Table of Content

05 December 2023, Volume 26 Issue 34

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Health Policy Research

Falls Prevention Intervention for Community-dwelling Older Adults from the Perspective of Policy Tools: an International Comparative Study

GU Hanxin, LIU Yang, LIU Yuanli

2023, 26(34):  4231-4238.  DOI: 10.12114/j.issn.1007-9572.2023.0092

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Background

Falls among older adults will cause a heavy burden on society and families. The development of effective falls prevention intervention policies for community-dwelling older adults is an important initiative to address this global public health problem.

Objective

To analyze and compare the content composition, key initiatives and implementation strategies of current falls prevention intervention policies for community-dwelling older adults in different countries from the perspective of policy tools.

Methods

Six countries in Asia, North America, and Europe, including Japan, Singapore, Thailand, the United States, Germany, and Russia, were selected as sample countries according to the degree of population aging and economic income level. Refer to the websites of relevant government departments such as the Ministry of Health, the Center for Disease Control and Prevention and directly affiliated institutions, as well as websites of nongovernmental organizations, such as Prevention of Falls Network Europe, National Council On Aging, U.S., Association of Fall Prevention, Japan, and National Association of Statutory Health Insurance Funds, Germany, the national policy documents of prevention interventions for community-dwelling older adults from January 2010 to June 2022 were searched by using "older adults" "fall/drop/accidental injuries" "prevention" as keywords. The text analysis was performed from the dimensions of policy tools such as demand-side type, supply-side type and environmental-side type, and injury prevention strategies such as education prevention strategies and evaluation strategies.

Results

Among the 24 policy documents, there were 212 coded targets in the dimension of policy tools, with environmental-side type, supply-side type and demand-side type policy tools accounting for 45.3% (96/212), 40.6% (86/212) and 14.1% (30/212), respectively. Among high-income countries, the public service tools under supply-side type policy tools were mostly applied in the United States and Germany, accounting for 40.5% (17/42) and 13.8% (8/58) ; the infrastructure construction tools under supply-side type policy tools were focused in Singapore〔24.1% (7/29) 〕. Among low and middle income countries, the environmental-side type policy tools were mostly applied in Russia and Thailand, accounting for 51.3% (20/39) and 55.6% (10/18), respectively. Public service was mostly applied among the supply-side type policy tools, accounting for 17.5% (37/212) ; technical standard was mostly applied among the environmental-side type policy tools, accounting for 10.8% (23/212) ; medicare payment was mostly applied among the demand-side type policy tools, accounting for 4.7% (10/212). In addition, there were 105 coded targets in the dimension of injury prevention strategies, with the education prevention strategies accounting for the highest proportion of 31.4% (33/105), the engineering strategy accounting for the lowest proportion of 5.7% (6/105). High-income countries are at the stage of multi-sectoral collaborative policy implementation, low and middle income countries are at the stage of policy implementation by the Ministry of Health stage.

Conclusion

Six countries focus on public service and infrastructure development under supply-side type policy tools; the application of demand-side type policy tools can be summarized as intervention services managed by medical insurance, intervention projects supported by financial funds, service purchases attracted by price subsidies, planning, organization, advocacy, and standard setting of environmental-side type policy tools. In combination with the priorities and specific measures of the six countries, it is suggested to learn from advanced experience in improving public services, strengthening evidence-based projects, standardizing technical standards, supporting financial incentives, expanding medical insurance programs, and providing price subsidies, thus further optimizing falls prevention intervention policies for community-dwelling older adults.

The Logic and Trend of Urban Community Health Service Policies in China

HUANG Jinling, ZENG Zhirong

2023, 26(34):  4239-4245.  DOI: 10.12114/j.issn.1007-9572.2023.0173

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Background

Urban community health services are key to promoting the high-quality development of community health. However, previous studies have seldom explored the evolutionary logic and development trend of community health service policies. It is difficult to provide a comprehensive answer to the questions of the generation, evolution and trend of community health service policies in China.

Objective

To understand the current status, evolutionary logic and trend of community health service policies, in order to provide intellectual reference for promoting the high-quality development of community health services and implementing the hierarchical diagnosis and treatment system.

Methods

The Central People's Government website, National Health Commission, relevant official provincial websites, CNKI, China Community Health Association and other platforms were searched from December 2019 to March 2022 for community health service reform related policies published at national level (n=98) from January 1997 to March 2022. The included policies were analyzed with the help of the policy orientation analysis model.

Results

The policy changes in urban community health services of China have gone through four stages since 1997, including initial exploration centered on the transformation and frame construction (from 1997 to 2002), normative construction focusing on the bottom of the public health network (from 2003 to 2008), prosperous development focusing on the mechanism reform (from 2009 to 2016), and deepening reform centered on quality improvement and empowerment (from 2017 to 2022). The changes in community health service policies in China follows the following evolutionary logic, including the dynamic mechanism from marketization to professionalization and social community linkage governance, target orientation from scale expansion to internal quality improvement, policy discourse changing from predominantly economics-based discourse to multiple tools coordination.

Conclusion

Community health service policies should promote the innovation of the dual collaborative governance framework and mechanism, strengthen the coordination among professional systems and their effective synergistic linkage with the social community governance systems; promote community value-based health care and trust-based health care with health as the core, establish and improve evaluation standards for the capacity and quality of specialized primary care; promote the diversified application and matching of policy tools to adapt to the diversified needs of community health and wellness interests.

Original Research

Current Situation and Countermeasure of Medical Service Capacity of Primary Care Physicians in China

LIAN Lu, CHEN Jiaying, WANG Xuanxuan, LI Yahui, ZHU Ya

2023, 26(34):  4246-4253.  DOI: 10.12114/j.issn.1007-9572.2023.0289

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Background

With the promotion of "strengthening the primary care" measures, the number of primary healthcare professionals in China has increased significantly, but there is still a gap between the capacity of primary care physicians and basic medical needs of residents.

Objective

To understand the current situation of the medical service capacity of primary care physicians in different regions and between urban and rural areas of China, explore the strategies to improve the medical service capacity of primary care physicians in China.

Methods

In August 2020, an online questionnaire survey on 8 537 primary care physicians in the primary care institutions in eastern, central and western China by using the method of multi-stage stratified sampling combined with typical sampling. The questionnaire was designed based on the indexes in the part of medical service of the medical service capacity evaluation tool of primary care physicians previously developed by the research group, which was used to evaluate the competence of primary care physicians in four aspects of diagnosis and treatment of common diseases and frequent diseases, emergency treatment of critical illnesses, medical service coordination and traditional Chinese medicine services and assess the extent to which their competence met the needs of their work. The competence of primary care physicians and the extent to which their competence met the needs of their work were compared in different regions and levels of medical institutions.

Results

A total of 8 469 valid questionnaires were collected, with the recovery rate of 99.2%. There were 6 954 (82.1%), 4 283 (50.6%), 4 800 (56.7%) and 4 464 (52.7%) primary care physicians who had the ability of diagnosis and treatment of common diseases and frequent diseases, emergency treatment of critical illnesses, medical service coordination and traditional Chinese medicine services. The rate of medical competence of primary care physicians in the central region were higher than those in the eastern and western regions from the perspective of regional distribution, with statistically significant differences (P<0.017) ; there were significant differences in the rate of medical competence of primary care physicians between rural and urban areas from the perspective of institutional level (P<0.05). Except for diagnosis and treatment of common diseases and frequent diseases, the rates of medical competence of other medical services of the primary care physicians in the rural area were higher than those in the urban area (P<0.05), the medical competence rates of emergency treatment of critical illnesses and traditional Chinese medicine services of primary care physicians in village clinics were higher than those in community health service centers and township hospitals, with statistically significant difference (P<0.005). In terms of the rate of ability to meet work needs, the rates of primary care physicians were 97.2% (4 233/4 357), 96.2% (4 269/4 436), 95.2% (3 227/3 388), 92.3% (3 954/4 284) in diagnosis and treatment of common diseases and frequent diseases, emergency treatment of critical illnesses, medical service coordination and traditional Chinese medicine services; the rate of primary care physicians was higher in the eastern region than in the central and western regions (P<0.017), higher in urban areas than in rural areas (P<0.05), and higher in community health service centers than in village clinics (P<0.005), with statistically significant differences.

Conclusion

There is a shortage of high-quality personnel in the team of primary care physicians in China. The abilities of emergency treatment of critical illnesses, medical service coordination and traditional Chinese medicine services still needs to be strengthened. The overall rate of medical competence of primary care physicians in the central region, rural areas and village clinics is high, but the rate of ability to meet work needs is low. It is necessary to provide more support to primary care physicians in each region in terms of improving policies and training methods in accordance with local conditions.

Evaluation of Medical Level in China by Provinces Based on Principal Component Analysis and TOPSIS Model

ZHOU Jie, HU Lingjuan, HUAI Qingyu

2023, 26(34):  4254-4260.  DOI: 10.12114/j.issn.1007-9572.2023.0106

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Background

During the nationwide epidemic of COVID-19 infection, the spatial agglomeration of medical resources in China has been highlighted, and there are obvious differences in medical level among provinces. Currently, the evaluation of medical level in China by provinces was mainly conducted by domestic scholars using quantitative methods, while comprehensive method was less applied to evaluate the medical level by provinces.

Objective

To understand the differences in the level of healthcare development in China by provinces, so as to provide a reference for healthcare decision makers.

Methods

In November 2022, CNKI, Wanfang Data Knowledge Service Platform, and Web of Science were searched by computer for the researches in the field of medical level. Based on the existing research results, relative and average indicators were selected to construct the evaluation index system. The data of each evaluation index was extracted or calculated by using China Health and Health Statistical Yearbook 2022 as the data source. Using the principal component analysis and TOPSIS model, the medical levels of 31 provinces in China (Hong Kong Special Administrative Region, Macao Special Administrative Region and Taiwan Province were not included in the statistics) were comprehensively evaluated.

Results

A total of 6 qualified papers were retrieved and 13 relative and average indicators were selected from three aspects of medical resources, medical services, and medical security to construct the evaluation system. The KMO value was 0.733, and Bartlett's spherical test showed that χ²=346.908, P<0.001, suggesting that the data were suitable for principal component analysis; four principal components were extracted according to the criterion of characteristic root above 1.000, including the scale of medical resources and quality of medical services (F1), the efficiency of medical institutions (F2), infectious disease control ability (F3), and other factors (F4), and the cumulative percent variance of the four principal components was 84.012%. After establishing the linear model of each principal component based on the matrix of the principal component scores, the comprehensive evaluation model for the medical level was obtained based on the cumulative percent variance of the four principal components: Y=0.439 85×Y1+0.158 54×Y2+0.154 40×Y3+0.087 34×Y4. The top three provinces in terms of comprehensive score of medical level were Beijing (151.908 points), Shanghai (124.379 points), and Tianjin (78.673 points). The TOPSIS proximity ranking showed that Beijing and Shanghai were at the top level (proximity was 0.767 and 0.646, respectively), and the 31 provinces could be divided into three echelons with proximity 0.400 and 0.201 as the nodes. The first echelon included three provinces of Beijing, Shanghai and Tianjin, the second echelon included 25 provinces such as Zhejiang Province and Sichuan Province, the third echelon included three provinces of Hebei Province, Ningxia Hui Autonomous Region and Tibet Autonomous Region.

Conclusion

There is an obvious imbalance in the level of medical development in China by provinces, showing an olive-shaped structure of "big in the middle and small at the two ends" in the overall distribution of medical level in 31 provinces. The government should increase the incline degree of policy for provinces with low ranking in medical level, such as Hebei Province, play a coordinating role in regional health planning, and implement targeted assistance by using telemedicine and medical big data.

Current Situation of the Construction of Family Doctor Team: an Investigation Based on the Perspective of General Practitioners

HAO Aihua, ZENG Weilin, LI Guanhai, XIA Yinghua, CHEN Liang

2023, 26(34):  4261-4268.  DOI: 10.12114/j.issn.1007-9572.2023.0035

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Background

Currently, there are many studies on family doctor contracting services from the perspective of residents, but few scholars have conducted studies on the current situation of family doctor team contracting based on the perspective of general practitioners (GPs) .

Objective

To understand the current situation of family doctor contracting services in primary health care institutions in Guangdong Province, and explore the factors affecting the contracted number from the perspective of the supplier.

Methods

From July 5—31, 2021, GPs in primary health care institutions in Guangdong Province were selected as the study subjects by using a multi-stage stratified cluster sampling method to conduct the survey with a self-designed questionnaire. The contracted number was compared by different GPs and their family doctor team characteristics. A two-level Logistic regression developed by R 4.2.2 software was used to identify influencing factors of contracted number above 2 000.

Results

A valid sample of 3 252 cases in family doctor team with contracted number more than 100 was screened, and the median contracted number was 1 400 (2 499) in 2020. The differences were statistically significant when comparing the contracted number by gender, age, education level, position, employment form, working years, working unit, working area, training acceptance, and annual income, number of team members, population size under jurisdiction, willingness of specialists from medical community to join the team, inpatient bed resources and guidance from superior departments (P<0.05). Zero model fitting showed that contracted number was clustered at the regional level (P<0.05). Two-level Logistic regression model showed that, with master's degree or above as the reference, the contracted number of the team including GPs with college〔OR (95%CI) =2.79 (1.84, 3.74) 〕and secondary/high school〔OR (95%CI) =2.83 (1.80, 3.86) 〕degrees were more likely to be above 2 000; taking no position as reference, the contracted number of the team including unit leaders〔OR (95%CI) =0.66 (0.33, 0.99) 〕was more likely to be above 2 000; taking temporary staff as reference, the contracted number of the team including formal staff〔OR (95%CI) =2.02 (1.53, 2.51) 〕was more likely to be above 2 000; taking the team with size of 3 or less people as reference, the contracted numbers of the teams with size of 4 to 6 people〔OR (95%CI) =1.31 (1.05, 1.57) 〕, 7-10 people〔OR (95%CI) =2.06 (1.75, 2.37) 〕, 11-19 people〔OR (95%CI) =3.67 (3.31, 4.03) 〕and≥20 people〔OR (95%CI) =3.46 (2.74, 4.18) 〕were more likely to be above 2 000; taking population size under jurisdiction at 2 000 or less as reference, the contracted numbers of the team with population size under jurisdiction at 2 001 to 9 999〔OR (95%CI) =2.37 (2.12, 2.62) 〕, 10 000 to 29 999〔OR (95%CI) =2.92 (2.65, 3.19) 〕and more than 30 000〔OR (95%CI) =2.86 (2.55, 3.17) 〕were more likely to be above 2 000; taking condition of having inpatient bed resources as reference, the contracted number of the teams without such resources〔OR (95%CI) =1.38 (1.14, 1.62) 〕was more likely to be above 2 000 (P<0.05) .

Conclusion

The population under jurisdiction and the large number of team members create favorable conditions for contracting; family doctor teams with GPs with positions, inpatient bed resources and high education level have a good understanding of family doctor contracting service policies and control the number of contracted patients better; comparing with temporary staff, GPs team with formal staff may undertake more contracting tasks.

Trends and Projections of Incidence and Mortality of Nasopharyngeal Carcinoma in China from 1990 to 2019

ZHU Wenpeng, HAN Mengqi, WANG Yuxin, WANG Guoping

2023, 26(34):  4269-4276.  DOI: 10.12114/j.issn.1007-9572.2023.0247

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Background

In 2020, there were 62 000 new cases of nasopharyngeal carcinoma (NPC) in China, accounting for about 80% of the NPC cases worldwide. Analysis of the trend and projection of the incidence and mortality of NPC can provide a scientific basis for the prevention and treatment of NPC.

Objective

To evaluate the trend of incidence and mortality of NPC in Chinese residents, and explore the effects of age, period and cohort on the risk of incidence and death of NPC.

Methods

From December 2022 to January 2023, data on the ASIR (age standardized incidence rate) and ASMR (age standardized mortality rate) of NPC in China were extracted from the Global Burden of Disease 2019 database. The Joinpoint regression model was used to analyze the trends in ASIR and ASMR of NPC in China from 1990 to 2019. The age-period-cohort model was used to analyze the age effect, period effect and cohort effect affecting the risk of incidence and death of NPC in China. The ASIR and ASMR of NPC in China in the next 20 years were predicted using the R BAPC package.

Results

There was an overall increasing trend in ASIR of NPC (AAPC=1.82, P<0.01) and decreasing trend in ASMR of NPC (AAPC=-2.45, P<0.01) among Chinese residents from 1990 to 2019. The overall risk of incidence and death of NPC generally increased with age (RR values ranged from 0.09 to 2.24 and 0.10 to 4.43 for males, 0.13 to 1.84 and 0.12 to 4.44 for females, respectively), but the incidence risk of NPC decreased after 55 years old (RR values ranged from 2.24 to 2.99 for males and 1.84 to 2.33 for females). The incidence risk of NPC increased (RR value ranged from 0.61 to 1.81 in males and 1.33 to 0.84 in females) over the years, and the risk of death from NPC decreased in females (RR value ranged from 1.42 to 0.79) and increased in males after 2005 (RR value ranged from 0.95 to 0.99). The later the birth was correlated with lower the risk of incidence and death of NPC (RR values ranged from 0.57 to 3.47 and 0.12 to 3.49 for males, 0.31 to 2.64 and 0.19 to 2.46 for females). It is predicted that the ASIR of NPC in China will continue to rise in the next 20 years, with 21.32/10⁵ in males and 4.95/10⁵ in females in 2039, the ASMR of NPC will decrease, with 1.88/10⁵ in males and 0.53/10⁵ in females in 2039.

Conclusion

The incidence of NPC in Chinese residents showed an increasing trend and mortality showed a decreasing trend from 1990 to 2019. Age effect and period effect dominate in terms of incidence risk of NPC, and age effect dominates in terms of the risk of death of NPC. It is predicted that the incidence of NPC will still increase and the mortality will decrease in the future.

Association between Chronotype and Dyslipidemia among Population Aged 40-65 Years

LIANG Xiaoxian, YANG Jin, JIN Juzhen, ZHOU Jing, HU Jin, GAI Yun, DING Xiaoyun, WANG Junhua, WANG Ziyun

2023, 26(34):  4277-4282.  DOI: 10.12114/j.issn.1007-9572.2022.0857

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Background

Lipid metabolism of middle-aged and older adults may be influenced by their late bedtime behavior, but the association between the above two still needs to be analyzed in-depth.

Objective

To explore the association between chronotype and dyslipidemia among populations with different gender, central obesity, late evening snacks and smoking.

Methods

A questionnaire survey was conducted among the population aged 40-65 years who received health examination in physical examination center, the First People's Hospital of Fuquan City from March to August, 2022 (n=697). General information and sleep conditions of the included patients were collected and chronotype was evaluated by single-item question of the Morning and Evening Questionnaire. Unconditional binary Logistic regression model was used to evaluate the association between chronotype and the risk of dyslipidemia. Stratified analysis was also performed by gender, central obesity and late evening snacks among the whole population, and performed by smoking among male population. Sensitivity analysis was used to exclude the effect of shift work.

Results

Among the included subjects, morningness preference chronotype accounted for 56.4% (n=393), while eveningness preference chronotype accounted for 43.6% (n=304), with 334 cases (47.9%) detected with dyslipidemia. Unconditional binary Logistic regression analysis showed that chronotype was an influencing factor of dyslipidemia〔OR (95%CI) =1.54 (1.10, 2.16) 〕, the risk of hypertriglyceridemia〔OR (95%CI) =1.48 (1.04, 2.12) 〕and low high-density lipoprotein cholesterol〔OR (95%CI) =1.79 (1.18, 2.72) 〕was higher in the adults with eveningness chronotype than those with morningness chronotype (P<0.05). Stratified analysis of the whole population showed that the risk of low high-density lipoprotein cholesterol was 1.80 times (95%CI: 1.12, 2.91) and 1.73 times (95%CI: 1.02, 2.81) in adults with eveningness chronotype of that in adults with morningness chronotype among male population and the central obesity population, respectively (P<0.05) ; the risk of hypertriglyceridemia was 3.43 times (95%CI: 1.30, 8.99) in adults with eveningness chronotype of that in adults with morningness chronotype among population with late evening snacks (P<0.05) ; while there was no significant effect of chronotype on dyslipidemia and other lipid indexes in female and non central obesity populations (P>0.05). The stratified analysis by smoking in male population showed that the risk of low high-density lipoprotein cholesterol was 1.83 times (95%CI: 1.03, 3.26) in adults with eveningness chronotype of that in adults with morningness chronotype in smoking population (P<0.05) ; while there was no significant of chronotype on hypercholesterolemia, hyper-LDL cholesterolemia and non-HDL-C abnormalities in both smoking and non-smoking populations (P>0.05) .

Conclusion

Eveningness preference chronotype may be a risk factor for dyslipidemia in adults aged 40-65 years, and the associations between dyslipidemia and chronotype may vary across populations with different gender, central obesity, late evening snacks, and smoking status.

Current Status and Influencing Factors of the Intention to Screen for High-risk Stroke among Community Residents in Guangdong

QIN Fengyin, ZHANG Qishan, LAI Jinjia, HUANG Yimin, HAN Guoyin, SUN Xinglan, WANG Fen, TAN Yibing

2023, 26(34):  4283-4289.  DOI: 10.12114/j.issn.1007-9572.2022.0679

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Background

Stroke high-risk population screening project is a national health project being vigorously promoted in China, but it is found that the participation rate of residents in it is low, which seriously affects the screening efficiency. Screening intention is an important predictor of screening behavior, however, there are few studies on the current status and influencing factors of the intention to screen for high-risk stroke among community residents.

Objective

To understand the current status of the intention to screen for high-risk stroke among community residents and explore the influencing factors.

Methods

A total of 648 residents of Guangdong Province were selected as survey respondents by using convenient sampling method from March to May 2022. Self-designed questionnaires (including General Data Questionnaire, Stroke High-Risk Screening Intention Scale, Stroke Health Knowledge Scale, Community Medical Service Trust Scale, Perceived Social Support Scale) were used to investigate the respondents. The scores of Stroke High-Risk Screening Intention Scale among residents with different characteristics were compared, and the factors affecting intention to screen for high-risk stroke among community residents were analyzed by multiple linear regression.

Results

A total of 600 valid questionnaires were collected with the recovery rate of 92.6%. The average total score of the Stroke High-Risk Screening Intention Scale among residents was (101.30±14.98), of which 352 (58.7%) residents had a high level of intention for screening, 248 (41.3%) residents had a middle or low level of intention for screening. There were significant differences in the scores of Stroke High-Risk Screening Intention Scale among residents by gender, residential status, hypertension, hyperlipidemia, smoking status, awareness of high-risk stroke screening, implementation of previous high-risk stroke screening in the community, acceptance of previous high-risk stroke screening, self-perceived lifetime risk of stroke and self-perceived risk of stroke within 1 year (P<0.05). There was a positive correlation of the score of Stroke High-Risk Screening Intention Scale with the scores of Stroke Health Knowledge Scale, Community Medical Service Trust Scale and Perceived Social Support Scale (P<0.05). Multiple linear regression analysis showed that gender, hypertension, hyperlipidemia, community has implemented stroke high-risk screening, self-perceived lifetime risk of stroke, scores of Perceived Social Support Scale, Community Medical Service Trust Scale and Stroke Health Knowledge Scale were influencing factors of intention to screen for high-risk stroke among community residents (P<0.05) .

Conclusion

The overall intention of community residents in Guangdong Province for high-risk stroke screening is high, but the screening intention of some residents still needs to be improved. It is suggested that the community should focus on male residents with low intention of screening, strengthen education of the health knowledge of stroke, especially risk factors, to help residents understand their own risk of stroke and the importance of high-risk screening. The investment in screening equipment and medical facilities in community health service institutions should be increased, the construction of community medical and nursing personnel needs more attention at the national level, so as to enhance the trust of residents in community medical services. Meanwhile, the positive impact of social support on the level of intention to screen for high-risk stroke should also be emphasized, to effectively increase the level of intention of residents to participate in high-risk stroke screening through expanding the publicity at the social level and creating an atmosphere of universal participation in screening.

Relationship between Community Health Service Experience and Glycemic Control Outcomes in Patients with Diabetes Mellitus

YANG Hui, HU Ruwei, LIU Ruqing, LU Junfeng, WU Jinglan

2023, 26(34):  4290-4295.  DOI: 10.12114/j.issn.1007-9572.2023.0087

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Background

Community health services play an effective role in delaying the progression of diabetes and managing diabetes complications. Previous studies have suggested that the subjective experiences of visits to community health centers by patients with diabetes contributes to their improved health outcomes. However, few studies have evaluated the correlation of glycemic control outcomes with specific service processes and objective experiences of programs received by diabetic patients in the community health service centers.

Objective

To explore the correlation between the community health service experiences and glycemic control outcomes in patients with diabetes mellitus.

Methods

A cross-sectional survey design and multi-stage, cluster random sampling method was used to select six community health service centers in the central urban area of Guangzhou, with one family doctor team randomly selected from each center. A total of 336 patients with diabetes who visited the corresponding family doctor teams from September to November 2019 were recruited as the study subjects. A questionnaire was conducted to collect baseline information, fasting plasma glucose (FPG) level, and Primary Care Assessment Tool (PCAT) scores. The glycemic control outcomes of patients were assessed based on the FPG level, and their experiences of community health services were assessed based on the PCAT scores. Logistic regression models were used to evaluate the effect of community health service experiences on glycemic control outcomes in diabetic patients.

Results

The glycemic control rate of the included diabetic patients was 73.2% (246/336). The total PCAT score and the scores for each dimension of PCAT with good glycemic control outcomes were higher than those of patients with poor glycemic control outcomes, and the difference was statistically significant (P<0.05). The results of multivariate Logistic regression showed an effect of total PCAT score on glycemic control outcomes in diabetic patients〔OR (95%CI) =0.12 (0.06, 0.23) 〕, as well as the scores for each dimension of PCAT (P<0.05). The results of subgroup analysis showed that for diabetic patients with different genders, types of health insurance and hypertension history, the total score of PCAT had an effect on the glycemic control outcomes (P<0.05) .

Conclusion

Community health service experience is a protective factor for the glycemic control outcomes of diabetic patients. Enhancing community health service experience is of great significance for improving the glycemic control outcomes in patients with diabetes.

The Current Status and Influencing Factors of Clinical Inertia in Type 2 Diabetes Patients in Community

LI Dianjiang, PAN Enchun, SUN Zhongming, WEN Jinbo, WANG Miaomiao, WU Ming, SHEN Chong

2023, 26(34):  4296-4301.  DOI: 10.12114/j.issn.1007-9572.2023.0178

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Background

Although type 2 diabetes mellitus (T2DM) cannot be completely cured, however, there is a consensus that timely community management of T2DM patients following guidelines can lead to good glycemic control. However, blood glucose of the patients is chronically suboptimal due to T2DM-related clinical inertia. It is crucial for improving the effectiveness of diabetes control to determine the current status and influencing factors of clinical inertia in T2DM patients in community, but there is limited literature on this topic.

Objective

To investigate current status and influencing factors of clinical inertia during health management in T2DM patients in community.

Methods

From January to December 2020, T2DM patients receiving health management services from the national basic public health services in Qingjiangpu and Huaian Districts, Huaian City, Jiangsu Province, were recruited using cluster random sampling method to perform face-to-face questionnaire survey, physical examination, and laboratory tests. Clinical inertia was defined as the absence of intensification in antidiabetic treatment for patients with inadequate HbA_1c control (HbA_1c≥7.0%) in the past three months. Stepwise multiple Logistic regression analysis was performed to identify influencing factors of the detection of clinical inertia in T2DM patients in community.

Results

A total of 3 346 T2DM patients with inadequate glycemic control (HbA_1c≥7.0%) were included in the study, with the overall detection rate of clinical inertia in T2DM patients of 93.96% (3 144/3 346), 94.84% (1 139/1 201) in men and 93.47% (2 005/2 145) in women, respectively. There were significant differences in the detection rate of clinical inertia among T2DM patients with different levels of dietary control, physical activity, blood glucose monitoring periods, diabetic complications, dyslipidemia (history), and history of coronary heart disease, stroke, and cancer. Stepwise multiple Logistic regression analysis showed that dietary control〔OR (95%CI) =0.585 (0.382, 0.894) 〕, glucose monitoring period≤1 week〔OR (95%CI) =0.470 (0.344, 0.644) 〕, presence of diabetic complications〔OR (95%CI) =0.606 (0.423, 0.868) 〕, dyslipidemia (history) 〔OR (95%CI) =0.725 (0.532, 0.988) 〕, history of coronary artery disease〔OR (95%CI) =0.659 (0.458, 0.949) 〕, and stroke〔OR (95%CI) =0.699 (0.511, 0.955) 〕were associated with a lower prevalence of clinical inertia in T2DM patients (P<0.05) .

Conclusion

There is a serious problem of clinical inertia in T2DM patients undergoing health management in community, the prevalence of clinical inertia is closely related to patients' dietary control, glucose monitoring period, presence of diabetic complications, and comorbid diseases (history) .

Conceptual Framework and Responding Approach of Treatment Burden of Type 2 Diabetes: a Video Recording-based Analysis

LIN Kai, YAO Mi, CHEN Zhang, JI Xinxin, LIN Runqi, CHEN Yongsong, Sim MOIRA

2023, 26(34):  4302-4307.  DOI: 10.12114/j.issn.1007-9572.2022.0864

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Background

Patients with type 2 diabetes commonly experience a high treatment burden. Currently, both domestic and international researches on the treatment burden of the specific diseases is still in its initial stage.

Objective

To summarize the conceptual framework of treatment burden related to type 2 diabetes in the Chinese population and explore proactive responding approaches for general practitioners based on video recordings of clinical consultation scenarios.

Methods

A retrospective analysis of video recordings from general practice training clinics in a standardized training base in Guangdong Province from 2018 to 2019 was conducted by using qualitative research methods such as observation record forms, notes from the fields, encoding-retrieval and thematic analysis, combining with existing conceptual framework of treatment burden.

Results

A total of 49 video recordings of doctor-patient communication about the treatment burden of type 2 diabetes were extracted from 25 video recordings. All 6 themes of the original conceptual framework were mentioned and 2 new themes (burden of medical information and drug-induced hypoglycemia) were identified by analysis that were mentioned repeatedly. A modified conceptual framework of the treatment burden of type 2 diabetes was finally developed containing 7 observable dimensions including economic, drug, medical management, lifestyle change, healthcare system, time/travel, and medical information burdens and the connotation of subtopics in each dimension. According to the analysis of the response approach, general practitioners who have received training can respond consciously to some of the treatment burdens (medications, medical information, time/travel, lifestyle change) by utilizing the skills of health education, enhanced communication, shared decision-making and motivational interviewing.

Conclusion

This study constructs a modified conceptual framework of treatment burden for patients with type 2 diabetes. General practitioners can consciously respond to treatment burdens of patients by using effective doctor-patient communication skills, in combination with the identification of conceptual dimensions in clinical practice.

The Management Effect of Diabetes "1358 model" on Community Diabetes Patients Based on "Precision Management Combining General Care and Specialty Care"

YAO Yuzhong, MA Xiaojun, SONG Huan, ZHONG Yu

2023, 26(34):  4308-4314.  DOI: 10.12114/j.issn.1007-9572.2022.0562

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Background

Difficult problems such as poor diagnosis and treatment capacity of diabetes in the community, low screening rate of complications, low standardized monitoring rate of blood glucose, and low rate of blood glucose compliance are the problems that general practitioners need to think about and solve when carrying out management of diabetes patients. It is necessary to explore and innovate the standardized management mode of diabetes in the community for making general practitioners become specialists in the general practice and achieve "precision management combining general care and specialty care".

Objective

To understand the management effect of diabetes "1358 model" on community diabetes patients based on "precision management combining general care and specialty care".

Methods

A total of 212 patients with diabetes who visited the outpatient clinic at the Hongkou District North Bund Street Community Health Service Center from May to July 2020 and had signed a contract with the community general practitioner were selected as the research subjects and divided into 106 cases in the control group and 106 cases in the intervention group by the random number table method. The patients in the control group received routine follow-up management, and the patients in the intervention group received the "1358 model" of diabetes based on "precision management combining general care and specialty care". One year after the intervention, the cognitive and behavioral levels of diabetes, the attainment of key indicators and the experience of visiting community health centers were compared between the two groups.

Results

There was no statistically significant difference in the cognition and behavior related to diabetes management and the attainment rate of key indicators between the two groups (P>0.05). After intervention, the proportions of patients in the intervention group who monitored FPG within 1 month, monitored 2 hPG within 1 month, carried out comprehensive blood glucose monitoring within 1 month, monitored HbA_1c within 6 months, carried out self-monitoring of blood glucose, recorded a blood glucose diary, standardized the use of medication, followed the doctor's advice on diet, screened for peripheral vascular complications within 1 year, screened for urinary albumin/creatinine within 1 year, screened for carotid artery plaques within 1 year, screened for the inner ocular fundus within 1 year were higher than those of the control group, and the difference was statistically significant (P<0.05) ; however, there was no significant difference in the proportions of patients with regular exercise and weekly foot examination between the two groups (P>0.05). After the intervention, the rates of FPG attainment, HbA_1c attainment and ABC composite attainment of patients in the intervention group was higher than those of the control group, and the difference was statistically significant (P<0.05) ; however, there was no statistically significant difference in the 2 hPG attainment rate between the two groups (P<0.05). The proportions of patients who thought that the community diagnosis and treatment capacity was good, the community drugs basically met the demand, the community had testing equipment for blood glucose-related indexes, the community could solve the basic health problems, the community could carry out screening for complications, the community consultation and guidance for specialized diseases was convenient in the intervention group were higher than those of the control group, and the difference was statistically significant (P<0.05) .

Conclusion

The "1358 model" of diabetes based on "precision management combining general care and specialty care" is of positive significance in promoting and improving patients' health beliefs, standardizing blood glucose monitoring behavior, improving the rate of compliance with key indicators, and enhancing community medical experience, which can be promoted and applied in the community. This model may break through the bottleneck of insufficient resources of diabetes specialty in the community, and further improve the management level and service connotation of diabetes specialty of general practitioners.

Exploration and Differential Analysis of Continuing Education of General Practitioners' Clinical Thinking Ability Based on Working Competence

ZHANG Hanzhi, GE Xuhua, LU Yuan, JIN Hua, GUO Aizhen, CHEN Yuge, MA Linlin, PAN Ying, YU Dehua

2023, 26(34):  4315-4321.  DOI: 10.12114/j.issn.1007-9572.2022.0565

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Background

The current training content of continuing education in general practice cannot meet the needs of clinical practice, as well as the lacking of thinking and characteristics of general practice in teaching faculty and evaluation methods.

Objective

To explore the training of clinical thinking in general practice through continuing education, so as to solve practical problems and improve working competence of general practitioners (GPs) .

Methods

The design of the 8th GPs' practice ability training workshop course was optimized based on the literature reading and feedback from the continuing education course of GPs' practice ability workshop in November 2020, and a questionnaire survey was conducted through the "wenjuanxing" platform among 200 GPs who participated in the 8th workshop course to evaluate the overall and various levels of improvement in their clinical thinking ability and working competence.

Results

A total of 200 questionnaires were distributed, and 172 valid questionnaires were collected, with a recovery rate of 86.0%. After the training, 52.3% (90/172) and 21.5% (37/172) of the GPs had improved and greatly improved their overall clinical thinking ability in general practice, respectively, and 56.4% (97/172) and 22.1% (38/172) showed improvement and great improvement in overall working competence. There was a statistically significant difference in the improvement of clinical thinking ability and working competence among GPs with different professional titles and job types after training (P<0.05). There were 134 (77.9%), 134 (77.9%), 133 (77.3%), 127 (73.8%), 114 (66.3%) GPs who believed that "reading images" "clinical thinking ability in general practice" "interpretation of test indicators" "diagnosis and treatment of common dermatological and pentacologic diseases" and "scientific research training" could significantly improve the working competence of GPs. There were significant differences in the improvement of working competence by the course on "reading images" "clinical thingking ability in general practice" "diagnosis and treatment of common dermatological and pentacologic diseases" among GPs with different professional titles and job types (P<0.05). There was significant difference in the improvement of working competence by "scientific research" training course section in GPs of different genders (P<0.05) .

Conclusion

Optimized continuing education of general practice has a significant effect on the clinical thinking and working competence of GPs. In the design of training to improve the clinical thinking and working competence of GPs, it is also necessary to pay attention to the integration of various types of knowledge and skills in the training, and the practice experience base and accumulation of the trainees.

Evaluation of the Application Effect of Virtual Reality Technology in Standardized Training of General Practice Residents

LI Jingjing, YUAN Ding, WANG Xiuling, KANG Hongfei, LAI Chengcheng, WANG Peisong, LU Guangping, GAO Yanxia

2023, 26(34):  4322-4328.  DOI: 10.12114/j.issn.1007-9572.2023.0143

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Background

The emergence of virtual reality (VR) technology is the breakthrough of medical education reform. It is the focus of clinical educators to apply VR technology to medical education and discuss the application effect. The application of VR in the standardized training of residents (referred to as residential training) is not rare, but the literature on the application of VR in the residential training of general practice has not been reported.

Objective

To explore the effectiveness of VR technology in the residential training of general practice, and provide a reference for the promotion and application of VR technology in the residential training of general practice.

Methods

From May 16, 2022 to August 16, 2022, a total of 58 general practitioners in the grade of 2020 in the Department of General Practice in the First Affiliated Hospital of Zhengzhou University, Henan Province were selected as the research objects and divided into the experimental group (n=29) and control group (n=29) by using random number generator. The experimental group adopted the teaching method of combining traditional theoretical training and VR skills training, and the control group adopted the method of combining traditional theoretical training and traditional skills training. The training content included the first aid of cardiopulmonary resuscitation and electric defibrillation, the treatment process of organophosphorus poisoning, and treatment process of independent sudden dyspnea in the hospital. Questionnaires were distributed to investigate the basic information of the subjects and their understanding of VR before the training, theoretical and skill assessments were carried out respectively after training, and the two groups of residents were compared in theoretical assessment results, skill assessment results, self-assessment results of the key points of training skills and satisfaction with teaching methods.

Results

There was no difference in gender, age and years of graduation between the experimental group and control group (P>0.05). After training, the theoretical and skill assessment scores of the experimental group were higher than those of the control group (P<0.05). With an assessment score ≥80 as excellence in assessment, the excellent rate of theoretical assessment in the experimental group was higher than the control group (P<0.05). The self-assessed rate of mastery of the key points of the first aid skills for electric defibrillation and organophosphorus poisoning in the experimental group was higher than the control group (P<0.05). The satisfaction scores of study interest, self-study ability, clinical thinking and judgment ability, clinical comprehensive ability, simulation of clinical environment, improvement of teaching effect, preparation for clinical practice and whether teaching is helpful to them were all higher than those of the control group (P<0.05) .

Conclusion

Compared with the traditional teaching mode, the application of traditional theoretical training combined with VR skills training teaching method is conducive to improving their mastery of professional knowledge, which has popularization value in the teaching of residential training of general practice.

Evidence-based Medicine

Detection Rate of Depression and Its Influencing Factors in Chinese Elderly: a Meta-analysis

WANG Yue, CHEN Qing, LIU Lurong

2023, 26(34):  4329-4335.  DOI: 10.12114/j.issn.1007-9572.2023.0269

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Background

China has been already in the stage of deeply aging society, and the health problems of the elderly are getting more and more attention. Depression in the elderly not only affects the quality of life in later life, but also increases the economic burden on society and families, so early identification of the influencing factors of its development is of great significance. However, the existing research conclusions are still controversial, and there are few relevant systematic reviews in China.

Objective

To explore the depression detection rate and its influencing factors in the elderly in China since 2018, provide reference for reducing the incidence of depression in the elderly and promoting healthy aging.

Methods

In January 2023, PubMed, EmBase, Web of Science, CNKI, Wanfang Date and VIP were searched for publicly available studies on factors influencing depression in Chinese elderly from 2018 to 2022. The data were extracted and the literature quality was evaluated according to the cross-sectional study quality assessment criteria of Agency for Healthcare Research and Quality (AHRQ) and Stata 15.0 was adopted for Meta-analysis.

Results

Twenty-three papers were finally included, with a cumulative study population of 75 599, and a total of 13 815 depressed older adults were detected; the AHRQ quality assessment scores of the papers ranged from 5 to 7. Meta-analysis results showed that the detection rate of depression in the elderly in China was 20.6%〔95%CI (16.6%, 24.8%) 〕, female〔OR=1.46, 95%CI (1.30, 1.64) 〕, advanced age〔OR=1.48, 95%CI (1.13, 1.94) 〕, lower education level〔OR=1.52, 95%CI (1.32, 1.75) 〕, no spouse〔OR=1.60, 95%CI (1.35, 1.91) 〕, living in rural areas〔OR=1.38, 95%CI (1.14, 1.66) 〕, suffering from chronic diseases〔OR=2.75, 95%CI (2.07, 3.66) 〕, 2 chronic diseases〔OR=1.84, 95%CI (1.07, 3.14) 〕, 3 or more chronic diseases〔OR=3.86, 95%CI (2.89, 5.15) 〕, poor self-rated health〔OR=3.47, 95%CI (1.14, 10.53) 〕, insomnia〔OR=2.62, 95%CI (1.88, 3.66) 〕, living alone〔OR=1.86, 95%CI (1.56, 2.21) 〕, no exercise〔OR=1.88, 95%CI (1.60, 2.20) 〕, self-care needs or partial needs〔OR=2.96, 95%CI (1.12, 7.85) 〕were risk factors for depression in the elderly (P<0.05), while drinking〔OR=0.67, 95%CI (0.50, 0.88) 〕and having friends〔OR=0.52, 95%CI (0.38, 0.71) 〕were protective factors (P<0.05) .

Conclusion

Although the detection rate of depression among elderly in China has decreased, it is still at a high level, and the elderly in China who are female, elderly, less educated, without spouse, living in rural areas, suffering from chronic diseases and chronic disease comorbidity, with poor self-rated health, suffering from insomnia, living alone, without exercise, and living in need or partial need of self-care may be more likely to suffer from depression.

Construction of Optimized Treatment Plan of Acupuncture for Migraine Based on Entropy Weight-TOPSIS Method

WANG Zhe, DONG Zhihao, ZHENG Hao, KONG Wencheng, ZHANG Yukuan, ZHANG Qiuyue, HAN Jing

2023, 26(34):  4336-4342.  DOI: 10.12114/j.issn.1007-9572.2022.0896

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Background

With the accumulation of high-quality evidence, the clinical effectiveness of acupuncture for migraine has been increasingly recognized. Numerous acupuncture clinical studies in China highlight and validate various acupuncture intervention schemes through clinical trials. Integrating and selecting these advantageous schemes to guide clinical practice has become a new focus in acupuncture research.

Objective

To conduct multicriteria decision making (MCDM) by using technique for order preference by similarity to an ideal solution (TOPSIS) method based on Meta-analysis, screen optimized treatment plan (OTP) of acupuncture for migraine and explore the ideas for constructing OTPs of acupuncture.

Methods

Wanfang Data, VIP, CNKI, SinoMed, PubMed, Web of Science, and EmBase were searched by computer for randomized controlled trials (RCTs) on acupuncture treatment for migraine published before April 2022. Two researchers independently screened the literature, extracted basic characteristics of literature〔author, year of publication, sample size, cure rate, efficiency rate and visual analogue score (VAS), etc.〕, and assessed the quality of the RCTs by using modified Jadad scale. Acupuncture treatment plans for migraine were summarized based on the characteristics of the included RCTs, and Meta-analysis was performed. The relative risk (RR) of cure rate and efficiency rate, and the mean difference (MD) of VAS scores for each plan were extracted based on the Meta-analysis results. The treatment frequency and score of the modified Jadad scale were calculated for each plan using sample size as the weight. The data were all included in the MCDM analysis, the weights of different decision criterion were determined using the entropy weight method. The TOPSIS method was finally used to select OTP of acupuncture for migraine.

Results

A total of 17 RCTs were included and categorized into 8 types of treatment plans of acupuncture for migraine (Tongyuan acupuncture, six-spirit points, bone-nearby acupuncture, conventional acupuncture, Gallbladder Meridian acupoints, head acupoints, penetration needling method and Siguan acupoints) according to the results of Meta-analysis. The TOPSIS evaluation indicated that the treatment plan of acupuncture focusing primarily on head acupoints is OTP, involving needling the head acupoints of Fengfu, Touwei, Toulinqi, Taiyang, Shuaigu, and Fengchi once daily or every other day, with an average treatment number of 11, with the main advantages of shorter treatment time and significant reduction in VAS.

Conclusion

The OTP of acupuncture for migraine screened and constructed in the study can provide reference for clinical application. The utilization of the entropy weight-TOPSIS method based on Meta-analysis presents a novel approach for constructing the OTPs of acupuncture for migraine.

Bibliometrical Study

Visual Analysis of Hotspots and Cutting-edge Trends of Community TCM Service Research in China in the Context of Healthy China

XU Jian, DAI Fangfang, PAN Wenlei, HUANG Qian, LU Ping, WANG Jianfeng, JIA Huan, YANG Yuqi, HUANG Jiaoling

2023, 26(34):  4343-4350.  DOI: 10.12114/j.issn.1007-9572.2023.0078

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Background

Community traditional Chinese medicine (TCM) service is an important step in promoting the construction of Healthy China. There are abundant academic research results in the field of community TCM service in China, but there is a lack of collation of these research results. Systematically sorting out the relevant literature in the field of community TCM service by using the method of bibliometrics can provide a macroscopic understanding of the research progress and hotspots in this field and reference for future research.

Objective

To sort out the hotspots and development trends of community TCM service research in China by using bibliometric methods.

Methods

On May 2 in 2022, CNKI, Wanfang Data Knowledge Service Platform and VIP were searched for relevant research literature on community TCM service research in China from January 2000 to April 2022. By using CiteSpace software, the visual analysis of the co-occurrence of authors included in the literature, keywords co-occurrence, clustering, timeline distribution, and burst terms were performed and the relevant graphs were plotted.

Results

A total of 1 440 papers were included, and the publication volume of community TCM services in China showed an overall increasing trend, with 75 papers (5.2%) published in 2000—2005, 382 papers (26.5%) in 2006—2011, and 983 papers (68.3%) in 2012—2022. The top three authors in the publication volume were Shi Yongxing (25 articles), Bao Yong (16 articles), and Liu Deng (14 articles). The top 5 high-frequency keywords in terms of centrality were "TCM" "Chinese medicine" "community" "general practitioner" and "general practice". The keyword clustering analysis formed 12 cluster labels, and the top three clusters by scale were "community" "TCM" and "general practitioner". The timeline distribution suggested that clusters such as "community" "TCM" "general practitioner" and "TCM nursing" were research hotspots in this field. From the perspective of burst terms, "family doctor" has the highest burst value (8.07), and "elderly people" "diabetes" "family doctor" "medical consortium" "general practice of TCM" and the "integrated medical care and elderly services" are future research directions.

Conclusion

The current status of community TCM service in China, development of TCM general practitioners and community TCM nurses, and the improvement of TCM service capabilities of community health care institutions are research hotspots. In the future, more attention will be paid to the digital compact TCM medical consortium based on the Internet platform and the contracted family doctor service model with the participation of TCM general practitioners, so as to better utilize the characteristics and advantages of community TCM services in integrated medical care and elderly services.

International Research Status and Hot Spot Analysis of InterRAI HC Based on Bibliometrics

FENG Xiaoyu, LI Wanling, LYU Siman, NI Cuiping, WANG Haocheng, LIU Yu

2023, 26(34):  4351-4358.  DOI: 10.12114/j.issn.1007-9572.2022.0848

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Background

The interRAI Home Care (interRAI HC) is a commonly used international assessment tool, which plays an important role in guiding medical staff to provide home-based care service for the elderly. However, there is a lack of systematic analysis on the use of this tool.

Objective

To summarize the hot spots of the international researches on the application of interRAI HC, so as to provide a reference for its application in the home-based care of community-dwelling older adults and future research in China.

Methods

On October 2022, PubMed was searched for literature related to interRAI HC application from inception to 2022-10-01. BICOMB 2.0 software was used to extract information such as the year and journal of publication, country of the first author, and subject terms to generate lexical matrix and co-occurrence matrix of high-frequency subject terms. gCLUTO 1.0 software was used for biclustering analysis of lexical matrix and strategic diagram graph was plotted.

Results

A total of 301 related papers were retrieved, which were mainly published in British and American academic journals with a fluctuating upward trend of annual publication. A total of 292 major subject terms were extracted and 28 high-frequency subject terms were identified by BICOMB 2.0 software, resulting in four clustering results, including health risk assessment, quality of care monitoring, psychological condition assessment and comprehensive geriatric assessment.

Conclusion

InterRAI HC plays an important role in health risk assessment, quality of care monitoring, psychological condition assessment of older adults and caregivers, and comprehensive geriatric assessment. The application of interRAI HC is still in the exploratory stage in China, and researchers can promote the development of home-based care of community-dwelling older adults in China on the basis of foreign experiences.