Progress of equalizing basic public health services in Southwest China--- health education delivery in primary healthcare sectors

A tryst of 'blood pressure control- sex- comorbidities': the odyssey of basic public health services in Yunnan in quest for truth

BACKGROUND

The Basic Public Health Service (BPHS), a recently announced free healthcare program, aims to combat the most prevalent Noncommunicable Disease-"Hypertension" (HTN)-and its risk factors on a nationwide scale. In China, there is a rife that HTN less impacts women during their lifetime. We, therefore, aimed to evaluate the sex disparity in hypertension patients with comorbidities among south-west Chinese and the contribution of BPHS to address that concern.

METHODS

We have opted for a multistage stratified random sampling method to enroll hypertensive patients of 35 years and older, divided them into BPHS and non-BPHS groups. We assessed the sex disparity in HTN patients with four major comorbidities- Dyslipidemia, Diabetes Mellitus (DM), Cardiovascular Disease (CVD), and Chronic Kidney Disease (CKD), and descriptive data were compiled. Odds ratios from logistic regression models estimated the effectiveness of BPHS in the management of HTN with comorbidities.

RESULTS

Among 1521 hypertensive patients,1011(66.5%) were managed in the BPHS group. The proportion of patients who had at least one comorbidity was 70.7% (95% confidence interval [CI]: 66.3-76.8%), patients aged 65 years and older were more likely to have coexisting comorbidities. Participants who received the BPHS showed significant blood pressure (BP) control with two comorbidities (odds ratio [OR] = 2.414, 95% CI: 1.276-4.570), three or more (OR = 5.500, 95%CI: 1.174-25.756). Patients with dyslipidemia and DM also benefited from BPHS in controlling BP (OR = 2.169, 95% CI: 1.430-3.289) and (OR = 2.785, 95%CI: 1.242-6.246), respectively. In certain high-income urban survey centers, there was sex differences in the HTN management provided by BPHS, with men having better BP control rates than women.

CONCLUSIONS

Perhaps this is the first study in China to succinctly show the effectiveness and sex disparity regarding "management of hypertensive comorbidities". This supports that the BPHS program plays a pivotal role in controlling BP, therefore should recommend the national healthcare system to give women a foremost priority in BPHS, especially to those from low-socioeconomic and low-scientific literacy regions.

The urban-rural disparities and factors associated with the utilization of public health services among diabetes patients in China

BACKGROUND

Basic public health services for diabetes play an essential role in controlling glycemia in patients with diabetes. This study was conducted to understand the urban-rural disparities in the utilization of basic public health services for people with diabetes and the factors influencing them.

METHODS

The data were obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS) with 2976 diabetes patients. Chi-square tests were used to examine the disparities in the utilization of diabetes physical examination and health education between urban and rural areas. Logistic regression was performed to explore the factors associated with the utilization of diabetes public health services.

RESULTS

Among all participants, 8.4% used diabetes physical examination in the past year, and 28.4% used diabetes health education services. A significant association with age (OR = 0.64, 95% CI:0.49-0.85; P < 0.05) was found between patients' use of health education services. Compared with diabetes patients living in an urban area, diabetes patients living in a rural area used less diabetes health education. (χ2= 92.39, P < 0.05). Patients' self-reported health status (OR = 2.04, CI:1.24-3.35; P < 0.05) and the use of glucose control (OR = 9.33, CI:6.61-13.16; P < 0.05) were significantly positively associated with the utilization of diabetes physical examination. Patients with higher education levels were more likely to use various kinds of health education services than their peers with lower education levels (OR = 1.64, CI:1.21-2.22; P < 0.05).

CONCLUSION

Overall, urban-rural disparities in the utilization of public health services existed. Vulnerable with diabetes, such as those in rural areas, are less available to use diabetes public health services. Providing convenient health service infrastructure facilitates the utilization of basic public health services for diabetes in older patients with diabetes, especially in rural areas.

Diabetes knowledge predicts HbA1c levels of people with type 2 diabetes mellitus in rural China: a ten-month follow-up study

Improving diabetes self-management (DSM) is facing real-world challenges among people with type 2 diabetes mellitus (T2DM) who have a low education level in resource-limited areas. This study aimed to investigate whether diabetes knowledge could predict glycemic levels in people with T2DM in rural China. This analytical cross-sectional study recruited 321 people with T2DM from eight villages by purposive sampling at baseline. After 10 months, 206 patients completed the follow-up survey and HbA1c tests, with a response rate of 64.17% (206/321). Multiple regression analysis was employed to explore the correlation between diabetes knowledge and HbA1c levels. The patient's diabetes knowledge was significantly negatively correlated with HbA1c levels before and after controlling for covariates in both hierarchical multiple regression and multiple logistic regression (p < 0.01). In addition, other influencing factors, including sex, age, marital status, employment status, income, and HbA1c levels at baseline, were also identified. Diabetes knowledge could predict HbA1c levels significantly among patients with low education levels in rural China. Therefore, interventions on improving diabetes knowledge need to be strengthened for patients in rural China so that they can improve their health outcomes and reduce the disease burden.

Classification of health needs: a cluster analysis of older adults in urban areas

BACKGROUND

In this study, a cross-sectional survey was used to understand and analyze the health status and health needs of the elderly in the community. The cluster analysis method was used to explore the relationship between health needs items and investigate the commonness among health demand items, to provide a reference for the development of health management of the elderly with chronic diseases.

METHODS

We used convenience sampling to recruit the participants (aged 60 and above) from four urban community centers in Jinzhou City, Liaoning Province, China, in this study. This study uses the Medical Outcomes Study(MOS)36-Item Short-Form Health Survey. The self-designed questionnaire includes sociodemographic characteristics, chronic diseases, physical examination conditions, illness in the past two weeks, and a health needs questionnaire. SPSS 18.0 was used for data entry and analysis. Data analysis methods included descriptive statistical analysis, t-test, one-way analysis, cluster analysis, and linear multiple regression analysis.

RESULTS

The rate of health needs among the elderly in the community for various health services is 1.3-69.7%, of which the top three are: regular physical examination (69.7%), day Care Center (67.7%), the establishment of a Medical Alert Systems (66.1%). The health needs of the elderly in the community are divided into three categories: basic needs (24 items), health education (13 items), and first aid (2 items). The regression analysis found that the influencing factors of health status were age, revenue and expenditure, medical expenses, health education, basic needs, and first aid.

CONCLUSIONS

The community should strengthen the management of chronic diseases of the elderly and the publicity and education of related knowledge, and provide complementary health care services according to the health needs of the elderly, improve the health of the elderly, and improve the quality of life of the elderly.

Regional differences in primary healthcare utilization in Java Region-Indonesia

BACKGROUND

Policymakers must understand primary healthcare utilization disparity to minimize the gap because they must seek fair service for every citizen. The study analyzes regional differences in primary healthcare utilization in Java Region-Indonesia.

METHODS

The cross-sectional research analyzes secondary data from the 2018 Indonesian Basic Health Survey. The study setting represented Java Region-Indonesia, and the participants were adults 15 years or more. The survey explores 629,370 respondents. The study used primary healthcare utilization as an outcome variable and province as the exposure variable. Moreover, the study employed eight control variables (residence, age, gender, education, marital, employment, wealth, and insurance). The study evaluated data using binary logistic regression in the final step.

RESULTS

People in Jakarta are 1.472 times more likely to utilize primary healthcare than those in Banten (AOR 1.472; 95% CI 1.332-1.627). People in Yogyakarta are 1.267 times more likely to use primary healthcare than those in Banten (AOR 1.267; 95% CI 1.112-1.444). In addition, people in East Java are 15% less likely to utilize primary healthcare than those in Banten (AOR 0.851; 95% CI 0.783-0.924). Meanwhile, direct healthcare utilization was the same between West Java, Central Java, and Banten Province. They are sequentially starting from the minor primary healthcare utilization: East Java, Central Java, Banten, West Java, Yogyakarta, and Jakarta.

CONCLUSION

Disparities between regions exist in the Java Region-Indonesia. They are sequentially starting from the minor primary healthcare utilization: East Java, Central Java, Banten, West Java, Yogyakarta, and Jakarta.

Health Information System and Health Care Applications Performance in the Healthcare Arena: A Bibliometric Analysis

There have been several studies centred on health information systems with many insights provided to enhance health care applications globally. These studies have provided theoretical schemes for fortifying the enactment and utilisation of the Health Information System (HIS). In addition, these research studies contribute greatly to the development of HIS in alignment with major stakeholders such as health practitioners and recipients of health care. Conversely, there has been trepidation about HIS' sustainability and resilience for healthcare applications in the era of digitalization and globalization. Hence, this paper investigates research on HIS with a primary focus on health care applications to ascertain its sustainability and resilience amidst the transformation of the global healthcare space. Therefore, using a bibliometric approach, this paper measures the performance of health information systems and healthcare for health care applications using bibliometric data from the web of science database. The findings reveal solid evidence of the constructive transformation of health information systems and health care applications in the healthcare arena, providing ample evidence of the adaptation of HIS and health care applications within the healthcare arena to the fourth industrial revolution and, additionally, revealing the resilient alignment of health care applications and health information systems.

A citation analysis and scoping systematic review of the operationalization of the Practical, Robust Implementation and Sustainability Model (PRISM)

Background

The Practical, Robust Implementation and Sustainability Model (PRISM) was developed in 2008 as a contextually expanded version of the broadly used Reach, Adoption, Effectiveness, Implementation, and Maintenance (RE-AIM) framework. PRISM provides researchers a pragmatic and intuitive model to improve translation of research interventions into clinical and community practice. Since 2008, the use of PRISM increased across diverse topics, populations, and settings. This citation analysis and scoping systematic review aimed to assess the use of the PRISM framework and to make recommendations for future research.

Methods

A literature search was conducted using three databases (PubMed, Web of Science, Scopus) for the period of 2008 and September 2020. After exclusion, reverse citation searches and invitations to experts in the field were used to identify and obtain recommendations for additional articles not identified in the original search. Studies that integrated PRISM into their study design were selected for full abstraction. Unique research studies were abstracted for information on study characteristics (e.g., setting/population, design), PRISM contextual domains, and RE-AIM outcomes.

Results

A total of 180 articles were identified to include PRISM to some degree. Thirty-two articles representing 23 unique studies integrated PRISM within their study design. Study characteristics varied widely and included studies conducted in diverse contexts, but predominately in high-income countries and in clinical out-patient settings. With regards to use, 19 used PRISM for evaluation, 10 for planning/development, 10 for implementation, four for sustainment, and one for dissemination. There was substantial variation across studies in how and to what degree PRISM contextual domains and RE-AIM outcomes were operationalized and connected. Only two studies directly connected individual PRISM context domains with RE-AIM outcomes, and another four included RE-AIM outcomes without direct connection to PRISM domains.

Conclusions

This is the first systematic review of the use of PRISM in various contexts. While there were low levels of ‘integrated’ use of PRISM and few reports on linkage to RE-AIM outcomes, most studies included important context domains of implementation and sustainability infrastructure and external environment. Recommendations are provided for more consistent and comprehensive use of and reporting on PRISM to inform both research and practice on contextual factors in implementation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13012-022-01234-3.

Satisfaction With Community Health Education Among Residents in China: Results From a Structural Equation Model

Background

Although community health education has drawn lots of attention from the public, evidence on resident satisfaction is still sparse. This study aims to explore the relationships among five dimensions (perceived quality, perceived value, public expectation, public trust, and public satisfaction) of satisfaction with community health education among Chinese residents.

Methods

We constructed a theoretical public satisfaction model for community health education based on the American Customer Satisfaction Index (ACSI) model. There are five dimensions in the theoretical model, including public expectation, perceived quality, perceived value, public satisfaction, and public trust. We recruited 474 respondents from a quota sampling based on gender and age, and collected information on five dimensions of satisfaction with community health education. The relationships of the five dimensions were examined using structural equation model.

Results

The mean scores of public expectation, perceived quality, perceived value, public satisfaction, and public trust for the participants were 11.44 (total 15), 123.89 (total 170), 14.18 (total 20), 10.19 (total 15), and 15.61 (total 20), respectively. We obtained a structural equation model with a good fitting degree. There was a direct effect of perceived quality on perceived value (γ = 0.85, P < 0.01), public trust (γ = 0.81, P < 0.01) and public satisfaction (γ = 0.58, P < 0.01), and a direct effect of public expectation on public satisfaction (γ = 0.36, P < 0.01) and perceived value (γ = 0.25, P < 0.01).

Conclusions

We provide a good tool to measure public satisfaction with community health education, which can be potentially used to measure public satisfaction and improve the effectiveness of health education.

Towards Universal Healthcare Coverage: Experience form the Implementation of the National Basic Public Health Service Program in China (Preprint)

Background

Public health service is an important component and pathway to achieve universal health coverage (UHC), a major direction goal of many countries. China’s National Basic Public Health Service Program (the Program) is highly consistent with this direction.

Objective

The aim of this study was to analyze the key experience and challenges of the Program so as to present China’s approach to UHC, help other countries understand and learn from China’s experience, and promote UHC across the world.

Methods

A literature review was performed across five main electronic databases and other sources. Some data were obtained from the Department of Primary Health, National Health Commission, China. Data obtained included the financing share of the national/provincial/prefectural government among the total investment of the program in 32 provinces in 2016, their respective per capita funding levels, and some indicators related to program implementation from 2009 to 2016. The Joinpoint regression model was adopted to test the time trend of changes in program implementation indicators. Face-to-face individual interviews and group discussions were conducted with 48 key insiders.

Results

The program provided full life cycle service to the whole population with an equitable and affordable financing system, enhanced the capability and quality of the health workforce, and facilitated integration of the public health service delivery system. Meanwhile, there were also some shortcomings, including lack of selection and an exit mechanism of service items, inadequate system integration, shortage of qualified professionals, limited role played by actors outside the health sector, and a large gap between the subsidy standard and the actual service cost. The Joinpoint regression analysis demonstrated that 13 indicators related to program implementation showed a significant upward trend (P<.05) from 2009 to 2016, with average annual percent change values above 10% for 6 indicators and below 6% for 7 indicators. Three indicators (coverage of health records, electronic health records, and health management among the elderly) rose rapidly with annual percent change values above 30% between 2009 and 2011, but rose slowly or remained stable between 2011 and 2016. In 2016, the subsidy standard per capita in the eastern, central, and western regions was equivalent to US $7.43, $7.15, and $6.57, respectively, of which the national-level subsidy accounted for 25.50%, 60.57%, and 79.52%, respectively.

Conclusions

The Program has made a significant contribution to China’s efforts in achieving UHC. The Program focuses on a key population and provides full life cycle services for the whole population. The financing system completely supported by the government makes the services more equitable and affordable. However, there are a few challenges to implementing the Program in China, especially to increase the public investment, optimize service items, enhance quality of the services, and evaluate the health outcomes.

Association between socioeconomic status and dental caries among Chinese preschool children: a cross-sectional national study

OBJECTIVES

Socioeconomic inequalities in oral health are often neglected in oral health promotion. This cross-sectional study assessed the association between dental caries and socioeconomic status (SES) among preschool children in China.

DESIGN

Cross-sectional study.

SETTING

Data from the Fourth National Oral Health Survey of China (2015), comprising of 40 360 children aged 3-5 years was used.

METHODS

Dental caries indicators including prevalence of dental caries, dental pain experience and number of decayed, missing and filling teeth (dmft). SES indicators included parental education and household income. The associations between SES and dental caries were analysed by using negative binomial regression or Poisson regression models according to data distribution. Relative and absolute inequalities in dental caries were quantified by using the Relative Index of Inequality (RII) and Slope Index of Inequality (SII), respectively.

RESULTS

There were significant associations between SES and prevalence of dental caries and dmft (p<0.001). Children from lower educated (RII 1.36, 95% CI 1.3 to 1.43; SII 0.97, 95% CI 0.81 to 1.13) and lower household income (RII 1.17, 95% CI 1.11 to 1.24; SII 0.55, 95% CI 0.35 to 0.75) families had higher dmft than those from well-educated and most affluent families. Relative and absolute inequalities in dental caries were larger in urban areas by household income, and in rural areas by parental education.

CONCLUSIONS

Association between dental caries and SES was demonstrated and socioeconomic inequalities in dental caries existed among Chinese preschool children.

Increasing Health Literacy in China to Combat Noncommunicable Diseases

Health literacy involves knowledge, motivation, and competence to access, understand, appraise, and apply health information to make judgments and make decisions every day to maintain or improve quality of life. It is of great importance to the health and wellbeing of individuals, families, and society and plays a crucial role in noncommunicable disease (NCD) prevention and control. Recognizing that health literacy is a public health challenge in China, the Chinese government has been making great effort to address this issue. This paper presented a general overview of health literacy status in China with a focus on NCDs, described China's challenges and practices in improving health literacy, and provided suggestions to decision makers, practitioners, and researchers to address the needs of health literacy in China.

Reconfigure rehabilitation services during the Covid-19 pandemic: best practices from Southwest China

PURPOSE

The healthcare system and service capacity are overwhelmed by the Covid-19 pandemic. There is a substantial unmet need for rehabilitation service to all patients affected by Covid-19 directly or indirectly. This article aims to describe how to rapidly reconfigure and bring rehabilitation services back during the pandemic.

METHOD

The Steer committee meeting was held for the development of a strategic preparedness plan and safety management based on principles and evidence of rehabilitation, which will lead to effective mitigation of consequences resulted from Covid-19.

RESULTS

Five measures were taken in Southwest China during the pandemic, which includes the "First contact responsibility" and management system; the full-coverage system for nosocomial infection control; the "Closed-off management" system; the full-coverage system for body temperature monitoring; the adoption of 5G-based telerehabilitation. With the implementation of these measures, the capacity and capability were enhanced to safely reopen and operate rehabilitation facilities in Southwest China.

CONCLUSION

Further measurement of quality of care and outcomes during and beyond the pandemic is needed in transforming the healthcare system and improving rehabilitation services. Hopefully, the positive message conveyed by this paper could encourage and support communities and the society of physical medicine and rehabilitation worldwide during this challenging time. IMPLICATIONS FOR REHABILITATION Rehabilitation services are essential and there is an unmet need posed by the Covid-19 pandemic. A feasible strategic plan and safety management measures are critical to reconfigure the capacity and capability of rehabilitation services suspended by Covid-19. The adoption of tele-rehabilitation technology has the potential to reshape public health emergency responses and the delivery of care. Measurement of quality and outcomes is of great importance to inform transformation and adaptation of rehabilitation services during and after the Covid-19 pandemic.