/711, 30.2%) of internet hospitals were established at the beginning of 2020 as an emergency response to the COVID-19 epidemic. The 711 internet hospitals consisted of the following 3 types of hospitals: government-oriented (42/711, 5.91%), hospital-oriented (143/711, 20.11%), and enterprise-oriented internet hospitals (526/711, 73.98%). The vast majority of internet hospitals were traditional hospitals (526/711, 74%). Nearly 46.1% (221/711) of internet hospitals requested doctors to provide health services at a specific web clinic. Most patients (224/639, 35.1%) accessed outpatient services via WeChat. Internet hospitals' consulting methods included SMS text messaging consultations involving the use of graphics (552/570, 96.8%), video consultations (248/570, 43.5%), and telephone consultations (238/570, 41.8%). The median number of available web-based doctors was 43, and the median consultation fees of fever clinics and other outpatient clinics were ¥0 (US $0) per consultation and ¥6 (US $0.93) per consultation, respectively. Internet hospitals have provided various services during the COVID-19 pandemic, including medical prescription, drug delivery, and medical insurance services.

CONCLUSIONS

The dramatic increase of internet hospitals in China has played an important role in the prevention and control of COVID-19. Internet hospitals provide different and convenient medical services for people in need.

The Influences of COVID-19 on Patients With Chronic Kidney Disease: A Multicenter Cross-Sectional Study

Background: The outbreak of coronavirus disease 2019 (COVID-19) has attracted global attention. During the lockdown period of COVID-19, follow-up of many patients with chronic disease had been interrupted, which brought severe challenges to better management of their disease. This study aimed at exploring the change of illness, daily life, and psychological responses during the COVID-19 pandemic among chronic kidney disease (CKD) patients. Methods: A total of 612 patients were enrolled in this study; 282 patients were categorized into the CKD stage 1-2 group and 330 patients were categorized into the CKD stage 3-5 group. Among two groups, 168 (27.5%) and 177 (28.9%) patients were female with a median age of 42 and 45, respectively. The study was conducted by collecting the questionnaires in five nephrology centers. The questionnaire consisted of assessment of anxiety by using the Self-Rating Anxiety Scale and the influences of COVID-19, which included basic demographic data, the influences of COVID-19 on illness and daily life, as well as the patients' psychological responses during the epidemic. Results: A total of 612 patients were included and divided into two groups according to eGFR. Ninety-six patients (34%) in the CKD stage 1-2 group and 141 patients (42.7%) in the CKD stage 3-5 group had reduced their follow-up frequency (p = 0.031). More patients with CKD stages 1-2 consulted online (25.9%), p = 0.005. Besides, patients in the CKD stage 3-5 group tended to be more anxious about follow-up (p = 0.002), fearful of being infected with COVID-19 (p = 0.009), and more likely to feel symptoms getting worse (p = 0.006). The standard scores of SAS were 48.58 ± 7.082 and 51.19 ± 5.944 in the CKD stage 1-2 group and the CKD stage 3-5 group, respectively (p < 0.001). There were significant differences in the severity of anxiety (p = 0.004). Conclusion: COVID-19 had a greater impact on patients with CKD stages 3-5 than those with stages 1-2 in terms of illness, daily life, and psychological disorder. Patients with CKD stages 3-5 were more anxious during the COVID-19 pandemic.

Development and evaluation of an eHealth self-management intervention for patients with chronic kidney disease in China: protocol for a mixed-method hybrid type 2 trial

Background

Chronic kidney disease (CKD) is a significant public health concern. In patients with CKD, interventions that support disease self-management have shown to improve health status and quality of life. At the moment, the use of electronic health (eHealth) technology in self-management interventions is becoming more and more popular. Evidence suggests that eHealth-based self-management interventions can improve health-related outcomes of patients with CKD. However, knowledge of the implementation and effectiveness of such interventions in general, and in China in specific, is still limited. This study protocol aims to develop and tailor the evidence-based Dutch ‘Medical Dashboard’ eHealth self-management intervention for patients suffering from CKD in China and evaluate its implementation process and effectiveness.

Methods

To develop and tailor a Medical Dashboard intervention for the Chinese context, we will use an Intervention Mapping (IM) approach. A literature review and mixed-method study will first be conducted to examine the needs, beliefs, perceptions of patients with CKD and care providers towards disease (self-management) and eHealth (self-management) interventions (IM step 1). Based on the results of step 1, we will specify outcomes, performance objectives, and determinants, select theory-based methods and practical strategies. Knowledge obtained from prior results and insights from stakeholders will be combined to tailor the core interventions components of the ‘Medical Dashboard’ self-management intervention to the Chinese context (IM step 2–5). Then, an intervention and implementation plan will be developed. Finally, a 9-month hybrid type 2 trial design will be employed to investigate the effectiveness of the intervention using a cluster randomized controlled trial with two parallel arms, and the implementation integrity (fidelity) and determinants of implementation (IM step 6).

Discussion

Our study will result in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China, which has the potential to optimize patients’ self-management skills and improve health status and quality of life. Moreover, it will inform future research on the tailoring and translation of evidence-based eHealth self-management interventions in various contexts.

Trial registration

Clinicaltrials.gov NCT04212923; Registered December 30, 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-020-02160-6.

Determinants of Patients' Intention to Use the Online Inquiry Services Provided by Internet Hospitals: Empirical Evidence From China

Background

Internet hospitals show great potential for adequately fulfilling people’s demands for high-quality outpatient services, and with the normalization of the epidemic prevention and control of COVID-19, internet hospitals play an increasingly important role in delivering health services to the public. However, the factors that influence patients’ intention to use the online inquiry services provided by internet hospitals remain unclear. Understanding the patients’ behavioral intention is necessary to support the development of internet hospitals in China and promote patients’ intention to use online inquiry services provided by internet hospitals during the prevention and control of the COVID-19 epidemic.

Objective

The purpose of this study is to identify the determinants of patients’ intention to use the online inquiry services provided by internet hospitals based on the theory of planned behavior (TPB).

Methods

The hypotheses of our research model were developed based on the TPB. A questionnaire was developed through patient interviews, verified using a presurvey, and used for data collection for this study. The cluster sampling technique was used to include respondents with chronic diseases. Structural equation modeling was used to test the research hypotheses.

Results

A total of 638 valid responses were received from patients with chronic diseases. The goodness-of-fit indexes corroborated that the research model was a good fit for the collected data. The model explained 45.9% of the variance in attitude toward the behavior and 60.5% of the variance in behavioral intention. Perceived behavioral control and perceived severity of disease had the strongest total effects on behavioral intention (β=.624, P=.004 and β=.544, P=.003, respectively). Moreover, perceived convenience, perceived information risk, emotional preference, and health consciousness had indirect effects on behavioral intention, and these effects were mediated by attitude toward the behavior. Among the four constructs, perceived convenience had the highest indirect effect on behavioral intention (β=.207; P=.001).

Conclusions

Perceived behavioral control and perceived severity of disease are the most important determinants of patients’ intention to use the online inquiry services provided by internet hospitals. Therefore, internet hospitals should further optimize the design of online service delivery and ensure a reasonable assembly of high-quality experts, which will benefit the promotion of patients’ adoption intention toward online inquiry services for health purposes. Perceived convenience, emotional preference, and perceived risks also have effects on behavioral intention. Therefore, the relevant quality control standards and regulations for internet hospitals should be further developed and improved, and the measures to protect personal information should be strengthened to ensure the patient safety. Our study supports the use of the TPB in explaining patients’ intention to use online inquiry services provided by internet hospitals.

The Internet Hospital Plus Drug Delivery Platform for Health Management During the COVID-19 Pandemic: Observational Study

Background

Widespread access to the internet has boosted the emergence of online hospitals. A new outpatient service called “internet hospital plus drug delivery” (IHDD) has been developed in China, but little is known about this platform.

Objective

The aim of this study is to investigate the characteristics, acceptance, and initial impact of IHDD during the outbreak of COVID-19 in a tertiary hospital in South China

Methods

The total number of and detailed information on online prescriptions during the first 2 months after work resumption were obtained. Patients’ gender, age, residence, associated prescription department, time of prescription, payment, and drug delivery region were included in the analysis.

Results

A total of 1380 prescriptions were picked up or delivered between March 2 and April 20, 2020. The largest group of patients were 36-59 years old (n=680, 49.3%), followed by the 18-35 years age category (n=573, 41.5%). In total, 39.4% (n=544) of the patients chose to get their medicine by self-pickup, while 60.6% (n=836) preferred to receive their medicine via drug delivery service. The top five online prescription departments were infectious diseases (n=572, 41.4%), nephrology (n=264, 19.1%), endocrinology (n=145, 10.5%), angiocardiopathy (n=107, 7.8%), and neurology (n=42, 3%). Of the 836 delivered prescriptions, 440 (52.6%) were sent to Guangdong Province (including 363 [43.4%] to Shenzhen), and 396 (47.4%) were sent to other provinces in China.

Conclusions

The IHDD platform is efficient and convenient for various types of patients during the COVID-19 crisis. Although offline visits are essential for patients with severe conditions, IHDD can help to relieve pressure on hospitals by reducing an influx of patients with mild symptoms. Further efforts need to be made to improve the quality and acceptance of IHDD, as well as to regulate and standardize the management of this novel service.

The Internet Hospital as a Telehealth Model in China: Systematic Search and Content Analysis

Background

The internet hospital is an innovative organizational form and service mode under the tide of internet plus in the Chinese medical industry. It is the product of the interaction between consumer health needs and supply-side reform. However, there has still been no systematic summary of its establishment and definition, nor has there been an analysis of its service content.

Objective

The primary purpose of this study was to understand the definition, establishment, and development status of internet hospitals.

Methods

Data on internet hospitals were obtained via the Baidu search engine for results up until January 1, 2019. Based on the results of the search, we obtained more detailed information from the official websites and apps of 130 online hospitals and formed a database for descriptive analysis.

Results

By January 2019, the number of registered internet hospitals had expanded to approximately 130 in 25 provinces, accounting for 73.5% of all provinces or province-level municipalities in China. Internet hospitals, as a new telehealth model, are distinct but overlap with online health, telemedicine, and mobile medical. They offer four kinds of services—convenience services, online medical services, telemedicine, and related industries. In general, there is an underlying common treatment flowchart of care in ordinary and internet hospitals. There are three different sponsors—government-led integration, hospital-led, and enterprise-led internet hospitals—for which stakeholders have different supporting content and responsibilities.

Conclusions

Internet hospitals are booming in China, and it is the joint effort of the government and the market to alleviate the coexistence of shortages of medical resources and wasted medical supplies. The origin of internet hospitals in the eastern and western regions, the purpose of the establishment initiator, and the content of online and offline services are different. Only further standardized management and reasonable industry freedom can realize the original intention of the internet hospital of meeting various health needs.

Mobile health technology combats COVID-19 in China

China empowers mobile health technologies to fight against COVID-19 pandemic. The success of mobile health here may be a useful reference for other parts of the world. We explore China's application of mobile health technologies to replenishing traditional public-health and social approaches for mitigating and suppressing COVID-19, and found that Internet hospitals alleviate the unavailability, inaccessibility, and inequity of health services during the outbreak; the fact-check and information-release platforms reduce the spread of misinformation; and the infection risk scoring systems facilitate restoring the order of production and life.

Patients' Perceptions of Barriers and Facilitators to the Adoption of E-Hospitals: Cross-Sectional Study in Western China

BACKGROUND

As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users' acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China.

OBJECTIVE

This study aimed to provide insights regarding the adoption of e-hospitals by investigating patients' willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology.

METHODS

We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients' sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals.

RESULTS

Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%).

CONCLUSIONS

We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries.

Postoperative online follow-up improves the quality of life of patients who undergo extraction of impacted madibular third molars: a randomized controlled trial

Objective

To evaluate the effect of online follow-up on the quality of life of patients who undergo extraction of impacted mandibular third molars.

Materials and methods

This study enrolled patients with impacted mandibular third molars who were treated at the Department of Oral and Maxillofacial Surgery of the Stomatological Hospital at Southern Medical University and divided them into test and control groups. The test group received an online follow-up on the first, third, and fifth days after tooth extraction, while the control group was not followed up with. Patients in both groups were reexamined on the postoperative seventh day, completing the postoperative symptom severity (PoSSe) scale to comprehensively and quantitatively evaluate their quality of life after tooth extraction. A visual analogue scale (VAS) was used to evaluate the degree of approval for an online follow-up after tooth extraction by 20 senior doctors (≥ 40 years old) and 20 young doctors (<4 0 years old).

Results

The PoSSe scale scores of the remaining options in the test group were significantly lower than those in the control group. The VAS score of senior doctors for online follow-up was significantly lower than that of young doctors.

Conclusions

A postoperative online follow-up effectively improved the quality of life of patients who underwent extraction of impacted mandibular third molars. Compared with senior doctors, young doctors were more likely to approve an online follow-up after tooth extraction.

Clinical relevance

Online medical care can be considered as an auxiliary tool to improve the effect of oral treatment.

Internet Hospitals Help Prevent and Control the Epidemic of COVID-19 in China: Multicenter User Profiling Study

BACKGROUND

During the spread of the novel coronavirus disease (COVID-19), internet hospitals in China were engaged with epidemic prevention and control, offering epidemic-related online services and medical support to the public.

OBJECTIVE

The aim of this study is to explore the role of internet hospitals during the prevention and control of the COVID-19 outbreak in China.

METHODS

Online epidemic-related consultations from multicenter internet hospitals in China during the COVID-19 epidemic were collected. The counselees were described and classified into seven type groups. Symptoms were recorded and compared with reported patients with COVID-19. Hypochondriacal suspicion and offline visit motivation were detected within each counselees' group to evaluate the social panic of the epidemic along with the consequent medical-seeking behaviors. The counselees' motivation and the doctors' recommendation for an offline visit were compared. Risk factors affecting the counselees' tendency of hypochondriacal suspicion and offline visit motivation were explored by logistic regression models. The epidemic prevention and control measures based on internet hospitals were listed, and the corresponding effects were discussed.

RESULTS

A total of 4913 consultations were enrolled for analysis with the median age of the counselees at 28 years (IQR 22-33 years). There were 104 (2.12%) healthy counselees, 147 (2.99%) hypochondriacal counselees, 34 (0.69%) exposed counselees, 853 (17.36%) mildly suspicious counselees, 42 (0.85%) moderately suspicious counselees, 3550 (72.26%) highly suspicious counselees, and 183 (3.72%) severely suspicious counselees. A total of 94.20% (n=4628) of counselees had epidemic-related symptoms with a distribution similar to those of COVID-19. The hypochondriacal suspicion (n=2167, 44.11%) was common. The counselees' motivation and the doctors' recommendation for offline visits were inconsistent (P<.001) with a Cohen kappa score of 0.039, indicating improper medical-seeking behaviors. Adult counselees (odds ratio [OR]=1.816, P<.001) with epidemiological exposure (OR 7.568, P<.001), shortness of breath (OR 1.440, P=.001), diarrhea (OR 1.272, P=.04), and unrelated symptoms (OR 1.509, P<.001) were more likely to have hypochondriacal suspicion. Counselees with severe illnesses (OR 2.303, P<.001), fever (OR 1.660, P<.001), epidemiological exposure history (OR 1.440, P=.01), and hypochondriacal suspicion (OR 4.826, P<.001) were more likely to attempt an offline visit. Reattending counselees (OR 0.545, P=.002) were less motivated to go to the offline clinic.

CONCLUSIONS

Internet hospitals can serve different types of epidemic counselees, offer essential medical supports to the public during the COVID-19 outbreak, reduce the social panic, promote social distancing, enhance the public's ability of self-protection, correct improper medical-seeking behaviors, reduce the chance of nosocomial cross-infection, and facilitate epidemiological screening, thus, playing an important role on preventing and controlling COVID-19.

The Relationship between Face-to-Face and Online Patient-Provider Communication: Examining the Moderating Roles of Patient Trust and Patient Satisfaction

Patient-provider communication is an important factor influencing patients' health-related outcomes. This study examined how the quality of face-to-face communication with providers is associated with their subsequent Internet use for patient-provider communication. With an analysis of two-wave panel data collected in China, results showed that face-to-face patient-provider communication had a positive and direct effect on online patient-provider communication at a later time point. In addition, patient trust and patient satisfaction both positively moderated the relationship between face-to-face and online patient-provider communication. The results of this study emphasized the important roles of patient-centered communication and patient-provider relationship in the process of eHealth and mHealth movement, particularly in the Chinese health care system.

SERIES: eHealth in primary care. Part 1: Concepts, conditions and challenges

Primary care is challenged to provide high quality, accessible and affordable care for an increasingly ageing, complex, and multimorbid population. To counter these challenges, primary care professionals need to take up new and innovative practices, including eHealth. eHealth applications hold the promise to overcome some difficulties encountered in the care of people with complex medical and social needs in primary care. However, many unanswered questions regarding (cost) effectiveness, integration with healthcare, and acceptability to patients, caregivers, and professionals remain to be elucidated. What conditions need to be met? What challenges need to be overcome? What downsides must be dealt with? This first paper in a series on eHealth in primary care introduces basic concepts and examines opportunities for the uptake of eHealth in primary care. We illustrate that although the potential of eHealth in primary care is high, several conditions need to be met to ensure that safe and high-quality eHealth is developed for and implemented in primary care. eHealth research needs to be optimized; ensuring evidence-based eHealth is available. Blended care, i.e. combining face-to-face care with remote options, personalized to the individual patient should be considered. Stakeholders need to be involved in the development and implementation of eHealth via co-creation processes, and design should be mindful of vulnerable groups and eHealth illiteracy. Furthermore, a global perspective on eHealth should be adopted, and eHealth ethics, patients’ safety and privacy considered.

Home Videos as a Cost-Effective Tool for the Diagnosis of Paroxysmal Events in Infants: Prospective Study

Background

The diagnosis of paroxysmal events in infants is often challenging. Reasons include the child’s inability to express discomfort and the inability to record video electroencephalography at home. The prevalence of mobile phones, which can record videos, may be beneficial to these patients. In China, this advantage may be even more significant given the vast population and the uneven distribution of medical resources.

Objective

The aim of this study is to investigate the value of mobile phone videos in increasing the diagnostic accuracy and cost savings of paroxysmal events in infants.

Methods

Clinical data, including descriptions and home videos of episodes, from 12 patients with paroxysmal events were collected. The investigation was conducted in six centers during pediatric academic conferences. All 452 practitioners present were asked to make their diagnoses by just the descriptions of the events, and then remake their diagnoses after watching the corresponding home videos of the episodes. The doctor’s information, including educational background, profession, working years, and working hospital level, was also recorded. The cost savings from accurate diagnoses were measured on the basis of using online consultation, which can also be done easily by mobile phone. All data were recorded in the form of questionnaires designed for this study.

Results

We collected 452 questionnaires, 301 of which met the criteria (66.6%) and were analyzed. The mean correct diagnoses with and without videos was 8.4 (SD 1.7) of 12 and 7.5 (SD 1.7) of 12, respectively. For epileptic seizures, mobile phone videos increased the mean accurate diagnoses by 3.9%; for nonepileptic events, it was 11.5% and both were statistically different (P=.006 for epileptic events; P<.001 for nonepileptic events). Pediatric neurologists with longer working years had higher diagnostic accuracy; whereas, their working hospital level and educational background made no difference. For patients with paroxysmal events, at least US $673.90 per capita and US $128 million nationwide could be saved annually, which is 12.02% of the total cost for correct diagnosis.

Conclusions

Home videos made on mobile phones are a cost-effective tool for the diagnosis of paroxysmal events in infants. They can facilitate the diagnosis of paroxysmal events in infants and thereby save costs. The best choice for infants with paroxysmal events on their initial visit is to record their events first and then show the video to a neurologist with longer working years through online consultation.

How Resource Scarcity and Accessibility Affect Patients' Usage of Mobile Health in China: Resource Competition Perspective

BACKGROUND

The last decade has witnessed many achievements in China's health care industry, but the industry still faces major challenges among which the uneven distribution of medical resources and the imbalance between supply and demand are the most pressing problems. Although mobile health (mHealth) services play a significant role in mitigating problems associated with health care delivery, their adoption rates have been low.

OBJECTIVE

The objective of this study was to explore the impact of resource scarcity and resource accessibility on the adoption of mHealth from the perspective of resource competition, to examine the concerning factors, and to provide a theoretical basis for promoting mHealth in China.

METHODS

We used 229,516 original registration records of outpatients to conduct an empirical analysis to examine the adoption of mHealth services from the perspective of resource competition.

RESULTS

The adoption rate of mobile services for outpatients was low, accounting for only 31.5% (N=71,707). The empirical results indicated that resource scarcity (beta=.435, P=.01) and accessibility (beta=-.134, P=.02) have a significant impact on the adoption of mHealth. In addition, gender (beta=.073, P=.01) and age (beta=-.009, P<.001) are significantly related to adoption of mHealth. Experience with mHealth has a moderating role in the relationship between resource scarcity (beta=-.129, P=.02), accessibility (beta=.138, P=.04), and adoption of mHealth.

CONCLUSIONS

In this study we demonstrate that the external environment (resource scarcity and resource accessibility) has a significant impact on the adoption of mHealth. This study also demonstrates that experience with mHealth has a moderating role in the relationship between the elements of the external environment. Finally, we confirm that mHealth is a key factor in the delivery and allocation of medical resources and provide a theoretical basis for government agencies to develop policies on mHealth.

Provision of Paid Web-Based Medical Consultation in China: Cross-Sectional Analysis of Data From a Medical Consultation Website

Background

Web-based medical consultation, which has been adopted by patients in many countries, requires a large number of doctors to provide services. However, no study has provided an overall picture of the doctors who provide online services.

Objective

This study sought to examine doctors’ participation in medical consultation practice in an online consultation platform. This paper aimed to address the following questions: (1) which doctors provide Web-based consultation services, (2) how many patients do the doctors get online, and (3) what price do they charge. We further explored the development of market segments in various departments and various provinces.

Methods

This study explored the dataset including all doctors providing consultation services in their spare time on a Chinese Web-based consultation platform. We also brought in statistics for doctors providing offline consultations in China. We made use of Bonferroni multiple comparison procedures and z test to compare doctors in each group.

Results

There are 88,308 doctors providing Web-based consultation in their spare time on Haodf, accounting for 5.25% (88,308/1,680,062) of all doctors in China as of September 23, 2017. Of these online doctors, 49.9% (44,066/88,308) are high-quality doctors having a title of chief physician or associate chief physician, and 84.8% (74,899/88,308) come from the top, level 3, hospitals. Online doctors had an average workload of 0.38 patients per doctor per day, with an online and offline ratio of 1:14. The average price of online consultation is ¥32.3. The online ratios for the cancer, internal medicine, ophthalmology-otorhinolaryngology, psychiatry, gynecology-obstetrics-pediatrics, dermatology, surgery, and traditional Chinese medicine departments are 16.1% (2,983/18,481), 4.4% (16,231/372,974), 6.3% (8,389/132,725), 9.5% (1,600/16,801), 5.8% (12,955/225,128), 18.0% (3,334/18,481), 10.8% (24,030/223,448), and 3.8% (8,393/22,3448), respectively. Most provinces located in eastern China have more than 4000 doctors online. The online workloads for doctors from most provinces range from 0.3 to 0.4 patients per doctor per day. In most provinces, doctors’ charges range from ¥20 to ¥30.

Conclusions

Quality doctors are more likely to provide Web-based consultation services, get more patients, and charge higher service fees in an online consultation platform. Policies and promotions could attract more doctors to provide Web-based consultation. The online submarket for the departments of dermatology, psychiatry, and gynecology-obstetrics-pediatrics developed better than other departments such as internal medicine and traditional Chinese medicine. The result could be a reference for policy making to improve the medical system both online and offline. As all the data used for analysis were from a single website, the data might be biased and might not be a representative national sample of China.