Table of Content

05 July 2023, Volume 26 Issue 19

Previous Issue    Next Issue

World General Practice/Family Medicine

Australian Physical Activity Referral and Its Implications for the Sharing Mechanism of General Practice and Sports Co-treatment in China

LI Liqiang, WU Jin, ZHANG Liqiang, WANG Xiaozan

2023, 26(19):  2311-2317.  DOI: 10.12114/j.issn.1007-9572.2022.0862

Asbtract ( )   HTML ( )   PDF (1192KB) ( )  

Figures and Tables | References | Related Articles | Metrics

As the acceleration of urbanization and population aging in China, the prevalence of various chronic diseases among residents is increasing, the prevention and control of various chronic diseases in the medical care and public health fields are becoming more and more severe. As one of the important treatment modalities, physical activity referral schemes (PARS) have achieved remarkable results in the prevention and treatment of chronic diseases abroad, among which PARS in Australia has become a model for "treatment + co-treatment". This study overviews the formation and development of PARS in Australia comprehensively, summarizes and analyzes its implementation experience. It is recommended to build a sharing and interaction mechanism of general practice and sports co-treatment in China in the context of the current development situation of medical care and sports rehabilitation in China from the following aspects: building a referral structure with general practice as the core, promoting the synergistic governance of general practice and sports co-treatment; improving the personnel training system of general practice and exercise physiology, accelerating the training of medical exercise and health coaches; promoting the innovation of the service system, accelerating the construction of scientific process of general practice and sports co-treatment; exerting the advantages of the Internet vigorously to build a data and information platform of general practice and sports co-treatment.

Research Progress of Workplace Violence among General Practitioners at Home and Abroad: Prevalence, Influencing Factors, and Intervention Strategies

LI Xinyan, FENG Jing, LEI Zihui, QU Ge, GAN Yong

2023, 26(19):  2318-2322.  DOI: 10.12114/j.issn.1007-9572.2022.0767

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

References | Related Articles | Metrics

General practitioners are medical personnel with high integrated degree, and are the "gatekeepers" of residents' health. Violent incidents affecting health care not only seriously harm the the physical and psychological health of general practitioners, also affect the quality and level of basic medical services, which increases the turnover of general practitioners and the economic burden on the health care system. Previous studies have shown that more than half of general practitioners had experienced workplace violence, with the most common types including verbal violence and threats, followed by physical violence, sexual harassment and assault, patients and their family members were the main perpetrators. The failure of the medical services quality to meet the demands of patients, alcohol abuse, drug abuse and mental disorders of perpetrators, poor physician-patient communication were important factors associated with workplace violence. It is suggested to improve policies and regulations, norms of conduct related to workplace violence of healthcare workers, establish and improve the reporting and punishment mechanisms, enhance the capacity of healthcare workers and health care institutions to provide medical services and prevent workplace violence, give proper play to the role of the public media, promote the establishment of "zero-tolerance" system for violence.

Trusted Evidence & Informed Decisions

Guidelines on Cardiac Rehabilitation in Patients with Coronary Heart Disease: a Systematic Review

LIU Jingtao, SU He, QIN Xiaojin, LAN Yunxia, ZHANG Jinzhi

2023, 26(19):  2323-2331.  DOI: 10.12114/j.issn.1007-9572.2022.0700

Asbtract ( )   HTML ( )   PDF (1251KB) ( )  

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

Background

It has been a consensus that cardiac rehabilitation is an effective comprehensive intervention for patients with coronary heart disease (CHD), but the quality of relevant guidelines is still unclear, and recommendations from the guidelines need to be integrated.

Objective

To systematically review the guidelines on cardiac rehabilitation in patients with CHD, providing evidence to inform clinical practice.

Methods

In June 2022, guidelines on cardiac rehabilitation in patients with CHD were searched in electronic databases of the Cochrane Library, Web of Science, PubMed, CNKI, CQVIP and Wanfang Data, relevant guideline repositories and association websites from inception to 30 June 2022. Literature screening and data extraction were performed by two researchers separately according to the inclusion and exclusion criteria. The quality of included guidelines was assessed using the Appraisal of Guidelines for Research & EvaluationⅡ (AGREEⅡ), and recommendations from which were summarized.

Results

Ten guidelines (eight of them are foreign guidelines) with publication time ranging from 2011 to 2020 were eventually included. The average score of every AGREEⅡ domain was 71% for scope and purpose, 65% for stakeholder involvement, 58% for rigor of development, 80% for clarity of presentation, 64% for applicability, and 45% for editorial independence. Four guidelines were rated as grade A and the remaining six as grade B. Six aspects are involved in recommendations, including basic requirements of cardiac rehabilitation, heath education, risk factors control, psychological support, exercise training, and improvement of cardiac rehabilitation participation.

Conclusion

The quality of included guidelines is at a moderate to high level. More efforts are needed to improve the domains in stakeholder involvement, rigor of development, applicability, and editorial independence. Recommendations of the 10 guidelines tend to be consistent, but there are still insufficient recommendations on improving cardiac rehabilitation participation. There is a gap in the quality between domestic and foreign guidelines, so it is necessary to develop a high-quality guideline on cardiac rehabilitation for patients with CHD in China.

Summary of Best Evidence for Prevention of Recurrence of Late-life Depression

ZHA Qianqian, XU Lianying, CHEN Juan, HUANG Wen, ZHANG Xinqiong

2023, 26(19):  2332-2338.  DOI: 10.12114/j.issn.1007-9572.2022.0727

Asbtract ( )   HTML ( )   PDF (1217KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The recurrence rate of late-life depression is high, however, there is a lack of research on intervention protocol to prevent recurrence of late-life depression at home and abroad.In the early stage, the research group explored the risk factors for recurrence of late-life depression, and the controllable risk factors were poor medication compliance, less physical activity, and less eating.

Objective

To search, evaluate and summarize the evidence related to the prevention of recurrence of late-life depression based on the above three risk factors.

Methods

In October 2022, the evidences related to the prevention of recurrence of late-life depression were searched in Web of Science, PubMed, Cochrane Library, American Guide Network, British Guidebook, Website of Registered Nurses Association of Ontario (RNAO), Evidence-based Nursing Center of Fudan University, CNKI and other databases from inception to October 2022, which include guidelines, systematic reviews, expert consensuses, evidence summaries, etc. The quality of the included guidelines, systematic reviews, expert consensuses and original researches were evaluated by investigators trained in systematic evidence-based medicine using the Appraisal of Guidelines for Research & EvaluationⅡ (AGREEⅡ) Instrument, AMSTAR, and the Australian Joanna Briggs Institute (JBI) evidence-based center evaluation standards (2016 version), respectively. Finally, the 2014 Australian JBI evidence-based health care center evidence grading and recommendation level system was used to summary, evaluate and grade the evidence.

Results

A total of 15 articles were included, including 3 guidelines, 11 systematic reviews and 1 RCT. The qualities of the 3 guidelines were graded as B or above, the qualities of 11 systematic reviews were graded as medium or above, and the quality of 1 RCT was graded as B. A total of 24 best evidence items were summarized from 6 aspects of intervention evaluation, diets and nutrition, exercise and rehabilitation training, psychosocial interventions, medication compliance, and effect evaluation.

Conclusion

The study summarizes the best evidence for prevention of late-life depression, suggesting that clinical staff should comprehensively evaluate the patients, and develop individualized intervention program focus on evaluation, diets and nutrition, exercise and rehabilitation training, medication compliance guidance, and psychosocial interventions, combining with the characteristics of patients and diseases.

Original Research·Focus on Primary Health Services

Fairness in the Distribution of General Practitioner Resources in Chinese Mainland

KOU Ruxin, MEI Kangni, BI Yuqing, CHEN Tong, DENG Shengen, XING Jiarun, WANG Qianqian, WANG Mengxue, LI Wei

2023, 26(19):  2339-2345.  DOI: 10.12114/j.issn.1007-9572.2022.0686

Asbtract ( )   HTML ( )   PDF (1417KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

In recent years, China has attached great importance to strengthening the development of general practitioner (GP) workforce and primary care service system. To innovate the incentive mechanism for GP training and employment and improve the training system for GPs, the government has also promulgated a series of policies and put forward major reform measures involving many aspects.

Objective

To analyze and evaluate the fairness of distribution of general practitioner (GP) resources in China, and to provide theoretical support for scientific and equitable allocation of GP resources.

Methods

Data were sourced from five volumes of China Health and Family Planning Statistical Yearbook (2017—2021), China Health Statistical Yearbook (2017—2021), and China Statistical Yearbook (2017—2021) in June 2022, including the number of GPs, the number of people registered as general medicine professionals, the number of people who obtained the General Practitioner Certificate after training, the number of GPs per 10 000 population, and the number of practicing (assistant) physicians in China, in each geographical division (eastern, central or western), and in each regionin, and the annual gross domestic product (GDP), gross regional product (GRP), and the year-end total population data of each region during 2016 and 2020. Additionally, the total land area of each region was extracted from the China ABC column on the website www.gov.cn. The Lorenz curve and the Gini coefficient were used to analyze the fairness in the distribution of GP resources. The Theil index was used to analyze differences in the distribution of GP resources in eastern, central and western China.

Results

The number of GPs in China increased from 209 083 in 2016 to 408 820 in 2020, showing a growth rate 95.53%. In 2020, the proportion of GPs among all practicing (assistant) physicians reached 10.01% (408 820/4 085 689), and the number of GPs per 10 000 population was 2.90. The Gini coefficients measuring demographic, economic, and geographical distribution inequalities of GP resources were 0.235, 0.178, 0.722, respectively for 2016, 0.231, 0.170 and 0.726, respectively for 2017, 0.225, 0.161 and 0.729, respectively for 2018, 0.177, 0.147 and 0.714, respectively for 2019, and 0.157, 0.136, and 0.707, respectively, for 2020. Overall, the Lorenz curve measuring the inequality in the distribution of GP resources by demographics or economy had lower degree of curvature than that by geography. A reduction was found in Theil index measuring unequal demographic, economic or geographical distribution of GP resources in 2020 compared with that in 2016 (from 0.046 to 0.020; from 0.022 to 0.013; from 0.482 to 0.428) .

Conclusion

During the five years, the distribution of GP resources in China presented the following features: the number of GPs increased rapidly and became an important part of the workforce of practicing (assistant) physicians, the registration rate of GPs gradually increased, and the total GP resources showed a continuous growth, but the ratio of GPs per 10 000 population was still unsatisfactory, great inter-region differences existed in the distribution of GP resources, and the equity of the distribution of GP resources by geography was more unsatisfactory than by demographics or economy.

Policy Document Analysis of China's Primary-level Public Health Governance System: a Case Study of the Public Health Committee

OU Xin, YANG Jia

2023, 26(19):  2346-2354.  DOI: 10.12114/j.issn.1007-9572.2022.0636

Asbtract ( )   HTML ( )   PDF (1547KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

In China, the governance of public health by the public health committee, a grassroots mass autonomous organization, is a new approach managing public health services in primary care. Many regions are exploring governance models of public health by the public health committee, aiming to make it a key hub to realize the vertical connection and horizontal linkage grid management of grassroots communities.

Objective

To analyze the policy documents related to the construction of local public health committees of various regions in China using policy document analysis, so as to provide a reference for improving the primary-level public health governance system and governance capacity.

Methods

In March 2022, we searched policy documents related to the construction of public health committees on the official websites of the local governments and health commissions of eight sample regions (Beijing, Guangdong, Chongqing, Shandong, Anhui, Guizhou, Gansu, and Ningxia Hui Autonomous Region) in which village (residential) public health committees have been constructed using "public health committee" as the key search term. Through literature review and policy document analysis, an analytical framework for the governance system of the public health committee was constructed. Nvivo 11 Plus was used for word frequency and coding analyses of the included policy literature.

Results

A total of 15 policy documents and 2 guidance manuals for the work of public health committees were ultimately included. Word frequency analysis showed that the five words, "hygiene" "public" "work" "committee" and "health", appeared most frequently, indicating that the selected policy literature conformed to the research theme. By using the analytical framework, the structural dimensions of the policy literature were determined, including four root nodes, namely, governance subjects, governance mechanisms, institutional guarantees, and capacity building, and 13 sub-nodes. There are 208 reference points for governance subjects, 48 reference points for governance mechanisms, 57 reference points for institutional guarantees, and 87 reference points for capacity building.

Conclusion

The local policy documents of the sample regions cover the contents of the four dimensions, but have different focuses. According to the framework in this study, further construction of the public health committee needs to set certain admission criteria with clear determination of rights and responsibilities for new committee members, establish an effective cooperation and communication mechanism, improve the system guarantee and provide financial and technical support.

Measurement of the Capitation-based Reimbursement Standard for Chronic Disease Management in Primary Care Clinics

NI Jianxiao, GAO Guangying, ZHAO Ning, LI Jin, XU Jiajie, WU Nina, YANG Jia

2023, 26(19):  2355-2360.  DOI: 10.12114/j.issn.1007-9572.2022.0483

Asbtract ( )   HTML ( )   PDF (1232KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The reimbursement of outpatient services is an essential part of the reform of medical insurance payment methods. With the comprehensive promotion of the reform on the medical insurance payment methods for inpatient services in China, the reform on insurance payment methods for outpatient services, such as capitation-based reimbursement and ambulatory patient groups (APG) point method, will gradually be put on the agenda.

Objective

To explore a capitation-based reimbursement scheme for chronic diseases applicable to Beijing based on an analysis of capitation-based reimbursement implemented in different countries and regions and the current situation of chronic disease management in Beijing, to provide a reference for implementing the capitation-based reimbursement reform for chronic diseases in Beijing.

Methods

This study used information related to essential medical services, reimbursement by health insurance, and essential public health service funds in Beijing's C and H districts. Then through an analysis of the information, the calculation method for capitation-based reimbursement standard for four common chronic diseases (hypertension, diabetes, coronary heart disease and stroke were selected in this study) applicable in the districts was designed to calculate the capitation-based reimbursement standard for major chronic diseases in primary outpatient clinics, providing a reference for promoting the capitation reform for chronic diseases in outpatient clinics.

Results

By analyzing the above-mentioned information in 2017—2019, the capitation-based reimbursement standard was 4 693.11 yuan/person for hypertension, 6 597.70 yuan/person for diabetes, 5 644.46 yuan/person for coronary heart disease, and 6 437.78 yuan/person for stroke in H district calculated using the bottom-up costing, and was 4 884.18 yuan/person for hypertension, 5 960.63 yuan/person for diabetes, 3 733.93 yuan/person for coronary heart disease, and 3 886.66 yuan/person for stroke in C district calculated using the top-down estimating.

Conclusion

In calculating the capitation-based reimbursement standard, as different chronic disease patient groups have different outpatient costs, considering the equity of medical insurance reimbursement and the rationality of capitation-based reimbursement, it is necessary to adjust the risk of the benchmark capitation, and develop personalized service packages for different types and severity of chronic diseases. In the promotion of capitation payment for chronic disease patients, it is necessary to provide personalized essential medical service and public health service packages for patients with different chronic diseases, further improve the chronic disease management capacity of community health institutions to improve the contracting rate and establish an effective incentive and assessment mechanism for general practitioners to rationally allocate capitation balance.

Health-related Quality of Life Measured Using the EQ-5D-3L and Health Service Utilization in Rural Residents of Ningxia

LI Peiwen, HE Jiahui, MA Ximin, QIAO Hui

2023, 26(19):  2361-2368.  DOI: 10.12114/j.issn.1007-9572.2022.0770

Asbtract ( )   HTML ( )   PDF (1443KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Exploring the factors affecting health service utilization is of great significance for optimizing the allocation of health services. Health-related quality of life (HRQoL) focuses on individuals' subjective self-assessment of their current health status, and may affect their health-seeking behaviors, but there are few studies on the impact of HRQoL on health service utilization of rural residents in China.

Objective

To explore the relationship between HRQoL and health service utilization of rural residents in Ningxia Hui Autonomous Region, and to provide a reference for the development of relevant policies/plans, and for the optimization health services in rural areas.

Methods

Data were collected from the Health Survey of Rural Residents Families 2019 conducted in four sample counties of Ningxia (Haiyuan, Pengyang, Xiji, Yanchi) from July to August 2019, involving 9 310 cases (≥15 years) with complete key information (gender, age, HRQoL-related indicators, health service utilization indicators). Detailed data of the residents were extracted, including socio-economic and demographic characteristics, health services accessibility, prevalence of chronic diseases, HRQoL measured using European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) and utilization of health services. The effects of health state utility values and visual analog scale (VAS) score on outpatient and inpatient health service utilization were analyzed by binary Logistic regression.

Results

The utilization rates of outpatient and inpatient health services of rural residents in Ningxia were 10.85% (1 010/9 310) and 18.86% (1 756/9 310), respectively. The mean health state utility values and mean VAS score of them were (0.965±0.090) and (69.97±17.84), respectively. Difference testing showed that residents with impaired self-care (in the EQ-5D-3L descriptive system) had higher rates of using outpatient health services〔OR (95%CI) =3.197 (2.633, 3.883), P<0.001〕and inpatient health services〔OR (95%CI) =4.802 (4.059, 5.681), P<0.001〕compared with those with impaired mobility, usual activities, or higher level of pain/discomfort or anxiety/depression. Binary Logistic regression analysis showed that after adjusting for various confounding factors, health state utility values and VAS score were associated with the use of outpatient and inpatient health services (P<0.05). Moreover, the prevalence of chronic diseases also significantly affect the utilization of outpatient and inpatient health services (P<0.05) .

Conclusion

HRQoL and the prevalence of chronic diseases were leading factors affecting the utilization of outpatient and inpatient services in Ningxia rural residents. As an independent predictive factor of residents' health service utilization, HRQoL can be used to assist in the evaluation and monitoring of health service quality and effect, and provide guidance for rational allocation of health resources.

Utilization of Traditional Chinese Medicine Community Services and Influencing Factors by Residents in the Main Urban Areas of Chongqing

GUO Daiyao, PU Chuan, PENG Yang, QIU Lan, HU Xinyu

2023, 26(19):  2369-2375.  DOI: 10.12114/j.issn.1007-9572.2022.0685

Asbtract ( )   HTML ( )   PDF (1484KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

With the increasing aging and the transformation of the disease spectrum of residents, there is increasing national attention to the development of Traditional Chinese Medicine (TCM) services. It is of great significant in better utilizing the proper value of TCM community services in the future to understand the current situation and influencing factors of TCM community services utilization.

Objective

To understand the current situation and influencing factors of TCM community services utilization among residents in the main urban areas of Chongqing from demander's perspective, so as to provide reference for the sustainable development of TCM community services.

Methods

On December 1, 2021, 23 community health service centers were selected by quota sampling method in proportion to the population in 9 central urban areas of Chongqing, and the residents in each community health service center and its surrounding communities by incidental sampling method were selected to conduct questionnaire surveys. The actual number of questionnaires distributed was 840 with 806 valid questionnaires and effective rate of 96.0%. Based on Anderson's health service utilization behavior analysis framework, the factors influencing individual service utilization behavior were summarized into three categories: tendency characteristics, enabling resources and demand factors. At the same time, the dimension of personal TCM culture was added. Binary Logistics regression was used to analyze the influence of the four dimensions on the utilization of TCM in the community.

Results

The utilization rate of TCM community services among the surveyed residents was only 35.9% (289/806), 12 indicators in 4 dimensions were associated with the TCM community services utilization, including propensity characteristics (age, marital status), enabling resources (type of medical insurance, medical expenditure in the last 2 weeks, whether the institutions can meet the basic medical needs of families, whether institutions provide TCM services), demand factors (chronic diseases, self-perception of physical condition in 2 weeks, demand for TCM community services), personal TCM culture (TCM referral willingness, TCM culture trust level, community TCM cultural atmosphere) (P<0.05) .

Conclusion

There are multidimensional and multifactorial influences on the TCM community services utilization among residents. Therefore, targeted measures should be taken to promote residents' utilization of TCM community services.

Original Research·Focus on Mental Disorders

Application of Disability Point Matching Intervention Programme Based on Intervention Mapping Theory in Patients with Schizophrenia Disability

CAO Xiaolang, WANG Weiliang, YU Hong, WANG Xue, ZHOU Yuqiu

2023, 26(19):  2376-2384.  DOI: 10.12114/j.issn.1007-9572.2022.0849

Asbtract ( )   HTML ( )   PDF (1779KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Schizophrenia is considered as one of the top 10 leading causes of disability and life survival time threatening, which is the main cause of mental disability. There are relatively few researches on early intervention and health management for patients with mental disability in China and abroad. In particular, there is a lack of research on interventions for mental disability at different time points in China.

Objective

To explore the effect of disability point matching (DPM) intervention programme based on intervention mapping theory on degree of disability, negative symptoms, insight, self-esteem level and family function in patients with schizophrenia disability.

Methods

A quasi-experimental study design was used in the research. The patients at P1 (disability1~<2 year, 70 cases), P2 (disability 2~<3 years, 70 cases) and P3 (disability≥3 years, 70 cases) were randomly divided into the intervention group (35 cases) and control group (35 cases) by using random numbers generated by SPSS. The control group at all three time points received routine care, and the intervention group received DPM based on the routine care. The duration of the intervention was 8 weeks, once a week. The patients were assessed using WHO Disability Rating Scale (WHO-DASⅡ), Positive and Negative Syndrome Scale-Negative Subscale (PANSS-N), Self-knowledge and treatment attitude questionnaire (ITAQ), Self-Esteem Scale (SES) and family adaptation, partnership, growth, affection, resolve (APGAR) before intervention, after 8 weeks of intervention, 3 months after 8 weeks of intervention and 6 months after 8 weeks of intervention, respectively. The health outcomes between the two groups at each time point were compared by using repeated measures analysis of variance.

Results

There were main effects and interaction effects of time and group in the WHO-DASⅡ, PANSS-N, ITAQ and SES scores at P1 after DPM intervention (P>0.05), there were main effects and interaction effects of time and group in the APGAR score at P1 after DPM intervention (P>0.05). WHO-DASⅡ and PANSS-N scores were lower and ITAQ (P>0.05), SES, and APGAR scores were higher in the intervention group than the control group at after 8 weeks of intervention, 3 months after 8 weeks of intervention and 6 months after 8 weeks of intervention (P<0.05). There were main effects and interaction effects of time and group in WHO-DASⅡ、ITAQ、SES、APGAR scores of patients at P2 after DPM intervention. WHO-DASⅡ score was lower and SES score was higher in the intervention group than the control group at after 8 weeks of intervention and 6 months after 8 weeks of intervention (P<0.05), ITAQ and APGAR scores were higher in the intervention group than the control group at after 8 weeks of intervention, 3 months after 8 weeks of intervention and 6 months after 8 weeks of intervention (P<0.05). There were main effects and interaction effects of time and group in WHO-DASⅡ and ITAQ scores at P3 after DPM intervention. WHO-DASⅡI score was lower and ITAQ score was higher than the control group at after 8 weeks of intervention, 3 months after 8 weeks of intervention and 6 months after 8 weeks of intervention (P<0.05) .

Conclusion

The DPM intervention program based on intervention mapping theory is effective in improving the disability degree, negative symptoms, insight, self-esteem and family function in patients with schizophrenic disability.

Influence of Policy Factors on Healthcare-seeking Behaviors in Patients with Schizophrenia

LIU Rui, DENG Jing, CHEN Ailing, CHENG Peihua, LUO Xingneng, HU Yongjiao, ZHANG Munan

2023, 26(19):  2385-2394.  DOI: 10.12114/j.issn.1007-9572.2022.0680

Asbtract ( )   HTML ( )   PDF (1899KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

In China, schizophrenia patients have a high demand for basic medical care, but irrational healthcare-seeking behaviors among them may cause a waste of health resources. So relevant policies have been promulgated to improve the ensuring of healthcare and reasonably guide schizophrenia patients to seek medical care. The current research on policy factors and healthcare-seeking behaviors has rarely addressed the association between mental health policies and healthcare-seeking behaviors of patients with schizophrenia.

Objective

To analyze the influence of policy factors on healthcare-seeking behaviors in schizophrenia patients, to understand the status and outcome of health service utilization in this group under the guidance of basic medical insurance policies and mental health policies, providing empirical evidence for policy improvement.

Methods

In November 2019, we obtained a sample of 2 314 schizophrenic individuals with valid key data by matching the personal data in the three-level psychiatric prevention and treatment network system in a district of Chongqing in 2018, with information related to personal health service utilization in the district obtained from the medical insurance information platform of Chongqing Human Resources and Social Security Bureau. Multivariate Logistic regression analysis was conducted with healthcare-seeking behaviors and the medical institution chosen for treatment as explained variables, participation in basic medical insurance (including basic medical insurance for rural and urban non-working residents or basic medical insurance for urban employees, and reimbursement for medical cost due to special outpatient diseases) and mental health policy coverage (involving community rehabilitation services, guardianship subsidy, subsidy from the local disability federation, subsidy from the 686 program, and free second-generation antipsychotics, and the mental disability certificate) as key explanatory variables, and patients' demographic characteristics as control variables.

Results

Of the participants, 1 915 (82.76%) had medical visits, including 1 482 seeking outpatient treatment, and 795 seeking inpatient treatment. Among those seeking outpatient treatment, the prevalence of choosing primary, secondary and tertiary care institutions was 17.01% (252/1 482), 72.87% (1 080/1 482), and 10.12% (150/1 482), respectively. And the prevalence of choosing primary, secondary and tertiary care institutions for inpatient treatment was 4.78% (38/795), 65.16% (518/795), and 30.06% (239/795), respectively. Logistic regression analysis showed that the type of basic medical insurance, reimbursement for medical cost due to special outpatient diseases, receiving community rehabilitation services, enrolment in the 686 program and involvement in the free second-generation antipsychotics program were factors associated with healthcare-seeking behaviors (P<0.05). The type of basic medical insurance, reimbursement for medical cost due to special outpatient diseases, receiving community rehabilitation services, enrolment in the free second-generation antipsychotics program, and the level of mental disability were factors associated with choosing outpatient settings for treatment (P<0.05). The type of basic medical insurance and the level of mental disability were associated with choosing inpatient settings for treatment (P<0.05) .

Conclusion

Policy factors played a positive role in guiding schizophrenia patients to seek medical treatment, but some problems were also revealed, such as low patient participation and insufficient coverage pathways. In view of this, efforts should be made as soon as possible to optimize mental health policies and the social support and assistance system, increase patient participation of relevant programs via strengthening the publicity of relevant policies, actively guide home-based rehabilitation activities, further promote community-based delivery of mental health services, and continuously improve the mental health security system.

Epidemiological Survey of the Prevalence and Associated Factors of Mental Disorders in Xinjiang Uygur Autonomous Region

GE Anxin, ZHANG Guiqing, JIANG Liang, XING Wenlong, HU Min, LI Haohao, MENG Yao

2023, 26(19):  2395-2401.  DOI: 10.12114/j.issn.1007-9572.2022.0761

Asbtract ( )   HTML ( )   PDF (1644KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Socioeconomic development, lifestyle changes and the COVID-19 pandemic all have an impact on people's mental and physical health, which may affect the prevalence of mental disorders. Currently, there is still no sufficient epidemiological information of mental disorders in Xinjiang.

Objective

To investigate the prevalence and influencing factors of common mental disorders among people aged 15 and above in northern Xinjiang, then compare the data with those of their counterparts in southern Xinjiang, and summarize the overall prevalence of common mental disorders in Xinjiang, providing a scientific basis for the formulation of corresponding mental health plans.

Methods

From November 2021 to July 2022, a multistage, stratified, random sampling method was used to select 3 853 residents from northern Xinjiang to attend a survey. General Demographic Questionnaire, and self-assessment scales (the 12-Item General Health Questionnaire, Mood Disorder Questionnaire, Symptom Checklist-90, etc.) and other assessment scales (Hamilton Depression Inventory, Bech-Rafaelsen Mania Rating Scale, Brief Psychiatric Rating Scale, etc.) were used as survey instruments. Mental disorders were diagnosed by the ICD-10 classification of mental and behavioral disorders by two psychiatrists with at least five years' working experience, or by a chief or associate chief psychiatrist when there is an inconsistency between the diagnoses made by the two psychiatrists.

Results

The point prevalence rate and age-adjusted rate of common mental disorders in northern Xinjiang were 9.71% (374/3 853) and 10.07%, respectively. The point prevalence rate and age-adjusted rate of common mental disorders in the whole Xinjiang were 9.69% (750/7 736) and 9.90%, respectively. The point prevalence rates of mood disorders, anxiety disorders, schizophrenia, organic mental disorders, and mental retardation in northern Xinjiang were 4.83% (374/7 736), 3.63% (281/7 736), 0.63% (49/7 736), 0.23% (18/7 736), and 0.36% (28/7 736), respectively. Multivariate Logistic regression analysis for northern Xinjiang showed that: the risk of mood disorders in females was 1.854 times higher than that in males〔95%CI (1.325, 2.593) 〕; The risk of mood disorders increased by 5.210 times in 25-34-year-olds〔95%CI (1.348, 20.143) 〕 and 3.863 times in 35-44-year-olds 〔95%CI (1.030, 14.485) 〕 compared with that in those aged ≥65 years; The risk of mood disorders increased by 0.199 times in those with high school or technical secondary school education〔95%CI (0.078, 0.509) 〕 and 0.147 times in those with two- or three-year college and above education〔95%CI (0.056, 0.388) 〕 compared with that in illiteracies. The risk of anxiety disorder in females was 1.627 times higher than that in males〔95%CI (1.144, 2.315) 〕; The risk of anxiety disorder increased by 0.257 times in 15-24-year-olds〔95%CI (0.091, 0.729) 〕, 0.243 times in 45-54-year-olds〔95%CI (0.101, 0.583) 〕, and 0.210 times in 55-64-year-olds〔95%CI (0.067, 0.661) 〕 compared to that of those aged ≥65 years old. The risk of schizophrenia among people living in villages or towns was 4.762 times higher than that of those living in cities〔95%CI (1.705, 13.300) 〕; The risk of schizophrenia among people with high school or technical secondary school education was 0.079 times higher than that of illiteracies〔95%CI (0.015, 0.405) 〕.

Conclusion

The prevalence of mood disorders and anxiety disorders is high among all types of mental disorders in Xinjiang. Females, rural people, or low educated people in northern Xinjiang are more prone to various types of mental disorders.

Characteristics of Newly Increased and Deceased Patients with Severe Mental Illness in a Community in Beijing from 2011 to 2021

SUN Xuhai, SHI Xiuxiu, ZHAO Zhengzheng, HAN Jinxiang

2023, 26(19):  2402-2407.  DOI: 10.12114/j.issn.1007-9572.2022.0759

Asbtract ( )   HTML ( )   PDF (1603KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

There is a contradiction between a large population with severe mental illness and insufficient capacity to receive and treat them in China. Most of these patients long-termly live in the community, so it is essential for community health institutions to provide this population with timely and effective primary mental health services.

Objective

To analyze the characteristics of newly increased and decreased patients with severe mental illness in a community in Beijing from 2011 to 2021, so as to provide evidence for the implementation of community-based prevention and treatment of mental illnesses.

Methods

In January 2022, information of registered patients with severe mental illness (schizophrenia, bipolar disorder, schizoaffective disorder, persistent delusional disorder, mental disorders associated with epilepsy or mental retardation accompanied by mental disorders) in a community of Beijing was obtained through Beijing Municipal Mental Health Information Management System, including demographic characteristics, disease status and the status of file creation. The yearly morbidity, mortality and years of life lost (YLL) rates were calculated for years between 2011 and 2021. With the patient information up to December 31, 2010 as the baseline, the information of newly increased and deceased patients from 2011 to 2021 was counted.

Results

From 2011 to 2021, the newly increased patients outnumbered the deceased ones, and the prevalence rate increased year by year since 2012, reaching 3.77‰ in 2021. Compared with the baseline, patients with severe mental illness in 2021 presented the following features: higher education level, a higher proportion of employers, a higher proportion of 60-year-olds and older, a lower proportion of schizophrenics, a higher proportion of patients with bipolar disorder, and a shorter duration of non-creation of files, and the differences were statistically significant (P<0.05). During the period, there were 212 newly increased patients, and most of them suffered from schizophrenia (57.08%, 121/212) or bipolar disorder (36.32%, 77/212). The age of the first onset was mostly between 19 and 45 years (65.57%, 139/212). The number of patients with 5 years or less of duration of non-creation of files was the most (40.57%, 86/212), and the average median was 8.5 (15.5) years. Among the 90 deceased cases, schizophrenics accounted for the highest percentage (86.67%, 78/90), and those aged over 60 years accounted for 74.44% (67/90). The top three causes of death were somatic disease (84.44%, 76/90), suicide (7.78%, 7/90), and accidental death (2.22%, 2/90). The YLL rate fluctuated between -0.250‰ and 1.436‰ during the period.

Conclusion

The period of 2011 to 2021 witnessed more newly increased community residents with severe mental illness than deceased ones, an increased prevalence trend of severe mental illness, a shortened duration of non-creation of files, and the aged as the major deceased group, and somatic diseases as the major cause of death. Targeted measures should be taken to cope with the above changes.

Original Research·Focus on General Practice Education

Construction of a Hierarchical Progressive Continuing Medical Education Model for General Practitioners with the Cooperative Framework between County-level Government and Medical Institutions and a Tertiary General Hospital

FANG Lizheng, HUANG Lijuan, ZHU Wenhua, LU Guoqiang, ZHANG Yan, JIN Mengqi, ZHU Yue, YU Xiaoming, SHENG Wei

2023, 26(19):  2408-2411.  DOI: 10.12114/j.issn.1007-9572.2023.0075

Asbtract ( )   HTML ( )   PDF (1397KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Continuing medication education for in-service general practitioners (GPs) is a key measure for strengthening the primary health care system, and the department of general medicine in a tertiary general hospital is an important institution undertaking the trainings for GPs. We introduced the development of a staged continuing medical education model for GPs initiated since 2020 by Deqing County Government with Health Bureau of Deqing County in collaboration with Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine and medical educations in Deqing, with a detailed description of the three stages of development, namely the formation of medical and educational framework of Sir Run Run Shaw Hospital in cooperation with the Deqing County Government and medical institutions in Deqing, the construction of "Sir Run Run Shaw Hospital-Deqing" regional GPs education community, and the implementation of trainings for GPs in primary care by the education community using a strategy of "hierarchical and progressive teaching, and cyclic strengthening". The development of this model will offer a reference for the construction of a regional GP training model using the cooperative framework between county-level government and medical institutions and the department of general practice in a tertiary general hospital.

Implementation of Hierarchical Progressive Continuing Medical Education Training Model for General Practitioners with the Cooperative Framework between County-level Government and Medical Instituions and a Tertiary General Hospital

ZHU Wenhua, FANG Lizheng, HUANG Lijuan, LU Guoqiang, ZHANG Yan, JIN Mengqi, ZHU Yue, YU Xiaoming, SHENG Wei

2023, 26(19):  2412-2416.  DOI: 10.12114/j.issn.1007-9572.2023.0077

Asbtract ( )   HTML ( )   PDF (1435KB) ( )  

Figures and Tables | References | Related Articles | Metrics

The design and implementation of county continuing professional development and training model for general practitioners is the core of the collaboration on continuing professional development of general practice between the Department of General Practice of Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine and Deqing County of Zhejiang Province. This article introduces the design and implementation of the "hierarchical progressive" continuing professional development training model in the collaboration framework in detail, shares a information platform by virtue of high-quality resources of general practice department of the general hospital, develops the county-level professional development training model for general practitioners, providing reference for colleagues.

Efficiency and Prospect of Hierarchical Progressive Training for County-level General Practitioners with the Cooperative Framework between County-level Government and Medical Instituions and a Tertiary General Hospital

HUANG Lijuan, FANG Lizheng, ZHU Wenhua, LU Guoqiang, ZHANG Yan, JIN Mengqi, ZHU Yue, YU Xiaoming, SHENG Wei

2023, 26(19):  2417-2422.  DOI: 10.12114/j.issn.1007-9572.2023.0076

Asbtract ( )   HTML ( )   PDF (1541KB) ( )  

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

Background

Since October 2020, relying on the teaching resources and experience of Department of General Practice of Sir Run Run Shaw Hospital, a three-stage hierarchical progressive teaching and training of "teacher training-backbone training-continuous training" has been carried out for general practitioners in People's Hospital of Deqing County and 12 subordinate primary care institutions in Deqing County.

Objective

To analyze the related efficiency of stratified stepped training for regional general practitioners from October 2020 to November 2021.

Methods

The stage competencies of 14 senior faculty members were evaluated prior to participation in training (October 2020), at the end of rotation training of Department of General Practice of Sir Run Run Shaw Hospital (January 2021) and at the end of the 12-month training (October 2021) ; the competency evaluation covers five aspects: general practice occupational competence, general practice clinical competence, general practice skills, general practice teaching competence and general practice professional competence. The stage competencies of 28 core general practitioners were evaluated prior to participation in training (January 2021) and after completing the 12-month training (December 2021), the competency evaluation covers four aspects: general practice occupational competence, general practice clinical competence, general practice skills and general practice professional competence. The stage competencies of 82 junior echelon general practitioners were evaluated prior to participation in training (January 2021) and after completing the 12-month training (December 2021), the competency evaluation covers three aspects: general practice occupational competence, general practice clinical competence and general practice skills.

Results

There were significant differences in general practice occupational competence among 14 senior faculty members (P<0.05) ; among them, the scores of general practice professional competence in the third month and the twelfth month of training were higher than those before training (P<0.05). There were significant differences in the scores of general practice clinical competence and general practice skills among the senior faculty members in different time points (P<0.05) ; the scores of general practice clinical competence and general practice skills in the third month and the twelfth month of training were higher than those before training (P<0.05). The scores of general practice teaching competence of senior faculty members in the twelfth month of training were higher than those in the third month of training (P<0.05). The scores of general practice professional competence, general practice clinical competence, general practice skills of 28 core general practitioners after training were higher than those before training (P<0.05). The scores of general practice professional competence, general practice clinical competence, general practice skills of 82 junior echelon general practitioners after training were higher than those before training (P<0.05) .

Conclusion

This study provides an orderly, robust and sustainable model of continuous training and ability improvement of regional general practitioners after practice with the leading and supporting of general hospitals, which can effectively enhance the competence level and improve job competency of regional general practitioners.

Digital and Smart Healthcare & Informationization

Causes and Countermeasures of Algorithmic Bias and Health Inequity

CHEN Long, ZENG Kai, LI Sha, TAO Lu, LIANG Wei, WANG Haocen, YANG Rumei

2023, 26(19):  2423-2427.  DOI: 10.12114/j.issn.1007-9572.2023.0007

Asbtract ( )   HTML ( )   PDF (1462KB) ( )  

References | Related Articles | Metrics

With the development of information technology, artificial intelligence shows great potentials for clinical diagnosis and treatment. Nevertheless, bias in algorithms derived by artificial intelligence can lead to problems such as unequal distribution of healthcare resources, which significantly affect patients' health equity. Algorithmic bias is a technical manifestation of human bias, whose formation strongly correlates with the entire development process of artificial intelligence, starting from data collection, model training and optimization to output application. Healthcare providers, as the key direct participants in ensuring patients' health, should take corresponding measures to prevent algorithmic bias to avoid its related health equity issues. It is important for healthcare providers to ensure the authenticity and unbiasedness of health data, optimize the fairness of artificial intelligence, and enhance the transparency of its output application. In addition, healthcare providers need to consider how to tackle bias-related health inequity, so as to comprehensively ensure patients' health equity. In this study, we reviewed the causes and coping strategies related to algorithmic bias in healthcare, with the aim of improving healthcare providers' awareness and ability to identify and address algorithmic bias, and laying a foundation for ensuring patients' health equity in the information age.

Recent Developments in the Application of Artificial Intelligence in the Diagnosis and Treatment of Osteoarthritis

GUO Tianci, CHEN Jixin, YU Weijie, LIU Aifeng

2023, 26(19):  2428-2433.  DOI: 10.12114/j.issn.1007-9572.2023.0019

Asbtract ( )   HTML ( )   PDF (1574KB) ( )  

References | Supplementary Material | Related Articles | Metrics

Osteoarthritis (OA) is a degenerative disease frequently encountered clinically, which can lead to loss of joint function in the late stage and is associated with a high disability rate. There is still no available cure for OA. Therefore, early diagnosis and precise treatment are the key to improving the therapeutic effect. Being an interdisciplinary research focus, artificial intelligence (AI) has been increasingly used in the diagnosis and treatment of OA recently, as it improves the diagnostic accuracy as well as clinical treatment and prognosis of OA. We summarized and systematically reviewed the literature on the application of AI in the diagnosis and treatment of OA, in which the application potential in assisting imaging diagnosis, surgical treatment, progression prediction and postoperative rehabilitation of OA was indicated, yet some limitations including non-standardized data collection and unstable algorithmic system were also identified. In the future, it is expected to establish a standardized clinical sample database and continuously optimize the algorithmic model, so as to better incorporate AI technologies in the diagnosis and treatment process of OA.

Reform for Primary Health Care

Exploratory Research on Models of Operating Elderly Care Facilities by Community Health Institutions from Integrated Medical and Elderly Care Perspective: a Case Study of Yinling Elderly Nursing Home Held by Beijing Xicheng District Yuetan Community Health Center

ZI Jing, DU Xueping

2023, 26(19):  2434-2438.  DOI: 10.12114/j.issn.1007-9572.2022.0813

Asbtract ( )   HTML ( )   PDF (1495KB) ( )  

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

The need for elder care has become more pressing as population aging is accelerating in China. The General Office of the State Council of the People's Republic of China has promulgated a number of opinions between 2013 and 2021 aiming at promoting the implementation of integrated medical and elderly care services, enhancing the quality of geriatric services, and strengthening aging services in the new era. And then primary care institutions and elderly care facilities have put the issue on the critical agenda, namely how to take actions to divide labor and cooperate to ensure the elderly to get security and support. This paper discusses the importance and necessity of the model of elderly care institutions operated by community health institutions, and analyzes its benefits and drawbacks from five dimensions: service providers, service scope, service forms, service receivers, and operational effects, with the expectation of gradually implementing the actions to improve the national level of integrated medical and elderly care, to develop a high-quality community-based integrated medical and elderly care model, and to promote the concept of healthy aging.