Table of Content

05 April 2022, Volume 25 Issue 10

Previous Issue    Next Issue

COVID-19 Containment

Roles of Primary Care in Response to the COVID-19 Pandemic Defined in Policy Documents

ZHOU Rui, YAO Nengliang, CHEN Fangfang

2022, 25(10):  1155-1161.  DOI: 10.12114/j.issn.1007-9572.2022.0107

Asbtract ( )   HTML ( )   PDF (618KB) ( )  

Figures and Tables | References | Related Articles | Metrics

The major promise for promoting primary care intuitions to take the initiative to play an active role in containing the COVID-19 pandemic is defining the duties and roles that they should undertake.

To review the policy documents related to COVID-19 issued by China's health administrative departments to make a systematic summary of the responsibilities and duties that should be undertaken by primary care institutions, offering guidance for COVID-19 containment in various regions of China.

In August 2021, we searched the official websites of the National Health Commission of the People's Republic of China (PRC) and its subordinate institutions for policy documents related to COVID-19 using "primary careinstitutions" "prevention and control at the community level" "COVID-19" and "COVID-19 prevention and control" as the main search terms. The policy documents containing "COVID-19 prevention and control" and "primary careinstitutions" were sorted out in chronological order of publication, and their contents were intensively reviewed, organized, summarized and analyzed.

Thirty-four policy documents extracted from the official websites of the National Health Commission of the PRC and its three subordinate institutions (Department of Primary Health, the former Bureau of Medical Administration and the former Bureau of Disease Prevention and Control) were finally enrolled. They were mainly formulated by the Joint Prevention and Control Mechanism of the State Council in Response to the COVID-19, General Office and Department of Primary Health of the National Health Commission of the PRC. According to these policy documents, the major responsibilities of primary care institutions in containing COVID-19 include: early detection and reporting the suspected COVID-19 cases; receiving trainings regarding knowledge related to COVID-19 containment and emergency preparedness drills for coping with the pandemic; strengthening nosocomial COVID-19 infection containment and personal protection against the pandemic; cooperating with the community in fighting the COVID-19 pandemic; implementing health education about COVID-19 containmentusing a scientific approach; health management of priority populations; collecting and submitting nucleic acid samples; COVID vaccination.

Primary care institutions play a vital role in containing COVID-19 in China. The local governments should follow policy guidelines, and take measures according to the local conditions to facilitate the primary care in stitutions to better their performance in response to COVID-19 as frontline responders.

Expert Advice on Community-based Grid Containment of COVID-19 Pandemic by the General Practice Network & Regional Medical Consortium

Specialty Committee for Primary Medicine Education, China Medicine Education Association, Commission of General Practice, Health Exchange and Cooperation Cross the Taiwan Straits Association, Guangdong Primary Healthcare Association, General Practitioner Branch of Guangdong Medical Doctor Association

2022, 25(10):  1162-1171.  DOI: 10.12114/j.issn.1007-9572.2022.0051

Asbtract ( )   HTML ( )   PDF (1309KB) ( )  

Figures and Tables | References | Related Articles | Metrics

The COVID-19 containment has become a top global public health concern. China has obtained a phased achievement in containing COVID-19 pandemic, during the process, primary medical institutions and general practitioner teams in regional medical consortiums have played a key role. To better guide and standardize the development of regional medical consortiums, give full play to the bridge role and grid management of general medicine in COVID-19 pandemic containment, and consolidate the achievements of COVID-19 pandemic containment further, we invited a group of related experts to develop the Expert Advice on Community-based Grid Containment of COVID-19 Pandemic by the General Practice Network & Regional Medical Consortium (the First Version for Trial Implementation) (hereinafter referred to as the Expert Advice) following in-depth analysis and thorough consideration of literature review results, suggestions extensively collected and practical evidence, which mainly includes the following aspects: the essential characters of the general practice network & regional medical consortium, organizational structure, contents and separation of responsibilities and duties, operation mechanism, content of the work, workflow, training and assessment. We hope the Expert Advice will contribute to the construction and operation of the general practice network & regional medical consortium in various regions for COVID-19 containment.

Policies Implemented in Beijing for Guaranteeing Healthcare for Community-dwelling Patients with Noncommunicable Diseases during the COVID-19 Pandemic

KANG Liangyu, SHANG Weijing, LIU Jue, LIU Min

2022, 25(10):  1172-1176.  DOI: 10.12114/j.issn.1007-9572.2022.0091

Asbtract ( )   HTML ( )   PDF (1261KB) ( )  

Figures and Tables | References | Supplementary Material | Related Articles | Metrics

The COVID-19 pandemic brings about influence and challenge for ensuring healthcare services for non-communicable diseases. To guarantee the healthcare services for community-living patients with non-communicable diseases and to meet their healthcare needs, the Beijing municipal government issued a series of policies and relevant supporting measures, including five parts: promoting the implementation of the extended prescription policy, providing Internet-based medical services, further implementing the hierarchical medical system, giving full play to the role of family doctors, and carrying out the service of doorstep delivery of medicines. We reviewed and summarized policies and corresponding measures implemented in Beijing for guaranteeing healthcare for community-dwelling non-communicable disease patients during COVID-19 early response period and ongoing containment period. By evaluating the implementation effect of the policies and comparing with those at home and abroad, it is found that the community chronic disease management under the continuous epidemic situation can be further optimized in the future from the aspects of strengthening the training of grass-roots medical personnel, paying attention to the monitoring of chronic diseases and their risk factors, accurate health management, continuing to implement the hierarchical diagnosis and treatment system, and exploring the whole cycle health management of chronic diseases.

Reflection & Innovation

Benefits and Models of Sexual Health Services Provided by General Practitioners

WU Jiang, CHEN Zhiyuan, LU Jingjie, XIANG Yuling, CHENG Dandan, LIN Chengbiao, YAN Weihui, HUANG Zhiwei

2022, 25(10):  1177-1180.  DOI: 10.12114/j.issn.1007-9572.2021.00.340

Asbtract ( )   HTML ( )   PDF (985KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Sexual health is an important component of human health. Ignoring, misunderstanding and having misconceptions of sexual health will greatly impair people's quality of life. Owing to the concept of holistic health in general medicine, influence of biopsychosocial model of health, and family as a vital unit of care, and adherence to protecting patient privacy as a professional responsibility, general practitioners (GPs) have obvious advantages in offering sexual health services. However, more efforts are needed to strengthen the promotion of sexual healthcare knowledge popularization, sexual health screening, and sexual problem diagnosis and treatment in primary care of China. To provide support for Chinese GPs to deliver sexual health services, Department of General Medicine, the University of Hong Kong-Shenzhen Hospital, has pioneered in providing sexual health services and exploring new service delivery models using actions such as constructing a sexual health service team and a genital examination skills workshop, carrying out the consultation about sexual history, and developing a standard diagnostic and therapeutic procedure for sexualproblems.

Development of a Personalized Pharmacologic Treatment Repository for Bronchial Asthma Based on the 2018 Guideline for the Diagnosis and Management of Bronchial Asthma in Primary Care（Practice Edition）

HUO Hongmin, YANG Yaofang, DONG Jiatian, MAO Zixian, HU Ping, SONG Fengchun

2022, 25(10):  1181-1185.  DOI: 10.12114/j.issn.1007-9572.2022.0147

Asbtract ( )   HTML ( )   PDF (990KB) ( )  

References | Supplementary Material | Related Articles | Metrics

Bronchial asthma is a chronic inflammatory disease with high heterogeneity, polygenic inheritance, complex etiology and many complications. The effects of prevention and treatment for a bronchial asthma patient often depend on whether the patient has received a personalized health management. In order to be in line with the international management level of bronchial asthma, the updates in the 2018 Guideline for the Diagnosis and Management of Bronchial Asthma in Primary Care (Practice Edition, here in after referred to as the 2018 Guideline) contain the idea of early intervention, optimized medication regimens, and highlighted standardized management approach regarding bronchial asthma. To promote personalized pharmacologic management of bronchial asthma in primary care, and to provide online pre-, mid- and post-diagnosis pharmaceutical services for physicians, as well as personalized pharmacologic monitoring and management services for bronchial asthma patients in the community, pharmacists have developed a search engine with integrated functions of "pre-judgment, early warning and prediction" to collect medication information related to bronchial asthma using the information technology, according to the pharmacologic treatment path "initial treatment, long-term treatment, degradation principle" put forward in the 2018 Guideline, with the "one factory, one drug, one specification" individualized instruction as a basis.

Article

Prevalence and Spatial Analysis of Chronic Comorbidity among Chinese Middle-aged and Elderly People

WANG Hao, ZHANG Lin, FANG Xiaoya, DENG Ruyue, YAO Jun

2022, 25(10):  1186-1190.  DOI: 10.12114/j.issn.1007-9572.2022.0127

Asbtract ( )   HTML ( )   PDF (1060KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Concurrent with global aging, China is seeing significantly increased base-case prevalence of chronic diseases and growing prevalence of multimorbidity, which seriously affect the safety and quality of life in middle-aged and elderly Chinese people. Understanding the spatial attributes of data is an effective way to learn the epidemic regularity of the disease. There is no research on the spatial distribution of chronic comorbidity.

To analyze the prevalence and spatial distribution of chronic comorbidity in Chinese middle-aged and elderly people (≥45 years) , providing support for the development of measures for regional containment of chronic diseases.

This study was carried out in March 2021. Data about sociodemographic characteristics and prevalence of 14 chronic diseases stemmed from the four wave of the China Health and Retirement Longitudinal Study, involving 19 498 people aged 45 and above. The geographic information system, ArcGIS 10.2 and Geoda 1.18 were used to conduct a spatial statistical analysis of prevalence of these chronic diseases.

In 2018, the prevalence of chronic comorbidity among middle-aged and elderly Chinese people was 55.77% (10 874/19 498) . And the prevalence of chronic comorbidity varied significantly by sex, age, educational background and marital status (P<0.05) . Arthritis or rheumatism was found to be the disease that most frequently coexisted with other diseases (58.23%, 6 332/10 874) . In terms of two comorbidities coexisted, gastric disease with arthritis or rheumatism had the highest prevalence (16.68%, 655/3 928) . As for three comorbidities coexisted, hypertension with gastric disease and arthritis or rheumatism had the highest prevalence (8.12%, 227/2 796) . The regional prevalence of comorbidity ranged from 39.86% (405/1 016 for Guangdong) to 75.25% (76/101 for Xinjiang) . Global spatial autocorrelation analysis showed that the spatial distribution of the chronic comorbidity prevalence showed a positive autocorrelation indicated by the Moran's I〔0.303 542 (P=0.006) 〕. Local spatial autocorrelation analysis showed that the Moran's I value of Qinghai, Gansu and Fujian were statistically significant (P<0.05) . The cluster type of Qinghai and Gansu was high-high, and that of Fujian was low-low.

The prevalence of chronic comorbidity among middle-aged and elderly Chinese people was high, with spatial differences. Priority should be given to the containment of highly prevalent chronic diseases, such as rheumatism, hypertension and gastric disease, and the key regions for containment were mainly in the northwest part of China.

Association between Depression Prevalence and Adverse Childhood Experiences in Middle-aged and Older People

LU Weiwei, ZHU Rui, CHEN Jun, FU Tengfei, ZHANG Jian, LIN Yuejun

2022, 25(10):  1191-1196.  DOI: 10.12114/j.issn.1007-9572.2022.0144

Asbtract ( )   HTML ( )   PDF (1101KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Depression prevalence and adverse childhood experiences (ACEs) in middle-aged and older people has become an increasingly concerned issue, yet it in Chinese population has been less reported, and needs to be further explored.

To investigate the epidemiology of ACEs among middle-aged and elderly Chinese people, and to analyze its association with depression prevalence, providing an accurate delineation of ACEs and depression prevalence in this group of Chinese people.

Information of 7 035 middle-aged and elderly people≥ 45 years old who met the research requirements were selected during July to August, 2021 from the database of China Health and Retirement Longitudinal Study held by Institute of Social Science Survey, Peking University, in which the questions in the Center for Epidemiologic Studies Depression Scale used in the CHARLS, ACEs (including abuse, neglect, dysfunctional family) and individual characteristics were screened and generated into new dummy variables with the weight reassigned. Covariates of those with ACEs (treatment group) and those without (control group) were included in a propensity score matching model, and propensity scores of them were estimated using robust standard errors in multivariate Logistic regression, then the covariates of two groups were matched using the 1∶1 nearest neighbor matching, and were checked using balance diagnostics and common support assumption. The influence of ACEs on the depression in those with ACEs was quantified by the average treatment effect on the treated.

Of the 7 035 respondents, 6 529 (92.81%) had experienced ACEs, 1 802 (25.61%) had experienced at least four ACEs, and 1 003 (14.26%) had a depressive state. Multivariate Logistic regression model demonstrated that age, gender, and self-rated health status were significantly associated with ACEs (P<0.05) . Individual characteristics of both groups after propensity score matching were comparable (P>0.05) , and went through the check of balance diagnostics and common support assumption. Propensity score matching-based analysis revealed that the risk of depression prevalence in those with ACEs was increased by a factor of 6.9% compared with those without (P<0.001) .

The prevalence of ACEs among middle-aged and elderly Chinese people was higher, which may significantly increase the risk of depression prevalence. Therefore, it is urgently needed to establish a system of ACEs screening and intervening to improve the level of healthcare services and well-being for these people.

Hypertension and Glycemic Control and Associated Factors for Poor Control in Patient Populations at High Risk of Atherosclerotic Cardiovascular Disease in the Community

YIN Zhaoxia, LUO Youlia, TAN Siwen, CHEN Yanli, FENG Haixuan, GONG Weijie

2022, 25(10):  1197-1205.  DOI: 10.12114/j.issn.1007-9572.2022.0163

Asbtract ( )   HTML ( )   PDF (1057KB) ( )  

Figures and Tables | References | Related Articles | Metrics

The low hypertension control rate or low glycemic control rate in people in the community have been attributed to patients' poor disease awareness and irregular medication in some studies. However, few studies have explored hypertension control rate and/or glycemic control rate in patients with good disease awareness and regular medication.

To investigate the adequate hypertension control rate and/or adequate glycemic control rate in hypertension and diabetic patients who are at high risk of atherosclerotic cardiovascular disease (ASCVD) but have good disease awareness and regular medication, and to explore the reasons for poor control, offering a theoretical basis for better prevention and control of ASCVD.

By use of cluster sampling, contracted patients with complete data of the China-PAR model who visited 10 community health centers in Shenzhen's Luohu District from August 2018 to April 2019 were selected, and received an assessment for screening the risk of 10-year ASCVD using the China-PAR model, and those with hypertension and/or diabetes who were at high risk of ASCVD (≥10 points) and volunteered to attend this study were further surveyed using a questionnaire developed by our research group. After that, those who were on regular medication with a good understanding of the threats of hypertension and/or diabetes, and targets for blood pressure control and/or fasting glycemia control, were finally enrolled. The rate of adequate hypertension control was compared between those with hypertension, the rate of adequate glycemic control was compared between those with diabetes, and the rates of adequate hypertension and glycemic control were compared between those with both hypertension and diabetes, by demographcihc factors. Then those who were found with inadequate hypertension and/or glycemic control were selected to attend an in-depth, semi-structured individual interview using a descriptive qualitative research design for understating the causes of inadequate hypertension and/or glycemic control. The contents of the interview were coded and categorized using NVivo 12, and were sorted, analyzed, and themes in which were identified using content analysis.

Totally 299 patients were finally enrolled, including 130 (43.5%) with hypertension, 9 (3.0%) with diabetes, and 160 (53.5%) with both hypertension and diabetes. Among the 290 hypertensive patients, 140 (48.3%) had adequate hypertension control. Among the 169 diabetics, 71 (42.0%) had adequate diabetes control. Among the 130 patients with simple hypertension, those with adequate hypertension control had older mean age than did those without (t'=3.758, P<0.001) . Among the 160 patients with both hypertension and diabetes, those with adequate hypertension control had older mean age than did those without (t'=2.203, P=0.031) . Among the 169 patients with diabetes, those with adequate control of fasting glycemia had lower rate of regular exercising (χ²=4.314, P=0.038) and shorter mean duration of diabetes (t=-3.180, P=0.002) , as well as lower mean frequency of blood glucose monitoring (Z=2.228, P=0.026) than did those without. Seven themes emerged from the interview: Patients did not feel compelled to reach the targets, feeling indifferent; Patients gave up after repeated treatments followed by failures to achieve the targets, feeling powerless; Patients took medicines regularly, but had problems in practical medication; Patients were restricted by various realistic factors; Patients were influenced by doctor-related factors, including doctors' irrelevant and ignorant attitudes; Patients had failures due to lack of self-control and unhealthy lifestyles; Other reasons, including unsuccessful medical insurance reimbursement, being afraid of over-control due to previous experiences of too low blood pressure or glucose, etc.

The high-risk population of ASCVD who had good disease awareness and took medications regularly still had low hypertension control rate and/or low glycemic control rate. Attention should be specially given to blood pressure levels in young hypertensive patients, and glycemic level in diabetic patients with regular exercising, a long history of diabetes, or frequent blood glucose monitoring. It is necessary to optimize the management of ASCVD in the community by encouraging patients to improve their mindset and change their unhealthy lifestyles, strengthening the promotion of standardized medication use, improving community health services, and improving patients' knowledge, beliefs and behaviors from the biopsychosocial perspective.

Chronic Disease Patients Involved in Shared-decision Making in General Outpatient Care in the Community：Current Status and Associated Factors

MA Wenhan, BAI Xuefei, CHEN Zhaojuan, ZHAO Yali

2022, 25(10):  1206-1212.  DOI: 10.12114/j.issn.1007-9572.2021.00.312

Asbtract ( )   HTML ( )   PDF (1045KB) ( )  

Figures and Tables | References | Related Articles | Metrics

The general practice clinic in community health centers is facing increasingly complex challenges to meet the medical needs of patients with chronic diseases. To improve chronic disease patients' health outcome and healthcare satisfaction, it will be of great significance to use shared decision-making (SDM) in the diagnostic and therapeutic process in the community, since SDM is a model based on doctor-patient mutual respect and cooperation and shows great promise as a possible major medical decision-making model.

To understand the status and associated factors of chronic disease patients involved in SDM in general outpatient care in the community, aiming to provide evidence for promoting the implementation of SDM in primary care.

We used cluster sampling to select seven general practitioners (GPs) in the clinic of Shuangyushu Community Health Center, Beijing, and 149 chronic disease patients seen by them between October 2019 and January 2020 as the participants. Through non-participant observation at the clinic, we used the Chinese version of the Observer OPTION 5 (OPTION-5) as an assessment tool to evaluate the extent to which GPs facilitated patient participating in SDM during the consultation. We used a self-developed general demographic questionnaire to collect patients' demographics, status of illness and treatment, as well as GPs' demographics. We compared the OPTION-5 score of the patients by demographic factors, and used stepwise multiple linear regression to explore the factors affecting patients' participation in SDM.

The mean visit length, and OPTION-5 score for the 149 patients were (4.1±2.7) minutes, and〔6.00 (3.00) 〕, respectively. The OPTION-5 score varied significantly across patients by age group and visit length (P<0.05) . Multiple linear regression analysis showed that patient visit length, prevalence of interruption of counseling due to other people, and prevalence of family member accompaniment to medical visits were associated with patients' participation in SDM (P<0.05) .

The participation of these patients in SDM was relatively low. Prolonging GP-patient communication time, ensuring that the diagnosis and treatment process is not interrupted, and giving patients a private space during diagnosis and treatment process may be feasible interventions to improve the participation of chronic disease patients in SDM in primary care.

Physicians' Perspective on Shared Decision-making：a Qualitative Study

YANG Linning, ZHENG Hongying, ZHAO Dan, YANG Yan

2022, 25(10):  1213-1219.  DOI: 10.12114/j.issn.1007-9572.2021.00.254

Asbtract ( )   HTML ( )   PDF (1035KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Shared decision-making has promoted the transformation of the role of patients from passive recipients of health care to active participants and supervisors, deeply reflecting the idea of patient-centered care. Research on shared decision-making in China is still in its infancy. Physicians are major participants in decision-making, but their perspectives on shared decision-making have been rarely studied.

To explore physicians' perspective on shared decision-making, offering evidence for the implementation of shared decision-making.

From May to July 2020, we conducted semi-structured interviews with 15 physicians selected by convenience sampling method from a grade A tertiary hospital in Shanghai for investigating their actual decision-making process, their views and attitudes about shared decision-making, and the obstacles to clinical implementation of shared decision-making. The interview results were analyzed by Colaizzi's method of data analysis.

Among the 15 physicians, 10 were male and 5 were female; aged 28-53 years old, with an average age of (38.4±7.0) years old; 4 residents, 5 attending physicians, 4 associate chief physicians, and 2 chief physicians; 5 physicians, 7 surgeons and 3 oncologists. Four themes including 15 subthemes were identified: differences in physicians thederstanding of policies related to shared decision-making; unclear understanding of physicians and patients' roles in shared decision-making; acknowledging the importance of shared decision-making; obstacles to clinical implementation of shared decision-making.

Our study suggests that improving physicians' understanding level of shared decision-making, and creating conditions facilitating clinical implementation of shared decision-making may promote the sound development of shared decision-making.

Improving Medication-taking Behavior and Blood Pressure in Hypertensive Patients Using the Stages of Change Model-based Health Education

SUN Xinying, GUO Yi, CHEN Ping, HE Chao

2022, 25(10):  1220-1226.  DOI: 10.12114/j.issn.1007-9572.2022.0141

Asbtract ( )   HTML ( )   PDF (1190KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Hypertension in Chinese adults has been featured by high prevalence and low control rate recently. And medication-taking behavior is one of the important factors greatly affecting hypertension control in this group.

To assess whether stages of change model (SCM) based-health education could improve medication-taking behavior in hypertensive patients.

This cluster randomized controlled trial was conducted in six community health centers with comparable service population size and healthcare conditions selected from Shunyi District, Beijing during September 2016 to June 2018. By use of coin tossing, three of the community health centers were randomly assigned to an intervention group, and another three to a control group, from which, a total of 400 hypertensive patients were recruited, 206 from the intervention group and 194 from the control group, receiving three times of SCM-based health education, and usual management, respectively. Questionnaire surveys and blood pressure measuring were performed in all participants at baseline, 3, 6 and 12 months after intervention for understanding of their sociodemographic characteristics, medication-taking behavior, blood pressure level and barriers to medication adherence.

The patients who completed the 3-month, 6-month and 12-month follow-up numbered 375 (intervention: 202, control: 173) , 290 (intervention: 147, control: 143) and 263 (intervention: 134, control: 129) , respectively. After the end of the 12-month intervention, the percentage of patients in action and maintenance stages increased from 27.7% (57/206) to 60.5% (81/134) in the intervention group, while that in the control group decreased from 50.0% (97/194) to 38.9% (49/129) . Generalized estimating equations on action stage showed statistically significant inter-group differences in the interaction terms at group enrollment time and follow-up periods after controlling for other confounding variables (P<0.05) , that was intervention group^×3-month follow-up〔OR (95%CI) =3.928 (2.628, 5.870) 〕, intervention group^×6-month follow-up〔OR (95%CI) =3.651 (2.333, 5.712) 〕, and intervention group^×12-month follow-up〔OR (95%CI) =4.133 (2.315, 7.377) 〕. Compared with the control group at baseline, the systolic blood pressure of the intervention group was continuously, significantly improved with the prolongation of intervention time at 3-month intervention〔b (95%CI) =-4.616 (-8.558, -0.675) 〕, at 6-month intervention〔b (95%CI) =-4.348 (-8.569, -0.127) 〕, and 12-month intervention〔b (95%CI) =-6.462 (-11.208, -1.716) , P<0.05〕, but the diastolic blood pressure of the intervention group achieved significant improvement only at the 3-month intervention〔b (95%CI) =-3.549 (-6.271, -0.827) , P<0.05〕.

This research indicated that SCM-based healtheducation could effectively contribute to hypertension control via improvingthe medication-taking behavior of hypertension patients, and increasing the percentage of these patients entering the stages of action and maintenance.

Development，Reliability and Validity of the Chinese Version of the Return-to-Work Self-Efficacy Questionnaire among Young and Middle-aged Stroke Patients

LIU Feng, ZHANG Zhenxiang, MEI Yongxia, GUO Yunfei, DUAN Yandan

2022, 25(10):  1227-1231.  DOI: 10.12114/j.issn.1007-9572.2022.0146

Asbtract ( )   HTML ( )   PDF (405KB) ( )  

Figures and Tables | References | Related Articles | Metrics

The prevalence of varying degrees of post-stroke dysfunctions commonly found in an increasing number of young and middle-aged stroke patients, has hindered them from returning to work quickly, and caused serious socioeconomic burdens. Return-to-work self-efficacy is an important predictor of returning to work, and the assessment of which may provide guidance for promoting patients to return to work. However, there is no scale measuring the return-to-work self-efficacy of Chinese stroke patients.

To develop a Chinese version of the Return-to-work Self-efficacy Questionnaire (RTW-SE) by translating the English version of the RTW-SE, then assess its reliability and validity in young and middle-aged Chinese stroke patients.

By use of forward and backward translation of the English version of the RTW-SE, the Chinese version of the scale was developed. Then the scale was tested in a sample of 130 cases, and was analyzed for item analysis and exploratory factor analysis. Then, the scale was retested in another sample (n=255) from November 2020 to April 2021 for confirmatory factor analysis. The Pearson correlation and critical ratio were used as parameters for item analysis, and the Cronbach's α and split-half reliability were used as parameters of the reliability of the scale. Content validity and structural validity were adopted as parameters of the scale validity. Content validity was expressed by scale- and item-level content validity indices. Structural validity was evaluated by factor analysis, including exploratory factor analysis and confirmatory factor analysis.

The response rates of the test, and retest for the scale were 93.1% (121/130) , and 96.1% (245/255) , respectively. The results of item analysis showed that item-total correlation coefficients ranged from 0.636 to 0.897, with critical ratios greater than 3 for all items (P<0.001) . Reliability analysis showed that the Cronbach's α and split-half reliability of the scale were 0.942, and 0.940, respectively. The scale- and item-level content validity indices were 0.95 and 0.80~1.00, respectively. By exploratory factor analysis, one common factor was extracted, and the factor loadings of items ranged from 0.628 to 0.901, with 63.919% as the percentage of explained total variance. The confirmatory factor analysis showed that the model fit was good.

The Chinese version of RTW-SE may be a reliable and valid tool for measuring return-to-work self-efficacy in young and middle-aged Chinese patients with stroke.

Quality of Integration of Medical Treatment-nursing-rehabilitation for Chronic Disease Patients in the Community from Patients' Perspective: a Cross-sectional Study in Hangzhou

YANG Min, ZHU Xuejiao, XU Manao

2022, 25(10):  1232-1237.  DOI: 10.12114/j.issn.1007-9572.2021.00.224

Asbtract ( )   HTML ( )   PDF (1011KB) ( )  

Figures and Tables | References | Related Articles | Metrics

It's necessary to pay urgent attention to the quality of the integration of medical treatment-nursing-rehabilitation in the service promotion process, especially the evaluation from the perspective of patients is lacking.

To investigate patients' perspective on the quality of integration of medical treatment-nursing-rehabilitation for chronic disease patients in the community in Hangzhou, to provide help for improving the quality of such services.

A questionnaire survey was conducted from June to September 2020 with 550 chronic disease patients selected by convenient sampling method from the service population of 10 community health centers in five major urban districts (Jianggan, Gongshu, Xihu, Shangcheng, and Xiacheng Districts) of Hangzhou, Zhejiang Province, for collecting their general demographic information, and diseases and treatment-related information, as well as experience of receiving integration of medical treatment-nursing-rehabilitation (using the Chinese version of SERVQUAL Scale consisting of effectiveness, responsiveness, reliability, communication and empathy) .

A total of 525 (95.5%) of the respondents returned responsive questionnaire. Among 525 patients with chronic diseases, 165 (31.4%) were satisfied with integration of medical treatment-nursing-rehabilitation. The patients' total average score of the service perception (5.14±0.44) did not reach their expected level (6.80±0.01) . From high to low the scores of each dimension were reliability (5.69±0.87) , effectiveness (5.43±0.85) , empathy (5.13±1.81) , communication (4.86±1.53) , responsiveness (4.77±0.98) . There was tiny difference among the scores of each dimension of the service expectation. The largest gap between perception and expectation was responsiveness (-2.01±0.14) and the smallest was reliability (-1.11±0.17) . Excluding the 20 "other" respondents in the satisfaction survey, a total of 505 respondents were analyzed by Spearman rank correlation. The results showed that the patients' service satisfaction was positively correlated with the service perception level in terms of total average score (r_s=0.741, P<0.001) , and the gap between perception and expectation (r_s=0.687, P<0.001) .

The patients' service experience and satisfaction were closely related. Currently, the five aspects of effectiveness, responsiveness, reliability, communication and empathy of integration of medical treatment-nursing-rehabilitation have not reached the level of expectation of patients with chronic diseases in the community, especially the responsiveness, indicating that it is necessary to further improve the level of the service in a targeted manner.

Changes in Knowledge and Attitudes towards Antibiotic Use among Primary Care Physicians in Hubei Province：a Propensity Score-matched Analysis

DUAN Lixia, LIU Chenxi

2022, 25(10):  1238-1245.  DOI: 10.12114/j.issn.1007-9572.2022.00.012

Asbtract ( )   HTML ( )   PDF (1065KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Physicians' irrational antibiotic prescriptions are fueling antibiotic resistance and seriously threatening public health. Physicians' knowledge and attitudes towards antibiotic use will directly affect their behaviors.

To describe the status in knowledge and attitudes regarding antibiotic use among primary care physicians in Hubei Province in 2018 and 2020, analyze the changes and relevant reasons over these two years, and to present relevant interventions, promoting rational antibiotic use in primary care physicians.

Two surveys were separately conducted (one was conducted from April to June 2018 with a stratified two-stage cluster sample, and the other was conducted from November 2019 to January 2020 with a two-stage cluster random sample) among Hubei's primary care physicians with the qualification of prescribing antibiotics who had written over 100 antibiotic prescriptions within 3 months prior to the survey. A self-developed questionnaire was used in the surveys to acquire information about demographics, knowledge of antibiotic use (whether antibiotics should be used in 10 common situations) , and attitudes (5 types of attitudes that may affect antibiotic use behavior) . A descriptive analysis was conducted on the accuracy rate and total scores of antibiotic use knowledge as well as total and item scores of attitudes to examine primary care physicians' knowledge and attitudes towards antibiotic use during 2018 and 2020. To determine changes in knowledge and attitudes within two years, propensity score matching (PSM) was used, with participants in 2018 designated as the control group and those in 2020 as the treatment group.

637 respondents of the 2018 survey and 616 respondents of the 2020 survey were included for final analysis. Before PSM matching, the mean score of antibiotic use knowledge of the2020 survey respondents was statistically higher than that of 2018 survey respondents〔 (5.54±1.46) vs (5.25±1.35) 〕 (P<0.05) . Moreover, the 2020 survey respondents also had statistically higher accuracy ratesin answering questions on the effect of ceftriaxone crossing the blood-brain barrier (48.5% vs 39.6%) and routes of aminoglycoside administration (55.7% vs 44.0%) (P<0.05) . Furthermore, 2020 survey respondents had higher mean overall score of attitudes towards antibiotic use〔 (55.41±5.02) vs (53.29±5.21) 〕 (P<0.05) . In particular, 2020 survey respondents had statistically higher mean overall scores of items regarding attitudes towards prescribing antibiotics due to meeting patient demands, ignoring the problem of antibiotic resistance, and lacking motivation to change their own irrational behaviors (P<0.05) . By PSM matching, 513 2020 respondents were successfully matched to 513 2018 respondents. After achieving a balance of covariates between groups, the2020 respondents still had statistically higher total mean scores of antibiotic use knowledge and attitudes towards antibiotic use (P<0.05) . Further analysis revealed that in those from community health centers, the 2020 survey respondents had statistically higher total scores of antibiotic use attitudes (P<0.05) , while no statistical differences were found in the total score of antibiotic use knowledge (P>0.05) . But in those from township health centers, the 2020 survey respondents had statistically higher total mean scores of antibiotic use knowledge and attitudes towards antibiotic use than did the 2018 survey respondents (P<0.05) .

Compared with 2018, the level of knowledge of antibiotic use in Hubei's primary care physicians was improved, but still was relatively low. Moreover, it seemed that they were more negative toward rational antibiotic use, tendingto prescribe antibiotics inappropriately. A systematic approach should be adopted to improve the knowledge of rational antibiotic use, strengthen the motivation for rational antibiotic use, and reduce irrationally antibiotic prescribing among primary care physicians.

Article·Primary Health Services

Centered Structures and Trend Changes in Academic Narratives of 10-year Development of Hierarchical Medical System in China

ZHANG Shue, WANG Yanping, WANG Hongni, ZHAO Xin, CHENG Siyu, JI Keyu, WANG Xiaohe, ZHANG Meng, SUN Tao

2022, 25(10):  1246-1253.  DOI: 10.12114/j.issn.1007-9572.2022.00.014

Asbtract ( )   HTML ( )   PDF (2810KB) ( )  

Figures and Tables | References | Related Articles | Metrics

The narratives of hierarchical medical sytem are generally classified into two patterns, one is the policy narrative, which is used to persuade the target audience to gain their support in practice, and the other is the academic narrative, which describes the thinking process of researchers to explore problems and enhance perceptions using words. The narratives of the hierarchical medical system are rich and diverse, but have been rarely systematically reviewed and summarized.

We explored the evolution process, focuses and characteristics of academic narratives of 10-year development of hierarchical medical system in China using social network analysis, aiming to provide a reference for improving the implementation of hierarchical medical system.

On March 21, 2021, we searched the database of CNKI for studies regarding hierarchical medical system in China published in academic journals in Chinese during January 1, 2009 to March 21, 2021 using "hierarchical medical system" "seeking healthcare in an orderly way" "seeking diagnosis and treatment services in an orderly way" "division of healthcare" "division of diagnosis and treatment" "first contact in primary care" "treating acute and chronic diseases separately" "cooperation between tertiary and secondary/primary hospitals" "bi-directional referrals" as keywords. Bibliometric methods, SATI 3.0 and UCINET 6.0 were used to explore the process, focuses and characteristics of academic narratives of hierarchical medical system through time series analysis, high-frequency keywords analysis, centrality analysis and small group analysis, and to generate visualized co-occurrence network diagrams of high-frequency keywords.

A total of 4 882 studies were included for analysis. According to the results of time series analysis, the development of the hierarchical medical system could be roughly divided into three stages: embryonic stage (2009—2013) , acceleration stage (2014—2017) and standardization stage (2018 to present) . In terms of the use of frequency, the top five high-frequency keywords were "hierarchical medical system" "medical consortium" "primary healthcare institutions" "bi-directional referrals" and "public hospitals". In terms of closeness centrality, the top five high-frequency keywords were "hierarchical medical system" "medical consortium" "primary healthcare institutions" "bi-directional referrals" and "general practitioners". Small-group analysis yielded three groups of word clusters: core word clusters (including "medical consortium" "reform of public hospitals" "bi-directional referrals" "general practitioners" and "first contact in primary care") , secondary word clusters (including "the internet" "internet-based healthcare" "internet-based hospital" and "telemedicine") , and marginal word clusters (including "diabetes" "chronic disease" "cognition" and "influencing factors") . Health policy rhetoric was an important part of the core word clusters. And secondary and marginal word clusters were constantly evolving and generating.

The academic narratives of hierarchical medical system have gradually derived from the mutually-promoted development of policies and real implementation regarding the hierarchical medical system, generally demonstrated various structures and relatively homogeneous research direction. Available academic and policy narratives of the hierarchical medical system are still limited to the scope of guiding principles, and the implementation of the concept and system still relies on the top-down push from the policy-making level, while the self-motivated micro-practices of hierarchical medical system in primary care have not yet emerged.

Influencing Factors and Path Combination of County Medical Community Innovation by Local Government：a Crisp Set Qualitative Comparative Analysis

ZHANG Min, ZHANG Shue, SHI Yu, WANG Hongni, JI Keyu, CHENG Siyu, ZHAO Xin, SUN Tao

2022, 25(10):  1254-1260.  DOI: 10.12114/j.issn.1007-9572.2022.00.016

Asbtract ( )   HTML ( )   PDF (1031KB) ( )  

Figures and Tables | References | Related Articles | Metrics

The analysis of the influencing factors of local government innovation has always been an important topic in the research of local government innovation.

To analyze the influencing factors and various combination types of local government's practice innovation toward county medical community.

In March 2021, the preliminary results of the 2nd "Searching for Value Cases of County Medical Community Practice" held by the County Medical Community Branch of the China Hospital Association was used as the source of cases; The "type of policy innovation" was used as the outcome variable ("central dominative innovation"/"local responsive innovation"=0; "local autonomous innovation"=1) ; The level of economic development, administrative level, geographical location, problem attributes, and platform were used as condition variables; The crisp set qualitative comparative analysis (csQCA) was used to explore the factors influencing the county medical community innovation by local government, in order to constructthe path models of innovation practice through necessary condition analysis and conditional combination analysis.

The consistency of all five conditional variables was<0.9, which meant that the level of economic development, administrative level, geographical location, problem attributes, and platform were not necessary conditions for autonomous innovation. The results of conditional combination analysis (based on intermediate solution) showed that a total of five sets of sufficient conditions were obtained, including "the level of economic development and non-geographical location and platform" "administrative level and non-geographical location and platform" "the level of economic development and problem attributes and platform" "non- the level of economic development and geographical location and non-problem attributes and platform" "the level of economic development and administrative level and geographical location and problem attributes", separately. All five groups had a sufficient condition consistency index of 1, original coverage of 0.14-0.43, net coverage of 0.14-0.43, and overall coverage of 1. The innovation practice of local government's medical community practice mainly presents two types of models, namely platform innovation model and motivational innovation model.

If local governments want to achieve high-level medical community innovation practice, they should pay attention to the strong correlation between policies and local economic development levels, activate local governments' willingness to innovate actively, and strengthen platform support for county medical communities. This study provided a special reference significance for understanding the practice innovation mechanism of county medical community.

Coordinated Development of Primary Care Resource Allocation and Economy as Well as Associate Factors in China: a Fuzzy-set Qualitative Comparative Analysis

LI Liqing, ZHAO Ling, LI Jiawen, LU Zuxun

2022, 25(10):  1261-1268.  DOI: 10.12114/j.issn.1007-9572.2022.0126

Asbtract ( )   HTML ( )   PDF (1077KB) ( )  

Figures and Tables | References | Related Articles | Metrics

The allocation of medical resources in China has been in an "inverted triangle" state for a long time. The unreasonable allocation of grass-roots medical resources is difficult to meet the increasingly diversified needs of medical services. The coupling and coordination between the allocation of grass-roots medical resources and economic development will affect the level of regional economic development and the service capacity of grass-roots medical institutions. At present, there is a lack of research on the current situation of their coordinated development and how their influencing factors work through combination.

To assess the level of coordinated development of primary care resource allocation and economy in China, and to determine the associated factors, providing a decision-making basis for further improving medical resource allocation and planning.

The research was carried out from November 2020 to April 2021. Data were collected from China Health Statistics Yearbook 2019 and China Statistical Yearbook 2019. fsQCA was implemented to assess the influence of the number of licensed (assistant) doctors, number of registered nurses, financial subsidy for part of salary, number of beds, number of primary care institutions, regional gross domestic product (GDP) , regional fiscal revenue, per capita disposable income, and per capita GDP (used as conditional variables) on the level of interconnected, coordinated development level of primary care resource allocation and economic level (the outcome variable) in 31 regions of China.

In 2018, only the mean level of interconnected, and coordinated development of primary care resource allocation and economy in eastern China (0.61) was within the range (0.6, 1.0] of coordinated development, and that in central China (0.50) was within the transitional harmony range (0.4, 0.6], while that in western China (0.38) was within the range of imbalanced and recessional development[0, 0.4]. The coordinated development of primary care resource allocation and economic level were found to be affected by many factors, and it may be facilitated by four configurations of its associated factors revealed by the configuration analysis: (1) number of beds * number of licensed (assistant) doctors * number of registered nurses * number of primary care institutions * financial subsidy for part of salary* ~ per capita disposable income * ~ per capita GDP; (2) ~ number of beds * ~ number of licensed (assistant) doctors * number of registered nurses * number of primary care institutions * ~ financial subsidy for part of salary* regional GDP * ~ per capita disposable income * per capita GDP; (3) number of licensed (assistant) doctors * number of registered nurses * number of primary care institutions * financial subsidy for part of salary * regional GDP * regional fiscal revenue * per capita disposable income * per capita GDP; (4) ~ number of beds * ~ number of licensed (assistant) doctors * ~ number of registered nurses * ~ number of primary care institutions * financial subsidy for part of salary * regional GDP * regional financial income * per capita disposable income * per capita GDP (* for "and", ~ for "not") . And these four configurations could be classified into three types of paths: primary care resource allocation-driven type, primary care resource allocation and economic balance type, and economic development-driven type.

The overall level of coordinated development of primary care resource allocation and economy in China was unsatisfactory, with obvious regional differences, which was mainly affected by the number of registered nurses, regional GDP, and regional fiscal revenue, but may be facilitated greatly by the above-mentioned four configurations of associated factors. Therefore, it is suggested that each region chooses one path to achieve high level of interconnected, and coordinated development of primary care resource allocation and economy according to their own resources and conditions, so as to promote the rational primary care resource allocation, and the coordinated development of medical resources and economic level, thereby improving the level of primary care services in China.

Evidence-based Medicine

Chinese Elderly Residents' Willingness to Use Integrated Medical and Nursing Care：a Meta-analysis

ZHANG Yujie, YIN Wenqiang, YAN Yu, SUN Yan, LI Cuiyu, ZHANG Tiantian, MENG Cuixiang, HU Jinwei, CHEN Zhongming

2022, 25(10):  1269-1274.  DOI: 10.12114/j.issn.1007-9572.2021.00.325

Asbtract ( )   HTML ( )   PDF (1517KB) ( )  

Figures and Tables | References | Related Articles | Metrics

With aging deepening, there is an increasing demand for medical and elderly care services in Chinese older residents. However, current medical and pension services are still in a state of disconnection. In this regard, integrated medical and nursing care could continuously satisfy their multi-level healthcare needs via orderly combining medical and nursing care resources.

To comprehensively analyze the willingness of Chinese elderly residents to use integrated medical and nursing care.

The literature on the willingness of Chinese elderly residents to use integrated medical and nursing care was searched in databases including CNKI, WanFang Data, CQVIP, PubMed and Web of Science from inception to December, 2020. Data of studies satisfying the inclusion criteria were extracted and meta-analyzed. The literature quality was evaluated by using the current situation survey bias risk assessment criteria (JBI) .

A total of 20 articles were included. The effective sample size of the study was 14 089 cases, and 4 268 residents were willing to participate. The JBI scores of the literature included in the study were 14-18 points, which were greater than 70% of the total score. The quality of the literature included in the study was high. The overall rate of Chinese elderly residents' willingness to use integrated medical and nursing care was 40.5%〔95%CI (33.3%, 47.7%) 〕. Results of subgroup analysis demonstrated that educational background〔OR (95%CI) =0.71 (0.59, 0.85) , P<0.01〕, number of children〔OR (95%CI) =1.72 (1.40, 2.11) , P<0.01〕, marital status〔OR (95%CI) =0.71 (0.57, 0.88) , P=0.02〕, whether living alone〔OR (95%CI) =1.30 (1.14, 1.49) , P<0.01〕, disease prevalence〔OR (95%CI) =1.34 (1.09, 1.64) , P<0.01〕 and awareness of integrated medical and nursing care〔OR (95%CI) =1.91 (1.61, 2.26) , P<0.01〕 were associated with these residents' willingness to use integrated medical and nursing care.

The rate of Chinese elderly residents' willingness to use integrated medical and nursing care was relatively low. High school education or above, number of children≤1, unmarried, living alone, having an illness, and knowing integrated medical and nursing care were associated with stronger willingness to use integrated medical and nursing care. To improve the level of willingness, it is of great necessity to strengthen the publicity of integrated medical and nursing care, establish diversified medical and nursing care homes, and continuously enrich integrated medical and nursing care services.

Caregiving Experiences of Family Caregivers for Children with Tumors：a Qualitative Systematic Review

HE Longtao, LI Menghua, WU Han

2022, 25(10):  1275-1282.  DOI: 10.12114/j.issn.1007-9572.2021.00.308

Asbtract ( )   HTML ( )   PDF (1078KB) ( )  

Figures and Tables | References | Supplementary Material | Related Articles | Metrics

As the most direct caregivers, family caregivers play a crucial role in caring children with cancer. Qualitative studies on their emotions and experiences have reported that they face great challenges and pressures during caring children with cance.

To perform an integrative synthesis of caregiving experiences of family caregivers of children with cancer, providing evidence derived from practice for improving the caring for such children, and their family caregivers' physical and mental health.

Qualitative studies regarding caregiving experiences of family caregivers for children with cancer were retrieved from Web of Science, PubMed, EmBase, Medline, CNKI, and Wanfang Data from inception to June 1, 2021. Literature screening, and data extraction were performed by two researchers, separately. Methodological quality was assessed using JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. And the results were synthesized using an integrative review approach.

Twelve studies were finaly enrolled. Thirty-eight complete evidence of 11 types arose from the synthesis and were summarized into two themes: (1) care challenges and burdens; (2) care resources. Each primary topic encompasses multiple sub-topics.

We found that family caregivers face a variety of burdens and challenges, and they attempt to actively solve them using their own strengths, supports from their own personal networks, other people, external sources (non-governmental, public and supportive policy resources) , culture and belief, as well as knowledge about hospice care. To relieve their care burden, and improve the quality of life of these children, it is suggested that medical workers should provide these caregivers with targeted guidance and supports with the features of the specific treatment phase of the children, and their caregivers' caregiving experiences and culture taken into consideration.