Chinese General Practice

Entrustable Professional Activities in General Practice: Applications and Prospects

Yanrong DU, Yanhua CHEN, Peicheng WANG, Hange LI, Chaoyang AN, Jiming ZHU

2022, 25(19): 2307-2314. DOI: 10.12114/j.issn.1007-9572.2022.0235

Asbtract ( )

HTML ( )

PDF (2196KB) ( )

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

The concept of entrustable professional activities (EPAs) was initiated by a medical professor in the Netherlands in 2005 with the aim of enhancing the implementation of competency-based medical education (CBME) in clinical practice. After more than ten years of development, great progress has been made in EPAs (mainly for training and assessment) in a variety of medical specialties in many countries, which has influenced general practice significantly. Some countries such as Canada, Australia and the U.S. have been developing their own EPAs in general practice, which can be applied to the supervision and assessment of trainees, and the entrustment decisions of supervisors. To our best knowledge, limited research in China has been focused on the EPAs, let alone their applications in general practice. We analysed the research developments, potential challenges and prospects of EPAs in general practice, hoping to provide evidence for future research in China.

Development of the Hospice Care System in China in the Promotion of Healthy Ageing: Status and Recommendations for Problems

Tao LUO, Yue ZHAO, Lanqiu LIU

2022, 25(19): 2315-2319. DOI: 10.12114/j.issn.1007-9572.2022.0257

Asbtract ( )

HTML ( )

PDF (1772KB) ( )

References | Related Articles | Metrics

Establishing and improving the hospice care system is an integrant part of healthy ageing. Currently, hospice care has been a part of the national healthcare services, and models of provision of hospice care using multi-agent approaches have been formed in China. Furthermore, the inpatient-outpatient-home-based hospice care model has begun to take shape. And some regions have also explored the guidance center-demonstration base-professional institutions-based system for promoting hospice care. However, many problems have been revealed during the development of the hospice care system, such as low coverage of hospice care, uneven distribution of hospice care resources, imperfect mechanisms for eligibility approval, performance assessment and ineligibility exit targeting hospice care provision institutions, and the absence of an integrated hospice care model. In view of this, we put forward the following recommendations: legally defining hospice care belonging to essential healthcare services in essence, improving the inpatient-outpatient-home-based hospice care model, building an integrated hospice care system focusing on home-based hospice care in communities, and establishing a national center-regional center-professional institutions-based hospice care promotion system.

Development of the Home-based Hospice Care System in Japan: Experience and Significance to China

Lanqiu LIU, Yue ZHAO

2022, 25(19): 2320-2324. DOI: 10.12114/j.issn.1007-9572.2022.0254

Asbtract ( )

HTML ( )

PDF (1647KB) ( )

References | Related Articles | Metrics

In the 21st century, Japan has carried out hospice care services, and developed a sound home-based hospice care system to address the social issues of "fewer children, more older people". And the development of the system is also a key part of Japan's healthcare provision system reform. We introduced Japan's home-based hospice care in terms of concept and ideas, provision institutions, providers and service profile, as well as laws ensuring corresponding imbursement, and put forward the following recommendations for the development of home-based hospice care and for the protection of rights and interests of older people to pass away at home via a sound system design in China: improving the laws about hospice care under appropriate conditions, stably developing home-based hospice care during the implementation of the current healthcare provision system, establishing and improving a collaborative mechanism in providing hospice care, and providing essential financial support for the development of home-based hospice care.

Hospice Care Legislation in South Korea and Its Implications for China

Lanqiu LIU, Yue ZHAO

2022, 25(19): 2325-2329. DOI: 10.12114/j.issn.1007-9572.2022.0255

Asbtract ( )

HTML ( )

PDF (1842KB) ( )

References | Related Articles | Metrics

The Act on Decisions on Life-sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life (hereinafter referred to as the Hospice Care Act) enacted by South Korea in 2016, clearly defines the definition of hospice care and the premise of implementing hospice care, stipulates the hospice care responsibilities and liabilities for the country's government, and sets up the framework of the hospice care system, which is of great significance to promote the development of hospice care and to protect the rights and interests of passing away peacefully in end-of-life patients in South Korea. We introduced the main contents of the Hospice Care Act, and the achievements obtained in South Korea since its implementation, aiming at providing insights into the promotion of hospice care legislation in China. To provide an all-round and refined legal protection for hospice care reform, innovation and high-quality development in China to support healthy dying in end-of-life patients, we put forward the following recommendations: clarifying the rights for hospice care patients, enacting specific regulations on hospice care when conditions are ripe, building a government-led hospice care system, affirming the concept of ineffective medical treatment, and stipulating the process of utilization of hospice care.

The Model of Community Home-based Hospice Care Delivery in the United Kingdom and the United States and Its Enlightenment to China

Yue ZHAO, Lanqiu LIU

2022, 25(19): 2330-2335. DOI: 10.12114/j.issn.1007-9572.2022.0256

Asbtract ( )

HTML ( )

PDF (1881KB) ( )

References | Related Articles | Metrics

Community home-based hospice care service plays an important role in hospice care service. Focusing on community home-based hospice care is the future direction of hospice care service development. As the early countries to develop community home-based hospice care delivery, the United Kingdom and the United States have accumulated rich experience in patient admission standard, service team and content, and funding guarantee of community home-based hospice care delivery, a relatively sound community home-based hospice care delivery system has been established in these two countries. China can appropriately learn from the development experience of community home-based hospice care in the United Kingdom and the United States, in order to formulate the admission standards of community home-based hospice care, strengthen the construction of multidisciplinary hospice care teams, incorporate the non-drug therapy into the scope of community home-based hospice care, implement the payment method of per-diem, so that the patients can die peacefully and dignifiedly in a familiar environment with their hospice rights protected.

Experience of Treatment Burden in Older Adults with Multimorbidity: a Qualitative Study

Zhi YANG, Jing GAO, Dingxi BAI, Ruirui LIU

2022, 25(19): 2336-2341. DOI: 10.12114/j.issn.1007-9572.2022.0169

Asbtract ( )

HTML ( )

PDF (1873KB) ( )

Figures and Tables | References | Related Articles | Metrics

Background

As the aging society develops, multimorbidity is increasingly prevalent in an increased number of older adults, which imposes a heavy treatment burden on the group, but the composition of treatment burden of elderly patients with chronic comorbidity in China is not clear.

Objective

To understand the real experience of treatment burden in elderly patients with multimorbidity, providing a theoretical basis for promoting the research on treatment burden in China.

Methods

By use of purposive sampling, 21 older inpatients with multimorbidity were selected from three hospitals (one is primary level, another is secondary and another is tertiary) in Chengdu from January to June 2021. Individual, face-to-face, in-depth, semi-structured interviews were utilized to collect their experiences of treatment burden, and the data were recorded, and analyzed using Colaizzi's method of data analysis.

Results

Of the participants, eight were women, and 13 were men; 10 were selected from the tertiary hospital, seven from the secondary hospital, and four from the primary hospital. Six themes were summarized: economic burden, drug burden, self-management burden, medical service burden, social burden and psychological burden.

Conclusion

Taken overall, the treatment burden was relatively heavy in older inpatients with multimorbidity. To reduce the treatment burden and improve the efficacy in this group, it is recommended that medical workers should pay attention to their treatment burden, and formulate individualized treatment plan for them.

Health Literacy Status and Influencing Factors among Outpatients in General Hospitals

Xiaoyan WANG, Xiangyang TIAN, Jian DONG, Xi CHU, Guofeng WEI, Zonghui WU, Tong SUN, Hong ZHANG

2022, 25(19): 2342-2348. DOI: 10.12114/j.issn.1007-9572.2022.00.007

Asbtract ( )

HTML ( )

PDF (2123KB) ( )

Figures and Tables | References | Related Articles | Metrics

Background

The changing disease spectrum of Chinese residents poses great challenges to the healthcare delivery. Understanding patients' health literacy and influencing factors is helpful to improve doctor-patient communication, promote patients' health and alleviate the pressure of healthcare delivery. However, the number of studies on patients' health literacy is insufficient, and most of them focus on those with a special illness.

Objective

To understand the status of health literacy and its influencing factors among Chinese outpatients, providing a scientific basis for improving patients' health status and self-management ability, and for medical workers to perform patient education and instruction, disease management and relevant improvement.

Methods

A systematic sampling method was used to select 14 secondary or tertiary general hospitals in eight regions in eastern, central and western China as survey settings, and outpatients (≥15 years old) of them during January to May 2021 were randomly selected and surveyed using the Patient Health Literacy Scale (PHLS) 〔those with scores <41 were deemed unlikely to have health literacy; those with scores ≥55 were judged as having high level of health literacy; those with scores between 41 and 54 were regarded as having moderate level of health literacy〕. The health literacy level of outpatients was compared by various personal factors. Ordinal and multinomial Logistic regression analyses were used to analyze the influencing factors of health literacy.

Results

Altogether, 2 808 cases who handed in responsive questionnaires were included for final analysis. The average score of PHLS in the respondents was (43.38±6.25) . The prevalence of health literacy, and high level of health literacy was 68.38% (1 920/2 808) , and 6.93% (133/2 808) , respectively. The level of health literacy varied obviously by age, education level, occupation, average household monthly income per person, prevalence of a family member working as a healthcare worker, and prevalence of using the way of acquiring health information (from medical workers, family members, friends or coworkers, activities conducted by the work unit or the community, listening to the radio, watching television, reading a newspaper/book, searching the Internet, or other approaches) (P<0.001) . Higher educational level and average household monthly income per person were associated with higher level of health literacy (P<0.001) . Being a student, worker of an industrial/mining enterprise, retailer or server was associated with higher level of health literacy (P<0.05) . Acquiring heath information from healthcare workers and searching the Internet were associated with higher level of health literacy (P<0.05) .

Conclusion

On the whole, the health literacy was moderate in outpatients of the 14 general hospitals. To improve the health literacy level in this population, it is suggested to improve the levels of health education and guidance for them by strengthening the key role of healthcare workers in health information delivery, giving more concerns to the low educated or low-income earners, and increasing the ways of acquiring health information.

Mechanism of Action of 10-week Aerobic Exercise versus Combined Aerobic and Resistance Exercise in Improving the Microcirculation in Obese College Students

Zhe XIAO, Huan ZHU, Jiangping HU, Mei YANG, Yong PENG, Huimin ZHOU

2022, 25(19): 2349-2355. DOI: 10.12114/j.issn.1007-9572.2022.0118

Asbtract ( )

HTML ( )

PDF (2321KB) ( )

Figures and Tables | References | Related Articles | Metrics

Background

Microcirculation dysfunction is closely associated with the development of obesity. Exercise intervention could effectively improve the microcirculation in obese people, but the intensity of an exercise intervention schemes often lacks of individualization and precision. FATmax is a precise and individualized exercise intensity determined on the basis of individual fat oxidation rate.

Objective

To compare the effects of aerobic exercise and combined aerobic and resistance exercise at FATmax intensity on improving the microcirculation in obese college students, and to explore the mechanism of action by analyzing the changes in nitric oxide (NO) , endogenous NO synthase (eNOS) , endothelin-1 (ET-1) and endothelial growth factor (VEGF) .

Methods

In March, 2021, Sixty-six obese college students were recruited from Hubei University for Nationalities, and equally randomized into sex-matched three groups with different 10-week interventions: aerobic exercise group (performing aerobic exercise at the FATmax intensity, 4 times a week, 60 minutes each time) , combined aerobic and resistance exercise group〔performing combined aerobic and resistance exercise at FATmax intensity, 4 times a week, 60 minutes each time (40 minutes for aerobic exercise and 20 minutes for resistance exercise) 〕, and control group (maintaining their normal living habits) . Body weight, body fat percentage, BMI, microvascular reactivity, transcutaneous oxygen pressure (TcPO₂) , muscle oxygen saturation (SmO₂) , NO, eNOS, ET-1, VEGF and HOMA-IR were tested on March 18 and June 2, 2021, respectively.

Results

The intervention modality and duration had significant interactive effects on body weight, BMI and body fat percentage of three groups (P<0.05) . In particular, the average body weight, BMI and body fat percentage decreased significantly in both aerobic exercise group and combined aerobic and resistance exercise group after the intervention (P<0.05) . What's more, the average post-intervention levels of the above-mentioned three indicators in the two groups were significantly lower than those of the control group (P<0.05) . The intervention modality and duration had significant interactive effects on microvascular reactivity, TcPO₂ and SmO₂ of three groups (P<0.05) . In particular, the average microvascular reactivity, TcPO₂ and SmO₂ increased significantly in both aerobic exercise group and combined aerobic and resistance exercise group after the intervention (P<0.05) . In addition, the average post-intervention levels of the average microvascular reactivity and TcPO₂ in the two groups were significantly higher than those of the control group (P<0.05) . The intervention modality and duration produced obvious interactive effects on NO, eNOS, VEGF and HOMA-IR of three groups (P<0.05) . In particular, the average NO, eNOS, and VEGF increased significantly and HOMA-IR decreased significantly in both aerobic exercise group and combined aerobic and resistance exercise group after the intervention (P<0.05) . Moreover, these two groups showed higher average post-intervention levels of NO and lower average post-intervention level of HOMA-IR than the control group (P<0.05) .

Conclusion

Both 10-week aerobic exercise and combined aerobic and resistance exercise at FATmax intensity could reduce body weight, body fat percentage, BMI and HOMA-IR in obese college students, and the latter may be more effective in improving microvascular reactivity and HOMA-IR. These two modalities of exercise improved microcirculation may be by improving the levels of NO, ET-1, VEGF and other factors.

Marital Status and Prognosis in Patients with Primary Central Nervous System Lymphoma: a Propensity Score Matching-based Study

Zhenqiang REN, Yi GUAN, Fei PENG, Yongtao SHI, Mengyang YU

2022, 25(19): 2356-2362. DOI: 10.12114/j.issn.1007-9572.2022.0116

Asbtract ( )

HTML ( )

PDF (2467KB) ( )

Figures and Tables | References | Related Articles | Metrics

Background

The prognosis of patients with primary lymphoma of the central nervous system (PCNSL) is poor, and identifying the prognostic predictors is the key to improving their prognosis. Biopsychosocial models suggest the important prognostic value of psychosocial factors, but the association of marital status, one important psychosocial factor, with the prognosis of PNSCL patients remains unclear.

Objective

To assess the association of marital status with the overall survival (OS) and cancer-specific survival (CSS) in patients with PCNSL.

Methods

The data of 3 993 patients diagnosed with PCNSL between 2000 and 2016 were extracted from the Surveillance, Epidemiology and End Results database in 2020, including sociodemographics〔marital status (married, or single containing unmarried, divorced or widowed) , age of diagnosis, year of diagnosis, ethnicity, gender〕, clinicopathological features (pathological type and location of the PCNSL) , treatment (surgery, radiotherapy and chemotherapy) and outcome data (survival and follow-up time) . The propensity score matching (PSM) was used to balance the baseline variables of the married and singles. The Log-rank test was used to compare the Kaplan-Meier curves of OS and CSS by marital status. Cox regression was used to identify the association of marital status with OS and CSS.

Results

After PSM, there were no significant differences in baseline variables between married and single patients (P>0.05) . The Log-rank test demonstrated that single patients had worse OS and CSS than the married (P<0.05) . Further analysis revealed that the widowed singles had worse OS and CSS than the married (P<0.05) . After adjusting for age of diagnosis, ethnicity, gender, year of diagnosis, pathological type and location of the PCNSL, surgery, radiotherapy and chemotherapy, multivariate analysis found that compared to those married, the risk of death was 1.24 times higher〔95%CI (1.14, 1.36) , P<0.001〕 and the risk of cancer-specific death was 1.22 times higher〔95%CI (1.11, 1.33) , P<0.001〕in singles. Further analysis revealed that compared with married patients, the risk of worse OS increased by a factor of 1.14〔95%CI (1.03, 1.27) , P=0.013〕 and that of worse CSS increased by a factor of 1.15〔95%CI (1.03, 1.29) , P=0.012〕in unmarried singles; the risk of worse OS and CSS increased by a factor of 1.23〔95%CI (1.07, 1.41) , P=0.004〕 and by a factor of 1.22〔95%CI (1.05, 1.41) , P=0.009〕, respectively, in divorced singles; the risk of worse OS and CSS increased by a factor of 1.37〔95%CI (1.21, 1.54) , P<0.001〕 and by a factor of 1.28〔95%CI (1.12, 1.46) , P=0.013〕, respectively, in widowed singles.

Conclusion

Marital status was associated with OS and CSS in PCNSL patients. The unmarried, divorced and widowed singles may have worse OS and CSS, suggesting that more attention should be given to the marital status of these patients besides biological characteristics of PCNSL during the clinical management.

Effect of Maternal Intestinal Floras on Neonatal Birth Weight

Xue XIAO, Yuqi WANG, Xiaolan LAI, Shaotao ZHONG, Cuiliu ZHAO, Dan LIU, Lin LI, Rongshao TAN, Hongling YANG

2022, 25(19): 2363-2370. DOI: 10.12114/j.issn.1007-9572.2022.0114

Asbtract ( )

HTML ( )

PDF (4528KB) ( )

Figures and Tables | References | Related Articles | Metrics

Background

Birth weight is closely related to individual health. Low birth weight is a high-risk factor for early neonatal death. Macrosomia is associated with higher risk of maternal and infant complications and various chronic diseases in adulthood. Therefore, it is very important to identify the influencing factors of neonatal birth weight.

Objective

To investigate the relationship between maternal intestinal flora and neonatal birth weight.

Methods

Participants were 516 singleton mothers and their babies〔24 with low birth weight (LW group) , 479 with normal birth weight (NW group) and 13 with macrosomia (OW group) 〕 delivered at term in Guangzhou Women and Children's Medical Center from January to September 2017. Maternal intestinal flora and clinical laboratory test parameters were collected, and the composition and diversity of intestinal flora were analyzed using QIIME. LEfSe analysis was used to compare the relative abundance of intestinal flora at the genus level of the mothers of three groups of babies to identify the flora with significant intergroup differences. MaAslin was used to assess associations of maternal laboratory test parameters and microbial genera. The Boruta was used to build models for predicting three types of neonatal birth weight using maternal laboratory test parameters and intestinal flora OTUs, to assess the association of maternal intestinal floras and neonatal birth weight.

Results

The analysis of maternal intestinal floras showed that the abundance of Firmicutes was the highest at the phylum level, and Faecalibacterium was significantly enriched at the genus level. There were no significant differences in Simpson's Diversity Index and Shannon Diversity Index at the phylum level across the maternal intestinal floras of three groups of babies (P>0.05) . LEfSe analysis found that compared with intestinal flora of mothers of LW group, the intestinal flora of mothers of NW group showed significantly enriched Streptococcus and Roseburia (P<0.05) , and significantly reduced abundance of Bacillaceae, Raphanus, Methanosphaera, Barnesiella and Paraprevotella (P<0.05) , while the intestinal flora of mothers of OW group demonstrated significantly enriched Closrtidiaceae and Alistipes as well as significantly reduced abundance of Barnesiella (P<0.05) . Compared with intestinal flora of mothers of NW group, the intestinal flora of mothers of OW group indicated significantly enriched Megamonas, Coprococcus, Veillonellaceae, cc-115, Closrtidiaceae and Alistipes, and significantly reduced abundance of Blautia and Eggerthella (P<0.05) . The area under ROC curve (AUC value) based on laboratory test parameter OTUs model and intestinal flora OTUs model was 0.62 and 0.77, respectively, in discriminating LW from NW, and was 0.65, and 0.78 respectively, in discriminating OW from NW.

Conclusion

Neonatal birth weight varied by the features of maternal intestinal floras. The OTUs model based on maternal intestinal flora could distinguish the neonatal birth weight. Maternal intestinal flora may be a good predictor of neonatal birth weight.

Multimorbidity Prevalence and Its Association with Health Service Utilization and Medical Costs among Middle-aged and Older Chinese People

Xiaoru FAN, Sha CHEN, Yuning SHI, Chun HAO

2022, 25(19): 2371-2378. DOI: 10.12114/j.issn.1007-9572.2022.0220

Asbtract ( )

HTML ( )

PDF (2539KB) ( )

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

Background

The high prevalence of multimorbidity among middle-aged and older adults has become a serious issue needing to be addressed by China's healthcare system. The number of chronic diseases is related to health service utilization and medical costs, but there is still a lack of relevant national surveys in China.

Objective

To understand the prevalence and features of multimorbidity and to examine its associations with health service utilization and medical costs among middle-aged and older Chinese adults.

Methods

Data were collected from the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS) during April to October 2021, involving 16 674 Chinese adults (≥45 years old) . Multimorbidity was defined as the coexistence of two or more of the self-reported 14 chronic conditions. Health service utilization was measured using inpatient service utilization in the past year and outpatient service utilization in the past month. Medical costs were measured using total inpatient cost and out-of-pocket (OOP) cost for inpatient care in the past one year, total outpatient costs and OOP cost for outpatient care in the past one month. Logistic regression was used to estimate the association between the number of chronic diseases and health service utilization. Quantile regression was adopted to estimate the association between the number of chronic diseases and medical costs.

Results

Of all participants, 9 561 (57.34%) had multimorbidity. 2 624 (15.74%) had utilized inpatient services in the past year, and 2 588 (15.52%) used outpatient services in the past one month. Inpatient service utilization, outpatient service utilization, total inpatient cost, OOP cost for inpatient care, total outpatient cost, and OOP cost for outpatient care varied significantly by the number of chronic diseases (P<0.05) . Multivariate Logistic regression analysis indicated that the number of chronic diseases was associated with inpatient service utilization (P<0.05) . Suffering from 1, 2, 3, 4 and ≥5 chronic diseases was associated with 1.882 times〔95%CI (1.547, 2.290) 〕, 2.939 times〔95%CI (2.429, 3.555) 〕, 4.231 times〔95%CI (3.490, 5.130) 〕, 5.723 times〔95%CI (4.680, 7.000) 〕, and 8.671 times〔95%CI (7.173, 10.482) 〕 higher rate of inpatient service utilization, respectively. Having 1, 2, 3, 4 and ≥5 chronic diseases was associated with 1.684 times〔95%CI (1.421, 1.995) 〕, 2.481 times〔95%CI (2.101, 2.931) 〕, 3.691 times〔95%CI (3.115, 4.374) 〕, 3.774 times〔95%CI (3.134, 4.544) 〕, and 5.577 times〔95%CI (4.698, 6.620) 〕 higher rate of outpatient service utilization, respectively. Each increased chronic disease was associated with an increase in both total inpatient costs and OOP for inpatient care at the upper and middle (50, 75 and 90 percentiles) percentile levels, with larger effects on the upper percentile 〔90th percentile Coeff (95%CI) =1 248.43 (219.20, 2 277.66) for total hospital costs; 90th percentile Coeff (95%CI) =706.36 (266.87, 1 145.86) for OOP for inpatient care〕. Each increased chronic disease was also associated with an increase in both total outpatient costs and OOP for outpatient care, and the effects on the upper percentiles were larger〔90th percentile Coeff (95%CI) =196.33 (31.06, 361.61) for total outpatient costs; 90th percentile Coeff (95%CI) =128.56 (26.83, 230.28) for OOP for outpatient care〕.

Conclusion

In middle-aged and older Chinese adults, multimorbidity was highly prevalent, and the increase in the number of coexisted chronic diseases was associated with higher rate of health service utilization and medical costs. The government should pay more attention on primary care to manage the demand for health services and medical costs associated with multimorbidity.

Effects of Chronic Diseases on Quality Adjusted Life Year and Economic Losses of the Elderly

Xinyue ZHAO, Xiao ZHENG, Yaqing XUE, Weiwei WU, Jiao LU, Chichen ZHANG

2022, 25(19): 2379-2384. DOI: 10.12114/j.issn.1007-9572.2022.0082

Asbtract ( )

HTML ( )

PDF (2153KB) ( )

Figures and Tables | References | Related Articles | Metrics

Background

Chronic diseases have become an important public health problem that affects the economic and social development of country and population health. Quantifying the disease and economic burden of the elderly can provide a better understanding of the impact of chronic diseases on individuals and society.

Objective

To understand the prevalence of common chronic diseases among the elderly in Shanxi Province and explore the quality-adjusted life year (QALY) loss and economic loss which caused by chronic diseases.

Methods

From June to August in 2019, a multi-stage random sampling method was used to select 3 250 elderly people aged≥ 60 years from 11 cities in Shanxi Province as the research subjects for a questionnaire survey. The questionnaire included general demographic information, disease status survey, and health-related quality of life status. The European Five-Dimensional Health Scale (EQ-5D-5L) was used to assess the health-related life quality of the elderly. The QALY loss caused by chronic diseases was calculated based on the Chinese EQ-5D-5L utility value score system, and the QALY loss and economic loss caused by common chronic diseases in Shanxi Province in 2019 were estimated by using population and GDP per capita from statistical bulletin.

Results

The results of univariate analysis showed that there were significant differences in the utility value of EQ-5D-5L among the elderly with different ages, living regions, educational levels, marital status, and family per capita monthly income (P<0.05) . The results of multiple linear regression analysis showed that higher per capita monthly income of families, being married and younger age were the protective factors for the health utility value of EQ-5D-5L (P<0.05) . The prevalence of chronic diseases among the elderly in Shanxi Province was 58.49% (1 901/3 250) . The top 5 chronic diseases by prevalence were: hypertension 29.45% (957/3 250) , diabetes 10.83% (352/3 250) , rheumatism or rheumatoid arthritis 10.28% (334/3 250) , hearing impairment 8.09% (263/3 250) , gastritis or peptic ulcer 6.49% (211/3 250) . Based on the estimation of the total population of Shanxi Province, the loss of QALY caused by five common chronic diseases in Shanxi Province in 2019 was 2 078 685 years, and the economic loss was 95 045 792 940yuan. The chronic disease causing the most QALY loss and economic loss in Shanxi Province was rheumatism or rheumatoid arthritis in Datong, Taiyuan and Luliang; in Jincheng, Yangquan city was hearing impairment; In Jinzhong, Linfen, Yuncheng, Shuozhou, Xinzhou, Changzhi City was hypertension.

Conclusion

The prevalence of chronic diseases among the elderly in Shanxi Province was relatively high, and chronic diseases will not only cause the loss of QALY of the elderly, but also cause a huge economic burden. Common chronic diseases vary by region in Shanxi Province, each region should determine the priority of disease prevention and treatment according to the actual situation, identify the key objectives and population of health management, so as to achieve a multiplier effect.

The Concentration of Healthcare Expenditures in Type 2 Diabetes Patients with Essential Medical Insurance Coverage

Xiangjun LI, Qijuan BIAN, Ping SHI, Zhonghua WANG

2022, 25(19): 2385-2390. DOI: 10.12114/j.issn.1007-9572.2022.0128

Asbtract ( )

HTML ( )

PDF (2200KB) ( )

Figures and Tables | References | Related Articles | Metrics

Background

Both excessive utilization and underutilization of medical services affect the fairness in the use of medical services. Therefore, studying the concentration of healthcare expenditures on chronic diseases, and analyzing the characteristics of patients with high and low medical expenditures could assess the fairness of the essential medical insurance system.

Objective

To analyze the concentration of healthcare expenditures in type 2 diabetes mellitus (T2DM) patients with essential medical insurance coverage.

Methods

Data of patients with a first diagnosis of T2DM and coverage of essential medical insurance were collected from the information system of a municipal medical insurance center in Jiangsu Province in July 2019, involving 24 107 cases with urban resident basic medical insurance (URBMI) and 109 265 cases with urban employee basic medical insurance (UEBMI) . Patients in each group were subgroup by the level of personal healthcare expenditure from high to low (percentile subgroups 1-5: top 1%, top 1%-5%, top 5%-10%, top 10%-50% and the remaining 50%) , and inter-percentile subgroup comparisons of the healthcare expenditure, medical insurance reimbursements, health service utilization, and population features were performed.

Results

Both healthcare expenditures and medical insurance reimbursements were highly concentrated in each group of T2DM patients: the healthcare expenditure of patients with URBMI in subgroups 1 and 2 accounted for 66.12% of the total healthcare expenditures, and medical insurance reimbursements of those with URBMI in subgroups 1, 2 and 3 accounted for 82.97% of the total medical insurance reimbursements. The healthcare expenditure of patients with UEBMI in subgroups 1 and 2 occupied 43.12% of the total healthcare expenditure, and medical insurance reimbursements of those with UEBMI in subgroups 1, 2 and 3 occupied 61.62% of the total medical insurance reimbursements. Gender, age and the perferred medical institutions were significantly different between patients in subgroups 1 and 2 and those in other three subgroups, and between patients in subgroups 1, 2, 3, and 4, and those in subgroup 5 regardless of the type of medical insurance (URBMI or UEBMI) (P<0.05) .

Conclusion

The healthcare expenditures and medical insurance reimbursements in insured T2DM patients were highly concentrated. In particular, the level of concentration of medical insurance reimbursements in those with URBMI was higher than that of those with UEBMI. The high concentration of healthcare expenditures indicates that T2DM patients with high healthcare expenditures may have excessive medical utilization and moral risk. Policy effort should be paid to the reimbursements level of those with low-to-moderate healthcare expenditures, and to improve their access to healthcare services.

Quality of Primary Care Services: a Perspective from Chronic Disease Patients

Jindan ZHANG, Xiaofan CHEN, Xiuhua MAO, Chenxi WANG, Xinting LIANG, Lu ZHANG, Aiyun CHEN

2022, 25(19): 2391-2398. DOI: 10.12114/j.issn.1007-9572.2022.0017

Asbtract ( )

HTML ( )

PDF (2632KB) ( )

Figures and Tables | References | Related Articles | Metrics

Background

Since the number of chronic disease patients is increasing, relevant prevention and treatment services have become important long-term tasks for primary care institutions. However, problems in the provision of primary care services seriously affect the perception of such services in residents, especially chronic disease patients.

Objective

To understand chronic disease patients' assessment of the quality of primary care services, providing evidence for improving the quality of chronic disease management services in primary care.

Methods

A survey was conducted between July and August, 2020 with chronic disease patients (n=630) selected from primary care settings in Guangdong's Chaozhou by use of multistage stratified random sampling. The Primary Care Assessment Tool-Adult Simplified Version (PCAT-AS) (consists of 10 domains, including first contact accessibility, coordination, ongoing, comprehensiveness, community orientation and other 5 domains) was used in the survey for understanding chronic disease patients' assessment of the quality of primary care services. Multiple linear regression was adopted to identify factors potentially associated with the PCAT-AS score.

Results

Altogether, 553 cases (87.8%) who returned responsive questionnaires were enrolled for analysis. The average total PCAT-AS score for all respondents was (95.88±13.44) . The top three domains ranked in terms of average standardized score were comprehensiveness (services needed) (7.89) , first contact accessibility (7.72) , and first contact utilization (7.58) , and the bottom three-ranked domains were coordination (referrals) (5.61) , community orientation (6.11) and patient and family centeredness (6.40) . Multiple linear regression analysis indicated that higher total PCAT-AS score was associated with living in urban areas in contrast to rural areas〔b (95%CI) =-6.983 (-10.598, -3.368) 〕, senior high school and higher education level instead of junior high school and lower education level〔b (95%CI) =4.046 (0.966, 7.125) 〕, permanent residents without the local hukou in contrast to those with local hukou〔b (95%CI) =-5.360 (-9.517, -1.202) 〕, good self-rated health instead of relatively poor self-rated health〔b (95%CI) =-4.962 (-8.438, -1.486) 〕 or poor self-rated health〔b (95%CI) =-7.787 (-12.789, -2.786) 〕, having a contracted family doctor instead of having no contracted family doctor〔b (95%CI) =4.686 (2.508, 6.865) 〕, first choosing a community health center for treating common diseases instead of a village clinic〔b (95%CI) =-5.865 (-9.951, -1.779) 〕 or a district/county-level hospital or tertiary hospital〔b (95%CI) =-6.061 (-11.330, -0.792) 〕, 4-6 primary care visits instead of 1-3 primary care visits〔b (95%CI) =5.876 (3.367, 8.384) or 7 or more primary care visits instead of 1-3 primary care visits〔b (95%CI) =9.045 (6.512, 11.579) 〕, and high satisfaction with primary care services instead of fair satisfaction〔b (95%CI) =-2.844 (-4.817, -0.870) 〕 or dissatisfaction〔b (95%CI) =-10.418 (-17.050, -3.786) 〕.

Conclusion

Overall, Chaozhou chronic disease patients reported a sound level of treatment experience in primary care. Specifically, they reported good primary care experience in three domains, including comprehensiveness, first contact accessibility and first contact utilization, but poor experience in community orientation, and coordination (including information systems and referrals) . However, urban patients reported better primary care experience than rural patients. So continued efforts are needed to strengthen primary care performance in rural areas.

Capabilities for Diagnosing and Treating Common Diseases in Primary Care Physicians in Henan: Current Overall Status and Solutions to Problems

Kun XIE, Dan HU, Lang PENG, Yahui LI, Jiaying CHEN

2022, 25(19): 2399-2403. DOI: 10.12114/j.issn.1007-9572.2022.0140

Asbtract ( )

HTML ( )

PDF (2238KB) ( )

Figures and Tables | References | Related Articles | Metrics

Background

One key to the development of the tiered diagnosis and treatment system lies in the establishment of a gatekeeping system in primary care supporting the implementation of first contact in primary care and the achievement of orderly healthcare-seeking. And the serving capacities of primary care professionals are essential in implementing first contact in primary care.

Objective

To understand the overall level of Henan primary care physicians' capabilities of diagnosing and treating common diseases, and to put recommendations for solving the problems.

Methods

In August 2020, by use of typical sampling method, physicians were selected from all primary care hospitals in four areas of Henan Province (Kaifeng's Xiangfu District and Lankao County, and Jiaozuo's Weidu District and Yanling County) . An online self-administered questionnaire survey was conducted with them for collecting information about their demographics, and capabilities of diagnosing and treating common diseases (involving the identification and diagnosis of common diseases, interpretation of relevant auxiliary examinations, and prescription of common medications) .

Results

In all, 1 844 cases attended the survey, and 1 669 of them (90.51%) who effectively responded to the survey were included for final analysis. Among the 1 669 respondents, 917 (54.94%) had secondary health school education level or below, 663 (39.72%) had no professional title, 524 (31.40%) had a rural doctor certificate, and 509 (30.50%) had a practicing certificate. Among the 1 117 village doctors, 722 (64.64%) were 45 years old and above, 83 (7.43%) were 60 years old and above, and 848 (75.92%) had secondary health school education level or below. Among 1 631 respondents, 1 564 (95.89%) were basically able to diagnose and identify common diseases, 1 402 (86.00%) could interpret the results of common auxiliary examinations, 1 542 (94.54%) could prescribe common medications, and 1 336 (81.91%) had capabilities to diagnose and treat common diseases. Compared with urban primary care physicians, rural primary care physicians had higher level of capabilities in identifying and diagnosing common diseases as well as prescribing common medications, but lower level of capabilities in interpreting biochemical tests and electrocardiogram results (P<0.05) .

Conclusion

In general, the overall level of professional qualities was unsatisfactory in Henan primary care physicians, especially in those working in rural areas. Their level of capabilities for diagnosing and treating common diseases was generally satisfactory, although there is still much room for improvement. A sound cooperative mechanism between primary care hospitals and higher level hospitals should be established to ensure the safety in primary care.

Development of an IMOI Model-based Evaluation System for Effectiveness of a Family Doctor Team in Beijing

Wenhan MA, Yi CHANG, Chao XU, Yali ZHAO

2022, 25(19): 2404-2413. DOI: 10.12114/j.issn.1007-9572.2022.0173

Asbtract ( )

HTML ( )

PDF (3448KB) ( )

Figures and Tables | References | Related Articles | Metrics

Background

In China, team-based service delivery model is a major emerging model for contracted family doctor services, but there is a lack of a tool for assessing the overall effectiveness of the family doctorteam.

Objective

To develop a IMOI model-based system for assessing the effectiveness of family doctor teams in Beijing, aiming at proving a tool for guiding the improvement and continuous development of the family doctor team.

Methods

The first draft of the Family Doctor Team Effectiveness Evaluation System (FDTEES) was developed using literature review and personal interview. Then the indicators of the system were assessed and revised according to consensuses of our analysis and the results of two rounds of consultations carried out between May and July 2021 using the Delphi technique (one was conducted with 24 experts, and the other with 21 experts) . The weight of the indicators of the system was determined by and analytic network process.

Results

The response rate of experts in the first, and second round of consultation was 87.5% (21/24) , and 100.0% (21/21) , respectively. The authority coefficients for the consultations ranged from 0.88 to 0.91. Kendall's W for the importance and applicability of the indicators of the FDTEES was 0.138 (P<0.001) , and 0.263 (P<0.001) , respectively, in the first round of consultation, was 0.255 (P<0.001) , and 0.257 (P<0.001) , respectively, in the second round of consultation. The final FDTEES consists of 71 indicators, including 7 first-level indicators〔team building (0.155) , quality of team members (0.155) , team member relationship (0.097) , team process (0.141) , team service results (0.155) , perception and satisfaction (0.155) , team redevelopment (0.141) 〕, 16 second-level indicators, and 48 third-level indicators.

Conclusion

The IMOI model-based FDTEES developed by us assesses the effectiveness of family doctor teams in Beijing from a team perspective, which may be a reference for effectiveness evaluation and development of family doctor teams in Beijing.

Effectiveness of Non-pharmacological Interventions on Symptom Clusters in Cancer Patients: a Network Meta-analysis

Congcong HE, Limin MENG, Huizhen LIU, Xiufang GUO, Feifei WANG, Dongmei LIN

2022, 25(19): 2414-2420. DOI: 10.12114/j.issn.1007-9572.2022.0086

Asbtract ( )

HTML ( )

PDF (2825KB) ( )

Figures and Tables | References | Related Articles | Metrics

Background

The presence of symptom clusters is associated with poor treatment outcomes and decreased quality of life in patients with cancer, and holistic interventions for symptom clusters can improve the management efficiency. Numerous non-pharmacologic interventions are available for symptom clusters in patients with cancer, but there is disagreement as to which interventions is the most effective.

Objective

To explore and compare the effectiveness of different non-pharmacological interventions in reducing the severity of symptom clusters in cancer patients.

Methods

In September 2021, randomized controlled trials (RCTs) about non-pharmacological interventions in reducing the severity of symptom clusters in cancer patients were searched in SinoMed, CNKI, Wanfang Data, CQVIP, the Cochrane Library, PubMed, Web of Science and Wiley Online Library databases from inception to September 2021. Two researchers independently screened studies based on the inclusion and exclusion criteria, extracted data, and performed risk of bias assessment using the Cochrane handbook for systematic reviews of interventions (version 5.1.0) . RevMan 5.3 was adopted for heterogeneity test using a traditional method and publication bias analysis. Addis 16.6 was used to make a network meta-analysis.

Results

Twelve RCTs were finally included, involving 1 116 cases, and eight non-pharmacologic interventions: cognitive behavior intervention, mindfulness-based stress reduction, acupoint massage, multiple-modality exercise, exercise and health counseling, auricular point sticking therapy, narrative nursing, and attention control. Network meta-analysis results showed that, for reducing the severity of symptom clusters in cancer patients, acupoint massage was superior to interventions other than mindfulness-based stress reduction, mindfulness-based stress reduction was superior to usual care and narrative nursing, and cognitive behavioral intervention was superior to multiple-modality exercise, usual care and narrative nursing (P<0.05) . The surface under the cumulative ranking curve score for the interventions in reducing the severity of symptom clusters in cancer patients ranked from highest to lowest was: acupoint massage>mindfulness-based stress reduction>cognitive behavior intervention>auricular point sticking therapy/attention control>multiple-modality exercise>usual care>narrative nursing>exercise and health counseling.

Conclusion

Based on the results of network meta-analysis and probability ranking, acupoint massage was recommended as the clinical priority non-pharmacological intervention to alleviate the severity of symptom clusters in cancer patients, followed by mindfulness-based stress reduction. In the future, high-quality, large-sample, multicenter, double-blind RCTs are needed to further validate the effects of different non-pharmacological interventions on improving symptom clusters in cancer patients, and to provide more reliable evidence for supporting the development of interventions for symptom clusters in these patients.

Effects of Aquatic Therapeutic Exercise in Stroke Rehabilitation: an Overview of Systematic Reviews

Nannan HU, Hong GUO, Keke LIN, Ao ZHANG, Shanshan CHEN

2022, 25(19): 2421-2428. DOI: 10.12114/j.issn.1007-9572.2022.0249

Asbtract ( )

HTML ( )

PDF (2958KB) ( )

Figures and Tables | References | Related Articles | Metrics

Background

Aquatic therapeutic exercise is an emerging physical therapy technique, which provides new ideas for improving the motor function and quality of life of patients with stroke. However, it is not clear that the rehabilitation benefits obtained by patients with stroke from aquatic therapeutic exercise, and the levels of methodological quality and evidence quality of relevant studies.

Objective

To overview the systematic reviews of aquatic therapeutic exercise in improving the rehabilitation in patients with stroke.

Methods

In June 2021, Systematic reviews assessing the effects of aquatic therapeutic exercise in stroke rehabilitation were searched in databases of PubMed, the Cochrane Library, EmBase, CINAHL, Web of Science, CNKI, WanFang Data, CQVIP and SinoMed from inception to June 15, 2021. Two researchers screened systematic reviews according to the inclusion and exclusion criteria and extracted data separately. The methodological quality was evaluated using AMSTAR 2. The reporting quality was evaluated using the PRISMA. The quality of evidence for major outcomes was evaluated using the GRADE system.

Results

A total of 9 reviews were included, 2 of which were in Chinese and 7 were in English. The analysis showed that the methodological quality of 1, 1, and 7 reviews were moderate, low, and extremely low, respectively. The reporting quality of 7 reviews were relatively complete, 1 review had some flaws, and 1 review had a serious information flaw. There were a total of 9 outcome indicators, and 49 bodies of evidence, and the quality of bodies of evidence was mostly low or very low. Aquatic therapeutic exercise improved the balance function, mobility and muscle strength of stroke patients to a certain extent. And the rehabilitation benefits had proven to be more when it was used in combination with dryland trainings.

Conclusion

Aquatic therapeutic exercise has proven to be effective in improving balance function, mobility and muscle strength in stroke patients with good safety. But the overall methodological quality and quality of evidence for major outcomes of included systematic reviews are unsatisfactory. It is suggested that future studies use a larger sample size and an improved design, which will provide evidence-based guidance for clinical management of stroke rehabilitation with aquatic therapeutic exercise.

A General Practice-based Approach to the Management of Resistant Hypertension First Diagnosed in the Community

Yang CHEN, Xueping DU

2022, 25(19): 2429-2434. DOI: 10.12114/j.issn.1007-9572.2022.0157

Asbtract ( )

HTML ( )

PDF (2423KB) ( )

Figures and Tables | References | Related Articles | Metrics

Hypertension is one major chronic disease that threatens the health of Chinese people. Resistant hypertension is a special type of hypertension with complex pathogenesis and etiology, which is more harmful since it can increase the probability of cardiovascular disease and poor prognosis, suggesting that it should be a focus of general practitioners. Although a series of guidelines on the management of resistant hypertension have been released, general practitioners' knowledge and understanding of this disease are various, and the diagnosis, treatment and management of resistant hypertension performed by them are not sufficiently standardized. We reported a case of resistant hypertension first diagnosed in the community, whose blood pressure gradually reached the target level after treatment. Based on the review of relevant literature, we analyzed the process and ideasof managementof this case, and gave a summary of the treatment experience, providing a reference for incumbent general practitioners and trainees attending the standardized general residency program to treat patients with resistant hypertension.

Table of Content