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Neill R, Zia N, Ashraf L, Khan Z, Pryor W, Bachani AM. Integration measurement and its applications in low- and middle-income country health systems: a scoping review. BMC Public Health 2023; 23:1876. [PMID: 37770887 PMCID: PMC10537146 DOI: 10.1186/s12889-023-16724-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Despite growing interest in and commitment to integration, or integrated care, the concept is ill-defined and the resulting evidence base fragmented, particularly in low- and middle-income countries (LMICs). Underlying this challenge is a lack of coherent approaches to measure the extent of integration and how this influences desired outcomes. The aim of this scoping review is to identify measurement approaches for integration in LMICs and map them for future use. METHODS Arksey and O'Malley's framework for scoping reviews was followed. We conducted a systematic search of peer-reviewed literature measuring integration in LMICs across three databases and screened identified papers by predetermined inclusion and exclusion criteria. A modified version of the Rainbow Model for Integrated Care guided charting and analysis of the data. RESULTS We included 99 studies. Studies were concentrated in the Africa region and most frequently focused on the integration of HIV care with other services. A range of definitions and methods were identified, with no single approach for the measurement of integration dominating the literature. Measurement of clinical integration was the most common, with indicators focused on measuring receipt of two or more services provided at a single point of time. Organizational and professional integration indicators were focused on inter- and intra-organizational communication, collaboration, coordination, and continuity of care, while functional integration measured common information systems or patient records. Gaps were identified in measuring systems and normative integration. Few tools were validated or publicly available for future use. CONCLUSION We identified a wide range of recent approaches used to measure integration in LMICs. Our findings underscore continued challenges with lack of conceptual cohesion and fragmentation which limits how integration is understood in practice.
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Affiliation(s)
- Rachel Neill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA.
| | - Nukhba Zia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Lamisa Ashraf
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Zainab Khan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Wesley Pryor
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Abdulgafoor M Bachani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
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Sultan M, Waganew W, Kassaye M, Beza L, Waleligh M, Azazh A, Yifru S, Redae B, Ataro D, Fisseha A, Ashagre A, Baru A. Facilitators and Barriers to National COVID 19 Guideline Adherence among Healthcare Providers in Ethiopia. Ethiop J Health Sci 2023; 33:183-192. [PMID: 37484189 PMCID: PMC10358374 DOI: 10.4314/ejhs.v33i2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/19/2022] [Indexed: 07/25/2023] Open
Abstract
Background Evidence-base practice needs to be supported by guidelines and decision-making protocols. This study aimed to look into the barriers and facilitators of adherence to national protocols in Ethiopia. Methods Exploratory qualitative method was implemented to explore adherence to protocol. The national COVID-19 case management guideline was used as this study's prototype reference. A total of five FGDS were conducted among 26 healthcare providers. A total of 14 physicians and 12 nurses participated in the FGDs. Semi-structured focus group discussions guides were used to facilitate the discussion among healthcare workers involved in COVID-19 case management. The FGDs were audio recorded, transcribed and analyzed thematically. Results Three broad themes have emerged from the content analysis. These include individual factors, environmental factors and system factors. System factors barriers to utilization include unclear guidelines, discordant guidelines and a lack of live national guidelines, while the main facilitator was supportive management. The environmental factors that were barriers to adherence included limited infrastructure and shortages of drugs suggested in the protocols. Conclusion Outdated and discordant guidelines and a shortage of suggested managements were barriers. Future similar works should consider the identified barriers and need regular updates to facilitate effective implementation.
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Affiliation(s)
| | | | | | | | | | | | - Sisay Yifru
- Saint Paul's hospital millennium medical college
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Fu L, Fang Y, Yang S, Xu Y. How to Make Primary Healthcare More Popular: Evidence from the Middle-Aged and Elderly in China. Healthcare (Basel) 2022; 10:healthcare10091783. [PMID: 36141395 PMCID: PMC9498696 DOI: 10.3390/healthcare10091783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Since 2001, China has been an aging society; it is expected to become superaged by 2033. This rapid aging trend poses a challenge to the elderly regarding their pension services and healthcare. Primary healthcare has great potential for serving older adults in the community, yet it is not popular. This study used 1977 samples from the 2018 China Health and Retirement Longitudinal Study database to explore the use of outpatient services in primary care institutions among the middle-aged and elderly. Using a structural equations model, we constructed a framework to explore pathways leading to primary outpatient use. We discovered that the supply of primary health services had a significant direct and mediating effect on the utilization of primary outpatient services, and that community pension services may indirectly discourage it. In addition, the supply of primary health services has a suppressor effect between medical insurance and primary outpatient utilization. Health insurance directly promotes primary outpatient utilization, while the supply of primary care institutions suppresses the positive influence of medical insurance on the utilization of primary outpatient services. Therefore, community pension services should pay attention to differentiated services. Moreover, adjusting the coordinated development of medical insurance and the supply of primary healthcare could enhance the positive effects of medical insurance for outpatients.
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Affiliation(s)
- Liping Fu
- College of Management and Economics, Tianjin University, Tianjin 300072, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin 300072, China
- College of Politics and Public Administration, Qinghai Minzu University, Xining 810007, China
| | - Ya’nan Fang
- College of Management and Economics, Tianjin University, Tianjin 300072, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin 300072, China
- Correspondence: (Y.F.); (S.Y.); Tel.: +86-18790223308 (Y.F.); +86-15022197928 (S.Y.)
| | - Shu Yang
- College of Management and Economics, Tianjin University, Tianjin 300072, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin 300072, China
- Correspondence: (Y.F.); (S.Y.); Tel.: +86-18790223308 (Y.F.); +86-15022197928 (S.Y.)
| | - Yanqing Xu
- School of Public Administration, Hainan University, Haikou 570208, China
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Hu X, Wang P. Has China's Healthcare Reform Reduced the Number of Patients in Large General Hospitals? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5428. [PMID: 35564824 PMCID: PMC9104654 DOI: 10.3390/ijerph19095428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/14/2022] [Accepted: 04/28/2022] [Indexed: 02/01/2023]
Abstract
Many studies have shown that the new round of healthcare reform launched by the Chinese government in 2009 has not effectively solved the problem in which patients more readily choose large general hospitals. We aimed to find out if this situation exists in every department of a large general hospital. This study collected the outpatient data of 24 departments for a large general hospital in Beijing. By calculating the average growth rate of outpatients in each department from 2014 to 2019, and the utilization rate of outpatient appointments in different departments in 2020, we found that the average growth rate of outpatients in 4 departments (16.6%) was negative, and the utilization rate of outpatient appointments in 13 departments (54.16%) was less than 80%. This shows that the number of patients in some departments is declining, and that there is an inefficient use of doctor resources. Obviously, this is inconsistent with people's current beliefs. Therefore, it is not entirely true that China's healthcare reform has not reduced the number of patients in large general hospitals. At the same time, the inefficient use of outpatient doctor resources is a phenomenon worthy of attention; if it persists, it will result in significant waste in the healthcare system. We suggest that policy makers and hospital managers in China, and countries similar to China, can attract attention and take measures.
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Affiliation(s)
| | - Ping Wang
- Medical Affairs Department, Peking University First Hospital, Beijing 100034, China;
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Lv Y, Fu Q, Shen X, Jia E, Li X, Peng Y, Yan J, Jiang M, Xiong J. Treatment Preferences of Residents Assumed to Have Severe Chronic Diseases in China: A Discrete Choice Experiment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228420. [PMID: 33203010 PMCID: PMC7697856 DOI: 10.3390/ijerph17228420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022]
Abstract
Objectives: This study aims to elicit the relative importance of treatment attributes that influence residents’ choice, assuming they are suffering severe non-communicable diseases (NCDs), to explore how they make trade-offs between these attributes and to estimate the monetary value placed on different attributes and attribute levels. Methods: A discrete choice experiment (DCE) was conducted with adults over 18 years old in China. Preferences were evaluated based on four treatment attributes: care provider, mode of service, distance to practice and cost. A mixed logit model was used to analyze the relative importance of the four attributes and to calculate the willingness to pay (WTP) for a changed attribute level. Results: A total of 93.47% (2019 of 2160) respondents completed valid questionnaires. The WTP results suggested that participants would be willing to pay CNY 822.51 (USD 124.86), CNY 470.54 (USD 71.41) and CNY 68.20 (USD 10.35) for services provided by experts, with integrated traditional Chinese medicine (TCM) and Western medicine (WM) and with a service distance <=30 min, respectively. Conclusions: The results suggested that mode of service, care provider, distance to practice and cost should be considered in priority-setting decisions. The government should strengthen the curative service capability in primary health facilities and give full play to the role of TCM in the prevention and treatment of severe chronic diseases.
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Affiliation(s)
- Yinghao Lv
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Qiang Fu
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St Louis, MO 63103, USA;
| | - Xiao Shen
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Erping Jia
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Xianglin Li
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Yingying Peng
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Jinghong Yan
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Mingzhu Jiang
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Juyang Xiong
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
- Correspondence:
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Hoa NT, Derese A, Peersman W, Markuns JF, Willems S, Tam NM. Primary care quality in Vietnam: Perceptions and opinions of primary care physicians in commune health centers - a mixed-methods study. PLoS One 2020; 15:e0241311. [PMID: 33119666 PMCID: PMC7595414 DOI: 10.1371/journal.pone.0241311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/12/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Measuring the performance of a primary care system is one of the very first steps to find out whether there is room for improvement. To obtain an objective and comprehensive view, this measurement should come from both the supply and demand sides of the system. Patients’ experiences of primary care have been studied around the world, but much less energy has been invested in researching providers’ perspectives. This research aims to explore how primary care physicians working at commune health centers in Vietnam evaluate their performance and their opinions on how to improve the quality of primary care services. Materials and methods First, a quantitative study was conducted using the validated Vietnamese PCAT questionnaire—provider expanded version (VN PCAT PE) targeting all primary care physicians (PCPs) working at commune health centers in a province of Central Vietnam. Next, a qualitative study was carried out, consisting of in-depth interviews with PCPs, to better understand the results of the quantitative survey and gain insight on barriers of primary care services and how to overcome them. Results In the quantitative portion of our study, 150 PCPs rated the quality of ongoing care and first contact in CHCs as the best (3.09 and 3.11 out of 4, respectively), and coordination as the worst performing core domain (2.53). Twenty-two PCPs also participated in our qualitative research. In regards to challenges that primary care physicians face during their daily practice, three central themes emerged: 1) patient factors such as client attitude and knowledge, 2) provider factors such as the burden of administrative work and lack of training opportunities, and 3) contextual factors such as low income and lack of resources including medicines and diagnostics. Participants recommended more health promotion campaigns in the media, increasing the number of services available at CHCs (such as being able to take blood samples), reducing the workload related to administration for CHC leaders, greater government subsidies, and providing more training courses for PCPs. Conclusions Findings from this study offer a valuable view from the supply-side of the primary care system, specifically those who directly deliver primary care services. Along with the earlier study on consumers’ evaluation of the Vietnamese primary care system, and literature from other low and middle-income countries, these findings offer emerging evidence for policymakers to improve the quality of primary care in Vietnam.
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Affiliation(s)
- Nguyen Thi Hoa
- Department of Family Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
- * E-mail: (NMT); (NTH)
| | - Anselme Derese
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Wim Peersman
- Research Group Social and Community Work, Odisee University College, Brussel, Belgium
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Jeffrey F. Markuns
- Global Health Collaborative, Department of Family Medicine, Boston University, Boston, MA, United States of America
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Nguyen Minh Tam
- Department of Family Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
- * E-mail: (NMT); (NTH)
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Zhang C, Fang F, Peng M, Zhao Y, Liu R, Jia C. Qualitative evaluation of the general practitioner chronic non-communicable diseases training programme. BMC MEDICAL EDUCATION 2020; 20:297. [PMID: 32912234 PMCID: PMC7488002 DOI: 10.1186/s12909-020-02226-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In China, general practitioners have limited ability to provide care for common chronic non-communicable diseases because they lack postgraduate training. In an attempt to improve general practitioners' skills in this regard, the present authors previously launched the Chronic Non-Communicable Diseases Training Programme. The present study aims to evaluate the effectiveness of this programme. METHODS Thirty-nine trainee general practitioners who participated in the programme underwent semi-structured interviews, which explored how they performed the training, what they achieved from the programme, and their suggestions for future programmes. The interview data were analysed using a thematic analysis approach. RESULTS Under the guidance of supervisors, the thirty-nine trainee general practitioners completed the structured but individualised training plan, which comprised a four-day basic theory class, 3 months practising in a ward, and 6 months assisting in an outpatient clinic. They reported an improvement in their ability to provide care for chronic non-communicable diseases and perform two-way referral, as well as their communication with patients. They also reported that, since returning to their communities, they had become more confident, were building better relationships with their patients, and had changed their clinic behaviours from copying prescriptions to making medical decisions independently. Their principal suggestion for the training programme was to alter the order of the training, as they preferred to practice in the ward before assisting in the outpatient clinic. CONCLUSION The course comprised a learner-centred, practice- and apprenticeship-based, general-practitioner training programme. Given the participants' progress and the beneficial effects of the programme reported in the interview data, it appears to be worthwhile to extend the General Practitioner Chronic Non-Communicable Diseases Training Programme.
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Affiliation(s)
- Chunyu Zhang
- Department of Health Reform and Development, China-Japan Friendship Hospital, Yinghua East Road 2#, Chaoyang District, Beijing, 100029, P.R. China
| | - Fang Fang
- Department of Health Reform and Development, China-Japan Friendship Hospital, Yinghua East Road 2#, Chaoyang District, Beijing, 100029, P.R. China
| | - Mingqiang Peng
- Hospital Office, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Ying Zhao
- School of Management, Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Ruixue Liu
- School of Management, Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Cunbo Jia
- Department of Health Reform and Development, China-Japan Friendship Hospital, Yinghua East Road 2#, Chaoyang District, Beijing, 100029, P.R. China.
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Li P, Luo Y, Yu X, Wen J, Mason E, Li W, Jalali MS. Patients' Perceptions of Barriers and Facilitators to the Adoption of E-Hospitals: Cross-Sectional Study in Western China. J Med Internet Res 2020; 22:e17221. [PMID: 32525483 PMCID: PMC7317627 DOI: 10.2196/17221] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/11/2020] [Accepted: 04/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users' acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China. OBJECTIVE This study aimed to provide insights regarding the adoption of e-hospitals by investigating patients' willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology. METHODS We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients' sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals. RESULTS Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%). CONCLUSIONS We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries.
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Affiliation(s)
- Peiyi Li
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, China
| | - Yunmei Luo
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, China
| | - Xuexin Yu
- Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jin Wen
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, China
| | - Elizabeth Mason
- Massachusetts General Hospital's Institute for Technology Assessment, Harvard Medical School, Boston, MA, United States
| | - Weimin Li
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Mohammad S Jalali
- Massachusetts General Hospital's Institute for Technology Assessment, Harvard Medical School, Boston, MA, United States
- MIT Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, United States
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Wang H, Shi L, Han X, Zhang J, Ma Y, Yang X, Liu M, Fan L, Lou F. Factors associated with contracted services of Chinese family doctors from the perspective of medical staff and consumers: a cross-sectional study. BMC Health Serv Res 2019; 19:986. [PMID: 31864354 PMCID: PMC6925852 DOI: 10.1186/s12913-019-4801-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 12/02/2019] [Indexed: 12/21/2022] Open
Abstract
Background The family doctor system has developed rapidly all over the world, and in the past few years, China has actively explored family doctor-type contracted services. This study aimed to explore the related factors of Contracted Family Doctors Services (CFDS) from the perspectives of medical staff and consumers, and to provide a stronger basis for the development and promotion of CFDS. Methods A combination of quantitative and qualitative methods were used in this study. A self-reported questionnaire was designed through a literature analysis, group discussions, expert consultations and a pre-investigation, and conducted among community health service providers in 12 community health service centres across four provinces of China. A total of 389 participants participated, and 320 valid questionnaires were obtained, with an effective response rate of 82.3%. A total of 36 consumers participated in in-depth interviews, and the effective rate was 100.0%. An exploratory factor analysis, a confirmatory factor analysis, inductive methods, and expert consultations were used to analyse the related factors of CFDS. Results The related factors of CFDS from the perspectives of medical staff were divided into four dimensions, with the following weighting coefficients: national government factors (31.9%), community health service agency factors (24.7%), consumer-related factors (22.6%), and contracted doctor-related factors (20.8%). The related factors of CFDS from the perspectives of consumers were divided into four dimensions, with the following frequency sequence: national government factors, contract doctor-related factors, community health service agency factors, and consumers-related factors. National government factors played an important role in CFDS from the perspectives of medical staff and consumers. Conclusions The related factors of CFDS were the same from the perspective of medical staff and consumers, but the weight of each factor was different. The development of CFDS is inseparable from the support of policies. It is suggested that the government should strengthen the publicity of CFDS, expand the coverage, introduce personalised contract programs that meet the needs of different groups, and promote the rapid development of CFDS.
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Affiliation(s)
- Huanyan Wang
- Department of Health Management, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China.,Human Resource Office, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lei Shi
- Department of Health Management, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Xuanye Han
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jinchan Zhang
- Department of Medical Dispute, Maternal and Child Health Hospital, Heyuan, Guangdong, China
| | - Yuanshuo Ma
- Department of Health Management, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Xi Yang
- Department of Health Management, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Ming Liu
- Department of Health Management, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Lihua Fan
- Department of Health Management, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China.
| | - Fengge Lou
- Department of Public Health Research, School of Public Health, Qiqihar Medical University, Qiqihar, Heilongjiang, China.
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Du S, Cao Y, Zhou T, Setiawan A, Thandar M, Koy V, Nurumal MSB, Anh H, Kunaviktikul W, Hu Y. The knowledge, ability, and skills of primary health care providers in SEANERN countries: a multi-national cross-sectional study. BMC Health Serv Res 2019; 19:602. [PMID: 31455377 PMCID: PMC6712608 DOI: 10.1186/s12913-019-4402-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/05/2019] [Indexed: 12/14/2022] Open
Abstract
Background Primary health care (PHC) is usually the initial point of contact for individuals seeking to access health care and providers of PHC play a crucial role in the healthcare model. However, few studies have assessed the knowledge, ability, and skills (capacity) of PHC providers in delivering care. This study aimed to identify the capacity of PHC providers in countries of the Southeast and East Asian Nursing Education and Research Network (SEANERN). Methods A multi-national cross-sectional survey was performed among SEANERN countries. A 1–5 Likert scale was used to measure eight components of knowledge, ability, and skill of PHC providers. Descriptive statistics were employed, and radar charts were used to depict the levels of the three dimensions (knowledge, skill and ability) and eight components. Results Totally, 606 valid questionnaires from PHC providers were returned from seven countries of SEANERN (China, Myanmar, Indonesia, Thailand, Vietnam, Cambodia, and Malaysia), with a responsive rate of 97.6% (606/621). For the three dimensions the ranges of total mean scores were distributed as follows: knowledge dimension: 2.78~3.11; skill dimension: 2.66~3.16; ability dimension: 2.67~3.06. Furthermore, radar charts revealed that the transition of PHC provider’s knowledge into skill and from skill into ability decreased gradually. Their competencies in four areas, including safe water and sanitation, nutritional promotion, endemic diseases prevention, and essential provision of drugs, were especially low. Conclusions The general capacity perceived by PHC providers themselves seems relatively low and imbalanced. To address the problem, SEANERN, through the collaboration of the members, can facilitate the appropriate education and training of PHC providers by developing feasible, practical and culturally appropriate training plans. Electronic supplementary material The online version of this article (10.1186/s12913-019-4402-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shizheng Du
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, People's Republic of China.,School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuling Cao
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, People's Republic of China.,Faculty of Nursing, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Tong Zhou
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Agus Setiawan
- Faculty of Nursing, Universitas Indonesia Kampus UI, Depok, Jawa Barat, Indonesia
| | | | - Virya Koy
- Chief Nursing Officer/Nursing Focal Person in Cambodia for WHO-WPRO, Phnom Penh, Cambodia
| | - Mohd Said Bin Nurumal
- Kulliyyah of Nursing, International Islamic University, 25100, Kuantan, Pahang, Malaysia
| | - Hong Anh
- School of Nursing, Phenikaa University, Hanoi, Vietnam
| | | | - Yan Hu
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, 200032, People's Republic of China.
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