The innovations in China’s primary health care reform: Development and characteristics of the community health services in Hangzhou

Objective:This study focuses on Hangzhou,a Chinese city with a population of nine million urban and rural residents,to examine the successful development and innovation experience of its primary health care service system during the new health reform in China since 2009 and then dis-seminate the findings through international third parties.Methods:Measures such as data analysis,study of documents and regulations,fieldwork,and expert discussions were used to systematically investigate primary health care in Hangzhou.The findings will have a profound practical impact on the health reform for nine million rural and urban residents throughout Hangzhou’s municipal boroughs.Results:Community health services in Hangzhou are characterized as follows:They are gov-ernment led;they are guaranteed with enough financing,personnel,facilities,and regulation;sup-ported by the unified information platform;general practitioners have been assigned the key role of health‘gatekeepers’;they provide primary care combined with basic public health services;there are integrated urban and rural health services and insurance coverage;and there is health care-pen-sion-nursing integration and general practitioner-contracted‘smart’services.Preliminary data collection and analysis indicate that the basic health status of Hangzhou residents is superior to that of residents of China as a whole,and some health indicators in Hangzhou are comparable to those in Western developed countries.Conclusion:It is reasonable to believe that the primary health care level in China,including Hangzhou,will be further developed and promoted with indexed performance evaluations and more effective implementation of additional measures.

Types of community health services selected by urban and suburban residents in Nanjing and influencing factors

Objective:The purpose of the current study was to determine the types of community health services selected by urban and suburban residents in Nanjing and the influencing factors in an ef-fort to improve the community health services to better meet the residents’demands.Methods:Between 15 May 2013 and 15 June 2013,eight community health service centers from four districts in Nanjing(Gulou District and Baixia District in urban areas and Jiangning District and Pukou District in suburban areas;two centers from each district)were selected using a stratified random sampling method of investigation sites.After an intercept interview with 487 community residents,univariate and multivariate analyses were performed by means of logistic regression.Results:Among the 487 users of community health services,there were 241 residents from urban areas(49.5%)and 246 residents from suburban areas(50.5%).Among the respondents,there were 191(39.2%)who usually received medical treatment from community health service institutions,including 74(38.7%)from urban areas and 117(61.3%)from suburban areas.The analysis showed that the factors which influenced urban residents in Nanjing to choose community health services for medical treatment included income,payment terms of medical fees,reasonable prices,medical fees,and expenses for medications,while factors influencing suburban residents to choose community health services for medical treatment included income,level of education,carrier,medical institutions selected when feeling severely ill,availability of preventive health services,availability of health counseling services,medical fees,and expenses for medications.Based on an analysis of the results by means of unconditioned binary logistic stepwise regression,the factors influencing whether or not the urban residents chose community health services for medical treatment included gender,age,level of education,payment terms of medical fees,treat-ment environment,and expenses for medications,while the factors influencing suburban residents included availability of preventive health services and expenses for medications.Conclusion:There was a difference between the types of community health services selected by residents in urban and suburban areas of Nanjing and factors influencing the selection of ser-vices were different.Community health service institutions in different areas should strengthen their own service capability according to the local residents’health demands.

The Development of Community-Based Family Healthcare: A Cross-Sectional Study in Haidian, Beijing, China

The outbreak of Covid-19 affects China’s health delivery system, and the current status of primary health services after the Covid-19 pandemic is not yet clear. To further explore the current status of demands of family health services, we conducted a cross-sectional survey, in the community of Haidian District, Beijing. Chi-square test analysis and multivariate logistic regression models were used to identify factors influencing residents’ demands for family healthcare services. Results show that population of married (OR = 3.108), living with parents (OR = 2.171), degree of Junior high school and above (OR = 7.250) and high school (OR = 7.670), Annual income: 0 - 56,000 (OR = 3.680) and 72,001 - 88,000 (OR = 1.690) have significant demands for family health care. The approach to building primary health services in Haidian District is worth promoting, but it is also important to pay attention to the health inequalities that can occur when patients are moved down to the grassroots level. .

Challenges faced by community health nurses to achieve universal health coverage in Myanmar:A mixed methods study

Objective:This study aimed to identify the challenges of community health nurses(CHNs)in delivering effective community health care to achieve universal health coverage(UHC)in Myanmar.Methods:A total of 30 CHNs from township health centers in the northeastern,southern,and western parts of Myanmar were purposefully recruited for quantitative and qualitative interviews.Quantitative data were processed using Microsoft Excel software,and qualitative data were analyzed using thematic analysis.This study is registered with researchregistry6201.Results:Around the country,30 CHNs uncovered their hardships in implementing primary health care to achieve UHC.Over 90%of the participants agreed to the problem of inadequate health infrastructure,while half of them felt unmotivated when they encountered role conflicts among various cadres of healthcare providers and poor opportunities for career promotion.Major problems arose from the lack of standard professional education at the entry point to community settings because most CHNs did not achieve specialized training in providing public health services.Complications are incapable of evaluating health services for policy-making and the inability to conduct health research to develop evidencebased practices.Insecure work and living conditions,unsupportive community relationships,and undereducation in professional practices were supportive major themes explored by CHNs to achieve a deeper understanding of the barriers to UHC.Not only the health system itself but also the population and other geographical factors have contributed to many challenges to CHNs.Conclusion:Myanmar’s CHNs face many challenges in achieving UHC.These challenges are not confined to the health sector.Some situations,such as geographical barriers and transportation problems,remain persistent challenges for healthcare providers.This study highlights the fact that current health systems should be strengthened by qualified healthcare providers and sufficient infrastructure.Meanwhile,public empowerment plays a critical role in promoting health development.

Roles of mutual help of local community networks in community health activities: Improvement for the quality of life of older people in Thailand

Objectives: This study aimed to describe work and activities of community networks focusing on the improvement of the quality of life (QOL) of older people in Thailand.The understanding of the work can help enhancing the community development and strengthening of local communities and their networks.Methods: Qualitative methods including in-depth interview,observation,and focus group discussion were employed to the study.64 participants participated to the study and were recruited from 4 key actors within the community.Content analysis was used to analyze the obtained data.This study was conducted in 6 local administrative organizations (LAOs) which selected from the outstanding areas of the project.Each LAO represents one sub-district of the regions of Thailand namely;(1) the upper north,(2) the lower north,(3)the upper eastern,(4) the lower eastern,(5) the central and (6) the south.Results: The findings of this study were categorized into three main themes: (1) Social capital including people in the community,social groups,and organizations,(2) Mutual help/collaboration activities composed of six sets of activities related to social capitals working on the improvement of QOL of older people,and (3) Impacts of the mutual help/collaboration activities on older people and local communities who help to improve of QOL of older people.Conclusion: The findings are important features for the community development.These themes should be recommended for community nurses,health related groups and organizations for the improvement of QOL of older people in the community.

Self-harm attempters' perception of community services and its implication on service provision

Objective:This study aimed at exploring the attempters'perception of community social services included any barriers to seeking help and services.Method:The participants were patients with self-harming behavior aged 15 years or above.A set of guiding questions were designed to explore the general barriers and accessibility to community social services.A voice recording was made,which was later converted into a text transcript and then preceded for content analysis with co-occurrence and similarity matrix interpretation.Two males and nine females with a history of self-harm aged between 24 and 58 years were recruited for the interviews.Result:The participants had diverse experiences and backgrounds,and attitudes toward community social services.However,there was a shared perception of the need to enhance community social services.There were four main themes and 12 sub themes identified.The main theme included the service availability,service accessibility,affordability and acceptability.For details,participants were unaware of the available types of care/social services in the community,and were unaware about the nearby social services.They also suggested extending service hours and focused services should be offered to help people with different backgrounds and needs.Actually,those with experience of service utilization had both positive and negative perspectives and they gave suggestions for service delivery,mainly extending service hours and offering focused services such as for gambling control and financial planning.In view of interaction with service providers,counseling skills and trust were highly appreciated by the participants.Conclusion:The results identified common circumstances of falling into financial hardship(gambling)and social fragmentation(divorce,poor family relationships,and poor marital relationships),which also suggested to enhance services on center location,service arrangement,and skill of caregivers.

Factors Affecting Patient Satisfaction with Community Health Service under the Gatekeeper System:A Cross-sectional Study in Nanjing,China

The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service（CHS） under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor‐patient relationships, information and support, organization of care, and accessibility（P 〈 0.001）. One or more factors such as gender and self‐perceived health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients＇ satisfaction with CHS by strengthening their awareness of the gatekeeper policy.

Analysis of Inpatient Bed Allocation Equity and Utilization in the City Community Health Service Center of China

The objective of this study was to examine the inpatient bed （IB） allocation equity and utilization in Chinese city commtmity health service centers （CHSCs）. The data were derived from the Baseline Survey of National City Community Health Service System Building Project, which was conducted in 1917 CHSCs in 28 cities in 2007. The IB allocation was analyzed in terms oflB alloca- tion quantity and distribution equity, and the IB utilization was analyzed by the IB utilization rate and average length of stay of the CHSC inpatients. The results showed that 49.3% of the CHSCs were equipped with IB; averagely, there were 45 IBs per CHSC, 0.94 IBs per 1000 people, and 0.38 nurses and 0.57 doctors per IB; the IB Gini coefficient was 0.32; the IB utilization rate was 40.06%; and the average length of stay of inpatients was 12.24 days. The conclusions were that IB allocation among the population was equitable, but the number of nurse per IB was not up to the national standard; and the CHSC IB utilization was low as a whole, thus inpatient service was not the main health service for Chinese CHSCs.

Quantitative Analysis on Economic Contribution of Community Health Service in China

In China, the implementation of community health service shows that the prevention is an essential and important part of our national health system and is helpful to decrease the medical expenditure gradually. According to the data from Health Statistic Information Center of Ministry of Health in China, we calculated that the total health expenditure of China would be decreased 8000.0 million yuan only in 2001, among which, 1188.3 million, 1953.9 million and 4833.0 million yuan were respectively saved for the government budget, the society and resident if implementing the policy of community health service powerfully. And every outpatient can save 15.46 yuan per time. By the quantitative analysis on the economic contribution of community health service, it can be proved that a great economic benefit could be gotten from the implementation of community health service.

The perceptions on good death of the older adults in the semi-urban community:A qualitative study

Objective This study aimed to explore the perceptions of good death of the older adults living in Bang Nang Li Sub-District,Amphawa District,Samut Songkhram Province,Thailand.Method The data of the study was collected using in-depth interviews between October 2019 to January 2020.The data collected a total of 14 older adults who had firsthand experience in caring for terminally ill patients were recruited for the study.Content analysis was employed to analyze qualitative data.Results The results of this study revealed the perceptions of good death which were categorized into three main themes and eight sub-themes,including 1)death without suffering(not suffering from life support devices,dying with care);2)natural death(death with the end of life expectancy,death with illness or ailments);and 3)death without the worries(preparation for death,spiritual and belief practice toward preparation for death,family and property management before death,death among family members and at their familiar place).Conclusion The findings of this research provided the insight to clarify the understanding of the perceptions on a good death of older adults.The findings can be used to support the practice and management of nursing education and health care providers who have to be involved in palliative care for terminally ill older adults.

The nurses’ voice of working in a newly established community based 24-hour support center for people with psychiatric disabilities

This study explores the perceptions of a small group of nurses working at a newly established 24-hour community-based service enter (SC) for users with psychiatric disability using a qualitative approach. Since the mental health reform in Sweden in 1995 where the communities (in Sweden called municipalities) were given the responsibility to establish service and support to people with severe psychiatric disabilities, they have struggled in finding suitable forms of these kinds of areas. In 2010, this led to the creation and development of a new center aiming to provide services and support based on the expressed needs of people with physchiatric disability in a community located in southern Sweden. During 2011, a total of three group interviews were performed to capture the employed nurses’ perceptions of this newly established SC. The interview texts were analyzed by way of qualitative content analysis. A first reading of the interview texts revealed that the nurses’ perceptions of the service center were unwaveringly positive but that their beliefs about who the specific target group were differed. The main finding was summarized by the theme: Making a difference—on an individual, professional, and organizational level. The sub themes were: 24-hour availability, unclear assignment, and preventing mental illness. The findings indicate a need for a community round-the-clock service center in this Swedish community and a more clear definition of the target group.

Efficacy of a Community-Based Trauma Recovery Program after a Fire Disaster

As industries develop,fire disasters and their associated damage are increasing.Investigating the mental health of victims is imperative because this is an essential issue for community recovery after a disaster.This study was conducted to determine the efficacy of a program implemented by a community mental health center based on the investigation of the victims’depression and post-traumatic stress disorder(PTSD)levels immediately after the disaster and at one-year follow-up.As a result,victims’depression and PTSD recovered over time,and more changes were confirmed.In particular,the high-risk group for PTSD showed a high program participation rate,and there was significant recovery over time compared with the group without PTSD.Based on these results,community mental health programs are an effective way to increase community mental health after disasters.In the future,community-based recovery programs after disasters should be expanded,and administrative support for them should be developed.

A cross-sectional study of breastfed infants referred for tongue tie assessment and frenotomy in one Canadian health region

Importance:Tongue tie(TT)is a condition that can cause infant feeding difficulties due to restricted tongue movement.When TT presents as a significant barrier to breastfeeding,a frenotomy may be recommended.Universally accepted diagnostic criteria for TT are lacking and wide prevalence estimates are reported.New referral processes and a Frenotomy Assessment Tool were implemented in one Canadian health region to connect breastfeeding dyads with a provider for TT evaluation and frenotomy.Objective:To determine the proportion of babies with TT as well as the frequency of frenotomy.Methods:This cross-sectional study included infants who initiated breastfeeding at birth and were referred for TT evaluation over a 14-month period.Data were collected retrospectively by chart review and analyzed using SPSS.Factors associated with frenotomy were examined using logistic regression.Results:Two hundred and forty-one babies were referred.Ninety-two percent(n=222)were diagnosed with TT and 66.0%(n=159)underwent frenotomy.In the multivariate model,nipple pain/trauma,inability to latch,inability to elevate tongue,and dimpling of tongue on extension were associated with frenotomy(P<0.05).Most referrals in our region resulted in a diagnosis of TT;however,the number of referrals was lower than expected,and of these two-thirds underwent frenotomy.Interpretation:TT is a relatively common finding among breastfed infants.Future research should examine whether a simplified assessment tool containing the four items associated with frenotomy in our multivariate model can identify breastfed infants with TT who require frenotomy.

The current status of community mental health services in three northern areas of China

Objective:This study investigated and discussed the current status of community mental health service in three northern areas of China(Beijing,Harbin,and Karamay)in an effort to improve the community mental health services in China.Methods:In this study 176 residents from communities of the three northern areas of China were involved and divided into 18 groups.The study was conducted according to a self-prepared structured interview outline.Results:The analysis was conducted based on the following four perspectives:1.commu-nity residents’understanding of the mental health problems and how they treated psychiatric patients;2.community residents’access to and application of mental health information;3.com-munity residents’attitude to accept mental health services and the factors influencing community residents to seek help from mental health services;and 4.community residents’attitude and will-ingness to participate in the activities of community mental health services.Conclusion:Based on the investigation and analysis regarding the current status of the com-munity mental health services in three northern areas of China,it is concluded that the residents do not have s clear and complete understanding of mental health.The characteristics of mental health services had a regional correlation.Currently,the mental health services do not work effectively,and the residents are somewhat passive in obtaining information about mental health.Community mental health services should be offered according to different individual needs of the residents and the actual situations of each region.

Social practices of nurse care coordination using sensor technologies e Challenges with an alert system adoption in assisted living communities for older adults

Objectives:From the view of everyday practices and the socio-technical coordination lens,this study aimed to analyz the gap between creators’intention and the users’implementation(mainly nursing staff and social workers)of an alert system in assisted living communities.Methods:Qualitative methods were employed by way of five user interviews and focus groups with six system developers.Modeling instruments were applied for data collection to analyze the different clinical workflows versus the expectations of the system development team.Results:Results indicate that the clinical workflow changed over time,which led to a mismatch of nurse care coordination,social practices,and technology use.The results show different mental models of the socio-technical practice.Applying the coordination theory,the following recommendations could be developed to overcome the mismatch.First,it is recommended that nursing staff set goals together.Second,a communication rhythmwith the nursing staff and developer teams should be established,with guided questions to facilitate the conversation,to shed light on the different workflows and the difference in social practices when using sensor technologies or alert systems.Third,a checklist for new employees should be created so they know how and on which devices to use the alert system.Fourth,the user experience with the alert system should be improved(e.g.,an improved user interface).Conclusions:This work indicates recommendations to close the mental model gap to overcome the mismatch between optimal use of the alert system and how the nursing staff is actually using it.

Efficiency of community health service in urban and suburban areas of Shanghai:based on production function

Objective:To analyze the efficiency of community health service in urban and suburban areas of Shanghai.Methods:Fifty community health centers in Shanghai that registered to create“National Demonstration Community Health Center”in 2013 were included in our study.The service efficiency was analyzed with the methods of econometrics based on Cobb-Douglas production function.Results:Two production functions were formulated for urban community health services and those in suburban areas;the equation for urban areas was:lnY=7.778+0.450lnL+0.350lnK+μ;and the equation for suburban areas was:lnY=6.329+0.728lnL+0.350lnK+μ.The results showed that among the inputs,labor had more effect on output than capital did.It also showed that marginal ben-efit of labor was different in urban and suburban areas.Urban community health centers were in the interval of decreasing returns to scale,while suburban community health centers were in the interval of constant returns to scale.Conclusion:Increasing human resource investment is a key factor for increasing community health service output.Due to the difference of scale merit between urban and rural areas,govern-ment or other policy makers should make the development policy for them accordingly.Those com-munity health centers in urban areas should pay more attention to the service efficiency and service innovation.

Comprehensive reform of community health service in east,middle and west regions of China:from patients’perspective

Objectives:To analyze the satisfaction of patients with community health service(CHS)and the changes of the CHS delivered before and after the new health reform in different regions of China,and to put forward relevant policy recommendations for CHS development.Methods:Twelve community health centers were selected by random sampling in each of the eight typical cities in the east,middle and west regions of China.Questionnaire survey was conducted among patients visiting these institutions during daily work hours.Results:The proportions of the participants who stated that the medical environment,service attitude and medical skills of the doctors were improved were higher in the west region than those of the east and middle regions;but the percentage of patients who held that the drug price had lowered was higher in the east region than those of the middle and west region,the differences were of statistical significance(P<0.0125).The patients’satisfaction rates with medical environment,service attitude,and technical skills of the medical staff in the west region were 88.9%,91.5%and 81.6%respectively,which were higher than those in the east and middle regions.In the east region,the satisfaction rate with the reimbursement for this visit was 58.5%,which was highest among the three regions;in the west region,patients’satisfaction rates with drug types and preventive care were 51.5%and 65.9%,respectively,which was significantly higher than those in the east and middle regions(P<0.0125).As recommended by the participants,the top three aspects of health services that need to be improved were drug type and quality(25.3%),drug prices(21.8%)and technical skills(18.2%)in the east region;infrastructure(28.2%),drug prices(21.8%)and drug types and quality(21.2%)in the middle region;infrastructure(30.8%),drug types and quality(28.1%)and reimbursement(27.9%)in the west region.Conclusions:The comprehensive CHS reform should take the opinions of patients into account;essential drug system should be consolidated continually;and the reform of the payment system should be promoted by actively cooperating with the health insurance organizations.

Development of community health service-oriented computer-assisted information system for diagnosis and treatment of respiratory diseases

Objective:Community health services are an emerging trend.We have found in practice that diagnosis and treatment of respiratory diseases in the community are distinct.The respiratory department’s daily work involves a number of outpatient registration items and a vast workload.The routine manual operation is inefficient and it is not convenient to make effective statistical analysis of the outpatient data to identify the risk factors closely related to diseases.Therefore,it is imperative to process the outpatient information of patients with respiratory diseases effectively and efficiently in a unified manner by means of computer technology.Methods:The design and realization of the Community Health Service-oriented computerassisted Information System for Diagnosis and Treatment of Respiratory Diseases(CHS-DTRD)was completed as part of the community intervention study on bronchial asthma that was carried out jointly by the Nanjing First Hospital Affiliated to Nanjing Medical University and the Hospital of Nanjing University of Science&Technology,and based on 2 years of experience and the needs of an overall analysis.Results:The computer-assisted information system for diagnosis and treatment was developed using Java Server Page(JSP)technology and introducing the advanced Asynchronous JavaScript XML(AJAX)technique and MS-SQL Server was used in the background database.CHS-DTRD was composed of eight functional modules(outpatient data maintenance,outpatient appointment,intelligent analysis for disease risk factors,query and statistics,data dictionary maintenance,database manipulation,access control,and system configuration).CHS-DTRD featured a friendly interface,convenient operation,and stability and reliability.Conclusion:Community health-oriented diagnosis and treatment of respiratory diseases is simple,programmable,and intuitive,thus the workload of physicians is significantly reduced and the work efficiency is improved.This system facilitates an intelligent analysis of disease risk factors using data mining technology,and provides physicians with suggestions on intelligent analysis for diagnosis of disease and conclusion of disease causes.

General medical practice in China:evaluation of urban community health care service functions based on a rough set reduction theory

Objective:This study aims to achieve an empirical evaluation on the functional performances of urban community health care services in fi ve administrative districts of Nanchang city in China.Methods:In order to increase effectiveness,data collected from fi ve administrative districts of Nanchang city were processed to exclude redundant information.Rough set reduction theory was brought in to evaluate the performances of community health care services in these districts through calculating key indices’weighed importance.Results:Comprehensive evaluation showed the score rankings from high to low as Qing-yunpu district,Xihu district,Qingshanhu district,Donghu district,and Wanli district.Conclusion:The objective performance evaluation had actually reflected the general situation(including social-economic status)of community health care services in these administrative districts of Nanchang.Attention and practical works of community health service management were needed to build a more harmonious and uniform community health care service system for residents in these districts of Nanchang.

Analysis on necessity of community health service development based on limits-to-growth archetype--taking Jiangxi province as an example

Objective:To analyze the necessity of community health service(CHS)development in Jiangxi province based on the current status of healthcare in Jiangxi Province.Method:The study did a systematic survey on the CHS development among health service organizations in Jiangxi province.The data of the survey were analyzed with system archetype analysis of Peter Senge.Results:Through system analysis,four limits-to-growth archetypes were built and analyzed.The obstacles restricting the development of healthcare systems were determined,and some effective countermeasures were proposed accordingly.Conclusion:In order to foster the sustainable development of healthcare in Jiangxi province and alleviate the problem of“difficulty and high cost to access medical services”effectively,the government should place more emphasis on the development of CHS.