Table of Content

05 June 2022, Volume 25 Issue 16

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Development of a General Practice plus Compact Regional Practice Consortium-based Chronic Disease Management Model with International Chronic Disease Management Models and Experiences as a Reference

Yang LIU, Kai WANG, Gexin XIAO, Jujiao XIAO, Jianbo GAO, Ni LIN, Dong CHEN, Huijun WANG, Qingfeng DU

2022, 25(16):  1923-1928.  DOI: 10.12114/j.issn.1007-9572.2022.0061

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The community-based chronic disease containment in China is still in its infancy, and there is a lack of a complete system for practical implementation with tertiary and secondary or primary hospitals collaboratively involved. We systematically summarized the development of chronic disease management in China, then analyzed the essentials of three major foreign chronic disease management models (chronic care model, innovative care for chronic conditions framework, and chronic disease self-management program) and chronic disease management experiences of Finland, the U.S., Australia, Japan with a focus on management ideas, systematic structures, and operable approaches. With these foreign models and experiences as a reference, we developed a general practice plus compact regional medical consortium-based chronic disease management model used in Lishui Town with complexity science and analysis for resource integration, against the backdrop of promoting the development of the compact county medical consortium and contracted family doctor services. We expect that our study could provide new ideas for the research on chronic disease containment in China's primary care.

The Predicament and Solution of the General Assistant Practitioners in Rural Areas under the Background of the Medical Practitioner Law

Yue ZHAO, Lanqiu LIU

2022, 25(16):  1929-1934.  DOI: 10.12114/j.issn.1007-9572.2022.0024

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Neither the Law on Practicing Doctors nor the recently passed Medical Practitioner Law has clearly stipulated the qualification examination for general assistant practitioners in rural areas, which has led to many difficulties faced by the general assistant practitioners in rural areas, impacting negatively on the construction of primary health care team in rural areas. This paper sorted out the policy evolution of the qualification examination of the general assistant practitioners in rural areas; summarizesd the existing problems faced by general assistant practitioners in rural areas in three aspects, namely legal identity, protection of practicing rights, and professional self-identity; demonstrated the feasibility of legalizing the qualification examination of general assistant practitioners in rural areas, and put forward the path and specific content of perfecting the general assistant practitioners in rural areas through legislation.

Implications of Domestic and Foreign Typical Chronic Disease Management Models for Rural Chronic Disease Management in China

Jin LI, Haiyan ZHANG, Jia YANG

2022, 25(16):  1935-1941.  DOI: 10.12114/j.issn.1007-9572.2021.00.327

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Chronic diseases have become a major public health issue that seriously affects people's health. In China, chronic disease prevalence is increasingly serious as population aging progresses, which poses great challenges to the management of chronic diseases. Chronic disease management in rural primary care is a weak part of domestic chronic disease management, the improvement of which will contribute to the achievement of goals of healthy China and rural vitalization. We performed comparisons between three foreign typical chronic disease management models (chronic care model, innovative care for chronic conditions framework, chronic disease self-management program) , and between three domestic typical ones (chronic disease self-management model, community general practice chronic disease health management model, Xiamen "three division co management" chronic disease management model) , in terms of features, service providers, merits and limitations. On this basis, we proposed recommendations on improving rural chronic disease management in China from four aspects: talent team building, multi-sectoral cooperation, government responsibility, and patient self-management.

Original Research·Population Health

The Burden of Chronic Obstructive Pulmonary Disease in China Predicted by ARIMA and NNAR Models: a Comparative Study

Chuangyi ZHAO, Kongjun YUAN, Yuan YANG, Guangqing ZHOU, Haiyan LI

2022, 25(16):  1942-1949.  DOI: 10.12114/j.issn.1007-9572.2022.0045

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Background

In China, a country with relatively serious burden of chronic obstructive pulmonary disease (COPD) , COPD is the third leading cause of death, and ranks third among all diseases in terms of disability adjusted life years (DALYs) . Effective prediction of the burden of COPD based on its prevalence, mortality and DALYs rate will provide theoretical support for the formulation of prevention and control measures.

Objective

To describe and analyze the burden of COPD and its temporal trends from 1990 to 2019, and to forecast the COPD burden between 2020 and 2024 in China, provide a basis for scientific prevention and control of COPD in China.

Methods

In December 2021, data about indicators measuring the burden of COPD in China from 1990—2019, including COPD prevalence, mortality and DALYs rates, were extracted from the Global Burden of Disease 2019. The average annual percentage change was used to measure the temporal trend of COPD prevalence, mortality and DALYs rates over the period. Autoregressive moving average (ARIMA) and neural network autoregressive (NNAR) models for COPD prevalence, mortality and DALYs rates were constructed based on data from 1990-2016 (training set) , and their predictive performance was tested using data from 2017—2019 (test set) . The relative error, mean absolute percentage error (MAPE) , mean absolute error (MAE) and root mean square error (RMSE) between predicted and actual values of these two models were calculated for comparing their goodness of fit and predictive performance. And the better model was used to estimate the COPD disease burden from 2020 to 2024.

Results

COPD prevalence, mortality and DALYs rates in China during 1990—2019: (1) The prevalence of COPD in the whole population increased from 2 344.40/100 000 to 3 175.37/100 000, with an average annual growth rate of 1.04%. And the average annual growth rates of COPD prevalence were 0.92% and 1.13% for men and women, respectively. (2) The mortality rate of COPD in the whole population decreased from 105.09/100 000 to 72.94/100 000, with an average annual rate of decrease of 1.29%. And the mortality rates in both men and women showed a decreasing trend, with average annual rates of decrease of 0.83% and 1.83%, respectively. (3) The rate of COPD DALYs in the whole Chinese population decreased from 2 206.55/100 000 to 1 400.71 /100 000, with an average annual rate of decrease of 1.56%. And the rates of DALYs in both men and women showed a decreasing trend, with average annual rates of decrease of 1.37% and 1.86%, respectively. The predicted values of the trends by both ARIMA and NNAR models were basically consistent with the actual values of trends, but the ARIMA model had smaller relative error, MAPE, MAE and RMSE, indicating that it may have better prediction accuracy. And by the ARIMA model, the predicted COPD prevalence in 2020—2024 was 3 229.77/100 000, 3 262.44/100 000, 3 292.38/100 000, 3 322.31/100 000, and 3 352.25/100 000, respectively; the predicted mortality rates were 74.50/100 000, 75.49/100 000, 76.11/100 000, 76.50/100 000, and 76.75/100 000, respectively; the predicted DALYs rates were 1 429.56/100 000, 1 452.07/100 000, 1 469.64/100 000, 1 483.35/100 000, and 1 494.05/100 000, respectively.

Conclusion

The trend of burden of COPD in China was predicted to be increased from 2020 to 2024 by the ARIMA model. Owing to the high goodness of fit and predictive accuracy demonstrated in the prediction, the ARIMA model may be used as a tool for predicting short-term burden of COPD.

Prevalence and Associated Factors of Decline in Activities of Daily Living among Middle-aged and Older Adults

Baoying XIONG, Taiyi LIU, Ting CHEN

2022, 25(16):  1950-1955.  DOI: 10.12114/j.issn.1007-9572.2022.0131

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Background

Along with the advance in the concept of healthy aging, the activities of daily living (ADL) in middle-aged and older Chinese adults has become a research focus. However, factors associated with the impairment of ADL in this group have been assessed in most of available studies while the changes in the process of ADL impairment have been scarcely explored.

Objective

To assess the prevalence and associated factors of decline in ADL during the aging process of middle-aged and older adults.

Methods

This study was conducted in March 2021. Data were collected from the four waves (2011, 2013, 2015, and 2018) of China Health and Retirement Longitudinal Study (CHARLS) , involving 11 439 individuals (≥45 years old) with normal baseline ADL followed up during 2011—2013, 2013—2015, or 2015—2018. Panel-data multinomial logit model was used to assess the associations of 13 factors (defined as independent variables, including demographics, health status, resource accessibility, and social psychology) with the decline in ADL (defined as dependent variable) in these people over the follow-up period.

Results

The numbers of cases of declined ADL over the three follow-up periods (2011—2013, 2013—2015, and 2015—2018) were 1 829 (44.53%) , 1 758 (40.43%) , 1 215 (40.72%) , respectively. Multinomial logit regression analysis indicated that age, gender, place of residence, education level, number of chronic diseases, prevalence of falls, prevalence of perceived pain, use of auxiliary equipment, natural logarithm of personal income per capita, and level of depression were associated with the decline in ADL (P<0.05) .

Conclusion

The decline in ADL in middle-aged and older Chinese adults may be related to age, education level, number of chronic diseases, auxiliary equipment usage, per capita income, and depression. To reduce the prevalence of declined ADL in this population, we put forward the following recommendations: promoting the construction of a public service system, strengthening chronic disease management in middle-aged and older adults, incentivizing the development of rehabilitation services market, increasing medical subsidies for specific groups, and attaching importance to the mental health of middle-aged and older adults.

Prevalence and Associated Factors of Weight Management among 18-79 Years Old in Beijing

Yingqi WEI, Aijuan MA, Kai FANG, Jing DONG, Jin XIE, Chen XIE, Zhong DONG

2022, 25(16):  1956-1962.  DOI: 10.12114/j.issn.1007-9572.2022.0159

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Background

Weight management should be extended to the entire population and not limited to special populations. Exploring the willingness, status, measures and influencing factors of adults' weight management, may contribute to the development of a reasonable, scientific, and easily operable method for reaching or maintaining a healthy weight.

Objective

To understand the prevalence and associated factors regarding achieving or maintaining a healthy weight in residents aged 18-79 in Beijing.

Methods

A survey was conducted from August to December 2017 with a stratified multistage sample of 13 188 permanent residents aged 18-79 from Beijing's 16 districts using a self-compiled questionnaire for understanding their self-assessed weight, weight changes within the past 12 months, and use of methods for weight control. The prevalence of weight management was compared by different characteristics. Methods for weight management used by weight controllers were comparatively analyzed by sex and age. We explored the differences in daily dietary habits and physical activity between weight controllers and non-weight controllers. Multivariate Logistic regression was used to analyze the factors associated with the implementation of weight management.

Results

The overall prevalence of weight management in the residents over the last 12 months was 29.90% (3 947/13 188) . The prevalence of weight management differed statistically by sex, marital status, level of education, diabetes prevalence, current smoking status, physical activity status, voluntary health check-ups, assessment of weight, change in weight over the past 12 months, and BMI (P<0.05) . Diet control〔87.31% (3 446/3 947) 〕 and physical exercise〔78.34% (3 092/3 947) 〕were the most widely used weight management methods. The proportion of men who used physical exercise and smoking for weight control was significantly higher than that of women (P<0.001) , whereas the proportion of women who used diet control and weight loss medications for weight control was significantly higher than that of men (P<0.05) . The proportion of residents who used physical exercise and smoking for weight control was differed statistically by age groups (P<0.05) . 2 668 cases (67.60%) used both diet control and physical exercise to control weight, among whom 60-70 year olds accounted for a higher percentage than did 18-44 year olds and 45-59 year olds (P<0.001) . 625 cases (15.83%) relied only on diet control to control weight, among whom 18-44 year olds accounted for a higher percentage than did 45-59 year olds and 60-79 year olds (P<0.001) . The prevalence of weight management by physical activity or smoking differed significantly across age groups. Compared with non-weight controllers, weight controllers had lower prevalence of inadequate intake of fresh fruit and vegetables and excessive intake of red meat (P<0.05) . Moreover, they had higher prevalence of doing ≥ 150 min of moderate to vigorous intensity activities per week (P<0.001) . Furthermore, they had higher prevalence of spending ≥4 hours per day in leisure-time sedentary behaviors (P<0.001) . Multivariate regression analysis showed that age<60 years, women, married/unmarried cohabitation, higher level of education (junior high school and above) , current non-smoking, alcohol consumption within the past 7 days, physical inactivity, voluntary physical examinations, correctly assessing one's own weight, weight gain/loss ≥ 2.5 kg in the past 12 months, and having a BMI within the range of normal to obesity were associated with higher possibility of implementing weight management (P<0.05) .

Conclusion

In these Beijing residents aged 18-79 years, diet control and increased exercise were popular for weight control, but the use of unhealthy weight management methods was also found. When guiding residents to use proper methods to control weight, individualized management programs should be developed with sex, age, education level and other factors taken into consideration.

Health Management Preference in Hubei Patients with Hepatitis B Virus-related Chronic Liver Disease: a Discrete Choice Experiment-based Analysis

Yanzhi PAN, Huimin MA, Yinghao LYU, Jinghong YAN, Juyang XIONG

2022, 25(16):  1963-1968.  DOI: 10.12114/j.issn.1007-9572.2022.0133

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Background

China has a large baseline number of patients with hepatitis B virus (HBV) -related chronic liver disease, and it is urgently to contain HBV infection prevalence. To do this, the issue that needs to be addressed quickly is transforming the hospital-based management into community-, hospital-, patient- and society-based management.

Objective

To quantify preferences of health management in patients with HBV-related chronic liver disease from Hubei Province, providing a basis for the development of strategies for containing chronic hepatitis disease and for managing such patients.

Methods

From July 2018 to July 2019, a discrete choice experiment survey was carried out with a multistage random sample of 180 patients with HBV-related chronic liver disease recruited from three cities (Wuhan, Shiyan, and Xiangyang) of Hubei Province using a questionnaire for collecting their general information, and preferences related to health management (choice sets in the discrete choice experiment consist of place for regular health checkups, average monthly expense for health management of HBV-related chronic liver disease, followed health management, and ways of accessing health management information of HBV-related chronic liver disease with different options) . The mixed Logit model developed in 15.0 was used for data analysis.

Results

The response rate of the survey was 89.4% (161/180) . Patients were more tended to choose a management pattern with lower average monthly expense, a hospital as the place for regular medical examinations, self-management or accessing health management information using offline approaches (P<0.05) . The amount of an additional monthly expense that the patients were willing to pay was 256.75 yuan if the place for regular health checkups was changed to a hospital from a community, 96.87 yuan if the management pattern was changed to self-management from a patient support group-based management, and 52.94 yuan if the approaches for accessing health management information were changed to offline from online. Compared with other choices, the change in the place for regular health checkups from a community to a hospital was the most popular in the patients (willingness increased by 87.29%) .

Conclusion

Patients with HBV-related chronic liver disease preferred to undergo regular health checkups and access health management information in hospitals, but were less likely to contract a family doctor or invest in health. To improve the containment of chronic liver disease, we put forward the following recommendations: strengthening hospitals' capabilities in treating HBV-related chronic liver disease, and their services delivered by a family doctor team, guiding patients to change the idea of "focusing on treatment rather than prevention", and delivering integrated online and offline services.

Original Research·Quality Improvement

Factors Associated with Potentially Inappropriate Prescribing among Elderly Adults in a Community Outpatient Clinic

Jiayin GENG, Yafang HUANG, Yanli LIU

2022, 25(16):  1969-1977.  DOI: 10.12114/j.issn.1007-9572.2022.0164

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Background

Elderly patients in community outpatient clinics often suffer from multiple chronic conditions and were particularly vulnerable to potentially inappropriate prescribing (PIP) .

Objective

To analyze the influencing factors of prescriptions for elderly patients becoming PIP in community outpatient clinics.

Methods

In March 2021, a combination of cluster sampling and simple random sampling was used to select drug prescriptions from elderly patients who visited a community health service center in Beijing from January 1 to December 31, 2019. The prescriptions were evaluated by two pharmacists with intermediate titles based on 2019 American Geriatrics Society Beers Criteria (abbreviated as Beers criteria) and Criteria of Potentially Inappropriate Medications for Older Adults in China (abbreviated as China criteria) , respectively. At the same time, the researchers collected the relevant data of the prescriber, elderly patients and the content of the prescription, and compared the differences in the characteristics of the prescriber, the prescription object and the prescription content of the prescriptions with different evaluation results. Binary Logistic regression method was used to analyze the factors affecting PIP prescribing and to conduct sensitivity analysis (selected prescriptions for patients≥65 years of age) . Descriptive analysis was used to describe the distribution of inappropriate medicine in PIP.

Results

A total of 815 outpatient prescriptions for elderly patients were included, including 266 (32.6%) PIP under the Beers criteria or 182 (22.3%) PIP under the Chinese criteria, respectively. According to the Beers criteria, the differences were statistically significant when comparing the age of prescribers, the age of elderly patients, the proportion of those with the diagnosis of hypertension and insomnia, the number of drug varieties, and the proportion of those with the drug categories of cardiovascular system drugs, antithrombotic drugs, central nervous system drugs, and gastrointestinal system drugs between PIP and non-PIP (P<0.05) . According to the China criteria, the differences were statistically significant when comparing the age or title distribution of prescribers, the proportion of those with the diagnosis of hypertension, coronary heart disease, diabetes, insomnia and osteoarthritis, and the proportion of those with the drug categories of cardiovascular system drugs, antithrombotic drugs, non-insulin hypoglycemic drugs, central nervous system drugs and non-steroidal anti-inflammatory drugs (NSAIDs) between PIP and non-PIP (P<0.05) . The binary Logistic regression results showed that, no matter under the Beers criterion or the Chinese criterion: the prevalence of coronary heart disease or insomnia in elderly patients had an impact on the prescription of PIP, and the inclusion of antithrombotic agents in the prescription was an influencing factor affecting the formation of PIP (P<0.05) . The results of the sensitivity analysis showed that hypertension, coronary heart disease and insomnia in elderly patients have an impact on the prescribing of PIP; the inclusion of antithrombotic medication in the prescription was an influencing factor affecting the formation of PIP (P<0.05) . According to the Beers' criterion, 266 PIP involved a total of 302 cases of inappropriate drug use, of which antithrombotic drugs accounted for 46.4% (140/302) , central nervous system drugs accounted for 16.2% (49/302) , endocrine system diabetes (non-insulin) drugs accounted for 13.9% (42/302) . According to the Chinese criterion, 182 PIP involved inappropriate medications in a total of 205 cases, of which antithrombotic drugs accounted for 44.9% (92/205) , central nervous system drugs accounted for 25.9% (53/205) , oral NSAIDs accounted for 14.1% (29/205) .

Conclusion

Among the community outpatient prescriptions for elderly patients, PIP accounted for a relatively high proportion. In the future, emphasis should be placed on community physicians' knowledge of safe and rational drug use, the use of antithrombotic drugs should be standardized, and the review of drug prescriptions for patients with hypertension, coronary artery disease and insomnia should be strengthened.

A Qualitative Study on Community General Practitioners' Perception of Dementia Screening

Juan YANG, Shouqin LI, Zhaoxin ZHANG, Xiubin ZHANG

2022, 25(16):  1978-1983.  DOI: 10.12114/j.issn.1007-9572.2022.0168

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Background

China is seeing an increasing number of people suffering from dementia as aging advances and life expectancy prolongs. Early diagnosis is extremely important for dementia.

Objective

To understand the attitudes and views of community general practitioners (GPs) regarding dementia screening, providing suggestions for the development of dementia screening in the community.

Methods

In July 2021, by use of purposive sampling, GPs were recruited from community health centers (stations) in Lanzhou, Gansu, and invited to attend a semi-structured, in-depth, face-to-face individual interview for understanding their attitudes and views toward dementia screening. The interview results were analyzed using phenomenological analysis and thematic analysis.

Results

Ten GPs from five community health centers and five community health stations were finally enrolled, including five males and five females, with an average age of (46.6±6.5) years〔range (35, 57) 〕, an average years of (14.90±8.46) working as a GP〔range (5, 26) 〕; seven with a bachelor degree; four with a title of attending physician. Three themes were extracted: insufficient basic conditions for carrying out community-based dementia screening, difficulties in carrying out community-based dementia screening, and improvement of community GPs' abilities to participate in dementia screening. Nine subthemes were also extracted.

Conclusion

Community GPs supported community-based dementia screening, but had insufficient capacities to carry out the screening. The following may be effective measures for promoting early screening and intervening dementia: improving the ability of community GPs to screen dementia, strengthening the publicity and popularization of dementia-related knowledge to reduce social discrimination against dementia, and deepening the development of contracted family doctor services.

Effect of Cognitive-behavioral Change Model-based Online Health Education in Hypertension Management

Liping CUI, Kun HU, Haoce HUANG, Ning DENG, Jia WEN, Lisen YANG, Yuexia ZHAO

2022, 25(16):  1984-1989.  DOI: 10.12114/j.issn.1007-9572.2022.0052

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Background

In China, a country owning a large number of hypertensive patients, offline management is still a major approach for hypertension prevention and control, but the efficiency and effectiveness of this approach are unsatisfactory. Therefore, it is necessary to develop a closed-loop hypertension management path using online management approaches actively explored based on cognitive-behavioral models.

Objective

To assess the effect of cognitive-behavioral change model-based online health education in the management of hypertension.

Methods

A total of 122 essential hypertension outpatients and inpatients were recruited from General Practice Department, General Hospital of Medical University of Ningxia Medical University from November 2018 to October 2019, and randomly divided into online management group (n=61) and off-line management group (n=61) . Off-line management group received routine management. Online management group received online health education (including systematic courses and personalized self-management information in line with the five stages of behavior transformation of hypertension patients provided via the WeChat platform for gradually changing their health-related behaviors) based on the cognition-behavioral change model (a model built upon improved knowledge-attitudes-behavior model, health belief model, and transtheoretical model) . Systolic blood pressure (SBP) and health-related behaviors at baseline and 12 weeks after intervention were compared between the groups.

Results

The average SBP levels at baseline demonstrated no significant difference between the groups (P<0.05) . After intervention, the average SBP level decreased significantly in both groups (P<0.05) , and it decreased more significantly in the online management group (P<0.05) . Two groups showed no significant differences in the prevalence of self-monitoring blood pressure, taking medications, eating a diet and exercising as well as taking actions to improve psychological state according to the doctor's advice at baseline (P<0.05) . After intervention, the prevalence of self-monitoring blood pressure according to the doctor's advice was significantly increased in the online management group (P<0.05) although the prevalence of other four of the above-mentioned health-related behaviors was still similar in both groups (P<0.05) .

Conclusion

This hypertension management approach developed based on mobile health technologies and the cognition-behavioral change model could help general practitioners to effectively manage hypertension patients, which will contribute to the improvement of work efficiency of general practitioners, and the achievement of long-term preservation and real-time analysis of patient management data. So this management is worthy of application and promotion.

Development, Reliability and Validity of the Five Habits Coding Scale

Qingyan WANG, Lanyi YIN, Yaxin YAN, Yan PENG, Chenjiao YAO, Qiuping TANG, Xinchun LIU

2022, 25(16):  1990-1994.  DOI: 10.12114/j.issn.1007-9572.2022.0135

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Background

Doctor-patient communication barrier is one of the major causes leading to medical disputes. Still, there are limited studies and rare instruments with good reliability and validity regarding doctors' ability to communicate with patients in China.

Objective

To construct the Five Habits Coding Scale (5HCS) and verify its reliability and validity.

Methods

The first draft of the Five Habits Coding Scale (5HCS) was formulated based on the Chinese version of the Four Habits Coding Scheme (4HCS) developed using Brislin's translation model in March 2014. Then from April to June 2014, the items of the first draft of 5HCS were revised in accordance with the expert consensuses obtained from two rounds of Delphi consultations, and after that, the final version of the 5HCS was developed, and utilized to evaluate 127 residents' abilities to communicate with patients in March 2018 for testing its internal consistency, inter-rater reliability, content validity and criterion-related validity.

Results

The final version of 5HCS consists of 21 items fell under 5 dimensions, namely "Show respect and kindness, harmonize doctor-patient relationship" "Provide information, guide patients' views" "Demonstrate empathy, build up trust" "Risk disclosure, informed consent", and "Provide diagnostic information, shared-decision making". The Cronbach's α of the scale was 0.716. The dimension-total correlation coefficients (Pearson correlation coefficients) ranged from 0.524 to 0.692, and the content validity index of each item (I-CVI) ≥0.81. The inter-rater reliability was calculated by intraclass correlation (ICC) (Pearson coefficient=0.912, ICC=0.912, P<0.01) . And the criterion-related validity was testified by comparing to the Chinese version of SEGUE (r=0.377, P<0.01) .

Conclusion

The 5HCS has been proved to be highly reliable and valid, so it could be applied and promoted as a tool to evaluate the doctor-patient communication ability of residents in China.

Original Research·Primary Care Health Services

Diffusion of China's Community Health Management Policies: an Analysis Using Diffusion of Innovation Theory

Hang XU, Xiaojing MA, Tao DAI

2022, 25(16):  1995-2002.  DOI: 10.12114/j.issn.1007-9572.2022.00.011

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Background

All levels of China gevernment departments have attached importance to community health management services, an important way for disease prevention and resident saveealth improvement, and successively promulgated relevant management policies. However, there is a lack of systematic review and research on the diffusion paths and characteristics of these policies, which are still unclear due to the diversity of promulgating agencies and types of polices.

Objective

To explore the process and features of the diffusion of China community health management policies, providing a reference for the formulation and promotion of these kinds of policies.

Methods

From June to September 2021, we searched policy documents related to community health management services published from January 1997 to September 2021 in the official websites of all levels of government and health administrative departments, as well as authoritative databases such as PKULAW.com and so on, then quantitatively analyzed the process and features of diffusion of them in terms of four aspects (intensity, breadth, speed, and direction of diffusion) using policy network analysis and keyword analysis by time series.

Results

A total of 1 540 policies related to community health management were retrieved (including 159 central policies and 1 381 local policies) . The development of community health management services in China may be divided into five stages: germination (1997—2004) , formation (2005—2008) , transition (2009—2012) , initial development (2013—2015) and innovation and development (2016—2021) . Policies which were diffused more intensively and widely were promulgated by central agencies of higher administrative levels, and mainly classified as planning, opinions, and laws. The absolute diffusion breadth of the top 10 policies in terms of diffusion intensity exceeded 30, and the absolute diffusion breadth of the top 10 policies in terms of spreading breadth exceeded 20. The diffusion speed of most policies showed a trend of first increasing and then slowing down over time. The diffusion of Chinese medicine health management policies mainly presented parallel diffusion among policy promulgating agencies at the same level, and top-to-bottom diffusion from the central policy promulgating agencies to the local ones.

Conclusion

Through policy diffusion research, we had a comprehensive understanding of the process and characteristics of diffusion of China's community health management policies, and drew a number of conclusions, including the five-stage development of these policies, and the policy diffusion process may be affected by the attributes of the administrative level of the promulgating agencies and types of policies. In addition, the diffusion of these policies could be achieved via multiple paths, with many mechanisms of action such as learning and imitation, with a speed of "first increasing, then slowing down" over time.

Development of Informatization in Primary Care in China's Regions Inhabited by Ethnic Minorities

Ling CHEN, Yingmin WU, Jiawei LI, Liyan ZHU

2022, 25(16):  2003-2007.  DOI: 10.12114/j.issn.1007-9572.2022.0139

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Background

The rapid development of informatization in primary care in regions inhabited by ethnic minorities during the 13th Five-Year Plan period (2016—2020) , has laid a foundation for the improvement of the serving capacity of primary care supported by information technologies, but there is a lack of research on information technology and the efficiency of primary care.

Objective

To assess the status including effectiveness of informatization in primary care in China asregions inhabited by ethnic minorities, to explore the impact of information technology on improving the efficiency of primary care.

Methods

From July to October 2020, 84 primary care institutions in 23 ethnic counties in three autonomous prefectures of Sichuan (Ganzi, Liangshan and Aba) were selected by stratified sampling, and whose directors were invited to complete a self-administered questionnaire survey for understanding the status including effectiveness of informatization in their institutions. Furthermore, the heads of local health committees and directors of primary care institutions in these ethnic counties were invited to attend a group discussion regardingthe setting of departments, service development, status of informatization and settings for information services in primary care institutions.

Results

In terms of software construction, of the 84 primary care institutions, 57 (67.9%) used the public health system, 44 (52.4%) used the family doctor management system, and 25 (29.8%) use the hospital information system. Forty-seven (56.0%) primary care institutions had achieved vertical connectivity with other institutions (mostly regional- and county-level institutions as well as other members in a regional medical consortium) using information technologies, and regional informatization. Institutions that had horizontal connectivity with 69 (74.4%) of the primary care institutions were medical insurance departments. Only 18 (21.4%) institutions had independent information departments, and 34 (41.0%) did not employ information professionals. Lack of information professionals〔64 (76.2%) 〕, insufficient funds〔52 (61.9%) 〕 and weak infrastructure〔51 (60.7%) 〕 were main problems revealed in informatization construction. Institutions with regional informatization, vertical connectivity with other institutions, and the construction of a hospital information platform with electronic medical record system as the core were superior to those without in terms of setting of laboratory and examination departments and provision of traditional Chinese medicine services (P<0.05) . According to the group discussion, the institutions had basically completed the construction of information standardization, with well-equipped hardware facilities, health informatization-derived management efficiencies, such as improved efficiency, increased scope of supervision, refined supervision, scientific decision-making and digital governance, and service potencies, such as increased efficiency, accessibility and quality of services.

Conclusion

Information technology could greatly contribute to the solving of bottleneck during services delivery in primary care in regions inhabited by ethnic minorities, which has promoted the setting of departments and service extension, and improved the accessibility of health services, as well as the innovation in service delivery modes in these institutions. Problems identified in the informatization construction include insufficient investment in informatization operation and maintenance, insufficient application and lack of information professionals. In view of this, it is suggested to strengthen the investment in informatization construction in primary care, establish a standardized and applicable health informatization training mechanism, pay attention to the construction of a health information talent team, and deepen the intelligent application of information technology in primary care services.

The Informatization Construction and Use of Primary Health Institutions in Jiangsu Province

Chunguo XING, Yingqiu XIA, Danyun WU, Yunxia LIAO, Ning ZHAO

2022, 25(16):  2008-2013.  DOI: 10.12114/j.issn.1007-9572.2022.0079

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Background

During the 13th Five-Year Plan in China, the rapid development of the informatization construction in the primary health of China has greatly promoted the improvement of the service level and quality of the primary health institutions, but there are still deficiencies in some aspects.

Objective

To investigate the status of informatization construction of primary health institutions in Jiangsu Province, in order to analyze the existing problems and provide corresponding countermeasures.

Methods

From July to October 2020, a stratified random sampling method was used to select 500 primary health institutions from 13 cities in Jiangsu Province to carry out a questionnaire survey. The contents of the questionnaire included the financial planning and fund sources for infomatization construction of the primary health institutions, status of information system construction of hospitals, the informatization of residents' health records, the deployment of informatization staffs, medical information sharing, status of telemedicine and satisfaction to the informationization of the primary health institutions. The vice president of business filled in the questionnaire according to the truth.

Results

A total of 416 valid questionnaires from the primary health institutions were obtained, accounting for 26.5% (416/1 567) of all the primary health institutions in the province. 80.0% (333/416) of the informatization construction of primary health institutions is planned by the county (city, district) government, and 67.3% (280/416) got fund from the government finance. 99.0% (412/416) of the primary health institutions constructed hospital information management system, 92.1% (383/416) constructed outpatient system, 81.7% (340/416) constructed electronic medical record system, 45.0% (187/416) constructed clinical information system, 98.3% (409/416) constructed information system of residents' health records. 31.3% (130/416) of the primary health institutions shared medical information to the patients, 83.9% (349/416) shared the medical information to the community health service station and the village clinics, 14.2% (59/416) shared the medical information to the superior hospitals, 29.1% (121/416) shared the medical information over the county, 4.3% (18/416) shared the medical information over the city. 38.2% (159/416) of the primary health institutions carried out such services as online appointment, ECG or CT diagnosis, and 15.6% (65/416) carried out real-time outpatient service. 81.3% (338/416) of the primary health institutions showed satisfaction to the informatization construction, and the institutions with different types or in different cities showed different satisfaction.

Conclusion

The overall informatization of primary health institutions in Jiangsu is is relatively good, but there are still phenomena such as unbalanced regional development, low level of cross-regional information sharing and lack of popularization of telemedicine, which needs to be further improved.

Beijing's Mental Health Workers' Perceptions of the Severe Mental Illness Reporting System

Haomin WANG, Xiaoyong LI, Ning ZHANG, Jiaoyue WU

2022, 25(16):  2014-2020.  DOI: 10.12114/j.issn.1007-9572.2022.0143

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Background

The Severe Mental Illness Reporting System (SMIRS) has been operated for many years as an important part of mental health monitoring, but its effectiveness needs to be further explored.

Objective

To analyze the perceptions of mental health workersfrom municipal-, district- and community-level hospitals in Beijing regarding the importance, main role, effects and problems during the implementation, and improvement measures concerning the SMIRS, providing suggestions facilitating the improvement of the system.

Methods

From March to June 2019, a survey was conducted among a convenient sample of 234 mental health workers from municipal-level psychiatric hospitals, and two stratified samples of 397 mental health workers (one sample of 183 cases from district-level psychiatric hospitals, and the other sample of 214 cases from community-level hospitals) , using a questionnaire named Status of the Rule of Mental Health Laws in Beijing for understanding these workers' general information and their perceptions of the SMIRS.

Results

The SMIRS was assessed as "very important" by 56.3% (103/183) of the mental health workers from district-level hospitals and 54.7% (117/214) of those from community-level hospitals, and as "relatively important" by 66.7% (156/234) of those from municipal-level hospitals.The major role of the SMIRS was assessed as "risk warnings for mental illnesses" by 76.9% (180/234) of the mental health workers from municipal-level hospitals and 82.7% (177/214) of those from community-level hospitals, and as facilitating community-based management of mental illnesses by 80.9% (148/183) of those from district-level hospitals. The implementation effectiveness of the SMIRS was evaluated as "relatively good" by 44.4% (104/234) of mental health workers from municipal-level hospitals, 50.3% (92/183) of those from district-level hospitals, and 50.9% (109/214) of those from community-level hospitals. And the number of workers choosing "relatively good" accounted for the highest percentage of the total workers from each kind of hospitals. The major problem during the implementation of the SMIRS was assessed as "involving patient privacy" by 77.8% (182/234) of the mental health workers from municipal-level hospitals, 78.1% (143/183) of those from district-level hospitals, and 83.2% (178/214) of those from community-level hospitals. And the number of workers choosing "involving patient privacy" accounted for the highest percentage of the total workers from each kind of hospitals. "Standardizing the system of information entry, registration, correction, and summary" was chosen as a measure for improving the implementation of the SMIRS by 73.5% (172/234) of the mental health workers from municipal-level hospitals, and 76.6% (164/214) of those from community-level hospitals, while "standardizing the system of information sharing and protection of patients' privacy" was chosen by 68.9% (126/183) of those from district-level hospitals.

Conclusion

The role and implementation effectiveness of the SMIRS have won the approval of mental health workers from municipal-, district- and community-level hospitals. To further improve the implementation of SMIRS with a dual emphasis on risk containment and privacy protection and consideration for patient management services, we put forward the following recommendations: detailing relevant legal provisions; insisting on ensuring patients access to relevant services (including management) , improving the mental health service system, and implementing the essential and major public health service programs; increasing policy publicity to improve the recognition of the system by patients and their families.

Original Research·Education

Barriers to Primary Care Provision and Relevant Solutions: an Analysis from the Perspective of Targeted Admission Medical Graduates

Yinsheng WANG, Changyin YU, Xue XIAO, Nian ZHANG, Chengju YUAN, Haifeng PU, Lai WEI

2022, 25(16):  2021-2027.  DOI: 10.12114/j.issn.1007-9572.2022.0148

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Background

The continuous development of the rural-oriented tuition-free medical education program has greatly contributed to the increasingly expanding of team of general practitioners in primary care. And the service status of targeted admission medical graduates has become a focus of current concern.

Objective

To explore the barriers faced by targeted admission medical graduates during the contracted period of providing primary care, and to propose corresponding countermeasures and suggestions.

Methods

From January to March 2021, 73 targeted admission medical graduates (admitted in 2010 & 2011) who were working in primary hospitals in Guizhou were selected to attend a semi-structured interview with an outline involving brief introduction of the development of their hospitals, job duties, job progression, main problems existing in work, capability areas for improvement, current situation of continuing education, current living conditions, level of targeted admission medical graduates valued by hospitals, future work plan, and so on. The interview results were analyzed in accordance with the procedures of grounded theory.

Results

One hundred and twenty-seven concepts, 21 categories, 7 main categories (work environment, policy guarantee, family factors, future planning, psychology and perception, person-job fit and career development needs) were identified by an analysis, forming four axes: working practice (primary medical conditions, environment, management and other factors restrict the development of targeted admission medical graduates, and they hope to get more organizational support and suitable job arrangements) , family factors (part of targeted admission medical graduates affected by factors such as family distance and economic pressure during the service period, it is difficult to take into account the responsibility of family care) , internal demand (targeted admission medical graduates are prone to psychological and cognitive gaps, think that their personal abilities and development are limited, and hope for better career development prospects) , policy driving (policy factors run through all aspects of primary care for targeted admission medical graduates, and the implementation and promotion of some policies are insufficient and need to be further strengthened) .

Conclusion

The targeted admission medical graduates in Guizhou mainly faced difficulties in career development, ability improvement, caring for families, economic treatment and other aspects during the contracted period of providing primary care. To improve the situation, retain them in primary care as well as promote their career development, it is suggested to establish a mechanism for receiving their feedback, providing long-term trainings and guidance for them, allocate targeted admission medical graduates from other places, speed up the construction of regional medical consortiums, set up special subsidy funds, and clarify the arrangements after the expiration.

Mental Health Status and Factors Associated with Psychological Problems among Trainees Attending the Standardized General Practice Residency Program: a Mixed-method Study

Yu XIA, Qirui LIN, Fangfang ZHENG, Jinzhi ZHANG

2022, 25(16):  2028-2035.  DOI: 10.12114/j.issn.1007-9572.2022.0153

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Background

The mental health of trainees receiving the three-year standardized general practice residency program (SGPRP) has been valued recently, and psychological problems are considered to be one major type of causes of their failure to complete the full training. So understanding the mental health status and associated factors of psychological problems in these GP trainees are of important significance for the development of residency training policies and programs.

Objective

To explore the mental health status and causes of psychological problems in GP trainees of SGPRP, improving the attention of SGPRP managers and the society given to the mental health of GP trainees.

Methods

This was a mixed-method sequential explanatory study. In January 2021, by use of convenience sampling, all in-service GP trainees of SGPRP were recruited from Peking University Shenzhen Hospital to attend a self-administered survey to complete the Demographic Questionnaire compiled by our research team and the Symptom Checklist 90 (SCL-90) . The total score and domain scores of the SCL-90 were analyzed overall, then were compared among the trainees by grade. For understanding the main life events triggering emotional or psychological problems and their associations with residency training program or specialty, and GP trainees' preferred assistance as well as suggestions for the development of SGPRP, from February to June 2021, purposive and heterogeneous sampling were used to recruit GP trainees with mental health assessment to attend an in-depth, semi-structured interview using phenomenological research procedure. The interview results were recorded, and transcribed, then coded using NVivo 12, and analyzed using Colaizzi's seven-step analysis and thematic analysis.

Results

All GPs (n=84) responded to the survey, with a 100% response rate. The mean total SCL-90 score and the mean total symptom index for 84 GP trainees were (149.61±50.55) , and (1.66±0.56) , respectively. Of them, 29 (34.5%) had a total score≥160. The prevalence of obsessive-compulsive, depression, interpersonal sensitivity, anxiety, paranoid ideation, anger-hostility, psychoticism, somatization and phobic-anxiety (prevalence of symptoms in each domain was defined as domain score≥2) was 53.6% (45/84) , 39.3% (33/84) , 34.5% (29/84) , 26.2% (22/84) , 22.6% (19/84) , 21.4% (18/84) , 19.0% (16/84) , 14.3% (12/84) , and 14.3% (12/84) , respectively. The depression domain score varied significantly across GP trainees by grade (P<0.05) . The prevalence of depression was 48.4% (15/31) in grade 2 GP trainees. In total, 21 GP trainees attended the interview, 14 (66.7%) of whom had a total SCL-90 score≥160. Four themes emerged from the analysis: impact of personal problems on psychological status; harm and benefits caused by interpersonal interactions at work; psychological stress related to the residency base; lack of confidence related to specialty choice.

Conclusion

The high prevalence of psychological problems in GP trainees may be closely related to personal factors and problems encountered during residency training. In view of this, psychological guidance and crisis intervention should be listed as an important part of residency training management, and efforts should be made to enhance the trainees' sense of existence and belonging as well as self-confidence, thereby helping them to successfully complete the training.

Evidence-based Medicine

Sleep Disturbance Prevalence Rate among Chinese Older People: a Meta-analysis

Zhenjie WANG, Man ZHAO, Tingwei CHEN, Zile GUO

2022, 25(16):  2036-2043.  DOI: 10.12114/j.issn.1007-9572.2022.0151

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Background

Along with the development of aging, much attention has been paid to geriatric health issues in China. Sleep disturbance is a common sleep problem endangering older people's health.

Objective

To systematically assess the prevalence of sleep disturbances in Chinese older people.

Methods

Studies about sleep disturbance in Chinese elderly were searched in database of CNKI, CQVIP, SinoMed, WanFang Data, PubMed, EmBase, The Cochrane Library, Web of Knowledge and PsycINFO from inception to 31st May, 2021. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies using the 11 criteria recommended by the Agency for Healthcare Research and Quality. Stata 16.0 was used for meta-analysis.

Results

A total of 91 studies, with a sample of 81 354 cases were included. Meta-analysis showed that the overall prevalence rate of sleep disturbances among Chinese older people was 46.0%〔95%CI (41.7%, 50.4%) 〕. Further analysis indicated that the prevalence of sleep disturbances among men and women was 40.0%〔95%CI (30.9%, 49.2%) 〕and 49.4%〔95%CI (42.8%, 55.9%) 〕, respectively. And it was 35.1%〔95%CI (28.8%, 41.4%) 〕 for the 60-70-year-olds, 46.1%〔95%CI (33.8%, 58.4%) 〕 for the 70-80-year-olds, and 44.4%〔95%CI (32.7%, 56.2%) 〕 for the 80-and-over-year-olds. The sleep disturbance prevalence rate among those living in urban and rural areas was 41.5%〔95%CI (32.8%, 50.2%) 〕and 44.0%〔95%CI (36.4%, 51.7%) 〕, respectively. And it was 46.3%〔95%CI (37.6%, 55.1%) 〕for those with junior high school or lower education level, and 37.9%〔95%CI (26.7%, 49.1%) 〕for those with senior high school or higher education level. Meta-regression analysis showed that marital status and chronic disease prevalence were associated with sleep disturbances (P<0.05) .

Conclusion

The prevalence of sleep disturbances in Chinese older people is high. To reduce the risk of sleep disturbances and improve the sleep quality in this group, the prevention and intervention of sleep disturbances should be valued and targeted interventions should be delivered.

Assessment Tools for Identification of Elder Abuse: a Systematic Review

Wenxian XU, Yucong SHEN, Chonghao ZHENG, Andong LIANG, Mengjiao CHEN, Yongjie ZHANG, Yeqin YANG

2022, 25(16):  2044-2050.  DOI: 10.12114/j.issn.1007-9572.2022.0033

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Background

Elder abuse is a global public health issue, with a yearly increase in its prevalence. As elder abuse often occurs covertly and is difficult to be detected and identified, effective assessment tools are prerequisites for detecting and stopping elder abuse.

Objective

To systematically review the studies on elder abuse assessment tools.

Methods

From January 10 to 24, 2021, we conducted a comprehensive search of 11 databases (PubMed, CHINAL, PsycINFO, EmBase, Scopus, Web of Science, Cochrane Library, CQVIP, Wanfang Data, CNKI, and Taiwan Scholar Database) to identify eligible studies of elder abuse assessment tools published up to December 31, 2020. Literature screening and data extraction were performed by two researchers, separately, and then were cross-checked. Methodological quality was evaluated, an authenticity assessment tool for scale measurement properties.

Results

A total of 29 studies were included, involving 19 elder abuse assessment tools, 18 of which were questionnaires in English and the other one was a questionnaire in Chinese. According to the evaluation content, these tools could be classified into two types: the risk of elder abuse (7) and elder abuse (12) . In particular, Assessment Tool for Domestic Elder Abuse, the Family Violence Against Older Women, and Family Caregivers' Misbehavior toward Elderlies on Hemodialysis belonging to the elder abuse type could be used to assess the severity of abuse.

Conclusion

As elder abuse has gradually attracted wide attention, the international community has developed various types of assessment tools targeting different groups, institutions and cultural backgrounds. Researchers should appropriately select assessment tools according to research objectives, participants, and research institutions, and should develop elder abuse assessment tools for Chinese older people in accordance with China's conditions and cultural background.