Analysis on influencing factors of patients experience in community health centers of Shenzhen,China

Objective To investigate the patients experience in community health centers( CHCs) and explore its associated factors. Methods A cross-sectional study was conducted among 330 patients who visited CHCs in Shenzhen,China from January to March 2018. Dependent variable was patient experience. Key descriptive variables were age,gender,marital status,working status groups,visits frequency for the past 6 months,whether patients had signed a family doctor,whether trusted in family doctor,whether had chronic diseases. Results Questionnaires for 300 patients were assessed. In the univariate analysis,patients experience total score was significantly associated with marital status( P < 0. 1),working status groups( P < 0. 1),frequency of visit for the past 6 months( P < 0. 05),whether had signed a family doctor( P < 0. 05),whether trusted in family doctor( P < 0. 05),whether had chronic diseases( P < 0. 05). The multivariate analysis showed that unmarried patients( P = 0. 011,OR = 2. 96,95% CI: 1. 24-5. 43) and had signed a family doctor( P = 0. 023,OR = 0. 44,95% CI: 0. 22-0. 85) were more likely to get a higher score. Conclusions Findings of this study showed a medium-level score of patients experience in the community. Patients had a quite good experience and more interventions should be focused upon the influence factors to improve patients experience.

Effects of Community Mental Health Centers on Oxidative Stress in Patients with Schizophrenia

Objective: The aim of our study was to evaluate of oxidative stress between the schizophrenic patients who regularly continued to Community Mental Health Centers (CMHC) and the patients who did not continue to CMHC. By this study, the effects of CMHC on oxidative stress between these two group of patients were assessed. Methods: Total number of 86 volunteers were enrolled in this study;43 (27 males, 16 females) patients who regularly continued (average 2 years, at least 3 days a week) to CMHC and 43 (25 males, 18 females) patients who regularly did not continue to CMHC. Total antioxidative stress (TAS), total oxidative stress (TOS), oxidative stress index (OSI), paraoxanase (PON1), arylesterase (ARE) and total thiol (T.Thl) levels were measured with a novel automated method. Positive and Negative Syndrome Scale (PANSS) was used to assess the patients. Results: TOS, PANSS-Negative subscale and PANSS-Total subscale were found to be significantly higher in the group of patients who were not continuing to CMHC, than the group of patients who were continuing to CMHC. ARE and T.thl were found significantly lower in the group of patients who were not continuing to CMHC. There was a significant positive correlation between PANSS-Negative Subscale and TOS, OSI in the group of patients who were not continuing to CMHC. There was a positive correlation between PANSS-Negative Subscale and TOS in the group of patients who were continuing to CMHC. Conclusions: Oxidative stress and negative symptoms of schizophrenia in the group of patients who were continuing to CMHC were less than in the group of patients who were not continuing to CMHC. Thus, regular follow up at CMHC is very important in the treatment of schizophrenia patients.

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.

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.

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.

上海市分级诊疗成效、难点和问题分析

目前,我国医疗需求巨大且持续增长,大医院医疗服务供不应求,分级诊疗建设任重道远。总结了上海市目前分级诊疗政策的着力点和作用,并对实际落实效果和存在问题进行分析,发现上海市所施行的"1+1+1"家庭医生签约制度和社区慢病门诊制度对于引导居民就医选择、打通转诊通道具有显著意义,但在服务协同、医生资源下沉社区、家庭医生培养等方面尚存在需要进一步改进的空间。

湖北省社区卫生服务中心中医药标准化建设现状

目的了解湖北省城市社区卫生服务中心(CHCs)自身中医药资源配备和中医药服务开展达标情况,为CHCs中医药服务建设提供参考。方法采用国家中医药管理局统一制定的问卷,对湖北省CHCs的中医药人力资源、中医科及中药房配置、中药配备及中医药服务在"六位一体"功能中的运用情况进行普查,参照2003年国家中医药管理局颁布的《CHCs中医药服务基本管理规范》要求,计算湖北省CHCs中医药资源配备与服务的相关指标达标率。结果湖北省CHCs共234家,大、中、小城市分别为95家(40.6%)、73家(31.2%)、66家(28.2%)。(1)湖北省大、中、小城市CHCs中医医师占医师总数15%以上的达标率分别为17.9%、16.4%、37.9%(P=0.003),50%的临床医师接受省级以上中医全科培训的达标率分别为2.1%、4.1%、1.5%(P=0.158);(2)单独设立中医科的达标率分别为70.5%、32.9%、51.5%(P<0.001);(3)单独设立中药房的达标率分别为94.7%、79.5%、81.8%(P=0.008);(4)中药饮片(家)品种数大于250种的达标率分别为75.8%、52.1%、47.0%(P<0.001),中成药品种数大于50种的达标率分别为88.4%、56.2%、65.2%(P<0.001);(5)中医预防传染病的达标率分别为77.9%、68.5%、62.1%(P=0.088),中西医结合防治2种以上慢性病的达标率分别为86.3%、74.0%、63.6%(P=0.004),建立中医健康档案的达标率分别为83.2%、65.8%、66.7%;运用4种以上中医疗法种数的达标率分别为97.9%、83.6%、75.8%(P<0.001);(6)中医保健达标率分别为84.2%、72.6%、60.6%(P=0.003),中医康复达标率分别为94.7%、87.7%、69.7%(P<0.001),中医健康教育达标率分别为90.5%、82.2%、71.2%(P=0.007),中医计划生育技术服务达标率分别为74.7%、49.3%、54.5%(P=0.002);(7)湖北省大、中、小城市CHCs中医药人力资源达标率分别为2.1%、0.0%、0.0%;中医药机构配置达标率分别为66.3%、24.7%、39.4%;中药配备达标率分别为66.3%、42.5%、37.9%;中医药在"六位一体"中同时应用的达标率分别为55.8%、23.3%、25.8%(P<0.001);中医药人员、机构、药品及服务均达标的综合达标率分别为2.1%、0.0%、0.0%(P<0.001)。结论湖北省小城市CHCs人力资源配备高于大、中城市,大城市CHCs其他资源高于中、小城市,大城市CHCs中医药服务达标率最高,小城市最低。

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.

The lived experience of a 24-hour support center for persons with psychiatric disabilities: Making me feel almost like an ordinary person

This study illuminates nine psychiatric disabled persons’ lived experience of a newly established community-based service center open around the clock. This new 24-hour support center (SC) was established in 2011 in a Swedish community to better match and facilitate the disabled persons’ needs. In order to illuminate the disabled person’s experiences individual interview was performed. A phenomenological-hermeneutical method inspired by Paul Ricoeur was used to interpret the texts. After a naive reading, a structural analysis revealed two themes: 1), becoming aware of myself as a person, and 2) having a lifeline and belongingness. The comprehensive understanding was interpreted as meaning “Making me feel almost like an ordinary person”, which incorporated the person’s past with their present together with a direction for the future and hope for a more fulfilling life.