Table of Content

05 December 2024, Volume 27 Issue 34

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Guidelines·Consensus

Chinese Expert Consensus on Clinical Diagnosis and Treatment of Test Anxiety Disorder

LU Na, LIU Huaqing, JI Yunxin, GUO Rongjuan, HE Danjun, JIAO Zhian, LIN Yuerui, TIAN Feng, ZHANG Guiqing, XU Zhi, AN Ganghui, ZHANG Yan, YUAN Yonggui

2024, 27(34):  4225-4233.  DOI: 10.12114/j.issn.1007-9572.2024.0190

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Test anxiety disorder is a group of symptoms related to stress caused by tests, exams, evaluations, and others. It is among the severe psychological problems in exams. Long-term test anxiety is likely to cause tension, fear, irritability, depression, and other negative emotions, and it disturbs working memory, attention, and other cognitive abilities and even leads to suicidal ideation. In order to standardize the clinical diagnosis and treatment of test anxiety disorder, under the organization of the Test Anxiety Disorder Collaboration of the Chinese Society of Psychosomatic Medicine, this expert consensus was formulated by 13 experts in the field of psychiatry and psychology. We collaborate and announce the expert consensus based on current research and clinical experience. We hope the consensus can provide clinicians with scientific and comprehensive guidance on test anxiety disorder, including epidemiology, etiology, clinical manifestations, evaluation, and treatment.

Focus on Hospitalization for Ambulatory Care Sensitive Conditions

Hospitalization for Ambulatory Care Sensitive Conditions: Concept, Identification and Policy Implications

LU Shan, ZHANG Yan, WANG Jianjian, PAN Jay

2024, 27(34):  4234-4240.  DOI: 10.12114/j.issn.1007-9572.2023.0011

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The accessibility and quality of ambulatory care (including outpatient and emergency services in primary care facilities, hospitals and other healthcare facilities) determine the efficiency of overall health care system and population health. Ambulatory care is also the core component of continuing care in an aging society. The concept of ambulatory care sensitive conditions (ACSCs) was firstly introduced by American researchers in 1990s. Since then, hospitalization for ambulatory care sensitive conditions (ACSHs) was widely used to evaluate the accessibility and quality of ambulatory care. In recent years, research on ACSH has gradually attracted the attention of scholars from all over the world, and preliminary research evidence from China indicated that the issue should not be ignored. This paper firstly introduces the origin of the concept of ACSH, then identifies the mixing concepts such as ACSH, avoidable hospitalization and inappropriate hospital admission, systematically summarizes the cutting-edge international identification criteria of ACSH, and finally discusses the policy value of ACSH as an indicator in the context of domestic and international research advances, clarifies the problems that should be noted in the identification of ACSCs in China, proposes strategies to reduce ACSH.

The Management Strategies for Ambulatory Care Sensitive Hospitalization

WANG Jianjian, ZHANG Yan, LU Shan, PAN Jay

2024, 27(34):  4241-4247.  DOI: 10.12114/j.issn.1007-9572.2023.0432

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The issue of hospitalization for ambulatory care sensitive conditions (ACSH) is a significant problem worldwide, resulting in an annual waste of at least one hundred billion yuan in health resources in China. Implementing targeted interventions to reduce ACSH is an essential pathway towards sustainable health systems. It helps to reduce the occurrence and progression of diseases, improve public health levels, and reduce economic burdens. This study aims to systematically analyze the influencing factors of ACSH, summarize international experiences in reducing ACSH, and explore ACSH management strategies suitable for China's health system. ACSH are influenced by individual factors, health system factors, and social factors. Internationally, measures to reduce ACSH mainly focus on medical service models, service provision, and service management. Drawing on international experience and China's practical situation, this study proposes the following recommendations for managing ACSH in China: firstly, it is recommended to incorporate ACSH into the evaluation system of health services, comprehensively monitor and manage ambulatory care sensitive conditions (ACSCs) ; secondly, enhance health service capacity, promote the standardization and normalization of disease management based on evidence-based approach; moreover, conduct localized research on ACSH and promote the implementation of high-quality evidence; finally, continuously strengthen population health literacy, enhance patients' and the public's correct understanding of reducing ACSH.

Research Status and Progress of Ambulatory Care Sensitive Conditions: a Bibliometric Analysis Based on CiteSpace

WANG Jianjian, LU Shan, ZHANG Yan, PAN Jay

2024, 27(34):  4248-4255.  DOI: 10.12114/j.issn.1007-9572.2023.0433

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Background

Ambulatory care sensitive conditions (ACSCs) are illnesses that can be prevented from resulting in hospitalization with timely and effective ambulatory care. As the global emphasis on improving healthcare service quality and efficiency increases, understanding the evolution and research trends of ACSCs becomes increasingly vital.

Objective

To analyze the research hotspots, frontiers, and trends in the field of ACSCs over the past 30 years.

Methods

The English literature related to ACSCs published in the Web of Science was searched in March 2023. CiteSpace was utilized to perform a visualization analysis of the publication year, authors, research institutions, keywords and references extracted from the identified articles. The time frame was set from 1992 to 2023, with each time segment spanning five years. The network node correlation strength was determined using the "Cosine" algorithm. For the analysis, "Author" "Institution" and "Keyword" were selected as nodes, resulting in knowledge maps that illustrate co-occurrence among authors, institutions, and keywords.

Results

From an initial pool of 1 701 articles, 1 698 were ultimately selected for analysis by CiteSpace. Research focusing on ACSCs had generally shown an upward trend in recent years. The top three prolific institutions were Harvard University [81 articles (4.77%) ], University of California [63 articles (3.71%) ] and University of Michigan [47 articles (2.77%) ]. Eight topic clusters were derived from keyword cluster mapping, namely "nursing home""public health""primary care""integrated care""impact""potentially avoidable hospitalizations""management", and "performance". Citation analysis showed that highly cited studies in this field focused on the status of avoidable hospitalizations, influencing factors, healthcare relationships, and reduction strategies.

Conclusion

Over the past 30 years, research in the field of ACSCs has rapidly progressed and is extensively utilized by major developed nations worldwide to evaluate and improve healthcare services. However, there is a lack of cross-regional collaboration among researchers and institutions, and research interests continually evolve. The main themes include the significance and policy implications of ACSCs and hospitalization for ambulatory care sensitive conditions (ACSH), influencing factors, practical applications, and policy insights. Domestic exploration of these crucial areas is insufficient and requires more attention in the future.

Article

The Usage of Smoking Cessation Related Behavior Change Techniques by Medical Staff in Smoking Cessation Clinics in China and Its Relationship with the Success Rate of Smoking Cessation

HONG Qiumian, LIAO Yanhui, JING Xiaojuan, ZHANG Ning

2024, 27(34):  4256-4263.  DOI: 10.12114/j.issn.1007-9572.2023.0775

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Background

Smoking cessation related behavior change techniques (BCTs) are defined as interventions that can change smokers' smoking behavior. At present, there are no studies to explore the current status of BCTs usage among outpatient healthcare workers for smoking cessation in China.

Objective

The current study aims to describe the frequency and perceived effect of medical staff using BCTs in smoking cessation clinics, and to investigate the association between the usage of BCTs by medical staff and successful quitting rate among smokers in smoking cessation clinics.

Methods

From February 2022 to March 2023, online questionnaire was distributed to medical staff in smoking cessation clinics in China through "WJX" to evaluate the frequency and perceived effect of 44 smoking cessation BCTs used, the success rate of smoking cessation, as well as the demographic characteristics such as age and gender. The hierarchical linear regression model and simple slope analysis were utilized to explore the factors affecting the success rate of quitting in smoking cessation clinics and to examine the interaction between frequency and perceived effect of BCTs used for promoting smoking cessation.

Results

Two-hundred and eighty-five healthcare professionals who had experience in smoking cessation clinics over one year were included in this study. On average, it is reported that healthcare professionals have used (29±13) smoking cessation related BCTs. The perceived average score for effectiveness of BCTs used was (3.15±0.96). The self-reported average success rate of smoking cessation was (37.0±24.3) %. There were statistically significant differences in the number of BCTs used and the perceived effect of medical staff with different highest education level and whether tracking smoking cessation rate of smokers (P<0.05). There were also statistically significant differences in the smoking cessation rate among medical staff with different years of working in smoking cessation clinics, position in the hospital and whether tracking smoking cessation rate (P<0.05). The hierarchical linear regression showed that after controlling for three variables, including the years of working in the clinics, the position of the clinic staff, and whether tracking smoking cessation rates of smokers, the perceived effect of BCTs used could positively predict the success rate of smoking cessation in the smoking cessation clinic [b (95%CI) =10.070 (7.066-13.075), P<0.05]. While the number of BCTs used was not a significant factor in the success rate of smoking cessation (P>0.05). When the interaction item of BCTs used × effect perception was further included, the explanatory of the model for the success rate of smoking cessation in the smoking cessation clinic increased by 2.2%, and the perceived effect of BCTs [b (95%CI) =11.711 (8.548-14.874), P<0.05], the number of BCTs used × effect perception had a positive predictive effect on the success rate of smoking cessation [b (95%CI) =2.921 (0.958-4.884), P<0.05] .

Conclusion

The use of quitting BCTs had a significant impact on the rate of successful smoking cessation in the smoking cessation clinic, and the number of BCTs used and the perceived effect had a significant interaction effect on the success rate of smoking cessation. In the future, it is necessary to improve the training program of smoking cessation practices, and accelerate the transformation and implementation of smoking cessation related BCTs so as to help more smokers to quit smoking successfully.

The Differences in Second-line Medication Preferences for T2DM Patients between North and South China

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

2024, 27(34):  4264-4272.  DOI: 10.12114/j.issn.1007-9572.2023.0653

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Background

In recent years, the number of diabetics in China ranks first in the world. While recommending metformin as the first-line hypoglycemic drug, the Chinese Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly (2022 edition) emphasize "patient-centere" and select appropriate second-line hypoglycemic agents for combination administration according to the clinical characteristics and preferences of patients. Because there are great differences in the prevalence rate and life behavior of type 2 diabetes between the north and the south of China, whether there is a difference in the second-line drug preference of patients with type 2 diabetes between the two places remains to be further demonstrated.

Objective

To analyze the difference of second-line drug preference among patients with type 2 diabetes mellitus in North and South China, and to provide empirical evidence for clinical and health management decision-making.

Methods

The study adopts a Discrete Choice Experimental design, Mixed Logit Model was used to analyze drug preference of patients with type 2 diabetes in the north and south of China based on Multi-stage random cluster sampling and convenient sampling, from October 2021 to January 2022.

Results

In this study, 1 443 questionnaires were distributed, and 1 388 were valid, with an effective recovery rate of 96.19%. Logit model analysis showed that the effect of blood sugar control, the risk of hypoglycemia, the risk of gastrointestinal side effects, whether the cardiovascular system can be protected, the way of taking drugs and the out-of-pocket cost/month were the influencing factors of the second-line drug preference of southern patients (P<0.05). Patients with type 2 diabetes in South China prefer to take oral second-line hypoglycemic drugs with 0 yuan, no risk of gastrointestinal side effects, strong blood sugar control effect, no risk of hypoglycemia events, and can protect the cardiovascular system (P<0.05). When the risk of gastrointestinal side effects changes from high to no risk, patients in South China are willing to pay 408.06 yuan per month. The effect of blood sugar control, the risk of hypoglycemia, the risk of gastrointestinal side effects, whether the cardiovascular system can be protected, the way of taking medicine, out-of-pocket expenses/month, and the change of body mass within half a year are the influencing factors of the preference for second-line medication in northern patients (P<0.05). The patients with type 2 diabetes in the north prefer the second-line hypoglycemic drugs with 0 yuan, strong blood sugar control effect, no risk of hypoglycemia events, cardiovascular protection and no risk of gastrointestinal reaction, taking orally and reducing body weight by 2.0 kg within six months (P<0.05). When the blood sugar control effect is weak and changed to strong, the patients in the north are willing to pay 435.98 yuan per month.

Conclusion

In addition to out-of-pocket expenses/month, patients with type 2 diabetes in the south pay more attention to gastrointestinal side effects, while patients with type 2 diabetes in the north pay more attention to the effect of blood sugar control. There are differences in second-line medication preferences between the two places. Regional differences provide a basis for individualized treatment of patients with type 2 diabetes mellitus. Clinical diagnosis and treatment should be "patient-centere" and pay attention to individual preference differences.

Investigation of Therapeutic Inertia and Influencing Factors in Primary Care Physicians during Hypertension Diagnosis and Treatment Process

WANG Xuezhu, WEI Tingting, LIU Pei, PAN Liping, LIU Ying, BIAN Bo

2024, 27(34):  4273-4279.  DOI: 10.12114/j.issn.1007-9572.2023.0915

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Background

Hypertension is a common chronic disease that seriously endangers the health of the population. The primary-care doctors are the main force in the management of hypertension. However, the doctor-induced therapeutic of inertia greatly affects the achievement of primary-care hypertension control.

Objective

The aim of this study is to investigate the current status of therapeutic inertia among primary healthcare providers in the diagnosis and treatment process of hypertension, and analyze the causes of therapeutic inertia, providing a reference basis for improving hypertension control rates in China.

Methods

A simple random sampling method was used to distribute questionnaires to primary healthcare providers in 32 primary healthcare institutions in Tianjin from July to August 2023. The therapeutic inertia in the diagnosis and treatment process of hypertension was evaluated from three dimensions: "soft reasons" and "overestimation of treatment efficacy" as well as "medical insurance policies". Binary Logistic regression analysis was employed to explore the influencing factors of therapeutic inertia.

Results

A total of 407 questionnaires were distributed in this study, and 386 valid questionnaires were collected, yielding an effective response rate of 94.84%. The average score for primary healthcare providers' knowledge of hypertension diagnosis and treatment was 6 (0.5), with a scoring rate of 61.11% (5.50/9.00). The total score for therapeutic inertia in hypertension management was 48 (7.0), with a scoring rate of 56.55% (45.24/80.00). The scores for the "soft reasons" dimension, "overestimation of treatment efficacy" dimension, and "medical insurance policies" dimension were 26 (4.8), 10 (2.0), and 6 (2.5) respectively, with scoring rates of 51.92% (25.96/50.00), 65.40% (9.81/15.00), and 46.40% (6.96/15.00) respectively. When comparing the average scores of the three dimensions of therapeutic inertia, the "overestimation of treatment efficacy" dimension had the highest score compared to the other two groups (P<0.05). Multivariate analysis indicated that gender, region, mastery of hypertension diagnosis and treatment, and a daily voulme of hypertensive individuals treated are the main factors influencing Therapeutic inertia among primary care physicians (P<0.05) .

Conclusion

Therapeutic inertia is prevalent among primary healthcare providers in the diagnosis and treatment process of hypertension. Low levels of hypertension treatment cognition, "overestimation of treatment efficacy", and "soft reasons" are the primary factors contributing to therapeutic inertia among primary healthcare providers. It is recommended to strengthen education on therapeutic inertia in hypertension, conduct diversified training on diagnostic and management knowledge, and promote clinical informatization and artificial intelligence decision-making systems to effectively improve the therapeutic inertia of primary healthcare providers in hypertension management.

Effect of Parkinson's Disease Management Model Dominated by Movement Disorder Specialists and Centered on Community Doctors

FENG Caixia, WANG Zengshuai, MU Hailin, YANG Hanxuan, TAMIR

2024, 27(34):  4280-4285.  DOI: 10.12114/j.issn.1007-9572.2023.0774

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Background

The incidence of Parkinson's disease (PD) is increasing year by year, which has increased the disease burden of medical insurance, and the current chronic disease management model has not played a role in the community management of PD patients.

Objective

To explore the effect of PD management model led by a movement disorders specialist and centered on community doctors, in order to improve the comprehensive management ability of community doctors for PD patients and improve the quality of life of PD patients.

Methods

One hundred and two PD patients who were treated at the Neurology Department of the Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology from January 2022 to May 2023 were selected as the research subjects and were divided into the control group and the active intervention group by random digit table method, with 51 cases in each group. The control group received conventional community management, while the active intervention group received proactive management by community doctors specializing in PD. The management content included drug adjustment, exercise rehabilitation, dietary nutrition, cognitive function and psychological function management. Evaluations were conducted for the patients within one week of their return to the community (before intervention) and six months later (after intervention). The evaluation included a single day equivalent dose of levodopa, UPDRS-Ⅲ, UPDRS-Ⅳ, Hoehn-Yahr (H-Y) staging, and 39-item Parkinson's Disease Quality of Life Questionnaire (PDQ-39) .

Results

At 6 months, the levodopa equivalent dose in the active intervention group was higher than before management, and the UPDRS-Ⅲ score, other complication dimensions of UPDRS-Ⅳ, and PDQ-39 score were lower than before (P<0.05). The Spearman rank correlation analysis results showed that the difference in PDQ-39 scores between the active intervention group and the control group before and after management was positively correlated with their scores in mental health, humiliation, cognition, social support, communication, and physical discomfort (r_s values ranged from 0.651 to 0.893, P<0.05), positively correlated with the score of other complication dimensions of UPDRS-Ⅳ (r_s=0.338, P<0.05), but not correlated with the UPDRS-Ⅲ score (P>0.05). The results of the univariate Logistic regression analysis showed that the probability of PDQ-39 reduction in the active intervention group was 11.769 times that of the control group (95%CI=4.340-31.918, P<0.001) .

Conclusion

The PD management model led by movement disorder specialists and centered on community doctors can improve the quality of life of patients, which provides a reference for PD community management.

The Health Characteristics and Health Needs of Perimenopausal Women in the Community

LIANG Hong, ZHANG Ying, XU Hanping, YE Aoxing, WU Lingling, ZHAO Jing

2024, 27(34):  4286-4294.  DOI: 10.12114/j.issn.1007-9572.2023.0936

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Background

With the continuous development of society and technological innovations, the average life expectancy of human beings has gradually increased, leading to the gradual increase in the number of perimenopausal women. This trend poses a serious challenge to the management of perimenopausal health in the community.

Objective

To understand the health characteristics and health needs of perimenopausal women in the community, explore the relationship between the two, and provide evidence to support the development and improvement of perimenopausal health management in community health service organisations.

Methods

Perimenopausal women (n=260) who attended or were accompanied to the Huamu Community Health Service Centre and its subordinate stations in Pudong New Area, Shanghai, from February to March 2023 were selected as study subjects. Questionnaires were used to collect information on the health characteristics of the study subjects (related to physiological stage, social characteristics, disease status, lifestyle, and quality of life), their knowledge of menopause and attitudes toward treatment, as well as their needs for knowledge related to menopause and preventive health care for menopausal diseases.

Results

Fifty percent (130/260) of perimenopausal women had a current history of chronic disease, 51.9% (135/260) of perimenopausal women had a past history of chronic disease, 73.8% (192/260) of perimenopausal women had fair/poor quality of sleep, 33.5% (87/260) of perimenopausal women did little exercise. 58.5% (152/260) of perimenopausal women were completely unaware or had only heard of menopause, 41.9% (109/260) of perimenopausal women had a negative attitude towards menopause treatment, 45.0% (117/126) of perimenopausal women needed menopause-related knowledge, and 66.6% (173/260) of perimenopausal women needed preventive health care for menopausal diseases. The results of ordered multicategorical Logistic regression analyses showed that literacy, the number of menopausal symptoms in the last 3 monthss, and attitudes toward menopause treatment were the factors influencing perimenopausal women's need for menopause-related knowledge (P<0.05), and literacy and attitudes toward menopause treatment were the factors influencing perimenopausal women's need for preventive health care for menopausal diseases (P<0.05) .

Conclusion

This study reveals the influence of health characteristics (e.g., literacy level, symptom severity) on health needs of perimenopausal women. Community health service providers should optimise health management programmes for perimenopausal women based on accurate data and provide comprehensive and personalised health management services for perimenopausal women in the community.

The Effect of Social Network-based Health Education on Self-management of Older Adults with Chronic Diseases in Community

LIU Yu, ZHAO Fang, WANG Li, LI Caihong, LIN Keke, BAI Xiaoyan, WU Shishi, ZHANG Ruiting, WANG Jing

2024, 27(34):  4295-4301.  DOI: 10.12114/j.issn.1007-9572.2023.0782

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Background

The memory and self-care abilities of older adults with chronic diseases are gradually declining, and relying solely on their personal strength for disease self-management is difficult to achieve good results, requiring more help from others. When providing health education to older adults with chronic diseases, it is not only necessary to focus solely on the elderly, but also to fully utilize the patient's social network and involve social network members in the disease management of the patients, to more effectively improve their self-management ability.

Objective

To explore the impact of social network-based health education on the self-management ability of older adults with chronic diseases in community.

Methods

From March 2021 to June 2022, older adults with chronic diseases who visited Beijing Fangzhuang Community Health Service Center, Clinic of Tsinghua Changgeng Hospital and Endocrinology Clinic of Beijing Hospital, Hongliancun Community were recruited. Using a computer-generated random number table, the older adults were assigned numbers in the order of recruitment, with odd numbers being intervention group and even numbers being control group. They were randomly divided into an intervention group and a control group in a 1∶1 ratio. The older adults in the intervention group received health education with their social network members, while those in the control group received health education alone. The Chronic Disease Self-Management Study Scale (CDSMS) was used to evaluate the effectiveness of chronic disease self-management before intervention, at the 6th and 12th months of intervention, meanwhile the Lubben Social Network-6 (LSNS-6) was used to assess their social network level.

Results

Eighty older adults with chronic diseases were enrolled, of which 1 patient (in control group) withdrew from the study due to two hospitalizations during the study period. Finally, 79 older adults completed the study: 40 older adults in the intervention group+40 members of their social network, and 39 older adults in the control group. The exercise dimension, cognitive symptom management dimension of self-management behavior subscale, and self-efficacy subscale of CDSMS had an interactive effect on time and grouping (F_{interation-values} were 7.174, 8.488, and 9.939, respectively, P<0.05) ; The main effect of time on the two subscales of CDSMS was significant (F_time-values were 13.527, 12.188, 7.576, 5.058, respectively, P<0.05) ; The main effects of grouping on three dimensions of CDSMS self-management behavior subscale were significant (F_group-values were 12.324, 7.383, 5.927, respectively, P<0.05). At the 6th month of intervention, the CDSMS exercise dimension score in the intervention group was higher than that in the control group (t=2.852, P=0.006), the difference was statistically significant. At the 12th month of intervention, the CDSMS exercise dimension score in the intervention group was higher than that in the control group (t=4.473, P<0.05), the score of cognitive symptom management dimension was higher than that in the control group (t=-2.780, P=0.005), the self-efficacy subscale score was higher than that in the control group (t=2.993, P=0.004), the differences were statistically significant.

Conclusion

A 12-month social network-based health education can improve some of the self-management behaviors and self-efficacy with chronic diseases.

Medical Service Capacity and Influencing Factors of Primary Health Care Institutions Under Medical Alliance

ZHANG Yalin, LIU Lidi, CHEN Zhengyong, LIU Changming, YANG Ziyu, CAO Yi, LIAO Xiaoyang

2024, 27(34):  4302-4307.  DOI: 10.12114/j.issn.1007-9572.2024.0064

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Background

The construction of medical alliance is important measure for deepening medical reform. It aims to move the focus and resource to primary health care institutions, and improve service capabilities. Studies have shown that the medical alliance can improve the service capabilities of primary health care institutions, but the exact reason for this is not clear.

Objective

To analysis the service capabilities of the of primary health care institutions, and explore the impact of service capabilities in the context of medical alliance.

Methods

In December 2019, we survey on staffing, outpatient and inpatient service and medical alliance construction of 381 primary health care institutions which participated in medical alliance in Chengdu by structured questionnaire. Local administrative departments of public health gave out and recovered questionnaire. With the number of staff, registered generals, beds, outpatient and emergency visits, admission, and the use rate of the beds as the indicator of the service capabilities, we used rank sum ratio to analyze the comprehensive medical service capabilities and divide them to 3 gear. Using orderly Logistic regression to explore the influencing factors of integrated medical services.

Results

The median number of staff in 381 primary health care institutions was 54 (48), registered generals was 4 (8), beds was 50 (50), outpatient and emergency visits was 49 460 (60 317), admission was 1 440 (2 071), the use rate of beds was 68.43% (45.18%). According to the rank and ratio, there were 61 (16.0%), 260 (68.3%), and 60 (15.7%) institutions with good, medium and poor comprehensive medical service ability, respectively. The analysis of orderly Logistic regression analysis showed that institutional building area, teaching rounds and remote film reading are the influencing factors of the comprehensive medical service capabilities of primary health care institutions (P<0.05) .

Conclusion

The medical service capacity of primary health care institutions in Chengdu, Sichuan Province are relatively good. Institutional building area, teaching rounds and remote film reading in the medical assistance method significantly affect the comprehensive medical service capabilities.

Investigation on Community Health Management Ability of Rural Doctors in China

XIE Kun, WANG Xuanxuan, LI Siqing, GAO Shuhong, CHEN Jiaying, ZHANG Zhaoyang

2024, 27(34):  4308-4314.  DOI: 10.12114/j.issn.1007-9572.2023.0817

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Background

As the gatekeepers for rural residents' health, rural doctors are the main providers of health management services for rural populations. Their community health management ability directly affects the health level of rural residents.

Objective

This study aims to investigate the current status of health management ability of rural doctors in China and explore strategies for enhancing their community health management ability, thus providing a basis for strengthening the building of a rural doctor team.

Methods

In August 2020, a multi-stage stratified cluster sampling and purposive sampling methods were used to select 3 916 rural doctors from five provinces in east, central, and western China. Rural doctors were surveyed using an online questionnaire platform called "Wenjuanxing". The questionnaire content included the rural doctors' ability to manage the health of children, women, elderly, and chronic disease patients, and the degree to which these needs were met, all of which were self-evaluated by the rural doctors.

Results

Of the 3 916 rural doctors surveyed, 3 494 (89.22%), 3 175 (81.08%), 3 775 (96.40%), and 3 738 (95.45%) were found to had the ability to manage the health of children, women, the elderly, and patients with chronic diseases, respectively. The ability of female rural doctors to provide family planning guidance, prenatal health guidance, prevention and treatment of menopause-related diseases, and screening for common gynecological diseases was better than that of male rural doctors (P<0.05) ; while the male village doctors had a higher rate of identifying and handling common chronic disease critical conditions, stable and regular treatment of common chronic diseases, prevention of complications, and health management abilities for chronic disease patients compared to female village doctors (P<0.05). Rural doctors with qualifications of medical practitioners or assistant medical practitioners had a higher proportion of those with the ability to prevent and treat menopause-related diseases than those with qualifications of rural practitioners and other qualifications (P<0.008 3). Rural doctors with qualifications of medical practitioners or assistant medical practitioners had a higher proportion of those with the ability to manage women's overall health than those with qualifications of rural practitioners (P<0.008 3). Rural doctors with qualifications of general practitioners had a higher proportion of those with the ability to manage the functional decline of the elderly among than those with qualifications of rural practitioners (P<0.008 3). Rural doctors with a bachelor's degree or above had a higher proportion of those with the ability to provide stable-period treatment and prevention of chronic diseases than those with a junior college diploma (P<0.017). Rural doctors in the eastern region of China had a higher proportion of those whose ability to guide the physical examination and screening for common diseases of the elderly meets the actual work needs than those in the central and western regions, and the proportion in the central region was higher than that in the western region, with statistically significant differences (P<0.017). Rural doctors in the eastern and central regions of China had a higher proportion of those whose ability to assess the health and self-care ability of the elderly, identify and intervene with negative emotions, and prevent functional decline met the actual work needs than those in the western region (P<0.017) .

Conclusion

At present, rural doctors in China basically had the ability to manage health, and female rural doctors had an advantage in providing women's health management services. However, rural doctors with qualifications of rural practitioners lack the ability to manage the health of some specific key populations, and the ability of rural doctors in the western region to manage the health of the elderly is relatively poor. Therefore, active measures should be taken to improve the quality of rural doctors and promote the stability and sustainable development of the rural doctor team.

Article·Focus on General Practice Education

Development and Application of an AI-based Empathic Language Teaching and Evaluation System for Doctor-patient Communication

SHAO Jianwen, LIU Huan, ZHANG Yue, ZHENG Aiming, CHEN Songyu, WANG Jinfan

2024, 27(34):  4315-4321.  DOI: 10.12114/j.issn.1007-9572.2023.0544

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Background

Under the background of new medical science, the deep integration of information technology and medical education is encouraged to train first-class medical talents to serve the construction of healthy China.Currently, empathy training in doctor-patient communication mainly consists of simulated communication and group discussion, with less reliance on artificial intelligence technology for learning.

Objective

To develop a system for teaching and evaluating doctor-patient communication empathy language. This system will be used in course teaching to pave the way for future doctor-patient communication empathy teaching methods. Carry out teaching applications to enhance the communication and empathy language expression skills of medical students and doctors, and gather feedback to optimize and improve the system.

Methods

Between September 2021 and February 2022, the research group focus on utilizing iFlytek speech recognition technology and the empathy semantic recognition algorithm. A system called the "Doctor-patient Communication Virtual Simulation Teaching and Evaluation System of empathic language" was developed using 10 typical cases of doctor-patient communication, demonstrations of empathic language, a semantic database of empathic language, empathic language skills, and an overall scoring standard.A total of 950 students from Nanjing Medical University, including 515 undergraduates, 102 medical doctoral students, and 333 clinicians participating in doctor-patient communication courses or training, were selected as the research subjects from March to May 2022. Based on this system, the Doctor-patient Communication Skills Course (2 class hours) teaching experiment was conducted at Nanjing Medical University. A self-designed questionnaire was used to gather information on the subjects' understanding of empathetic language connotations, their improved empathetic language skills, their perception of system ease of use, and their perception of how the system integrates into the rationality of teaching. NVivo software was used to analyze the subjects' feedback, comments, and suggestions.

Results

Following the implementation of the system, there were statistically significant differences in the mastery of empathic language connotation, the degree of enhancement of empathic language ability, the degree of convenience of the system, and the degree of integration of the system into teaching rationality among undergraduate students, clinicians, and medical doctoral students (P<0.05). 76.1% (723/950) of the participants evaluated that they had "fully mastered" or "highly mastered" the connotation of empathic language. 93.8% (891/950) of the study subjects indicated that the system could "significantly enhance" or "somewhat enhance" the empathic language ability, and 89.5% (850/950) of the study subjects rated the convenience of the system as "very convenient" or "relatively convenient". 95.1% (903/950) of the study subjects rated the degree of cognition of the rationality of integrating the system into teaching as "very reasonable" or "relatively reasonable". The top five words mentioned in the feedback and suggestions are communication, pronunciation, teaching, program, and standard.

Conclusion

This system can help improve medical student and doctors'ability to empathize in doctor-patient communication by learning from individual cases and applying those lessons more broadly. Additionally, the use of an autonomous teaching evaluation system frees up the constraints of time and space in teacher-student interactions. The system's standardized teaching method has received positive and rational feedback from participants, indicating its potential for a wide range of applications. However, the system is still in the early stages of exploration and requires further refinement.

Article·Focus on Combination of Medicine and Nursing Service

Exploration and Practice of Smart Combination of Medicine and Nursing Service Model

LI Liguo, FU Hongguang, GAO Na, ZHAO Yonghong, LI Wei, ZHENG Pengyuan

2024, 27(34):  4322-4326.  DOI: 10.12114/j.issn.1007-9572.2023.0211

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At present, the aging situation in China is becoming increasingly severe. The elderly are facing difficulties in acquiring elderly service and medical care in the process, in which the elderly need digital service of the combination between medical and nursing care urgently. However, there still exist some problems of the combination of medical and nursing care in the present stage, such as imperfect models, low level of intelligence, inefficient integration mechanism of resources related to "medical care" and "nursing care", and the inadequate phenomenon in which the service of combination of medical and nursing care leads to "the castle in the air". In view of the current difficulties and blocking points in the combination of medical and nursing care, the research team of this paper use digital and intelligent methods to construct 5 types of smart medical and nursing service models, including "full chain" "multi-subject integration" "active health" of traditional Chinese medicine, "return to the community" and "return to the home". Furthermore, the research team issused 6 group standards, seted up 2 landmark projects, and established more than 20 demonstration application bases across the country in the meantime as well as incorporate 500 community/township promotion plans of Henan Provincial government, which achieve good demonstration effects. This paper briefly introduces five types of model specifications from four aspects of model conception, model composition, model operation mechanism and model function, so as to facilitate the further study and popularization of the five models.

Performance Evaluation and Obstacle Factor Diagnosis of Community Embedded Integrated Medical and Nursing Care with Characteristics of Traditional Chinese Medicine

SI Jianping, WANG Xianju, GUO Qing

2024, 27(34):  4327-4335.  DOI: 10.12114/j.issn.1007-9572.2023.0910

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Background

In the context of "comprehensively promoting the construction of a healthy China" and "actively responding to the national strategy of aging population", scientific evaluation of the performance of community embedded integrated medical and nursing care with characteristics of TCM is the key to improving the quality of integrated medical and nursing care.

Objective

Evaluate the performance of community embedded integrated medical and nursing care with characteristics of TCM and analyze main obstacles, providing practical basis for government departments to formulate relevant policies and carry out performance evaluation of it.

Methods

In November 2022, the performance evaluation index system for community embedded integrated medical and nursing care with characteristics of TCM was transformed into three questionnaires: basic information of the institution, satisfaction of staff and the elderly. From November 2022 to January 2023, a questionnaire survey method was used to collect basic data from 10 sample institutions, as well as satisfaction data from staff and the elderly. From February to March 2023, the TOPSIS method was used to evaluate the performance of community embedded integrated medical and nursing care with characteristics of TCM, and the obstacle degree model was used to analyze the main obstacle factors of service performance.

Results

The overall embeddedness, structural embeddedness, relationship embeddedness, and embedded performance C_n of the 10 institutions are ranked consistently, 7 institutions have the same ranking of cognitive embedding and embedding performance C_n, and the ranking is consistent with the service performance C_n of each institution. The main obstacles to the performance of community embedded integrated medical and nursing care with characteristics of TCM are C33 (number of TCM health care guidance services), C44 (elderly satisfaction), C8 (institutions and partners adhere to win-win cooperation), C37 (the proportion of TCM non pharmacological therapy rehabilitation nursing personnel), C39 (number of elderly people served) .

Conclusion

The embeddedness, structural embeddedness, and relational embeddedness of community embedded integrated medical and nursing care with characteristics of TCM have a positive impact on its embedding performance. Cognitive embedding has a basic positive impact on embedding performance. Government departments should clarify their functional positioning, strengthen policy support, improve the evaluation system, pay attention to dynamic evaluation, and guide and promote the high-quality development of community embedded integrated medical and nursing care with characteristics of TCM. Institutions with characteristics of TCM should strengthen their structural embedding, relationship embedding, and cognitive embedding with partners, in order to continuously improve their service performance, to meet the diversified and multi-level health care service needs of the elderly in home communities. At the same time, should grasp the degree of embedding, so as not to produce the negative effect of embedding.

Efficiency Evaluation of the Integrated Medical and Nursing Care Services in Beijing's Nursing Homes

ZHU Lili, HAO Xiaoning, ZHENG Yanhui, LIU Zhi, ZHOU Yuchen

2024, 27(34):  4336-4340.  DOI: 10.12114/j.issn.1007-9572.2023.0375

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Background

The degree of aging in China is constantly deepening, and the demand for medical and nursing care services among residents is increasing day by day. Exploring how the integrated medical and nursing care services can develop efficiently with high quality is of great practical significance for actively responding to the aging population.

Objective

This study provided a reference for improving the service efficiency and optimizing resource allocation by analyzing the efficiency evaluation of the integrated medical and nursing care services in Beijing's nursing homes.

Methods

On-site survey of elderly care organisations in Beijing, May 2018.

The output-oriented BCC model in Data Envelopment Analysis (DEA) was used to evaluate the technical efficiency, pure technical efficiency, scale efficiency of the integrated medical and nursing care services of 62 nursing homes in Beijing. Input indicators: number of institutional beds, number of medical staff, number of elderly caregivers (carers). Output indicators: number of totally disabled/severely impaired elderly, number of partially disabled/mildly impaired elderly, and number of self-care elderly.

Results

It is found that in the technical efficiency, pure technical efficiency, and scale efficiency of 62 nursing homes in Beijing, the proportion of DEA effective unit is 12.903%, 35.484% and 12.903% respectively. The average values of technical efficiency, pure technical efficiency and scale efficiency are 0.599, 0.788 and 0.760 respectively. Among them, 12.903% of nursing homes are in the state of constant returns to scale, 70.968% are in the state of decreasing returns to scale, and 16.129% are in the state of increasing returns to scale.

Conclusion

The overall service efficiency of nursing homes in Beijing is low, and there are phenomena of resource waste and mismatch between supply and demand. It is suggested that nursing homes should scientifically locate the target group, provide accurate services, reasonably calculate the input capacity, and promote service cooperation between the hospital and the nursing home. The government should continue to implement the further implementation of relevant support policies.

Evidence-based Medicine

Meta-analysis of the Effect of Carbohydrates on Cardiovascular Disease Risk Factors

LI Yiguang, LIU Hejun, ZHAO Jinpeng, FENG Yan, XU Yinlan

2024, 27(34):  4341-4349.  DOI: 10.12114/j.issn.1007-9572.2023.0296

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Background

As the leading cause of death in the world, cardiovascular diseases pose a serious threat to human health. Diet has attracted much attention as an important intervention, but the effect of carbohydrates on cardiovascular disease is unknown.

Objective

To analyze the evidence of the correlation between carbohydrate intake and cardiovascular disease risk.

Methods

Wanfang Data, CNKI, VIP, SinoMed, PubMed, Cochrane Library and Embase were searched by computer for randomized controlled trials on the risk of carbohydrates and cardiovascular disease published from inception to January 2023. Two researchers performed literature screening, data extraction, and quality evaluation separately. RevMan 5.3 was used for data analysis.

Results

A total of 16 randomized trials were included. Carbohydrate could significantly reduce triglyceride level by 0.17 mmol/L (95%CI=-0.24--0.10, P<0.000 01). The level of triglyceride decreased by 0.25 mmol/L (95%CI=-0.33--0.17, P<0.000 01) in carbohydrate diet intervention for less than 6 months, and 0.15 mmol/L (95%CI=-0.29--0.01, P=0.04) in 12-23 months group. Plasma HDL-C level increased by 0.09 mmol/L (95%CI=0.07-0.10, P<0.000 01), and plasma LDL-C level increased by 0.10 mmol/L (95%CI=0.02-0.17, P=0.01) .

Conclusion

The overall effect of low carbohydrate diet on cardiovascular risk factors is more favorable below 6 months and 6-11 months, but it has no significant effect on cardiovascular risk factors after 2 years, and its long-term effect needs further study.

A Meta-analysis of the Incidence and Influencing Factors of Persistent Cough in Patients after Lung Cancer Surgery

2024, 27(34):  4350-4352.  DOI: 10.12114/j.issn.1007-9572.2023.0606

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