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.

Research progress on the health status and community management service needs of mobile elderly people

The health status of the floating elderly population and the need of community management services are complex and important problems.Owing to the change of living environment and the insecure medical care,the mobile elderly people have more health and psy-chological problems compared to the rest of the elderly population.Therefore,the community should take a variety of measures to meet their needs and help them to better adapt to the new living environment,and maintain their physical and mental health.This paper aims to summarize recent studies on the physical and emotional health problems of mobile elderly people and related community management service needs.

A study on the health service demands and influence factors among elderly people based on a community survey in Western China

Objective:To investigate the health service demands and to analyze influencing factors among elderly people based on a community survey in Guilin,China.Methods:A random sampling was used to investigate 366 elderly people in a community using a Health-Care-Needs questionnaire,which was designed by The Western Nursing Alliance research team in China.This survey was used to understand the basic situation,financial condition,health condition,self-care abilities,pension plan,and care services demands of the elderly residing at home.Additionally,this article analyzed the influencing factors contributing to the obtained results.Results:The top 3 nursing needs were security needs(1.61±0.45 points),health education needs(1.54±0.57 points),and respect and self-development needs(1.13±0.64 points).Logistic multifactor regression analysis showed that gender,monthly income,lack of exercise,activities of daily living(ADL)scores,methods of medical payment,and pension plan were independent factors affecting elderly nursing needs.Conclusions:The home-based health services supply for elders did not meet their needs.Therefore,a comprehensive approach considering multifactors such as gender,income,exercise,self-care ability,medical expense payments,and supporting preferences should be considered to address the complex needs of health care.

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 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.

Application Effect of Health Management in Community Diabetic Population

Objective: This study aims to improve the health level of patients with diabetes in the community through health management measures under the concept of health management. Methods: Community residents were selected to detect, collate and analyze the social demographic information, body mass index, fasting blood glucose and blood lipid level of diabetic patients before and after health management. Results: The study showed that after the implementation of health management education in the community, the detection rate of diabetes patients increased, but the population was no longer mainly elderly patients, but mainly people under 60 years old. The levels of body mass index, fasting blood glucose, triglyceride (TG), total cholesterol (TC) and low-density lipoprotein (LDL) were significantly decreased (all P Conclusion: Through the investigation of patients before and after health management in residential communities, this study shows that the correct implementation of health management can effectively improve the physiological indicators of diabetes patients, improve the level of health quality, and provide a reference for the prevention and treatment of diabetes patients in communities.

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.

Regional differences in the health status of Chinese residents:2003–2013

Health inequality is an increasing concern worldwide. Using the coefficient of varia- tion, Theil index, exploratory spatial data analysis, and spatial panel econometric model, we examined the regional inequality, spatio-temporal dynamic patterns, and key factors in the health status of Chinese residents from 2003 to 2013. We found that China＇s residential health index （RHI） decreased from 0.404 to 0.295 in 2003-2013 at an annual rate of 2.698%. Spatially, resident health status, based on the RHI, has improved faster in the western region than in the eastern and central regions. Inequality in resident health status continued to in- crease between 2003 and 2013; inequality between regions decreased, but health status inequality expanded within regions. Furthermore, disparities in health status grew faster in western regions than in the eastern and central regions. The spatial distribution of resident health status formed a ＂T-shaped＂ pattern across China, decreasing from east to center then to the west with a symmetric decrease north and south. Using the change in Moran＇s / from 2003 to 2008 and 2013, we found that the distribution of resident health status across China has narrowed. All the hot spots and cold spots have decreased, but they are also stable. Resident health status formed a stable cold spot in the western regions, while the east coastal area formed a stable hot spot. Selected explanatory variables have significant direct impacts on resident health status in China： increasing per capita GDP, per capita spending on health, and urbanization, and improving environmental quality all lead to better resident health status. Finally, we highlight the need for additional research on regional inequality of resident health status across multiple time, spatial, and factor domains.

Self-assessed health and its aspects in the case of Mongolia

Self health assessment is a simple indicator that is widely used for measuring an individual’s perception of his or her overall health. Many studies have been conducted by way of showing which particular aspects should be included in health self assessment, especially in developed world. In the developing world, however, very few studies have examined self health assessment. The aim of this study was to identify particular aspects and associations in self health assessment and differences between subgroups in Ulaanbaatar, Mongolia. The area sampling approach and Kish tables were used for selecting respondents. Total 500 respondents were surveyed by paper-based questionnaires. Spearman’s analysis and multiple logistic regression analysis were used to show relations between variables. Sociodemographic status, such as age and gender, proved to be important in self health assessment. Other factors affecting self health assessment included the number of family members, daily life and lifestyles, social environment, community motivation, and utilization of health services. Women, the elderly, or people with less-than- normal access to information suffer from poor self-assessed health. People who are socially inactive and who have poor living conditions are less likely to use health care services and are likely to assess their health as “poor.” In order to reduce the poor self-assessed health status it is important to address disparities in socioeconomic factors, such as age, gender, employment, and residential area. In addition, more attention should be paid to community and health services, as well as to health promotion and empowerment activities, including income-generation activities. Further research is also needed, however, for better understanding of about the local people and their health-related issues.

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.

A National Cross-Sectio nal Survey Dataset on Com mon Disease and Influencing Factors of Chinese Internal Migrants in 2017

This data article describes the dataset from a national cross-sectional questionnaire survey on Chinese internal migrants in 2017.The survey was part of the Chinese Migrants Dynamic Survey,which is an annually conducted large-scale national questionnaire survey on internal migrants.The respondents in the described dataset were migrants and registered local residents aged over 15 years old.A multistage stratified probability-proportionalto-size(PPS) sampling method based on the 2016 annual report data of China Migrant Population was adopted.The questionnaire was designed to collect demographic information of respondents and their family members,intention of migration or settlement,health status,health services accessibility,social integration,and epidemic influencing factors of common diseases,including hypertension,type 2 diabetes,diarrhea,fever,rash,icterus,conjunctival redness,cold,and other illnesses or injuries.The sample population in this survey include 13,998 internal migrants and 14,000 registered local residents from eight domestic cities/prefecture/districts across China.It is the most widely covering and highly representative dataset on common diseases and influencing factors of internal migrants in China.The dataset can be used to study common diseases and influencing factors among floating Chinese population.It provides data support for government to improve healthcare accessibility and the equity of public health services for internal migrants in China.

Study on the quality of life and the factors influencing it in elderly patients

A society of advanced age is arriving with the increasing number of elderly patients. Little attention has been paid to the quality of life of elderly patients, which is decreasing gradually. This article aims to study the quality of life among elderly patients and explore the factors influencing it, in addition to exploring effective ways to improve the quality of life of elderly patients.

军队特勤人员高同型半胱氨酸血症检出率及影响因素分析

目的 探讨特勤人员高同型半胱氨酸血症(HHcy)检出率及影响因素,为开展针对性的健康干预提供科学依据。方法 以2023年9月至2024年1月在某疗养中心参加特勤体检鉴定的618例特勤疗养员为研究对象,内容包括人口学特征、生活方式、体格检查和实验室检测等资料。结果 调查人群同型半胱氨酸(Hcy)平均水平12.10(10.00~14.60)μmol/L,HHcy检出率为23.79%,平均年龄(34.21±7.46)岁,均为男性。多因素Logistic回归分析结果显示,吸烟(OR=1.833,95%CI 1.152,2.915)、勤务类别(OR=1.697,95%CI 1.240,2.323)、低密度脂蛋白胆固醇(LDL-C)(OR=5.764,95%CI 3.229,10.292)、尿酸(UA)(OR=1.693,95%CI 1.116,2.570)、胆红素(BIL)(OR=2.015,95%CI 1.330,3.052)、肌酐(CR)(OR=3.164,95%CI 1.624,6.162)是HHcy的影响因素。结论 吸烟、勤务类别、LDL-C、UA、BIL和CR是HHcy的影响因素,应对存在高危因素的人群采取相应措施,尽早进行健康干预,以降低心脑血管等慢性疾病发生的风险。

甘肃省老年人卫生服务利用现状及影响因素研究——基于安德森模型

目的:了解甘肃省两县区老年人卫生服务利用现状及其影响因素,为完善医疗卫生服务体系建设,提高老年人卫生服务可及性提供参考。方法:构建安德森卫生服务利用行为模型,分析老年人卫生服务利用的影响因素。结果:样本地区老年人近一个月门诊就诊率为4.03%,近一年住院服务利用率为12.98%;多因素Logistics回归分析显示,以前吸烟、到达最近医疗机构时间大于30分钟的老年人门诊服务利用率较高;患慢性病、政府救助对象、离家最近的医疗机构为县级及以上医院的老年人住院服务利用率较高;需要因素对老年人卫生服务利用的影响最大。结论:样本地区老年人卫生服务利用率较低,应通过加强基层卫生服务体系建设、完善医疗保险救助制度、落实基本公共卫生服务项目,提高老年人卫生服务利用,防止因贫致病、因病返贫。

我国农村订单定向医学生履约意愿及影响因素研究

农村订单定向医学生免费培养项目(简称订单定向项目)是国家为加强农村基层卫生人才培养而实施的重要项目。我国基层医疗卫生人才总量不足、质量不高问题较为突出,实施好订单定向项目至关重要。农村订单定向医学生(简称定向医学生)履约意愿的提高是保证订单定向项目持续开展的关键。研究针对我国定向医学生履约意愿现状及影响因素研究进行综述。分析结果提示,国内针对定向医学生履约意愿开展了较多研究,不同地区定向医学生履约意愿存在明显差异,同一地区开展的不同研究结果差异也较大,国内学者主要从社会人口学因素和认知因素两个方面对定向医学生履约意愿的影响因素进行了探讨。后续应开展全国统一性调查,加强院校培养模式和政策因素与履约意愿的相关性探讨,并开展更多履约激励策略的研究,以达到提高定向医学生履约意愿的目的。

基于霍恩-米特模型的医防融合执行影响因素分析

医防融合作为我国医药卫生体制改革的重要方向,对于满足人民群众全方位的健康需求具有重要意义,如何建立科学、有效的医防融合模式是当务之急。本研究运用文献分析等方式收集资料,综述我国医防融合政策的实施现状及困境,并基于霍恩-米特模型的6个维度,对医防融合政策执行影响因素进行分析。在此基础上提出应细化政策目标,明确政策执行标准,加大资源供给力度,丰富政策执行方式,探索医防机构利益共同点、完善“协同机制”,积极引导政策执行者开展医防融合服务等举措,旨在为今后医防融合服务得到高质量提升提供借鉴意义。

膝关节骨性关节炎患者卫生服务利用现状及其影响因素分析

目的 调查膝关节骨性关节炎(KOA)患者卫生服务利用现状,并分析其影响因素。方法 2022年2-12月,使用便利抽样法,采用自行设计的KOA患者就医行为调查问卷进行横断面调查,并应用logistic回归分析KOA患者卫生服务利用的影响因素。结果 该调查共纳入390例患者,160例(41%)处于低就医水平,回归分析结果显示,就医水平受年龄、居住地、居住情况、疾病认知、就诊花费路程、个人月收入、慢性病共病、西安大略及麦克马斯特大学骨关节炎指数评分量表(WOMAC)评分等是卫生服务利用现状的影响因素(P<0.05)。结论 KOA患者的卫生服务利用现状堪忧,高龄、独居、农村、疾病认知缺乏、就诊路程长、个人收入低、共病、躯体功能症状轻的患者就医水平较差,护士应该增加对该类人群的关注,根据不同的就医水平制订适当的方案,促进其行为改变,优化患者卫生服务利用率。

卫生健康服务水平统计测度及影响因素分析

新医改背景下,提升卫生健康服务水平是推进健康中国建设的有效途径之一。依据卫生健康服务水平统计测度指标体系和中国31个省级面板数据,研究中国卫生健康服务水平及其影响因素,结果显示:中国卫生健康服务水平呈阶段式“上升—下降—上升”的“N”型波动趋势,截面差异显著,其系统聚类为五个类别,2010年以来,中国卫生健康服务水平均有不同程度的波动;不同地区卫生健康服务水平高低次序为:东部>中部>东北>西部,区域非均衡性特征明显,东部、中部、东北和西部分别呈现平稳提升、波浪式上升、波浪式下降和平稳发展的波动特征;仅妇幼保健水平呈现平稳提升的发展态势,各省市区妇幼保健水平均高于其他子系统;医疗卫生投入占比、财政支出、财政收入、医疗保障、城镇化水平和电信业务总量等均能促进卫生健康服务水平的提升,而医疗消费指数、人均地区生产总值和人口密度的作用相反。该结果可为优化卫生健康服务管理提供经验依据。

居家失能老年人照护需要满足状况及影响因素分析

目的了解我国居家失能老年人照护需要满足状况,分析影响因素,以期为建立和完善我国老年人照护服务和保障体系提供参考。方法采用中国健康与养老追踪调查(CHARLS)2020年数据,选取居家失能老年人样本,根据安德森模型设置自变量,描述性统计居家失能老年人照护需要满足状况,运用卡方检验和二元Logistic回归分析未满足照护需要的影响因素。结果共纳入2473名居家失能老年人,其中36.2%的老年人存在照护需要未满足情况,男性、失能程度低、经济状况差、无医疗保险、无配偶、与子女交往少、可选择其他照护资源不足的居家失能老年人更容易出现照护需要未满足的情况。结论建议引导家庭成员积极承担照护老年人的责任,探索以人为本的整合型照护服务,重视男性养老护理员培养,发展灵活多样的照护服务项目,建立完善的社会化照护服务体系,同时可通过发展养老储蓄账户、长期护理保险和商业照护保险等方式来缓解居家失能老年人照护经济压力。

内蒙古地区高血压患者自我管理现状及影响因素调查

目的调查内蒙古地区高血压患者的自我管理现状及影响因素。方法于2022年9月至2023年10月,采用分层随机抽样方法从内蒙古的东、中、西部盟市共抽取766例高血压患者进行高血压自我管理现状问卷调查,采用多因素Logistic回归分析探究高血压自我管理的影响因素。结果766例患者中,自我管理低、中、高水平各占35.77%、39.03%、25.20%。高中/中专文化程度、退休人员、平均月收入≤1000元、身体质量指数(BMI)分级正常或超重、病程≤5年或6~10年、自费、已建立或未建立健康档案、签约家庭医生、经常或有时进行社区高血压健康宣教和生活方式指导均是高血压患者自我管理水平的影响因素(P<0.05)。结论内蒙古地区高血压患者的自我管理现状总体处于中低等水平,应着重提高较低文化程度、低收入、BMI超重、病程较短、自费患者的自我管理水平。有效落实健康档案及家庭医生签约服务、社区经常性开展高血压健康宣教和生活方式指导能有效提高患者的自我管理能力。