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    05 February 2021, Volume 24 Issue 4
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    Monographic Research
    Physician Agency Theory-based Development Strategies for China's Contracted Family Physician Services　
    FANG Hai
    2021, 24(4):  381-386.  DOI: 10.12114/j.issn.1007-9572.2021.00.114
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    The relationship between patients and physicians can be regarded as principles and agents. Physician agency theory has been used to study physician behaviors in health economics and management. The contracted family physician services regulate the principle-agent relationship between patients and physicians using a formal contract. The utility of family physicians depends on their income and the total health of the contracted patients，which in turn depend on the quantity and quality of the services provided by the family physician. This paper analyzed the behavior of family physician in the process of contracted services with the physician agency theory，and discussed the development strategy from the perspective of healthcare providers，including promoting the capitation payment reform in primary care，implementing the system of charging a fee for contracted services，improving the performance income of family physician，and linking with the quality of patient service.
    Theoretical Study on the Impact of Incentive Mechanism on Physicians' Practice Behaviors during the Implementation of Contracted Family Doctor System in China　
    JING Rize，FANG Hai
    2021, 24(4):  387-391.  DOI: 10.12114/j.issn.1007-9572.2021.00.087
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    Background　Promoting the delivery of contracted family doctor services is an important way to change the traditional delivery pattern of China's primary health services，and an important task for deepening the reform of the pharmaceutical and healthcare system，and a cornerstone of achieving the Healthy China 2030 goals. Reasonable incentive mechanism may significantly ensure that family doctors take initiative at work. However，there are no theoretical analyses of the impact of the current incentive mechanism，especially the changed health insurance reimbursement methods，on practice behaviors of family physicians. Objective　To build up a theoretical framework and a model of family physicians' practice behaviors under the implementation of family doctor system using the principal-agent theory in China. Methods　The principal-agent theory was used to develop a model for analyzing the practice behaviors of family physicians under different health insurance payment methods for family physicians，especially when fee-for-service（FFS） and capitation payments coexist. Results　If the FFS payment system is used，the moral hazard will be inevitable，and family physicians have no incentive to suppress patients' additional needs. If the capitation payment system is used，the total utility or benefit of family physicians will increase，but the utility obtained from patients' health will decrease. The global budget shall be implemented under the premise that the quantity and quality of health services are reasonably designed，otherwise family physicians will have the motivation to treat patients selectively so as to increase their benefits. The income of Chinese family physicians mainly comes from the medical earnings obtained in FFS and the contracted service fee obtained by capitation. Increasing the proportion of contracted service fee can improve the quality of care provided by family physicians. However，the increase in income may not necessarily have a positive effect on the health care quality，since the earnings obtained in FFS account for a large portion of the income. Conclusion　The payment system of family physicians in primary health institutions in China is suggested to be gradually transformed to payment by capitation. At present，family physicians can be encouraged to provide medical services of higher quality by enlarging the proportion of family physicians' contracted service fee in total income.
    Impact of Contracted Service Fee on Family Physicians' Practice Behaviors and Patients' Healthcare Cost：a Study Based on a Two-level Variance Component Model　
    JING Rize，LAI Xiaozhen，FENG Huangyufei，FANG Hai
    2021, 24(4):  392-399.  DOI: 10.12114/j.issn.1007-9572.2021.00.088
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    Background　In China，the charging for services delivered by the contracted family physician is an important financial incentive for family physicians，this incentive mechanism of income distribution may affect the practice behaviors of family physicians. Objective　To analyze the impact of contracted service fee on family physician's practice behaviors，including the number of visits，the average consulting time per visit and the medical costs of patients，so as to provide evidence for the construction of family physician system in China. Methods　A total of 27 community health centers were selected from Xiamen City，Hangzhou's Yuhang District，Shanghai's Changning District，and Beijing's Xicheng and Fangshan Districts from July to September 2019，from which all incumbent family physicians（n=420） were surveyed by a questionnaire designed by research group consisting of demographic data and basic characteristics of the working environment，incentive mechanism，and perceptions and practice behaviors related to contracted services. The two-level variance component model and multiple linear regression model were used for analysis. Results　The survey obtained a response rate of 96.4%（405/420）.Correspondence analysis found that compared with family physicians whose contracted service fee accounted for less than 10% of total monthly income，there was a 0.84 times decrease in the number of daily referrals（P=0.01），a 32% increase in the total monthly healthcare cost of patients（P=0.01），and a 13% increase in the average cost of per visit（P=0.02） among those with contracted service fee accounting for 10% to 20% of total monthly income，and there was a 1.96 minutes decrease in the average consulting time per visit（P=0.01），and a 36% increase in the total monthly healthcare cost of patients（P=0.02） among those with contracted service fee accounting for 20% to 30% of total monthly income，and there was a 14.68 times increase in the number of daily consultations（P<0.01），a 2.66 minutes decrease in the average consulting time per visit（P<0.01），a 53% increase in the total monthly healthcare cost of patients（P<0.01），and a 22% increase in the average cost per visit（P=0.01） among those with contracted service fee accounting for more than 30% of total monthly income. Conclusion　Increasing the proportion of contracted service fee can increase the service volume of family physicians and reduce the number of daily referrals，which is conducive to improving physicians' work enthusiasm and promoting patients to seek healthcare in primary care and the development of hierarchical diagnosis and treatment. However，the increase in the proportion of contracted service fee may reduce the average consulting time per visit of family physicians，so it is necessary to maintain the balance between quality and the quantity of such services. In addition，it is recommended to further promote the gatekeeping mechanism in which family physicians act as the gatekeeper of medical expenses for patients.
    Incentive Factors of Family Physician Team Members in Different Positions　
    FENG Huangyufei，JING Rize，WANG Jiahao，FANG Hai
    2021, 24(4):  400-406.  DOI: 10.12114/j.issn.1007-9572.2021.00.089
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    Background　To improve the subjective initiatives of family physician team members，it is necessary to establish an effective incentive mechanism. Different incentive factors may have different effects on these team members. Objective　To compare the level of satisfaction with and preference of incentives in family physician team members in different positions，providing a basis for further improving and refining the incentive mechanism for the team. Methods　Using a questionnaire designed by research group，a survey on demographics，basic characteristics of the working environment，the incentive mechanism，and the preference for incentive factors was conducted in all 676 incumbent family physician team members（consisting of family physicians，nurses and public health workers） from 27 community health centers in Xiamen，Hangzhou，Shanghai，and Beijing from July to September 2019，Chi-square test or analysis of variance was used for comparing the demographics and preferred incentives among the members in different positions. Results　A total of 676（96.6%） cases who handed in responsive questionnaires were finally included. There were significant differences in the proportion of family doctor special fund and contracted service fee in the monthly income and total income of family doctor team members in different positions（P<0.001），and the proportion of clinical medical workers was higher than that of nursing and public health workers（P<0.016 7）. There were significant differences in the evaluation of the matching degree between income and work value of family doctors among different positions of family doctors（P<0.05）；the proportion of public health workers who thought that the matching degree of income and work value was higher than that of nursing workers（P<0.016 7）. There was no significant difference in the satisfaction of family doctor team members in different positions（P=0.204）. There were significant differences in the participation of family doctor team members in different positions（P<0.05）；the proportion of clinical medical workers participating in staged refresher training was higher than that of nursing and public health workers（P<0.016 7）. The proportion of clinical medical workers participating in relevant professional courses training was higher than that of nursing workers（P<0.016 7）. There was no significant difference between the promotion of family doctor team members and the promotion of professional title among different positions（P>0.05）.  The majority of family physician team members believed that personal income and welfare were the most important motivators，including 95.6%（387/405） of family physicians，95.7%（180/188） of nurses and 98.8%（82/83） of public health workers. Training opportunities，social recognition and respect，title promotion opportunities ranked the second，third and fourth，respectively. The fifth incentive factor was unit management for family physicians，workload for nurses，and working conditions for public health workers. Conclusion　The incentive mechanism varies for family physician team members in different positions. Members engaged in clinical medicine have higher levels of income，welfare and training than those engaged in nursing and public health. Moreover，different family physician team members have different preferences for incentive factors. We should continue to optimize the salary structure of family physician team members，increase family physicians' income and contract service fee，and improve financial incentives；strengthen training，and improve the service capacity at primary health care institutions；protect the rights and interests of medical personnel，and raise their social recognition.
    Changes in Policies for General Practitioners in Sichuan Province：a Policy Instrument-based Analysis　
    LIU Lidi，LIAO Xiaoyang，DU Peng，ZHANG Peng，WANG Lei，YANG Ziyu，CHEN Bowang，CHEN Lu，LIU Changming，ZHANG Yalin，ZOU Chuan
    2021, 24(4):  407-413.  DOI: 10.12114/j.issn.1007-9572.2020.00.414
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    Background　Currently，the ratio of general practitioners（GPs） to 10 000 residents fails to reach the 2020 target set in China's 13th Five-year Plan（2016—2020）. Moreover，the rate of registered GPs is low，especially in western China. Policy instruments are a general term for the means adopted by the government to achieve policy objectives. Only when policy instruments are appropriate，can policy implementation results be consistent with the policy objectives. Objective　To analyze the highlights and weaknesses as well as changes of the policies for GPs issued by the People's Government of Sichuan Province from 2009〔the year in which deepening the reform of the pharmaceutical and healthcare system（the new round of medical reform） was initiated〕 to 2019. Methods　From December 2019 to January 2020，using "general practitioners" in Chinese as key words，we searched the official websites of the People's Government of Sichuan Province and Health Commission of Sichuan Province for policy documents for GPs issued from January 1，2009 to December 31，2019，and performed content analysis and quantitative analysis of the texts of the policy documents in terms of types and development changes of policy instruments. Results　A total of 48 policy documents were included，involving 268 coded policy instruments，consisting of normative，incentive，capacity-developing，authoritative，systematic reform，symbolic and hortatory instruments，accounting for 4.9%（13/268），8.6%（23/268），22.4%（60/268），54.5%（146/268），7.8%（21/268） and 1.9%（5/268），respectively. The number of policy instruments had a first peak in 2012，with authoritative instruments as the major type. Then authoritative instruments decreased significantly and incentive instruments increased significantly. And the instruments had a second peak in 2018，with capacity-developing instruments as the major type. Goals and planning were used the most〔32.1%（86/268）〕，while consensus propaganda was least frequently used〔0.4%（1/268）〕. Policy planning，policy implementation，policy supervision and policy evaluation accounted for 51.1%（137/268），44.4%（119/268），3.4%（9/268）and 1.1%（3/268），respectively. Conclusion　The results of the policy instruments for GPs implemented since 2009 in Sichuan Province show that the instruments could meet GPs' actual needs and benefit their development. Future policy optimization should focus on the use of symbolic and hortatory and incentive instruments，with consideration of comprehensive associations between different types of instruments，and appropriately balanced use of them. Moreover，supervision and evaluation during policy implementation should be strengthened.
    Research Status with Hot Topic Analysis of Patient Safety in China Using Bibliometrical Method　
    OUYANG Lu，FENG Lei
    2021, 24(4):  414-420.  DOI: 10.12114/j.issn.1007-9572.2020.00.457
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    Background　Patient safety is a core goal of clinical medical care. Ensuring patient safety has become the core theme of the quality of medical care. Understanding the research status with hot topic analysis of patient safety is the basis for further studies. Objective　To analyze the research status including hot spots of patient safety in China，to provide a reference for related research. Methods　On November 8th，2019，studies about patient safety published between January 1，2010 and November 8，2019 were systematically searched across three retrieval data sources，CNKI，Wanfang Data and CQVIP databases，with "sufferer safety"（患者安全） and "patient safety"（病人安全） as the key words. EndNote X7 was used to exclude the duplicate ones. Bibliometrical method was used to analyze the publication time and authors. CiteSpace 5.5.R2 was used to conduct visualized analysis of the extracted key words. Results　A total of 887 qualified articles were included. From 2010 to 2019，the number of these studies showed an upward trend as a whole（from 46 to 114），among which the number showed a blowout growth trend from 2012 to 2013（from 56 to 74）. Core authors published 33.26%（295/887） of the total articles，which was lower than that（50%） proposed in the Price Law. High-frequency key words concerning patient safety included safety management，nursing，nursing management，nursing safety，patient safety culture and inpatient. From the perspective of burst terms，nursing，safety management，patient，risk management，medical worker and patient participation emerged. Visualized cluster analysis revealed that there were seven clusters，including nursing safety，medical safety，elderly patients，nurse，endoscopy，intensive care unit and falls. Conclusion　Patient safety and medical safety，nursing safety，and safety of elderly patients are the research hotspots about patient safety in China，while the value concept and discourse system，policy orientation and updating of laws and regulations，scientific evaluation system concerning patient safety have not yet become the focus of attention. The development trends mainly focus on three aspects，such as the patient participation for patient safety，evaluation and related evaluation systems of patient safety level，and the informatization of patient safety management.
    Efficiency of Mental Health Services Delivery in Township Hospitals of Guangxi Based on Data Envelopment Analysis　
    WEI Xiaofei，QIN Xianjing，PENG Rong，FENG Jun，FENG Qiming
    2021, 24(4):  421-426.  DOI: 10.12114/j.issn.1007-9572.2020.00.307
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    Background　As township hospitals undertake the main work in mental health prevention and treatment in rural areas，it is crucial to evaluate whether their mental health services efficiency meets the maximum demand，but rare relevant studies can be found currently. Objective　To evaluate the mental health services efficiency in township hospitals in Guangxi using data envelopment analysis（DEA），aiming to provide references for the application of DEA in mental health management evaluation. Methods　From January to June，2018，15 counties were randomly selected according to geographical distribution and economic development level in Guangxi，and from each 3 township hospitals were extracted by population-based sampling，and finally 45 township hospitals（A1-A45） in total participated in our questionnaire survey. A self-designed questionnaire named Mental Health Services Performance in Township Hospitals was used，which includes the general status of townships，financial investment and human resource for mental health services delivery，and file documenting，standardized management，regular medication and condition stability of the patients with severe mental disorders. Financial investment and the number of mental health workers（including part-time workers） were selected as input indicators，and the proportions of the file documenting，standardized management，regular medication and condition stability of the patients were applied as output indicators based on policy research and literature review. The output-oriented BCC model was employed to analyze the relative efficiency of mental health services delivery，and to calculate the projection value of each indicator. Results　The survey achieved a response rate of 100.0%. The average overall technical efficiency（OTE） of the 45 township hospitals in delivering mental health services was 0.450，among which the hospital coded as A7 had the lowest（0.109）. The pure technical efficiency was 0.956 on average，of which the hospital coded as A8 had the lowest（0.710）. The scale efficiency was 0.462 on average，of which the hospital coded as A38 owned the lowest（0.125）. Only 6（13.3%）hospitals（coded as A3，A21，A22，A28，A34，A36） were relatively efficient，with OTE，pure technical efficiency and scale efficiency reaching 1.000. 23（58.97%） were pure technically efficient in relative（pure technical efficiency=1.000）. 39（86.7%） presented decreasing returns to scale. To improve the efficiency of 39 inefficient township hospitals，the proportions of the file documenting，standardized management，regular medication and condition stability of the patients with severe mental disorders need to be improved by 0.29‰，8.63%，8.02% and 6.06% on average，respectively. Conclusion　The overall efficiency of mental health services delivery is low in township hospitals of Guangxi. And there exist some issues such as insufficient utilization and inappropriate composition and allocation of mental health resources，low scale efficiency，and decreasing returns. Besides，inappropriate mental health management of patients with severe mental disorders and internal management and quality control of township hospitals are also problems. And the output of the mental health services delivery still has much room for improvement. To enhance the efficiency of mental health services delivery，available mental health resources should be effectively allocated and used with optimized composition，and the development of sound hospital culture and working mechanism should be strengthened.
    Implementation Effect of Nursing Care Subsidy Policies for Guardians of Patients with Severe Mental Disorders in Beijing　
    NIU Tianyuan，HUANG Qingzhi，ZHANG Boyuan
    2021, 24(4):  427-431.  DOI: 10.12114/j.issn.1007-9572.2020.00.455
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    Background　Family plays an important role in the prevention of mental disorders，and patient care，and functional rehabilitation. The Mental Health Law of the People's Republic of China grants guardians various rights and obligations，but the patient often lacks of a guardian or his guardian faces great pressure caused by nursing workload in daily life. The Interim Measures on Guardians' Application for Subsidies for the Care and Supervision of Patients with Severe Mental Disorders（hereinafter referred to as IMGASCSPSMD） has been implemented in Beijing since 2016，aiming to help to reduce the family burden of the patients，and to incentivize the patient's guardian to better perform duties. Objective　To evaluate the effectiveness of the implementation of the IMGASCSPSMD in Beijing. Methods　From November 2018 to January 2019，our research group adopted a spatially stratified，multi-stage cluster sampling design and a self-designed questionnaire to investigate the implementation effect of mental health policies in Beijing. The data of this study came from part of the investigation，concerning the awareness of the IMGASCSPSMD in patients/patients' family members and the evaluation of the implementation results of the IMGASCSPSMD in medical workers. Results　Of the 682 patients and their family members，614（90.0%） expressed that they knew about the policy. Univariate analysis revealed that the awareness of the IMGASCSPSMD differed significantly among the patients/patients' family members by the level of healthcare agencies for seeking mental health services，education level，household monthly income per person，and the duration of mental disorders（P<0.05）. Logistic regression analysis indicated that household monthly income per person was associated with the awareness of the IMGASCSPSMD among the patients/patients' family members（P<0.05）. Among the 631 medical workers，375（59.4%） indicated that the implementation of IMGASCSPSMD has played an incentive role. Univariate analysis revealed that opinions about the incentive effect of the IMGASCSPSMD implementation varied significantly among medical workers by the level of medical institutions and professional title（P<0.05）. Logistic regression analysis showed that medical workers from different levels of medical institutions had different views on the incentive role of IMGASCSPSMD implementation（P<0.05）. Conclusion　The implementation of the IMGASCSPSMD in Beijing has achieved good effect. However，community-based mental health services are still lack of sufficient policy support which required further implementation and better results，and the understanding and attention from the society. Moreover，the services are limited. Supportive policies concerning community-based mental health services should be further implemented，and the delivery patterns for such services should be improved，and the serving capacities of community-based health organizations should be enhanced.
    The Cost Calculation of Community Hospice Care Service Project　
    CAO Wenqun，SHEN Tianhan，ZHANG Ruiyun，MIAO Jun
    2021, 24(4):  432-437.  DOI: 10.12114/j.issn.1007-9572.2020.00.348
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    Background　The hospice care project faces with the problem of insufficient financial compensation for the overall funding，which limits the development of hospice care services，and reasonable compensation depends on the accurate cost calculation of hospice care services.  Existing researches mostly analyze the compensation for community hospice care services from the gap between the income and expenditure of institutions，and lack the accurate calculation of various costs. Objective　To analyze the cost calculation of community hospice care services，so as to provide a reference for reasonable compensation for hospice care services in the community. Methods　The hospice care services provided by Jing'an Temple Street Community Health Service Center in Jing'an District of Shanghai in 2018 were chosen as the research objects，and the cost data were collected and calculated. Results　A total of 234 services were included and 179 services were retained after the merger of inspection services at a cost of 46.5（23.0，84.0）yuan.  Among the 179 services，manual evacuation of faeces had the lowest cost（1.3 yuan）and gradeⅠcare had the highest cost（401.7 yuan）.  There were 138 pay items in 179 services，and compared with the price of medical services in Shanghai，only 37（26.8%）service items cost less than the price charged，3（2.2%）service items cost equal to the price  charged，and 98（71.0%）service items cost more than the price charged，including 14 services in the general practice，7 services of traditional Chinese medicine，32 nursing services，27 radiology services，4 services of B-mode ultrasonography and ECG，and 14 inspection services. Conclusion　The funding for community hospice care services needs to pay attention to classified compensation，and there is insufficient financial compensation for hospice care services in general practice，traditional Chinese medicine，nursing，ECG，radiology，B-mode ultrasonography and inspection.
    Intervention Effects and Costs of the Pre-diabetes Population in a Community in Shanghai City with WeChat　
    XU Lei，LI Jian
    2021, 24(4):  438-441.  DOI: 10.12114/j.issn.1007-9572.2020.00.374
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    Background　Prediabetes is a high-risk stage for diabetes development. Intervening in the lifestyle of people with prediabetes can reduce the risk of developing diabetes. However，there were few reports on WeChat management of pre-diabetes population and analysis of the effect and cost of this management method. Objective　To explore the intervention effects and costs of the pre-diabetes population with WeChat by family physician team. Methods　This study was conducted from January 2019 to September 2019. The standard pre-diabetes patients were selected from the database of Guangzhong Street Community Health Service Center of Hongkou District. The patients were divided into non-intervention group，traditional intervention group and WeChat group by random number table method，with 50 patients in each group. In the non-intervention group，health education was only provided in the outpatient department；in the traditional group，intervention was conducted in the traditional strengthening way；in the WeChat group，intervention was conducted in the WeChat way. The intervention period was 6 months. Fasting blood glucose（FBG）and 2 h postprandial blood glucose（2 hPG）levels before and after intervention were compared in the three groups. Results　After the intervention，FBG and 2 hPG in WeChat group and traditional group were lower than those of non-intervention group，and 2 hPG in non-intervention group was higher than that before intervention（P<0.05）. FBG and 2 hPG in traditional group and WeChat group after intervention were lower than those before intervention（P<0.05）. The conversion rate to normal of the traditional group and WeChat group was higher than that of the non-intervention group，and the conversion rate to diabetes of the traditional group and WeChat group was lower than that of the non-intervention group（P<0.016 7）. The per capita intervention cost of the WeChat group was 36.4 yuan，which was 35% of that of the traditional group，compared with 104 yuan in the traditional group. Conclusion　It is an economic，feasible and effective new management method for family doctors to intervene in the pre-diabetes population with WeChat.
    Relationship between Skin Autofluorescence Value and Carotid Artery Atherosclerotic Plaque Disease　
    LIU Lin，ZHANG Jian，LIU Wei，HUANG Youyuan，JIA Jia，WANG Shuyu，ZHANG Yang，WANG Yikun，DONG Liguang，WANG Anping，SI Mokui，GAO Ying，ZHANG Junqing
    2021, 24(4):  442-446.  DOI: 10.12114/j.issn.1007-9572.2020.00.601
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    Background　Carotid atherosclerotic plaque is an important risk factor for cardiovascular and cerebrovascular diseases. Ultrasound is often used to evaluate carotid atherosclerotic plaque，but ultrasonic examination has relative high requirements on equipment，operator's ability and fund. Skin autofluorescence（SAF），a simple，rapid and non-invasive method，has a predictive value for cerebrovascular events and death. So we discussed the relationship between SAF value and carotid atherosclerotic plaque. Objective　To discuss the relationship between SAF value and carotid atherosclerotic plaque in community-dwelling Chinese populations. Methods　6 055 eligible residents aged over 40 in a Beijing community were invited to conduct a cross-sectional study from September 2018 to December 2018. SAF test，clinical history collection，physical examination，hematology test and carotid B-ultrasonography examination were performed in all subjects. According to the results of B-ultrasonography，the subjects were divided into carotid lesion group and non-carotid lesion group. With carotid lesion as dependent variable，and traditional risk factors of cardiovascular and cerebrovascular diseases such as standardized gender，age，BMI，smoking，diabetes，hypertension，dyslipidemia，hyperuricemia，chronic renal insufficiency and SAF as independent variables，Logistic regression analysis was performed to explore the relationship between SAF value and carotid atherosclerotic plaque. Results　Carotid lesion group（n=2 953） had much higher SAF value than non-carotid lesion group（n=3 102）〔77.2（70.8，85.1） AU vs 73.4（68.0，80.1） AU〕（P<0.001）. Binary Logistic regression analysis showed that SAF value was associated with the risk of carotid artery disease〔OR=1.006，95%CI（1.000，1.012），P=0.043〕. Analysis of subgroups stratified by quartiles of SAF value〔low（less than 69.2 AU），intermediate（greater than 69.2 but less than 75.1 AU），high（greater than 75.1 but less than 82.4 AU），very high（greater than 82.4 AU）〕 revealed that the risk of carotid artery lesion in very high SAF subgroup increased by a factor of 1.200〔OR=1.200，95%CI（1.012，1.423），P=0.036〕 compared with that of low SAF subgroup. Further analysis found that in people younger than 60 years，the risk of carotid artery disease in very high SAF subgroup was 1.751 times higher than that in low SAF subgroup〔OR=1.751，95%CI（1.270，2.415），P=0.001〕；in smokers，the risk of carotid artery disease in very high SAF subgroup was 1.903 times higher than that in low SAF subgroup〔OR=1.903，95%CI（1.297，2.792），P=0.001〕. Conclusion　SAF is independently associated with carotid atherosclerotic plaque. Significantly increased SAF is more significantly correlated with carotid artery lesions than low SAF in people under 60 years old or smokers.
    Association of Hyperuricemia with Common Chronic Diseases in Middle-aged and Older People over 45 Years in China　
    CHEN Lei，WU Chengkai，KANG Junming，LI Wenyuan
    2021, 24(4):  447-452.  DOI: 10.12114/j.issn.1007-9572.2020.00.599
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    Background　The detection rate of hyperuricemia is increasing，whose high incidence has brought great harm to public health. Available studies suggest that high uric acid is associated with chronic diseases, and increasing evidence supports that hyperuricemia may be a high risk factor for other chronic diseases. Objective　To analyze the association of hyperuricemia with common chronic diseases in middle-aged and elderly people. Methods　Data came from part of the 2015 China Health and Retirement Longitudinal Survey，involving 9 022 cases（>45 years old） with complete blood test information. Chi-square test was used to compare hyperuricemia prevalence in participants by demographic factors. Multivariate unconditional Logistic regression was used to examine the association between hyperuricemia with common chronic diseases. Results　A total of 1 117 cases（628 men and 489 women） were found with hyperuricemia, accounting for 12.38%. Men had higher hyperuricemia prevalence than women〔14.65%（628/4 287） vs 10.33%（489/4 735）〕（P<0.01）. After adjusting for confounding factors，hyperuricemia was found to be associated with hypertension〔OR（95%CI）=1.621（1.399，1.877）〕，hyperlipidemia〔OR（95%CI）=1.465（1.245, 1.724）〕 and digestive diseases〔OR（95%CI）=0.801（0.687，0.934）〕，but had no association with diabetes，heart disease and stroke. In men with hyperuricemia，hyperuricemia was found to be associated with hypertension〔OR（95%CI）=1.555（1.273，1.899）〕，hyperlipidemia〔OR（95%CI）=1.510（1.203，1.895）〕，diabetes〔OR（95%CI）=0.649（0.474，0.890）〕 and digestive diseases〔OR（95%CI）=0.772（0.623，0.957）〕. In women with hyperuricemia, hyperuricemia was associated with hypertension〔OR（95%CI）=1.696（1.363，2.111）〕，and hyperlipidemia〔OR（95%CI）=1.452（1.146，1.839）〕. Conclusion　Hyperuricemia may be associated with hypertension，hyperlipidemia，and digestive diseases in middle-aged and elderly people aged over 45 years. Men may be more prone to hyperuricemia. Effective interventions should be delivered to groups at high risk for hyperuricemia to reduce the morbidities of related chronic diseases.
    Establishment of the Norms of Proactive Prevention Behavior Scale in the Population at High Risk of Digestive System Cancer in Heilongjiang　
    XIN Bo，ZHAO Qiuli，WANG Nannan，YU Yang，MA Dexin，ZHANG Yukun
    2021, 24(4):  453-459.  DOI: 10.12114/j.issn.1007-9572.2021.00.045
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    Background　The prevention and control of digestive system cancer is under tough conditions，but there are differences in prevention awareness and behaviors in the population at high risk of digestive system cancer. There is a lack of reference for physicians and nurses to evaluate the prevention ability among them. Therefore，it is of great significance to establish the regional norm of the proactive cancer prevention behavior scale，which may greatly promote cancer prevention. Objective　To establish the norms for the proactive prevention behavior scale in the population at high risk of digestive system cancer（DSC-PPBS），to provide references for the evaluation of high-risk population of digestive system cancer. Methods　From May 2019 to January 2020，DSC-PPBS was used to investigate high-risk population of digestive system cancer from 6 grade A tertiary hospitals，3 grade A secondary hospitals，and 3 community health centers in Heilongjiang. The characteristics of their DSC-PPBS scores were used to develop the mean，percentile and threshold norms for this specific population. Results　Of the 1 400 cases surveyed，1 236 returned responsive questionnaires with a response rate of 88.29%. The mean norms of DSC-PPBS were established according to gender and age groups（40-45，46-65，≥66 years）. The percentile norms of DSC-PPBS from the 5th percentile to 95th percentile were established with 5% as interval. The threshold norms were based on the four critical points（-s、-0.5s、+0.5s、+s），the cancer prevention status of the subjects was divided into five categories：poor，relatively poor，general，good，excellent，and the four demarcation standards were in closed with the 15th，30th，70th and 85th of the percentiles norm. Conclusion　The mean norm，percentile norm，and threshold norm of DSC-PPBS in the population at high risk of digestive system cancer in Heilongjiang are well-represented，which lay a foundation for further promotion of the scale. It can be used as a reference for clinical and community physicians and nurses to evaluate the intervention of prevention behaviors in the population at high risk of digestive system cancer.
    Effect of a Multicomponent Exercise Prescription in Elderly Patients with Cognitive Frailty　
    YE Ming，LI Shuguo，ZHU Zhengting，ZHU Huiming
    2021, 24(4):  460-466.  DOI: 10.12114/j.issn.1007-9572.2021.00.015
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    Background　Cognitive frailty is associated with an evidently high risk of disability and all-cause mortality. Detecting and managing cognitive frailty at early stages may reverse adverse outcomes and poor quality of life. Objective　To study the effect of a multicomponent exercise prescription on frailty phenotype，cognitive function，dietary intakes，and nutritional parameters in elderly patients with cognitive frailty. Methods　From January 2017 to December 2018，ninety elderly patients with cognitive frailty were randomly divided into multicomponent exercise group（n=45） and control group（n=45）and received corresponding interventions. Their frailty indicators（6-meter timed walk，grip strength，Fried frailty phenotype score），Mo-CA scores，dietary intakes，and nutritional parameters〔albumin，prealbumin，transferrin，lymphocyte count，and Mini Nutritional Assessment（MNA） score〕 were recorded at baseline，at 3 and 6 months after intervention. Results　The frailty indicators，Mo-CA score，dietary（vegetables，fruits，fish/shrimp，poultry/meat，eggs，liquid milk，nuts） intakes，and nutritional indices were significantly different in two groups（P<0.05）. The frailty indicators，Mo-CA score，dietary （vegetables，fruits，fish/shrimp，poultry /meat，eggs，liquid milk，nuts） intakes，and nutritional indices were significantly different in two groups at different measurement times（P<0.05）. Intervention contents and duration had substantial interaction on time taken for frailty indicators，dietary（vegetables，fruits，fish/shrimp，poultry /meat，eggs，liquid milk，nuts） intakes，and nutritional indices（P<0.05）. Compared with the control group，the exercise group took less time to complete the 6-meter timed walk and had lower frailty phenotype score，and higher grip strength，Mo-CA score，albumin，prealbumin，transferrin，the number of lymphocytes，and MNA score at the end of 3-month or 6-month intervention（P<0.05）. After 3-month intervention，the intake of vegetables，fruits，fish/shrimp，eggs，liquid milk increased in the exercise group compared with control group（P<0.05）. After 6-month intervention，the intake of vegetables，fruits，fish/shrimp，poultry /meat，eggs，liquid milk and nuts improved in the exercise group compared with control group（P<0.05）. Self-controlled comparisons showed that in the exercise group，the time required to complete the 6-meter timed walk and fraity phenotype score decreased，while the grip strength，Mo-CA score，the intake of vegetables，fruits，fish/shrimp，poultry /meat，eggs，liquid milk and nuts，albumin，pre albumin，transferrin，the number of lymphocytes，and MNA score increased at the end of 3-month or 6-month intervention，compared with at pre-intervention（P<0.05）. Conclusion　The multicomponent exercise prescription can improve the frailty phenotype，cognitive function，dietary intakes，and nutrition in elderly patients with cognitive frailty.
    Demographic-based Analysis of Sleep Quality in Elderly Smokers in Hebei Province　
    WANG Wenhui，LIU Xiao，ZHANG Lili，ZHANG Yunshu，LI Keqing
    2021, 24(4):  467-472.  DOI: 10.12114/j.issn.1007-9572.2021.00.019
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    Background　Sleep problems are highly prevalent nowadays，especially in the elderly.Studies have shown that sleep quality is associated with nicotine exposure，and may be varied by the level of smoking. But there is lack of studies about the influence of smoking on the sleep quality in the elderly. Objective　To investigate the relationship between smoking and sleep quality in the elderly based on analyzing the sleep quality in elderly smokers in Hebei Province. Methods　Data were part of the results of an epidemiological survey of mental diseases conducted in Hebei Province in 2016 using multistage，stratified and random sampling，including general demographic information，smoking history，Pittsburgh Sleep Quality Index（PSQI），and so on. Sleep quality was compared in terms of subscales of PSQI across non-smokers，light，moderate and heavy smokers divided by the Smoking Index to analyze the influence of smoking on sleep quality. Logistic regression analysis was used to evaluate the relationship between smoking and sleep quality. Results　A total of 5 343 cases were included，with an average age of （68.4±7.0） years，including 3 973 non-smokers（74.36%），536 light smokers（10.03%），512 moderate smokers （9.58%），and 322 heavy smokers （9.77%）. The 4 groups had significant differences in average age，gender ratio，ratio of living in urban areas to rural areas，distribution of education level，prevalence of independent living，medical insurance situation，average monthly household income，drinking，cardiovascular disease and tumor（P<0.05）. Moreover，the group also demonstrated significant differences in the average scores of subscales of PSQI：subjective sleep quality，sleep latency，sleep duration，habitual sleep efficiency，sleep disturbances，use of sleeping medication，daytime dysfunction and PSQI total score（P<0.05）. Multivariate logistic regression analysis showed that after adjusting for age，gender，education level，prevalence of independent living，monthly household income，exercise frequency，drinking，cardiovascular disease and tumor，smokers had an increased risk of sleep disorders〔OR（95%CI）=2.452（1.738，3.461）〕generally.And the risk of sleep disorder increased with the level of smoking：light smokers〔OR（95%CI）=1.622（1.032，2.549）〕，moderate smokers〔OR（95%CI）=2.753（1.833，4.137）〕，heavy smokers〔OR（95%CI）=3.554（2.304，5.483）〕. Conclusion　Among elderly Chinese people，sleep disorders are more common in smokers than in nonsmokers. Sleep quality may vary by the level of smoking.Higher smoking index may be associated with worse sleep quality.
    Composition of Diseases in Patients Discharged from General Wards of Suburban Community Health Centers，Pudong New Area　
    MA Xiujun，XIA Qingshi，ZHANG Shengbing，FAN Yun，DU Zhaohui
    2021, 24(4):  473-479.  DOI: 10.12114/j.issn.1007-9572.2021.00.021
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    Background　With the change of functional orientation，community health centers（CHCs） become a supplier for general healthcare services consisting of 6 types（prevention，medical，healthcare，health education，rehabilitation services and guidance on family planning） instead of mainly medical services，and the original specialty wards such as internal，surgical and gynecology and obstetrics have become the general wards. Understanding the composition of diseases in inpatients receiving general care in CHCs helps primary care institutions to accurately identify the patients' health needs and formulate targeted disease prevention and treatment strategies. Objective　To investigate the composition of diseases in inpatients receiving general care from suburban community health centers，Pudong New Area，providing a reference for the implementation of targeted interventions for disease prevention and treatment，and for carrying out appropriate professional trainings for medical workers. Methods　Retrospective analysis was used to analyze the sex ratio，age，first diagnosis and other data of discharged patients from the general wards of suburban CHCs，Pudong New Area from 2015 to 2017. These information were derived from "Shanghai Medical Institutions Medical Records Statistical Management System". Results　From 2015 to 2017，there were a total of 49 352 patients discharged from the general ward in the suburb CHCs of Pudong New Area，including 27 294 females（55.30%），and 22 058 males（44.70%）. 42.59% （21 019/49 352） of them aged 80 and above. The top 3 systemic diseases were respiratory diseases〔40.95%（20 208/49 352）〕，circulatory system diseases〔32.46%（16 021/49 352）〕，and digestive system diseases〔7.32%（3 611/4 352）〕. The monthly percentage of these 3 systemic diseases showed that among the total discharged patients，respiratory disease patients accounted for the largest percentage in January〔13.94%（2 816/20 208）〕，circulatory system disease patients accounted for the largest percentage in March〔9.53%（1 527/16 021）〕，and digestive system disease patients accounted for the largest percentage in August〔12.21 %（441/3 611）〕. The top 3 single illnesses were sequelae of cerebral infarction〔12.90%（6 244/49 352）〕，chronic obstructive pulmonary disease with acute lower respiratory tract infection〔12.65%（6 366/49 352）〕，and acute bronchitis〔9.44%（4 658/49 352）〕. The top one single illness was chronic obstructive pulmonary disease with acute lower respiratory tract infection 〔17.75%（3 915/22 058）〕 in males，and was sequelae of cerebral infarction〔13.37%（3 649/27 294）〕 in females. Conclusion　Among the discharged patients from general ward of suburban CHCs，Pudong New Area，elderly patients with chronic diseases accounted for the largest percentage；the peak incidence was associated with season；the challenges to prevent and treat cerebral infarction and chronic obstructive pulmonary disease were great. In view of this，general practitioners in these CHCs，the main supplier for healthcare services，should formulate disease prevention and treatment strategies in accordance with the patient's age，disease profile，peak incidence，and other features as well as the conditions of the CHCs，and improve the delivery of demand-oriented community health services. Besides，comprehensive abilities of community general practitioners and nurses should be improved by strengthening the theoretical and practice trainings regarding the diagnosis and treatment of high-incidence diseases in the community.
    Application Effect of "Driving School VIP Training Model" and "Five，Three，One-step Transition Method" in Standardized Training of General Practitioners in Community Clinics　
    WANG Yuanmei，ZOU Wusong，WANG Zhihong，YANG Qiaoxin，WANG Shiqi
    2021, 24(4):  480-483.  DOI: 10.12114/j.issn.1007-9572.2020.00.291
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    Background　General practitioners（GPs） are the backbone of basic health services and the "gatekeepers" of resident's health，so community outpatient training for GPs is very important. However，there is no unified procedure and standard for the training of GPs in China at present. It is necessary to explore effective and feasible teaching methods for GPs in community clinics. Objective　To explore the application effect of "Driving School VIP Training Model" and "Five，Three，One-step Transition Method" in the standardized training of GPs in community clinics. Methods　Taking the 42 trainees in the 2017 and 2018 "Wuhan Sino-US General Practice Residents Standardized Training Pilot Project" as the research objects，20 were trainees in the 2017 class with 11 males and nine females.All of them were fresh graduates of undergraduate courses，and all had no doctor's practicing license. There were 22 trainees in the 2018 class with 12 males and 10 females. Three of them had college degrees and doctor's practicing license，and the remaining 19 trainees were fresh graduates.the "Driving School VIP Training Model" and "Five，Three，One-step Transition Method" were used in the training. Questionnaire surveys were conducted one month after training in August 2017 and August 2018，and six months after training in December 2017 and December 2018. The questionnaire mainly included five aspects，time control，independent consultation，humanistic care，service concept of general practice，and satisfaction with community rotation. All five aspects were used 5-point scale and a training score≥3 was good. Statistical analysis of the results of the two surveys was conducted. Results　After six months of training，the proportion of trainees who scored ≥3 in time control，independent consultation，and humanistic care was higher than that after one month of training（P<0.05）. However，in terms of service concept of general practice and satisfaction with community rotation，the proportion of trainees who scored ≥3 was not statistically different from that after one month of training（P>0.05）. Conclusion　The application of "Driving School VIP Training Model" and "Five，Three，One-step Transition Method" in the standardized training of GPs in community clinics can improve trainee's ability in time control，independent consultation and humanistic care with good teaching effect.
    Current Situation and Countermeasures of Standardized Training for General Practitioners in Shenzhen　
    LIU Jianxin，XU Xingzhi，CHANG Yuanyuan，RAO Xin，SUN Wenmin，LU Zuxun，LI Yang
    2021, 24(4):  484-489.  DOI: 10.12114/j.issn.1007-9572.2020.00.278
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    Background　General practitioners（GPs） are the "gatekeepers" of residents' health and the control of medical expenses. They are the main implementers and providers of community health services who play an important role in basic medical and health services. The quantity and quality of GPs directly determine the quality and effectiveness of health services in China. Objective　This study retrospectively analyzed the standardized GP training in Shenzhen during 2008 to 2014，and summarized the successful experiences and discovered existing problems，in order to provide a basis for improving the reform and innovation of the standardized GP training system. Methods　Through self-designed questionnaires，a retrospective survey was conducted from July to August，2018，on 638 GPs who participated in the standardized GP training and graduated from 2008 to 2014 in Shenzhen. The survey content included the basic information，factors affecting the participation in training，the degree of assistance to the actual work，the best way to train GPs，advantages and opportunities compared to GPs who did not participate in training，training satisfaction，and areas for improvement in the training. Results　A total of 638 questionnaires were distributed，and 523 valid questionnaires were recovered with an effective rate of 82.0%. The number of GPs participating in the standardized GP training in Shenzhen had increased year by year from 54 in 2008 to 131 in 2014. The proportion of respondents who were satisfied with the overall training situation was 46.8%（245/523）. Among them，five items whose satisfaction exceeded 50.0% were theoretical training（52.0%，272/523），faculty quality of theoretical courses（56.6%，296/523），faculty quality of clinical base teaching（52.0%，272/523），community practice teaching（51.4%，269/523），and faculty quality of community practice teaching（51.2%，268/523）. Compared with GPs who did not participate in the training，69.2%（362/523），57.2%（299/523） and 38.8%（203/523） of the respondents believed that their advantages were mainly in the diagnosis and treatment ability，learning ability and doctor-patient communication ability，respectively. The top three areas need to be improved in standardized GP training were the lack of independent practice opportunities，teaching ability，and the overall arrangement of rotation within departments. Conclusion　The quantity and quality of GPs participating in standardized GP training in Shenzhen have steadily increased with preliminary results. Optimizing the content of theoretical training courses，improving the training methods of clinical and community practice，strengthening the targeted training of teacher's ability，increasing the incentives for teaching，and strengthening the feedback of assessment results will help to further improve the quality of standardized GP training.
    Further Clinical Training for In-service Medical Workers in a Community Health Center of Beijing　
    JI Yan，SUN Yange，YAN Chunze，DING Lan，DING Jing
    2021, 24(4):  490-495.  DOI: 10.12114/j.issn.1007-9572.2020.00.235
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    Background　Further clinical training for medical workers is a way to improve the quality of medical treatment. Further study in primary care community helps to provide targeted training and guidance for medical workers working at the community health center. Moreover，drawing lessons from the statistical analysis of the study results facilitates the hosted healthcare settings to improve the study program. Objective　To perform a statistical analysis of the overall status of further clinical training for medical workers from 2016 to 2019 conducted by Yuetan Community Health Center，Fuxing Hospital，Capital Medical University，to provide evidence for improving the design of study procedure in a reasonable way，and enhancing the overall as well as individual effectiveness of training in physicians. Methods　Data were collected from Yuetan Community Health Center，Fuxing Hospital，Capital Medical University，during March 2016 to July 2019，mainly including further clinical training status（number of each batch of trainees，training duration，source region，work unit，training cost），demographic information of trainees（n=67）（gender，age，title，department，position），and training arrangements（planned and actual training departments，and number of actual training departments）. A group interview was conducted with 7 trainees who participated in the training in July 2019 for investigating their satisfaction with the training in training course arrangement necessity, course content and so on. Results　Statistics showed that during this period from March 2016 to July 2019，this community center launched 33 batches of trainings lasting for at least 5 days in total. In 21 batches of trainings（63. 6%），there was only one trainee. 15 batches of trainings lasted for less than 30 days，accounting for a major proportion of the total（45.4%）. The trainees participating in 20 batches of trainings（60.6%） came from regions except Beijing or from other countries. The trainees mainly worked at community health centers（stations） 〔16 batches（48.5%）〕. 24 batches of trainings（72.7%） were free. Most of the trainees were female 〔39（56.5%）〕，aged between 30 and 40 years old〔37（53.6%）〕，had intermediate title〔31（44.9%）〕，worked at general practice department 〔21（30.4%）〕 and administrative department 〔16（23.2%）〕，and had no administrative position〔43（62.3%）〕. The top 3 planned training departments were general practice department 〔30 trainees（46.4%）〕，administrative department〔14 trainees（20.3%）〕，nursing department tied with rehabilitation department 〔9 trainees（13.0%），respectively〕. The top 3 actual training departments were general practice department 〔41 trainees（59.4%）〕，preventive health care department〔27 trainees（39.1%）〕，and administrative department〔25 trainees（36.2%）〕. The trainees were trained in 1-4 departments actually，and the largest and the second largest portions of them were 1 department〔32（46.4%）〕and 2 departments〔17（24.6%）〕，respectively. In terms of the necessity of curriculum arrangement，six trainees held the attitude of "very need"，one of them held the attitude of "need"，and seven people rated the satisfaction of the lecturer as "very satisfied". Seven trainees were interested in the content of the course. Conclusion　Yuetan Community Health Center holds many batches of further clinical trainings for medical workers to satisfy the high demand of medical workers. These trainees mainly have intermediate titles with no administrative position，and mainly choose to be trained in 1-4 departments，and the largest proportion of them are trained in one department. Moreover，they are highly satisfied with the training. However，there are also problems such as delays in the update of the training process，so further optimization of the process is required to ensure scientific training，standardized management，and high-quality teaching.
    Effect of Community-based Monitoring on Blood Pressure Control in Preschool Children：a Pilot Study　
    CHEN Yitong，MA Mingjing，JI Lang，WU Wen，MENG Linghui
    2021, 24(4):  496-503.  DOI: 10.12114/j.issn.1007-9572.2020.00.388
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    Background　The prevalence of hypertension in childhood increases year by year. Childhood hypertension will bring long-term health risks to the human body. As it is often asymptomatic，early diagnosis and treatment are the key to effective management of this disease. However，the blood pressure monitoring management model for preschool children is not clear. Objective　To develop a simple and feasible community-based blood pressure monitoring mode for preschool children. Methods　From January to July 2018，our research group entrusted Tuanjiehu Community Health Center to screen for hypertension in preschool children（n=382） in its service coverage area，and the children were given stratified management according to their blood pressure levels（blood pressure monitoring methods and hypertension diagnostic criteria adopted were from the 2010 Blood Pressure Reference Standards for Chinese Children and Adolescents）. Results　The screen identified 42（11.0%） children with hypertension，38（9.9%） with elevated blood pressure and 302（79.1%） with normal blood pressure. Then the blood pressure of the hypertensive children was remeasured twice，but four of them were lost to follow up during the measurement process. Three of them were still hypertensive after three-time measurement were transferred to the cardiovascular clinic of a higher level hospital for clinical diagnosis and treatment. The 47 children with elevated blood pressure（including the above-mentioned 38 children with elevated blood pressure and 9 children who were found with hypertension in the first measurement but were identified with elevated blood pressure in 2 subsequent measurements） were given life behavior interventions according to the results of a survey using the Life Behavior Questionnaire developed by our research group. And the 328（85.9%） children with normal blood pressure were given the routine management of the community health center. Both the rates of self-awareness of suffering from hypertension and receiving hypertension management were 90.5%（38/42）. The average systolic blood pressure of male children was higher than that of female children〔（98±9） mm Hg vs.（95±9） mm Hg〕（P=0.001）. The average diastolic blood pressure of male children was similar to that of female children〔（55±8） mm Hg vs.（55±7）mm Hg〕（P>0.05）. Conclusion　Using this community-based blood pressure monitoring mode，children can receive stratified management according to their blood pressure levels，and those with hypertension can be identified early and transferred to higher level hospitals timely，so this mode is of great significance in early detection and treatment of childhood hypertension.
    Path Analysis of Influencing Factors for Medication Compliance in Community-dwelling Elderly Patients with Hypertension　
    WANG Yongxin，LI Xiaoju，JING Mingxia，ZHANG Mei，LIANG Rujiang
    2021, 24(4):  503-508.  DOI: 10.12114/j.issn.1007-9572.2020.00.409
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    Background　Medication compliance is a key determinant of whether a drug treatment could be achieve good therapeutic effects in hypertensive patients. So it is essential to understand medication compliance and associated factors to improve blood pressure control rate in such patients. Objective　To analyze the medication compliance and associated factor of pathways of action in elderly hypertensive patients in the community，providing a reference for medical workers to formulate measures to improve medication compliance in such patients. Methods　From July to August 2017，by use of typical sampling，1 157 elderly hypertensive patients were selected from 3 urban and 2 rural communities（of the Xinjiang Production and Construction Corps） in a city，and received a face-to-face questionnaire survey regarding demographics and medication compliance. Path analysis using Anderson's model of health service utilization was performed to analyze the interrelationship among influencing factors of medication compliance. The survey achieved a response rate of 94.20%（1 090/1 157）. Results　The respondents included 396 men（36.33%） and 694 women（63.67%），and had a mean age of（73.5±7.3）years，and a good medication compliance of 63.21%（689/1 090）. There were statistically significant differences in medication compliance among hypertension patients with different propensity（place of residence），enabling resources（medical insurance reimbursement policies for outpatient cost for special chronic diseases，life stresses，monthly antihypertensive drug cost），demand factors（self-assessed health statu，sleep disorders），and health behavior（drinking）（P<0.05）. There were significant differences in the number of chronic diseases and the average duration of hypertension between the patients with good medication compliance and those with poor medication compliance（P<0.05）. Analysis revealed that place of residence（effect size=-0.113），sleep disorder（effect size=-0.114） and self-assessed health status（effect size=-0.076），drinking（effect size=-0.150），and medical insurance reimbursement policies for outpatient cost for special chronic diseases（effect size=0.126） were directly associated with medication compliance. Hypertension course（effect size=0.020） and monthly antihypertensive drug costs and the percentage of such costs（effect size=0.044） that could be reimbursed according to the medical insurance reimbursement policies for outpatient cost for special chronic diseases had an indirect effect on medication compliance. Sleep disorders caused by life stresses had an indirect effect on medication compliance（effect size=-0.023）（P<0.05）. Conclusion　The medication compliance of this population needs to be further improved. To achieve this，health education delivered by medical workers should be strengthened，and life stresses associated with sleep disorders should be reduced. Moreover，policymakers are suggested to adjust the reimbursement standard for outpatient cost for special chronic diseases and increase the reimbursement rate.
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