A profile of patients' and doctors' perceptions, acceptance, and utilization of e-health in a deprived region in southwestern China

Status and analysis of Free Hospital-Based Internet + Nursing Health Consultation Services: a retrospective study

BACKGROUND

With the increasing demand for healthcare services, Free Hospital-Based Internet + Nursing Health Consultation Services have emerged as an innovative model to provide patients with timely and convenient nursing guidance.

OBJECTIVE

To comprehensively evaluate the implementation and effectiveness of Free Hospital-Based Internet + Nursing Health Consultation Services, identify existing challenges, and propose evidence-based optimization strategies to enhance the precision and efficiency of future services.

METHODS

A retrospective analysis was conducted based on the hospital information system, retrieving orders for Free Hospital-Based Internet + Nursing Health Consultation Services from Mianyang Central Hospital between 2021 and 2023. This analysis included the staffing structure on the nurse's side and details of patient orders. Statistical analyses were performed using SPSS 25.0 software.

RESULTS

Our hospital's talent pool for Free Hospital-Based Internet + Nursing Health Consultation Services comprises 128 nurses, with dynamic adjustments to the nurses and departments based on health consultation orders. From 2021 to 2023, the total number of consultations was 2,328, with a consultation time of 3,001,409 min. Among them, 2,203 consultations were accepted, 25 were declined, and 100 exceeded the time limit. The top three departments in terms of consultation volume were Obstetrics and Gynecology (25.78%), Pediatrics (23.92%), and Dermatology (20.96%). With the annual growth in the service, the total number of consultations, accepted consultations, declined consultations, and overdue orders increased each year, although the differences were not statistically significant (P > 0.05). The consultation waiting time showed a decreasing trend, recorded at 665, 356, and 404 min, respectively. The average consultation time remained stable at 1,414, 1,373, and 1,346 min.

CONCLUSION

Nurse-led Free Hospital-Based Internet + Nursing Health Consultation Services provide patients with convenient and efficient health consultation channels, helping to meet the growing health demands of patients. As the service has expanded over the years, the overall consultation volume has shown an upward trend while maintaining stable service quality and gradually reducing waiting times, offering more timely nursing health consultation services. Future recommendations include multicenter studies to explore the effectiveness and safety of Free Hospital-Based Internet + Nursing Health Consultation Services.

Decomposition and comparative analysis of urban-rural differences in eHealth literacy among nursing students: A multisite cross-sectional study

BACKGROUND

Investigating the urban-rural differences in eHealth literacy among Chinese nursing students is imperative for enhancing healthcare education and practice. This study aimed to investigate the factors that contribute to urban-rural differences in eHealth literacy among Chinese nursing students and measure their respective contributions.

DESIGN

A multisite cross-sectional study.

SETTINGS

In China.

PARTICIPANTS

A total of 967 nursing students were involved in this study.

METHODS

Multivariate linear regression models were used to explore the associations between sociodemographic and health-related factors and the eHealth literacy of Chinese nursing students. Additionally, Blinder-Oaxaca decomposition was employed to scrutinize the factors attributing to the urban-rural differences in eHealth literacy among Chinese nursing students, elucidating their respective contributions.

RESULTS

The mean eHealth literacy score for urban nursing students (mean: 20.26, SD: 3.61) exceeded that of rural nursing students (mean: 19.53, SD: 3.56) (p < 0.001). Blinder-Oaxaca decomposition analysis indicated that 84.82 % of the urban-rural differences in eHealth literacy among nursing students can be explained. The urban-rural differences are primarily explained by family health (40.05 %).

CONCLUSIONS

The study emphasizes the importance of tailoring educational curricula to address urban-rural differences in eHealth literacy among nursing students in China. Specifically, incorporating content related to family health in educational programs is crucial.

Preparedness, Challenges, and Opportunities for Digital Intervention for Chronic Disease Management: A Qualitative Study in Rural Areas of South Korea

Motivated by the prevalence of an aging population and the associated increase in chronic diseases, coupled with rising medical expenditure, the Korean government initiated a pilot project in Pyeongchang-gun, Gangwon-do, a rural area, to implement a "smart online-to-offline (O2O) digital health care model" aimed at managing and preventing chronic diseases. However, there is limited understanding regarding perspectives and levels of preparedness for digital health among stakeholders at various levels. In-depth focus group interviews were conducted with elderly and non-elderly community members, health care providers, and staff members at Pyeongchang Health and Medical Center. The study found the presence of both positive and negative perceptions and a lack of preparedness across different levels. At the end-user level, it was observed that community members, especially the elderly, have low levels of health and digital literacy, compounded by limited access to social support. At the health care provider level, there was uncertainty about the acceptance of the digital health program. At the area level, the need to bolster health staff members and enhance their capacity was observed. Recommendations include: customizing the design of the online and offline service components by considering end-user factors (such as age, occupation, and household type) that may contribute to disparities in health; establishing a platform for providers to share their experiences to facilitate the effective incorporation of digital health into their practices; and preparing an appropriate provider payment mechanism.

Comparing the Quality of Direct-to-Consumer Telemedicine Dominated and Delivered by Public and Private Sector Platforms in China: Standardized Patient Study

BACKGROUND

Telemedicine is expanding rapidly, with public direct-to-consumer (DTC) telemedicine representing 70% of the market. A key priority is establishing clear quality distinctions between the public and private sectors. No studies have directly compared the quality of DTC telemedicine in the public and private sectors using objective evaluation methods.

OBJECTIVE

Using a standardized patient (SP) approach, this study aimed to compare the quality of DTC telemedicine provided by China's public and private sectors.

METHODS

We recruited 10 SPs presenting fixed cases (urticaria and childhood diarrhea), with 594 interactions between them and physicians. The SPs evaluated various aspects of the quality of care, effectiveness, safety, patient-centeredness (PCC), efficiency, and timeliness using the Institute of Medicine (IOM) quality framework. Ordinary least-squares (OLS) regression models with fixed effects were used for continuous variables, while logistic regression models with fixed effects were used for categorical variables.

RESULTS

Significant quality differences were observed between public and private DTC telemedicine. Physicians from private platforms were significantly more likely to adhere to clinical checklists (adjusted β 15.22, P<.001); provide an accurate diagnosis (adjusted odds ratio [OR] 3.85, P<.001), an appropriate prescription (adjusted OR 3.87, P<.001), and lifestyle modification advice (adjusted OR 6.82, P<.001); ensure more PCC (adjusted β 3.34, P<.001); and spend more time with SPs (adjusted β 839.70, P<.001), with more responses (adjusted β 1.33, P=.001) and more words (adjusted β 50.93, P=.009). However, SPs on private platforms waited longer for the first response (adjusted β 505.87, P=.001) and each response (adjusted β 168.33, P=.04) and paid more for the average visit (adjusted β 40.03, P<.001).

CONCLUSIONS

There is significant quality inequality in different DTC telemedicine platforms. Private physicians might provide a higher quality of service regarding effectiveness and safety, PCC, and response times and words. However, private platforms have longer wait times for their first response, as well as higher costs. Refining online reviews, establishing standardized norms and pricing, enhancing the performance evaluation mechanism for public DTC telemedicine, and imposing stricter limitations on the first response time for private physicians should be considered practical approaches to optimizing the management of DTC telemedicine.

Short- and long-term impacts of the National Essential Medicines Policy on drug availability, price, and usage in a deprived rural county in southwestern China: an interrupted time series analysis across 8 years

Background

China's National Essential Medicines Policy (NEMP) has been implemented for over 15 years; yet empirical evidence on its long-term impacts is lacking, particularly in remote and rural regions. This study aims to assess the short-and long-term effects of NEMP on the drug availability, price, and usage in a deprived rural county in southwestern China.

Methods

A quasi-experimental design was employed, featuring a single-group pre-and-post comparison. We gathered 74,436 procurement records spanning from 2009 to 2016 from the drug warehouses of local medical institutions. Pharmaceutical data were analyzed quarterly, considering various policy and therapeutic attributes. Fisher's Drug Price Index (DPI-F) was calibrated for the retail and wholesale prices of a consistent collection of 405 medications. We conducted interrupted time-series analysis to examine the immediate and enduring impacts of NEMP's initial (commencing in January 2011) and second (starting from December 2015) stages.

Results

After initiation of NEMP, the number of available essential medicines surged by 115 but subsequently faced a steady quarterly decline (-9.1) in township healthcare centers (THCs, primary care). Conversely, county hospitals (secondary care) initially saw a reduction of 40 in drug availability but later exhibited a steady increase (+4.2 per quarter) up to the second-stage NEMP. Regarding price, THCs encountered abrupt (-26.1%/-15.9% in retail/wholesale price) and sustained (-0.2%/-0.3% per quarter) price drops after NEMP. The immediate price change after NEMP in county hospitals were milder but significant in non-essential medicines, and long-term declines were also observed in all drugs. As for total sales, a significant long-term disparity emerged between THCs (+0.9% per quarter) and county hospitals (+3.3% per quarter). Following the second-stage NEMP, retail prices in county hospitals further decreased, although wholesale prices did not; however, following price upward trends were observed in both THCs and county hospitals. Lastly, the influences of NEMP varied across different therapeutical categories of medicines.

Conclusion

NEMP has successfully regulated drug prices in primary and secondary healthcare facilities in remote and rural areas, both short-term and long-term. However, a remarkable disparity in medicine availability and utilization was observed between different levels of facilities over time. Continuous monitoring is essential, with increased attention needed on the uneven impacts of the policy on diverse drugs, facilities, regions, and demographics.

Quality assessment of online osteosarcoma-related videos in Mainland China: A cross-sectional study

BACKGROUND

Information about orthopedics diseases on the Internet has not been extensively assessed. Our purpose was to evaluate the quality of online information of osteosarcoma on current video-sharing platforms in mainland China.

METHOD

TikTok and Bilibili were independently queried from June to July 2023 by four independent researchers using the Microsoft Edge web browser. Information about the videos and creators was recorded, and descriptive analyses were conducted.

RESULTS

After data extraction, a total of 95 videos were included, in which 43 videos were uploaded by certified doctors (45.3%), with 35 videos (36.8%) uploaded by certified orthopedic surgeons. Of the content of these videos, 78.9% were introduction (n = 75), 64.2% were on professional knowledge (n = 61), 28.4% were on treatment (n = 27), while 5.3% were on surgical techniques (n = 5). The mean DISCERN total score was 43.8 ± 13.4, and the mean JAMA score was 3.8 ± 0.3.

CONCLUSIONS

Videos about osteosarcoma on current video-sharing platforms were extensive, but were not comprehensive and professional. Although current online videos have the potential to improve public awareness on osteosarcoma, due to their quality and content, were not assessed to be good sources for medical education.