Chinese General Practice

Scientific Research is a Responsibility and Priority for the Development of General Practice in China

LIANG Wannian

2024, 27(01): 0-C1. DOI: 10.12114/j.issn.1007-9572.2024.A0007

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The Position Attractiveness Dilemma of Primary General Practitioners in China from the Perspective of Talent Development Mechanism

WU Ning, DANG Yuan, ZENG Cheng, SHI Muran, LI Zongyou, WANG Xiaoyuan, CHANG Hongfei

2024, 27(01): 1-8. DOI: 10.12114/j.issn.1007-9572.2023.0468

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General practitioners (GPs) are the"gatekeepers"of residents' health. In China, Up to 2021, 84.4% of GPs account for 22.7% of the total primary physicians. The quantity and quality of the GP workforce are related to the level of primary care services. In recent years, the central government and governments at all levels have attached great importance to the construction of the GP workforce and successively introduced many supportive policies. However, the number of GPs in China currently only accounts for 10.1% of practicing (assistant) physicians, and the lack of position attractiveness of GPs has become the main reason restricting the development and growth of the GP workforce. Based on the talent itself, this paper constructs a talent development mechanism-oriented model of "primary general practitioner-position attractiveness" to deeply analyze the dilemmas of GPs in seven aspects of education, recruitment, application, motivation, evaluation, development and support, explore countermeasures to solve the problems, in order to provide a scientific basis for enhancing the position attractiveness of GPs, stabilizing the talent team of GPs, and improving the quality and level of primary care services.

The Continuous Improvement and Realization Path of Primary Healthcare Services from the Perspective of Empowerment

CAO Chenglin, CAO Wenwen, MENG Feiyue, HU Zhi, BAI Zhongliang

2024, 27(01): 9-14. DOI: 10.12114/j.issn.1007-9572.2023.0411

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In the context of the new round of medical and health system reform in China, it is of great significance to improve primary healthcare service system and continuously improve the capacity and quality of primary healthcare service. Under the guidance of empowerment theory, this study systematically summarizes relevant research literature, and the results indicated that full empowerment can be achieved through strengthening the guidance for primary health care, focusing on the maintenance of primary healthcare talents, adjusting the allocation mechanism of health resources, and improving the service quality evaluation system, which is conducive to the establishment of a comprehensive, continuously coordinated, fair and accessible integrated high-quality primary healthcare service system. This study further proposes strategies for continuous improvement and enhancement of primary healthcare service quality, aiming to provide reference and basis for solving the structural difficulties in improving the quality and capacity of primary healthcare services.

Adapting the Depression Component of WHO Mental Health Gap Intervention Guide (mhGAP-IG.v2) for Primary Care in Shenzhen, China: a Delphi Study

Searle Kendall, Blashki Grant, Kakuma Ritsuko, YANG Hui, LYU Shurong, LI Baoqi, XIAO Yingying, Minas Harry

2024, 27(01): 15-26. DOI: 10.12114/j.issn.1007-9572.2022.0852

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Background

Primary care doctors in Shenzhen, China are increasingly expected to identify and prevent depressive disorder; however, they have received limited mental health training and community healthcare centres (CHCs) do not provide standardised protocols for the diagnosis and care of depressive disorder. The World Health Organization's mental health gap intervention guide, version 2 (mhGAP-IG.v2) is a decision support tool for non-specialists for the assessment, management and follow-up of mental, neurological and substance use disorders (including depressive disorder). Given that mhGAP-IG.v2 is a generic tool, it requires adaptation to take account of cultural differences in depression presentation and unique characteristics of China's emergent mental health system.

Methods

A two-round, web-based, Delphi survey was conducted. A panel of primary care doctors from Shenzhen, were invited to score their level of agreement with 199 statements (arranged across 10 domains) proposing changes to the content and structure of mhGAP-IG.v2 for use in Shenzhen. Consensus was predefined as 80% panelists providing a rating of either "somewhat agree/definitely agree", or "definitely disagree/somewhat disagree" on a five-point scale for agreement.

Results

79% of statements received consensus with a mean score of 4.26 (i.e. "somewhat agree"). Agreed adaptations for mhGAP-IG.v2 included: an assessment approach which considers a broader spectrum of depression symptoms and reflects the life course of disease; incorporating guidance for screening tool usage; clarifying physicians' roles and including referral pathways for intersectorial care with strong family involvement; aligning drug treatment with national formularies; stronger emphasis of suicide prevention throughout all sections of the guide; contextualizing health education; reflecting a person-centred approach to care. Panelists chose to maintain diagnostic and treatment advice for bipolar patients experiencing a depressive episode as in the current guide.

Conclusion

An adapted mhGAP-IG.v2 for depression recognises China's cultural and contextual needs for assessment guidance; unique primary healthcare system organization, priorities and treatment availability; and diverse psychosocial educational needs. An adapted mhGAP-IG.v2 could both inform the future training programs for primary care in Shenzhen and also offer an additional mental health resource for non-specialists in other countries.

Common Foreign Quality Evaluation Tools of Primary Health Care and Their Implications for China

LIU Lidi, LIAO Xiaoyang, ZHAO Qian, GUO Yiming, WEN Yuqi, LIU Changming, FANG Xiang

2024, 27(01): 27-35. DOI: 10.12114/j.issn.1007-9572.2023.0054

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Primary health care (PHC) is the bottom of the health care system, and its quality not only relates to the construction of hierarchical medical system, but also affects the health level of residents. Scientific and reasonable evaluation of PHC quality is the cornerstone of quality improvement, however, a unified and standardized quality evaluation system of PHC has not been developed in China. Therefore, the international quality evaluation tools of PHC are classified into four categories based on the evaluation focus: quality evaluation tools based on PHC connotations, quality evaluation tools emphasizing the functional characteristics of PHC, quality evaluation tools based on the perceptions of demand and/or supply side stakeholders, and other disease-specific tools or indicator systems. The content and characteristics of each tool were introduced and compared separately, their applicability and shortcomings were analyzed, and the evolution was reviewed, in order to provide reference for the construction of PHC quality evaluation tools in China.

Growth Trends and Overweight/Obesity Status of Children Aged 7-12 Years in China from 2014 to 2020

LENG Zheng qing, ALIMUJIANG· yimiti·taerkin

2024, 27(01): 36-44. DOI: 10.12114/j.issn.1007-9572.2023.0203

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Background

Since the reform and opening up in China, socio-economic development has developed rapidly, and the basic indicators such as children's height and body mass have risen rapidly. Previous studies have shown that the growth in height of Chinese children has slowed in recent years, while the growth in body mass has accelerated, leading to a high prevalence of overweight and obesity currently. Investigating the current growth and nutritional status of Chinese children is important to prevent and address the negative effects of growth trends.

Objective

To analyse the trends of growth and overweight/obesity in Chinese children aged 7 to 12 years from 2014 to 2020, and provide a scientific basis for formulating measures to promote children's physical fitness and prevent obesity.

Methods

In this study, height, body mass and BMI data of 10 817 children aged 7 to 12 years from four surveys of the China Family Panel Studies (CFPS) in 2014, 2016, 2018 and 2020 were selected in May 2022. The trends of height, body mass, prevalence of overweight, obesity and overweight/obesity stratified by gender and urban/rural areas. Logistic regression analysis was also used to explore the factors influencing overweight and obesity among children aged 7 to 12 years in China from 2014 to 2020.

Results

Compared with 2014, the height of 7 to 12 years urban female children, rural male children and rural female children in 2020 increased by 3.8 cm (95%CI=1.3-6.2 cm), 6.5 cm (95%CI=4.3-8.5 cm), 6.6 cm (95%CI=4.3-8.8 cm) respectively Compared with 2014, the body mass of 7 to 12 years urban male children, urban female children, rural male children and rural female children in 2020 increased by 2.3 kg (95%CI=0.8-3.9 kg), 2.1 kg (95%CI=0.6-3.7 kg), 3.0 kg (95%CI=1.7-4.2 kg), 3.0 kg (95%CI=1.8-4.2 kg), respectively, the difference was statistically significant (P<0.05). The prevalence of overweight/obesity among boys increased from 26.5% to 29.5%, the prevalence of obesity and overweight/obesity among girls decreased from 12.1% and 21.1% to 7.9% and 17.3%, the prevalence of overweight and overweight/obesity among urban children increased from 11.7% and 21.6% to 14.9% and 26.4%, and the prevalence of obesity and overweight/obesity among rural children decreased from 14.3% and 25.8% to 11.2% and 21.6% from 2014 to 2020, respectively, which were statistically significant (P<0.05). The results of multivariate Logistic regression analysis showed that age and sex were the influencing factors for prevalence of overweight in children (P<0.05) ; urban/rural areas, age, and gender were the influencing factors for prevalence of obesity and overweight in children (P<0.05) ; age was the influencing factor for prevalence of obesity in boys (P<0.05) ; age and year were the influencing factors for prevalence of obesity in boys (P<0.05) ; age was the influencing factor for prevalence of overweight in girls (P<0.05) ; urban/rural areas, age and year were the influencing factors for prevalence of overweight and obesity in girls (P<0.05) .

Conclusion

From 2014 to 2020, the body shape of children aged 7 to 12 years in China increased rapidly, with greater increase in rural areas than urban areas, and the gap between urban and rural areas has been narrowing. Meanwhile, the prevalence of overweight and obesity in boys and urban children continued to increase, while that in girls and rural children decreased. Rural/urban areas, age and gender are factors influencing the prevalence of overweight/obesity in children.

Association of Tooth Loss with Hearing Impairment in Chinese Older Adults Aged 65 Years and Above

WANG Ruijie, LI Hongyu, SHI Hong

2024, 27(01): 45-50. DOI: 10.12114/j.issn.1007-9572.2023.0383

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Background

Hearing impairment and tooth loss are common among the elderly and seriously endanger their physical and mental health. However, there are limited studies on the correlation of tooth loss, denture use with hearing impairment in the elderly.

Objective

To explore the correlation of tooth loss with hearing impairment among Chinese older adults aged 65 years and above.

Methods

In January 2023, 15 161 eligible older adults aged 65 years and above were selected as the study subjects in the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). With hearing impairment as the outcome variable, the number of natural teeth as the explanatory variable, sociodemographic, lifestyle, and health status information as covariates, multivariate Logistic regression model was used to analyze the effect of tooth loss on hearing impairment, and subgroup analyses of age, gender, activities of daily living abilities and denture use were conducted.

Results

Among the 15 161 subjects, 3 655 (24.11%), 2 355 (15.53%), 4 008 (26.44%) and 5 143 (33.92%) older adults were with teeth number of≥20, 10-19, 1-9 and 0, respectively, and 6 148 (40.55%) had hearing impairment. The results of the multivariate Logistic regression model after adjusting for confounders showed that compared to those with teeth number≥20, older adults with teeth number of 10-19, 1-9 and 0 had higher risk of hearing impairment, with an OR (95%CI) of 1.31 (1.08-1.58), 1.57 (1.32-1.86) and 1.97 (1.65-2.36), respectively. The results of the stratified analysis showed that the association between teeth number and hearing impairment was more significant in older adults aged ≥80 years and those without denture use (P<0.05) .

Conclusion

Tooth loss was associated with increased risk of hearing impairment in Chinese older adults, and those who were older and do not use dentures are at higher risk for hearing impairment.

Exercise Tolerance and Its Influencing Factors in Patients with Stable Coronary Artery Disease under Standardized Community Management

YANG Ling, DU Xueping, DONG Jianqin, DONG Yuming

2024, 27(01): 51-58. DOI: 10.12114/j.issn.1007-9572.2022.0368

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Background

Patients with stable coronary artery disease (SCAD) have a high risk of atherosclerotic stenosis of the coronary arteries, plaque rupture and thrombosis, and a high probability of recurrent cardiovascular events, which is the essential cause of repeated hospitalization. Cardiac rehabilitation mainly based on exercise rehabilitation in developed countries leads to a significant decrease in the incidence, mortality, and readmission rates of cardiovascular disease in these countries and reduces medical costs.

Objective

To investigate exercise tolerance and its influencing factors in the standard management of SCAD patients in Department of General Practice, Yuetan Community Health Service Center, Fuxing Hospital, Capital Medical University, so as to provide a scientific basis for future cardiac rehabilitation in community.

Methods

In January 2020, a total of 980 SCAD patients with standardized management under the age of 75 years were searched in the community health information system (CHIS) (doctor workstation) of Department of General Practice, Yuetan Community Health Service Center, Fuxing Hospital, Capital Medical University by using cluster sampling method. Self-designed questionnaires [including tools such as the General Information Questionnaire and the Veterans Specific Activity Questionnaire (VSAQ) ] were used to investigate the patients. Based on the metabolic equivalents (METs) values measured by VSAQ, they were categorized into exercise tolerance≤7.0 METs group and exercise tolerance>7.0 METs group, and the differences in the clinical data of SCAD patients with different levels of exercise tolerance were compared. Logistic regression analysis was used to explore the factors influencing the exercise tolerance in SCAD patients.

Results

Among 980 patients with SCAD, 108 (11.0%) patients had exercise tolerance>7.0 METs, 619 (63.2%) had 5.0-7.0 METs, and 253 (25.8%) had<5.0 METs. Gender, age, PCI acceptance, prevalence of diabetes mellitus, blood pressure attainment, regular exercise, exercise intensity level, and exercise time per session of SCAD patients in the exercise tolerance≤7.0 METs group were compared with those in the exercise tolerance >7.0 METs group (P<0.05). Logistic regression analysis showed that gender, age, presence of diabetes, blood pressure attainment, regular exercise and exercise intensity were the influencing factors of exercise tolerance level in SCAD patients (P<0.05) .

Conclusion

SCAD Patients have exercise awareness, but their overall level of exercise tolerance is low (≤7.0 METs), with a lacking of exercise guidance. It is recommended to improve their quality of life by increasing their exercise tolerance level through exercise rehabilitation.

The Current Status and Influencing Factors of Treatment Adherence to National Chronic Disease Management Services for Hypertensive Population in a Community Healthcare Center in Guangzhou

PAN Hongwei, LIU Li, MA Chao, DENG Guangpu, FANG Haoting, HUANG Shuwei, ZHU Hong

2024, 27(01): 59-66. DOI: 10.12114/j.issn.1007-9572.2023.0170

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Background

The hypertensive population has a large base in China, and its preventive and treatment measures rely mainly on the chronic disease management service program within the National Basic Public Health Service. However, current studies have shown low utilization rate of it, so it is of great significance for improving the participation of the National Chronic Disease Management Service and health level in the hypertensive population to conduct a survey of participants to determine the factors affecting their treatment adherence.

Objective

To investigate and analyze the current status and influencing factors of treatment adherence of hypertension management services within the National Basic Public Health Service, and provide reference for improving treatment adherence in hypertensive patients.

Methods

A total of 295 participants of hypertension management services in the community served by a community healthcare center in Guangzhou City from June to September 2022 as the study subjects by using a multi-stage sampling method. The General Information Questionnaire and the Emotional Balance Scale (positive and negative emotions) were used to investigate the basic information of the study subjects, and the Hypertension Treatment Adherence Scale was used to investigate the current status of treatment adherence among the study subjects. Multivariate Logistic regression analysis was used to explore the influencing factors of treatment adherence to the National Chronic Disease Management Service in the hypertensive population, and the influence of the combined positive and negative emotion status on treatment adherence to the National Chronic Disease Management Service in the hypertensive population.

Results

A total of 310 valid questionnaires were distributed, 295 valid questionnaires were recovered, with a validity rate of 95.2%; the total score of the Hypertension Treatment Adherence Scale was (94.24±8.67), of which the score of medication adherence was (21.06±2.45), medication malpractice was (31.33±3.90), tobacco and alcohol management was (8.44±1.88), and management of daily life was (33.41±4.61), with good adherence rate of 52.2% (154/295) ; the positive emotion score in the Emotional Balance Scale was (3.76±1.02), and the negative emotion score was (2.63±1.12) ; the results of multivariate Logistic regression analysis showed that gender, age, BMI, education level, blood pressure control, self-perceived physical condition, satisfaction with the point of care, more positive emotions and less negative emotions were the influencing factors for good treatment adherence to the National Chronic Disease Management Service in the hypertensive population (P<0.05) ; treatment adherence to the National Chronic Disease Management Service in the hypertensive population with a combined status of more positive and less negative emotions was 15.867 times higher than that of less positive and more negative emotions (P<0.05), and the treatment adherence with the combined status of more positive and more negative emotions was 5.114 times higher than that of less positive and more negative emotions (P<0.05) .

Conclusion

There is still room for improving treatment adherence to the National Chronic Disease Management Service for hypertensive patients. In addition to objective factors such as gender and age, there is also a need to focus on the emotional management, feedback effect of the treatment and the experience of patients in community healthcare canters.

Second-line Medication Preference in Patients with Type 2 Diabetes: a Study Based on a Discrete Choice Experiment

LIU Zhigang, LIU Shimeng, ZHENG Lyuyun, XUE Wenjing, CAO Chenchen, LIU Jing, CHEN Yingyao

2024, 27(01): 67-73. DOI: 10.12114/j.issn.1007-9572.2023.0142

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Background

With the continuous improvement of diabetes prevention and treatment strategies, clinical guidelines recommend first-line hypoglycemic agents while emphasizing a "patient-centered", and the selection of appropriate second-line hypoglycemic agents based on patients' clinical characteristics and preferences.

Objective

To quantitatively analyze second-line hypoglycemic agents selection preferences in patients with type 2 diabetes mellitus (T2DM) by using a discrete choice experiment, so as to provide reference for clinical diagnosis and treatment for T2DM patients.

Methods

This study conducted a questionnaire survey on T2DM patients selected from Hainan and Shanxi provinces from October 2021 to January 2022 by using a combination of multi-stage random cluster sampling. The questionnaire included basic personal information of the respondents, information related to disease treatment and discrete choice experimental choice set (seven attributes of glycemic control, risk of hypoglycemic events, risk of gastrointestinal adverse events, body mass change within six months, cardiovascular protection, mode of medication administration, and out-of-pocket/monthly costs, each of which included a various levels were included through the literature review, focus group discussion, and pre-tests). A mixed Logit regression model was used to quantify the preference of T2DM patients for second-line hypoglycemic agents, and the regression coefficients reflected the direction and magnitude of the preference for second-line hypoglycemic agents among T2DM patients. Willingness to pay (WTP) reflected the monetary value of patients' willingness to pay or receive compensation after the changes in different attribute levels.

Results

A total of 1 443 questionnaires were distributed and 1 388 valid questionnaires were recovered, with an effective recovery rate of 96.2%. All seven attributes had an effect on medication preference of T2DM patients (P<0.05), the top three influences on medication preference were the effect of glycemic control, the risk of gastrointestinal adverse reactions, and the risk of hypoglycemic events, respectively. The change in body mass within six months had the lowest impact. Patients with T2DM were willing to pay 411.16 yuan per month when the blood glucose reduction increased from 0.5% to 2.5%, while patients with T2DM were willing to pay only 96.78 yuan per month when the change in body mass switched from an increase of 3 000 g to a decrease of 2 000 g over six months.

Conclusion

T2DM patients preferred second-line hypoglycemic drugs with good glycemic control, no risk of gastrointestinal adverse reactions, no risk of hypoglycemic events, cardiovascular protection, oral mode of administration, and a body mass reduction of 2 000 g within six months.

Beneficiary Population Analysis of Curative Care Expenditure in Community Health Service Institutions before and after Comprehensive Medical Reform in Beijing

JIANG Yan, MAN Xiaowei, ZHAO Liying, CHENG Wei

2024, 27(01): 74-78. DOI: 10.12114/j.issn.1007-9572.2023.0086

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Background

It is of great significance to clarify the characteristics of the main population served by community health service institutions for the precise reform of community health service institutions in the next step.

Objective

To provide accurate data support for the next reform policy formulation and adjustment by analyzing the characteristics of the beneficiary population in terms of curative care expenditure (CCE) in community health service institutions in Beijing before and after the comprehensive reform.

Methods

The basic data of this study was obtained from the basic database of total health expenditure accounting in Beijing from 2016 to 2019, and other data was obtained from Beijing Health Statistical Yearbook, Beijing Health Financial Statistics Annual Report, and Beijing Health Expenditure Accounting Report from 2016 to 2019. The multi-stage stratified cluster sampling was adopted to select community health service institutions, and the annual out-patient data and in-patient data were included from HIS system. System of Health Accounts 2011 (SHA 2011) was used to calculate and analyze the situation of the beneficiaries of community health service institutions.

Results

The CCE of community health service institutions in Beijing increased from 12.181 billion yuan to 22.245 billion yuan with an average annual increase of 19.07% from 2016 to 2019. The CCE of middle-aged and elderly patients over 40 years age accounted for more than 92% over the years, and CCE of patients in the age groups of 60s and 80s increased rapidly, with an average annual growth rate of 24.08% and 25.84%, respectively. Among the CCE, endocrine, nutritional and metabolic diseases, abnormal symptoms, signs and test results, circulatory system diseases accounted for the highest proportion. The CCE of endocrine, nutritional and metabolic diseases, nervous system diseases, abnormal symptoms, signs and test results increased rapidly, with an average annual growth rate of 40.11%, 48.40% and 32.43%, respectively.

Conclusion

The effectiveness of hierarchical diagnosis and treatment has begun to emerge after the comprehensive reform. Community medical service resources in Beijing are mainly consumed by middle-aged and elderly patients and patients with chronic non-communicable diseases such as endocrine and circulatory diseases. The comprehensive reforms guided more middle-aged and elderly people and patients with chronic diseases to community health service institutions. Community health service institutions should improve their service capacities in many aspects, such as service capacity, human resource, chronic disease management and medical consortium construction, to consolidate and maintain the effectiveness of the reform.

The Relationship between Multi-dimensional Frailty and Impairment of Activities of Daily Living in Rural Elderly

ZHAO Yi, YANG Jingyuan, YANG Xing, ZHOU Quanxiang, JIANG Yun, HUANG Hui, ZHU Yujie

2024, 27(01): 79-84. DOI: 10.12114/j.issn.1007-9572.2023.0428

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Background

Previous studies have confirmed a correlation between physical frailty and impairment of activities of daily living (ADL) in the elderly, but it is still unclear whether there is a correlation of psychological and social frailty in the elderly with their ADL impairment.

Objective

To investigate the multi-dimensional frailty of the elderly in rural areas and the correlation of dimensions with ADL impairment, so as to provide evidence for preventing disability rural older adults.

Methods

A cross-sectional study was conducted, older adults aged ≥60 years from 30 administrative villages in 2 cities of Guizhou Province were selected for the study from July to September 2021 (n=1 298) by using a multi-stage cluster sampling method. The demographic characteristics, prevalence of chronic diseases and sleep quality of the subjects were collected by questionnaire, and the multi-dimensional frailty of the elderly was assessed by Chinese version of Tilburg debilitating scale, ADL scale was used to assess the impairment of ADL in the elderly, multivariate Logistic regression was used to analyze the effects of multi-dimensional frailty and its dimensions on the impairment of ADL in the elderly, and the multifactor-adjusted population attributable risk percentage (PARc%) was calculated.

Results

Of the 1 298 older adults, 498 (38.37%) were with ADL impairment, 40 (3.08%) were with BADL impairment, 494 (38.06%) were with IADL impairment; 382 (29.43%) were with multi-dimensional frailty, 319 (24.58%) were with physical frailty, 567 (43.68%) were with psychological frailty, and 69 (5.32%) were with social frailty. After adjusting for confounding factors of age, gender, education level, marital status, and sleep quality, the results of binary Logistic regression analysis showed that multi-dimensional frailty, physical frailty, and psychological frailty in older adults had effects on and ADL, BADL and IADL impairments (P<0.05). Further analysis of the population attribution risk of multi-dimensional frailty, physical frailty, and psychological frailty for ADL showed that multi-dimensional frailty had the greatest population attributable risk for BALD impairment [PARc% (95%CI) =24.6 (19.1-27.1) ], psychological frailty had a relatively high population attributable risk for ADL impairment [PARc% (95%CI) =18.4 (12.1-24.5) ], BADL impairment [PARc% (95%CI) =23.6 (3.2-33.7) ], and IADL impairment [PARc% (95%CI) =19.4 (12.4-24.7) ] .

Conclusion

The multi-dimensional frailty, physical frailty and psychological frailty of the rural elderly in Guizhou province are related to the impairment of ADL, BADL and IADL, with greater attribution of psychological frailty for disability. Enhancing screening and interventions for multi-dimensional frailty in older adults, particularly psychological frailty, may reduce the risk of disability in older adults.

The Effect and Satisfaction of Mobile Network in the Hypertension Management of Community-dwelling Older Adults

YAO lin, SHANG Danmei, ZHAO Hui, LIU Xinyu, LIU Yongwei, JIANG Yong

2024, 27(01): 85-90. DOI: 10.12114/j.issn.1007-9572.2023.0379

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Background In the context of the deep integration of information technology with various industries, as well as the strong promotion of the development of smart healthcare by the country, the management of chronic diseases in community has also been gradually explored and transformed from the traditional mode to the informationized and intelligent management mode. In the case of deep aging gradually, it is necessary to clarify whether informationized chronic disease management is effective for the elderly population.Objective To understand the role of mobile network in the management of chronic diseases in the elderly, so as to provide reference for research on informationized management of related chronic diseases.Methods Using convenience sampling method, a total of 650 elderly hypertensive patients registered with community health service centers in four communities under the jurisdiction of Linghe District, Jinzhou City were selected as study subjects from January to July 2022. The study subjects were divided into the intervention group and control group based on the principle of prioritizing the proximity of living location under informed voluntary consent, with 325 cases in each group. The control group was treated with routine community chronic disease management and face-to-face follow-up once every two months. The intervention group was treated with network hypertension management based on the control group, with an intervention of 6 months. The effects were evaluated using the Hypertension Knowledge Level Scale (HK-LS), Therapeutic Adherence Scale for Hypertensive Patients (TASHP), and Hypertension Patients Self-Management Behavior Rating Scale (HPSMBRS), and a satisfaction survey was conducted.Results After the intervention, the scores of HK-LS, TASHP and HPSMBRS dimensions in the intervention group were higher than those in the control group (P<0.05) ; 93.5% (275/294) of the older adults believed that mobile network-assisted hypertension management facilitated access to medical care, 86.4% (254/294) believed that it saved the cost of medical care, and 80.6% (237/294) believed it facilitated condition monitoring. Further survey of the factors affecting the effect of management were mainly physical factors, psychological factors, and dissatisfaction with hardware and software equipment.Conclusion Mobile network assisted hypertension management in community can effectively improve the knowledge level, treatment compliance, and self-behavior management ability of elderly patients with hypertension, with high level of satisfaction.

The 5-year Survival of Elderly Hypertension and Diabetes Patients Combined with Dyslipidemia

CAI Guangyun, CAI Yanjun, WANG Libin, LIU Deyi, WEI Shishi, WANG Hong, TIAN Chaowei

2024, 27(01): 91-97. DOI: 10.12114/j.issn.1007-9572.2023.0346

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Background

With the aging of the Chinese population, the prevalence of chronic comorbidity among the elderly has been increasing by year. Hypertension, diabetes or hyperglycemia, and dyslipidemia are the most common patterns of chronic comorbidity among the elderly in China. However, the survival and influencing factors of this most common pattern of chronic comorbidity remain unclear.

Objective

To investigate 5-year survival of elderly hypertension and diabetes patients combined with dyslipidemia, and analyze the common risk factors.

Methods

Retrospective cohort analysis was used in this study. Elderly residents (≥60 years old) who underwent health examination in the West Campus of the Second Affiliated Hospital of Guangzhou Medical University in 2016 were selected as the study subjects, their relevant information was collected through the Resident Health Record Information System, Health Insurance Information Network, Resident Death Information Network, Resident Health Management Information Registry Platform and telephone interviews, mainly including baseline information such as demographic characteristics, disease-related conditions, medical records, as well as follow-up and death information. According to the survival of the study subjects, they were divided into survival and death groups; according to the presence of hypertension and diabetes, they were divided into no hypertension and diabetes group, hypertension group, diabetes group, hypertension combined with diabetes group; according to the presence of dyslipidemia, they were divided into normal dyslipidemia group, mixed hyperlipidemia group, hypertriglyceridemia group, hypercholesterolemia group, and simple lipoprotein disorder group; according to the presence of hypertension and diabetes mellitus and the presence or absence of combined dyslipidemia were categorized as normal group, hypertension and/or diabetes mellitus group, non-simple dyslipidemia group, non-simple dyslipidemia+hypertension and/or diabetes mellitus group, simple dyslipidemia group, and simple dyslipidemia+hypertension and/or diabetes mellitus group. Log-rank test was used to compare the difference in 5-year crude survival rate between different groups. Multivariate Cox proportional hazards regression analysis was used to explore the influencing factors of 5-year crude survival rate of elderly residents with hypertension and diabetes combined with dyslipidemia.

Results

A total of 3 463 elderly residents with complete data and clear diagnosis were collected, including 1 486 males (42.91%) and 1 977 females (57.09%), and a total of 287 (8.29%) died by the end of follow-up. There were significant differences in gender, physical exercise, prevalence of hypertension and diabetes, dyslipidemia, BMI, waist circumference, fasting blood glucose level, red blood cell count level, hemoglobin level, white blood cell count level, platelet level, serum alanine aminotransferase level, serum creatinine level, blood and urine nitrogen level between the survival group and death group (P<0.05). There was significant difference in 5-year crude survival rate of elderly physical examination residents among the no hypertension and diabetes group, hypertension group, diabetes group, and hypertension combined with diabetes group (χ²=15.730, P=0.001). There was statistically significant difference in 5-year crude survival rates among the normal blood lipid group, mixed hyperlipidemia group, hypertriglyceridemia group, hypercholesterolemia group and simple lipoprotein disorder group (χ²=29.290, P<0.001). In addition, there was significant difference in the 5-year crude survival rates among the normal group, hypertension and/or diabetes group, non-simple lipoprotein disorder group, non-simple lipoprotein disorder + hypertension and/or diabetes group, simple lipoprotein disorder group, simple lipoprotein disorder + hypertension and/or diabetes group (χ²=42.400, P<0.001). Multivariate Cox proportional hazards regression analysis showed that daily physical exercise, BMI, waist circumference, fasting blood glucose level, red blood cell count level, hemoglobin level, serum aspartate aminotransferase level and serum creatinine level were the influencing factors of 5-year crude survival rate of elderly residents with hypertension and diabetes combined with dyslipidemia (P<0.05) .

Conclusion

Compared with the general population, the 5-year crude survival rate of people with hypertension and diabetes combined with dyslipidemia is lower, especially those with lipoprotein disorders. At the same time, lifestyle, nutritional status, liver and kidney function also have a significant impact on the 5-year crude survival rate. In the management of chronic diseases such as hypertension, diabetes and dyslipidemia, it is necessary to pay attention to the improvement of lipoprotein level, nutritional status, liver and kidney function and lifestyle in addition to actively lowering blood pressure, blood glucose, cholesterol and triglyceride levels.

Barriers in Monitoring and Management of Chronic Kidney Disease in Type 2 Diabetes Based on the Perspective of General Practitioners: a Qualitative Research

YANG Haiyan, LI Ting, JIN Guanghui, LU Xiaoqin

2024, 27(01): 98-104. DOI: 10.12114/j.issn.1007-9572.2023.0388

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Background

The prevalence rate of type 2 diabetes is increasing in China. General practitioners play an important role in the prevention and treatment of type 2 diabetes and its complications. Chronic kidney disease (CKD) is a common co-existing disease in patients with diabetes. However, at present, there is little research evidence on type 2 diabetes combined with CKD in primary care in China.

Objective

To investigate the obstructive factors in the monitoring and management of type 2 diabetes mellitus with CKD from the perspective of general practitioners.

Methods

From May to July 2022, a one-to-half structured interview was conducted with snowball sampling among general practitioners in an urban area of Beijing, and the interview outline was formulated based on the theoretical domains framework (TDF). NVivo 11 software was used to encode and classify the interview contents. Subject frame analysis method was used to sort out and analyze the data, and extract the theme.

Results

13 general practitioners were interviewed in this study, and the years of working in general practice ranged from 8 to 22 years. The study identified barriers related to six domains in TDF, namely knowledge/skills, beliefs about outcomes, motivation and goals, medical background, resources and norms of conduct. After refining again, the themes were lack of systematic knowledge and skills related to CKD, imperfect incentive mechanism of primary medical staff, lack of smooth referral process between primary medical institutions and higher hospitals, poor self-management ability of patients and other obstacles.

Conclusion

There are many factors preventing general practitioners from monitoring and managing patients with type 2 diabetes complicated with CKD in the community. It is necessary to strengthen the knowledge and skills training of general practitioners with diabetes mellitus complicated with CKD, improve the ability of general practitioners to monitor and manage CKD, improve the incentive mechanism of primary medical institutions and establish an effective referral process with superior hospitals, strengthen the health education of patients, improve the self-management ability of patients, and enhance the prevention and treatment ability of primary medical institutions with type 2 diabetes complicated with CKD.

A Developmental Model of Postpartum Depression from the Perspective of Role Transition: an Explanatory Case Study

LIN Yuping, ZHOU Tianchun, ZHOU Huixin, ZHU Xinli, DING Yan, Schwank Simone

2024, 27(01): 105-110. DOI: 10.12114/j.issn.1007-9572.2023.0389

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Background

Postpartum depression (PPD) is one of the most common health problems among postpartum women worldwide, and it is also the most disabling disorder in reproductive period of women, which has a negative impact on the physical and mental health of mothers, infants and their families.

Objective

To analyze the causes of PPD, validate or revise the previous theoretical hypothesis "self-interpersonal model of PPD from the perspective of role transition", and provide intervention targets for the construction of effective prevention programs.

Methods

Using the explanatory case study method, based on the previous theoretical hypothesis, 15 women who experienced PPD symptoms and underwent routine postpartum checkups in the postpartum rehabilitation clinic of Obstetrics and Gynaecology Hospital of Fudan University from November 2022 to January 2023 were selected as the cases using the theoretical sampling method and following the "replication logic", who were interviewed by face-to-face, semi-structured in-depth personal interviews. Max QDA 2022 qualitative data analysis software was used to summarize the textual information, analytical method of constructive interpretation was used to analyze the results of each case in comparison to the previous theoretical hypotheses.

Results

The causes of maternal PPD symptoms in this study did not go beyond the self and interpersonal aspects of the previous theoretical hypotheses and could be further summarized as four types of stressors, including "cannot take care of oneself" "cannot take care of the baby" "cannot manage the relationship with spouse" "cannot manage relationships with significant others".

Conclusion

The previous theoretical hypothesis of the "self-interpersonal model of PPD from the perspective of role transition" has been validated and concretized, in view of this, the four types of stressors can be used as targets for the development of PPD prevention programs to prevent PPD in the future.

The Applications of Big Data and Artificial Intelligence in the Prevention and Control of COVID-19 from the Perspective of Haddon Model

GAO Jinghong, WANG Yanyan, JIANG Shuai, FU Hang, DUAN Yanran, WANG Sufan, WANG Chengzeng

2024, 27(01): 111-117. DOI: 10.12114/j.issn.1007-9572.2023.0288

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Big data and artificial intelligence technologies have played a positive role in the prevention and control of COVID-19 outbreaks. However, its application and future trends has not been comprehensively discussed. Starting from the problems faced by the prevention and control of COVID-19, this study provided an overview of the common big data and artificial intelligence technologies and their practical application cases in the prevention and control of COVID-19 based on the introduction of the advantages of big data and artificial intelligence technologies, then discussed the application of big data and artificial intelligence technologies focusing on three elements of infectious source, route of transmission and susceptible population from the three stages that before, during, and after the COVID-19 outbreak based on the Haddon model perspective. The results of the study are important for clarifying the positive role of big data and artificial intelligence technologies in each stage of COVID-19 epidemic as well as their directions of development and application, further improving the efficiency and quality of the prevention and control of COVID-19, and effectively responding to new infectious diseases in the future.

Application of Modified SEIR Model in Epidemic Prevention and Control: a Real World Study

YANG Lichao, ZENG Huatang, HU Mengzhi, WU Liqun, TIAN Qiannan, WEI Liangzhou, ZHU Jiming, LIANG Wannian

2024, 27(01): 118-124. DOI: 10.12114/j.issn.1007-9572.2023.0292

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Background

The Severe Acute Respiratory Syndrome Coronavirus 2 Omicron variant (SARS-CoV-2, Omicron) has been widely spread around the world. Since February 2022, Shenzhen was continuously affected by it as a major hub connecting domestic and international transportation, resulting in rapidly increasing number of infected cases.

Objective

To construct a modified susceptible-exposed-infected-recovered (SEIR) model for providing policy references and suggestions with applied value for epidemic prevention and control in Shenzhen, China, so as to alleviate the pressure of prevention and control.

Methods

This study developed a modified SEIR model targeting the epidemiological characteristics of the Omicron variant such as rapid transmission, high concealment, and general susceptibility of the population, introducing groups with policy characteristics as close contacts, secondary contacts, quarantined individuals and carriers, based on traditional SEIR model of infectious disease dynamics. The relevant parameters of the modified model were determined by fitting the Shenzhen epidemic data of February 18 to 28, 2022.

Results

The predicted data of the model were basically consistent with the actual data from March 01 to 04, 2022, providing a reliable basis for predicting the subsequent development of the epidemic. Subsequently, the Omicron variant outbreak in Shenzhen between 5 to 19 March 2022 was forecasted through this modified model to provide guidance for epidemic prevention and control measures in terms of the degree and time of manual intervention in epidemic prevention and control, and healthcare resource requirements such as patient beds and isolation rooms.

Conclusion

The modified SEIR model developed in this study has proved its practical value in forecasting epidemic development, formulating and adjusting epidemic control measures, and allocating health resources.

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