Elderly healthcare service at the community health centers in the Pearl River Delta region,China

Objective:The recent population census showed China had officially become a graying society.In the meantime,China also faces a growing burden of non-communicable diseases.Since 2009,a series of policies have been implemented to enhance primary care at the community level.This study describes the elderly care services provided in the differently organized community health centers(CHCs).Methods:It covered 13 CHCs of six cities located within the Pearl River Delta(PRD)region.In-depth interviews were conducted with a total of 59 health administrators,CHC managers,and CHC doctors regarding elderly care.Results:The study found that accessibility of healthcare for elders has been improved due to the development of health insurance schemes as well as preferential policy to encourage the CHC utilization by the elderly.All the CHCs provide health examinations and chronic disease management to the permanent elderly within their catchment district.However,some preventative care such as fall prevention,immunization and mental health management are not provided.Conclusion:Key barriers include low capacity of health service providers in the CHCs,and a lack of government investment in CHCs.Our report provides an empirical evidence for the health care reform in China.

Efficiency of community health centers in China during 2013-2015:A synchronic and diachronic study

Objective:We aimed to explore the efficiency of community health centers(CHCs)in China from 2013 to 2015,providing policy suggestions for optimizing the allocation of health resources.Methods:Data on the efficiency of CHCs in 30 provinces/autonomous regions/municipalities in China's Mainland(except Tibet)from 2013 to 2015 were collected from China’s Health and Family Planning Statistical Yearbook 2014,China’s Health and Family Planning Statistical Yearbook 2015,and China’s Health and Family Planning Statistical Yearbook 2016.Data envelopment analysis and Malmquist index analysis were performed to investigate the efficiency of sampled CHCs during this period at the national level and the regional level.The applied input indicators include the numbers of CHCs,community health workers,and beds,and the output indicators consist of the numbers of visits and inpatients,the occupancy rate of beds,and the average length of stay.Results:In 2015,the average annual overall technical efficiency,pure technical efficiency,and scale efficiency of CHCs in 30 regions at the national level were 0.715,0.705,and 0.972,respectively.Eight regions(Guangdong,Guizhou,Hainan,Ningxia,Qinghai,Shanghai,Zhejiang,and Chongqing,accounting for 26.7%of the total)had efficient CHCs with overall technical ef-ficiency of 1.000,and the other 22 regions had surpluses of 131 CHCs,5573 community health workers,and 2086 beds on average.In 2015,the average annual technical change index,pure technical efficiency change index,total factor productivity,technical efficiency change index,and scale efficiency change index of CHCs at the national level were 1.034,1.002,1.024,0.990,and 0.988,respectively.Compared with 2013,the former three increased by 3.4%,0.2%,and 2.4%,respectively,while the latter two decreased by 1.0%and 1.2%,respectively.Conclusion:On the whole,efficiency improvements of CHCs were achieved at the national level from 2013 to 2015,but with obvious interregional differences.In regions with inefficient CHCs identified by data envelopment analysis,there was a problem of coexistence of shortage and wastage of community health resources.In view of this,targeted measures should be taken to optimize the allocation of community health resources,and the management of CHCs should be strengthened to improve the efficiency of these institutions.

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.

Associations between risk factors for cardiovascular diseases and frailty among community-dwelling older adults in Lanzhou,China

Objectives:To examine the relationship between cardiovascular disease risk factors and frailty in a sample of older Chinese adults.Methods:A total of 458 community-dwelling older adults(>65 years)in Lanzhou,Gansu Province of China participated in a cross-sectional survey.Their status was evaluated in terms of frailty phenotype(unintentional weight loss,exhaustion,low activity levels,slowness and weakness).Participants were categorized as not frail,prefrail or frail.Cardiovascular disease risk factors that were assessed included:blood pressure,body mass index,waist circumference,blood glucose,total cholesterol,triglycerides,lowdensity lipoproteins and high-density lipoproteins.Results:Individuals with obesity had an increased risk of prefrailty(OR:2.26;95%CI:1.05,4.84).Hypertension was inversely associated with frailtyamong the participants(OR:0.31;95%CI:0.11,0.87)after adjusting for covariates.Conclusions:The findings suggest that much more attention should be paid to weight control of the elderly in the community for preventing them from transition to prefrailty or frailty.Active prevention and control of cardiovascular diseases among the community-dwelling elder are still of great importance.

Multidimensional health literacy profiles and health-related behaviors in the elderly:A cross-sectional survey

Objectives:To investigate health literacy profiles using a multidimensional tool in the elderly,analyze the factors related to health literacy,and explore the relationships between health literacy and health-related behaviors.Methods:A cross-sectional survey including 440 participants was conducted at a community health center and a village health center in Changsha,Hunan Province,between June 2020 and August 2020.We used the Health Literacy Questionnaire(HLQ)to assess the elderly’s health literacy.Sociodemographic data and health-related behaviors of them were surveyed with a self-designed questionnaire.Latent profile analysis,Pearson’s chi-squared and ordinal logistic regression were used to analyze the data.Results:The median age of the 440 respondents was 68 years.The participants had the lowest scores in the“appraisal of health information”subscale(2.22±0.52),followed by“navigating the healthcare system”subscale(2.89±0.81)of HLQ.Based on the analysis of three profiles,respondents who were 60 e74 years(OR=2.06,95%CI:1.23e3.42,P=0.006),living in urban areas(OR=3.28,95%CI:2.17e4.94,P<0.001),with secondary education or above(OR=2.86,95%CI:1.92e4.27,P<0.001),and having health insurance(OR=1.89,95%CI:1.02e3.51,P=0.042)were significantly associated with health literacy.Statistically significant associations were found between health literacy level and health-related behaviors,including medical service-seeking behavior(χ^(2)=25.14,P<0.001),exercising regularly(χ^(2)=34.08,P<0.001),and taking a medical examination in the past 12 months(χ^(2)=24.76,P<0.001).Conclusion:The multidimensional health literacy survey has identified the low health literacy level among the elderly in community settings.It revealed the relationships of sociodemographic character-istics,including age,education level and residence,with health literacy.These findings emphasized the importance of health literacy in promoting health behaviors,guiding a profound understanding of the Chinese elderly’s health needs and health literacy to develop community-based health promotion interventions.

Integration of traditional Chinese medicine and Western medicine in a Chinese community health center

Objective:Although the literature is abundant on traditional Chinese medicine(TCM)in the West,there is limited information on how TCM is integrated with Western medicine(WM).We describe how one Chinese Community Health Service(CHS)system located in Beijing integrates WM and TCM.Methods:Our information is based on the authors’observations,interviews with center TCM practitioners,and discussions with center administrators.Results:We summarize our observations according to the following themes:selection of type of practitioner;frequent diagnoses of patients seen by TCM clinicians;types of TCM ser-vices provided;economic factors;challenges;and future directions.Patient age,nature of the problem,and cost may determine whether or not Chinese patients initially consult TCM or WM practitioners.Because of referral pathways between the WM and TCM practitioners,up to one-third of the patients receive integrated care.TCM physicians see more patients per day than do their WM counterparts;TCM physicians also earn higher salaries.Although there are clearly close collaborative relationships between the TCM and WM practitioners,a few TCM providers report that lack of respect between the two fields may be a barrier towards further integration.Conclusion:Given governmental policies and the cost differentials between WM and TCM,the future for the integration of the two medical traditions within the CHS system appears to be favorable;however,issues of mutual respect and workforce issues may challenge success-ful integration.Our impressions are limited by the fact that we observed practices in only one community in one district of Beijing.