Exploration on the Implementation of the Integration of Medical and Preventive Model in China’s Primary Health Care Institutions

Objective To explore the different modes and approaches of medical and preventive integration in current primary health care institutions in China.Methods Through literature analysis,field research,telephone interviews,and other methods the implementation status was evaluated to systematically study the main experience and effect of implementing medical and preventive integration services in pilot areas.Results and Conclusion At present,there are three implementation modes of medical-prevention integration,namely,vertical mode based on the medical community,internal mode with optimized service process,and internal mode with great service capabilities.The three medical-prevention integration modes have their respective focuses,but they need to be further improved in terms of policy support,technical staffing,information system construction,and drug use.

The Acquisition and Utility of the Family Medical History in Primary Care: A Cross-Sectional Study

Background: Acquisition of family medical history (FMH) is emphasized as a part of obtaining a complete medical history, but whether FMH is consistently documented and utilized in primary care, as well as how it can affect patient care in this context, remains unclear. Thus, the objectives of this study were to determine: 1) if FMH is regularly acquired in a representative primary care practice (the Queen’s Family Health Team, QFHT);2) what is included in the FMH obtained;3) what the utility of FMH is with regards to patient management in primary care;and 4) to utilize healthcare practitioners’ perspectives in order to elucidate any findings regarding the acquisition and utility of FMH at the QFHT. Methods: Patients were interviewed in order to obtain their FMH. For each patient, the FMH obtained was compared to the FMH documented in the patient’s record to determine the record’s completeness. Each patient’s FMH was analyzed for significant history of coronary artery disease (CAD), diabetes mellitus type II (DMII), substance abuse (SA) and colorectal cancer (CRC). Participants were patients scheduled for appointments at the QFHT between May and July 2011. Any patient of the QFHT older than 25 years was eligible to participate. Clinical staff of the QFHT completed an online questionnaire to determine healthcare practitioners’ perspectives regarding the acquisition and utility of FMH. Results: 83 patients participated in the study. Participants ranged in age from 25 - 86 years (median: 63 years);69% were female. FMH present in patients’ records was often either incomplete (42% of charts reviewed) or not documented at all (51% of charts reviewed). Knowledge of FMH can affect patient management in primary care for the diseases assessed (CAD, DMII, SA and CRC). HCP do consider FMH to be important in clinical practice and 86% of respondents stated that they regularly inquired about patients’ FMH. Interpretation: Despite the belief by HCP that FMH is important, there is a disparity between this belief and their practices regarding its documentation and utilization. Finally, analysis of the FMH of the representative population studied shows that information commonly missing in patients’ FMH can affect patient management at a primary care level.

Contributions of Primary Health Care and Next Step Considerations: A Systematic Review

The essential consideration is the cornerstone of a solid medical care system that provides outstanding health outcomes at a low cost. Medical therapy has evolved over the previous century from concentrating on random etiologies to lifestyle, race, and environmental factors. The aim behind these changes is to serve the public health requirements by delivering frequent and easy services based on the individual, couple, or family. Accurate evaluation of the magnitude by which primary health care contributes to the health care system is essential to the improvement of these contributions and determining next step considerations. The number one factor has been associated with greater access to medical care, better health outcomes, and reduced hospitalization and ER (emergency room) visits. The number one consideration may also help balance the adverse effects of poor financial situations on well-being. Therefore, we need more primary care doctors in the US. Research is also necessary to understand which essential consideration models provide acceptable health results.

A Study on the Public Awareness of Hierarchical Medical System in Taiwan

The purpose of hierarchical medical system is to lead in terms of improving efficiency, differentiating healthcare services and promoting labor division by changing the healthcare seeking behavior. The purpose of this research aims to discuss the public awareness of hierarchical medical system in Taiwan for the reference of health policy makers. We obtained our research data using a questionnaire survey;the total number of qualified patients was 1340. This research finds that more subjects agreed to the hierarchical medical system and medical referral system, but many people still disagreed with changes to their healthcare seeking choices due to policy promotion. Subtle changes, therefore, are observed that imply a crisis in terms of the trust in healthcare. The healthcare seeking behavior will not change if there is a difference between the medical awareness of patients and policy implementation, and the government needs to be concerned with this result when making policies.

The Pathway of China’s Integrated Delivery System:Based on the Analysis of the Medical Consortium Policies

With the deepening of China’s health-care reform,an integrated delivery system has gradually emerged with the function of improving the efficiency of the health-care delivery system.For China’s integrated delivery system,a medical consortium plays an important role in integrating public hospitals and primary care facilities.The first medical consortium policy issued after the COVID-19 pandemic apparently placed hope on accelerating the implementation of a medical consortium and tiered health-care delivery system.This paper illustrates the possible future pathway of China’s medical consortium through retrospection of the 10-year process,changes of the series of policies,and characteristics of the policy issued in 2020.We considered that a fully integrated medical consortium would be a major phenomenon in China's medical industry,which would lead to the formation of a dualistic care pattern in China.

Association between availability of glucose-lowering drugs in primary health institutions and diabetes patients’medication adherence:a cross-sectional study in Shandong Province,China

Background:Primary health care system is a critical component of diabetes care and management.This article aimed to analyze the availability of glucose-lowering drugs in primary health institutions(PHIs)in China,and to explore the relationship between availability of glucose-lowering drugs and medication adherence among type 2 diabetes mellitus(T2DM)patients.Methods:This cross-sectional study conducted in Shandong Province,eastern China(hereafter referred to as Shandong),between August and December 2017.In total,2520 community-managed T2DM patients were selected from 68 PHIs in Shandong,including 62 village-level and 6 township-level PHIs.The self-developed questionnaire was used to survey the availability of glucose-lowering drugs in PHIs.Patients’medication adherence was assessed by four self-reported questions,and was classified as either adherent or non-adherent.Descriptive statistics was used to analyze the availability of glucose-lowering drugs in PHIs and the medication adherence among the T2DM patients.Multilevel logistic regression models were used to explore the relationship between the availability of glucose-lowering drugs in PHIs and patients’medication adherence.Results:A total of 1866 T2DM patients prescribed with at least one glucose-lowering drug were included in analysis.Among them,58.5%patients followed their antidiabetic treatment well.In village-level PHIs,the patient’s adherence rate was lower than in township-level PHIs(55.9%vs.61.1%,P<0.05).Among the 68 PHIs,average(2.53±0.97)glucose-lowering products(generic names)were available,which in village-level PHIs were less than in township-level PHIs(2.47 vs.3.17,P<0.05).And the number of available glucose-lowering products in PHIs was associated with the adherence of T2DM patients.Conclusion:Poor availability of glucose-lowering products was found in PHIs in Shandong.The availability of glucose-lowering products in PHIs was positively associated with patients’medication adherence,and could be enhanced to improve the control of diabetes in primary care settings.

On Rural Medical Care and Health Undertaking Development during New Medical Reform

Based on in-depth survey of township hospitals in Lushan County of Henan Province, this paper studies the development situations of rural medical care and health undertaking in the course of new medical reform. Results show that both rural medical institution and public health undertaking have considerable development in this course. Working capital situation gradually turns better. However, there are still problems and challenge of shortage of high quality medical care personnel, lack of employment mechanism, poor medical environment, and imperfect bidding and purchasing system of medicines. To further develop rural medical situation, it should improve medical environment, speed up informationization construction, and give prominence to functional orientation.

Dissatisfaction with the Health Service and Non-Adherence to Antihypertensive Medication Treatment in Brazil

Purpose: Possibly the dissatisfaction with health services influences the non-adherence to medication treatment process. However, such association needs further investigation to extrapolate its results to different groups, for instance, those using only public health services. The aim of the study was to investigate the association between dissatisfaction with the public health service and non-adherence to antihypertensive pharmacotherapy. Methods: Cross-sectional descriptive study. 392 patients with hypertension participated;these were undergoing outpatient treatment at Primary Health Care, in a city of Brazil. Data collection occurred between December 2011 and March 2012 through home visits with the application of semi-structured questionnaire. Results: The majority of the interviewed were satisfied with the care received. However, it was found that there was association between non-adherence to pharmacotherapy and dissatisfaction with the reception service, scheduling appointment, care received from the health team, solvability of health problems, group activities, and physician professional. Conclusion: When health professionals do not aim for a service of quality that promotes user’s satisfaction with the health service, it cannot reach good levels of adherence to therapy.

Health Training Needs at Primary Care Level Health Facilities in Rural Western Uganda

Introduction: Continual education is recognized worldwide as a tool for the professional development of health care practitioners. It is however effective when the training targets the appropriate needs of the target beneficiaries. This study was therefore aimed at identifying priority training needs of Primary Care Level health professionals in rural Western Uganda. Methods: This was a descriptive cross-sectional survey among 35 rural community health facilities represented by their managers in rural Western Uganda. Participants were invited to Mbarara University of Science and Technology and responded to a self-administered questionnaire and also participated in qualitative group discussions guided by Facilitators from the Community Based Education and Research Services unit within the Community Health Department of Mbarara University of Science and Technology. Priority health training needs were determined based on the computed weighted scores. Results: The majority of managers of rural primary care level health facilities were medical officers by the level of training (51.43%) and male by gender (68.57%). Priority health training needs identified were child health and maternal health with total weighted scores of 12.0 and 10.9 respectively. Qualitatively, emerging themes included;leadership and management, and supervisory roles during student field attachments. Conclusion: Priority health training needs at rural Primary Care level health facilities were child health, maternal health, leadership and management, and supervisory skills. There is dire need to train rural primary care level, health professionals. In-service training based on identified needs should be offered by MUST in partnership with regional stakeholders. This is likely to enhance the quality of services provided by rural primary care level health facilities.

Health reform in China:Developments and future prospects

In 2009,China initiated a new round of health reform to establish a wellfunctioning health system.The 2009 health reform did make some significant achievements in improving affordability and accessibility.In particular,social health insurance has been expanded significantly and various social health insurance plans have covered over 95%of total population in China by 2011.The Chinese government also has significantly increased fiscal input for health financing.However,affordability remains a serious concern as the social health insurers,as purchasers,were not very effective in containing the growth of health expenditure.Accessibility to primary care and public health is another concern.In this context,health governance reforms are necessary to address affordability and accessibility issues.Health governance set rules for key actors of the health system(including service providers,health insurers and government departments)by taking into account the strategies and incentives of these actors in their interactions.In recent years,a series of reforms in health governance have been initiated.Some progresses have been achieved.For the next stage of health reform,issues including how to further reform the governance structure of medical institutions and how to improve resource allocation in the health system are critical.

Promoting Health Behavior Change in Canada: A Quality Improvement Project Integrating Prevention and Wellness in Frontline Care

Background: The critical need for Health Behaviour Change (HBC) for preventative care has been highlighted by the COVID-19 pandemic. This quality improvement project assessed the effectiveness and acceptability of Fountain of Health HBC tools as a minimal intervention for primary and secondary prevention among Canadian clinicians and their patients. Methods: Clinicians received HBC education and tools (paper tools and app-based) to assist their patients in setting a S.M.A.R.T (Specific, Measurable, Action-oriented, Realistic, Time-limited) goal at baseline and assessed four weeks later. Primary outcome measures were: 1) patient self-report of success at goal attainment;2) patient self-reported evaluation of change in well-being and health attitudes;and 3) clinician experience and engagement. Results: A total of 2184 clinicians received HBC education. Of these, 759 clinicians registered to participate in the project. 961 patients set S.M.A.R.T. HBC goals using either the paper tools (PT) or the app format. Patient data revealed nearly all patients (89% of PT users and 90% of app users) at least partially succeeded in attaining their goal at a four-week follow-up. Most patients (85% of PT and 80% of app users) also reported improvement in their well-being. A significant difference in health beliefs and attitudes was found in both PT (p < 0.001) and app users (p = 0.003). Conclusions: HBC is challenging. Educating and providing clinicians with HBC tools as a minimal intervention was found to be a successful health prevention strategy to improve patient well-being and health attitudes, and achieve S.M.A.R.T. goals. Results show HBC tools, education, and support for clinicians are both acceptable and effective for HBC in frontline care. These findings are relevant and timely given greater reliance on virtual care in the wake of the COVID-19 pandemic. Further research with rigorous methodology is needed to implement programs to achieve sustainable HBC to promote health on a large scale.

Patient-centered medical home and integrated care in the United States: An opportunity to maximize delivery of primary care

The reciprocal relationship between mental and physical health is well established.Undiagnosed,untreated,and poorly managed mental health conditions are associated with numerous physical health complications,poor treatment adherence,and decreased quality of life.Despite growing evidence regarding the importance of effectively addressing these conditions in primary care,the rates of identification remain low and follow-up and management by primary care providers has been criticized.The objective of this review was to demonstrate the role of Patient-Centered Medical Home(PCMH)and mental health integration in addressing comprehensive health care needs in primary care patients,and to describe common barriers and facilitators to the implementation of these types of programs.

Comparison of the medical security system between the United Kingdom and China

In this day and age,few issues have aroused more bitter controversy than the one of how to keep the balance between fairness and cost-effectiveness in healthcare system.On one hand,a well-designed healthcare system

The impacts of national essential medicine policies on the rational use of medicines in China: A cross-sectional study in primary health care institution

Irrational use of medicines is a major problem worldwide, and it is believed there would be positive correlation between the National Essential Medicines Policies(NEMPs) and the level of rational use of medicines(RUMs). Though there is some early evidence on the NEMPs’ effects on RUMs in China, the evidence is scarce, and conclusions vary. In the present study, we aimed to evaluate the impacts of the NEMPs of China on the RUMs in the primary health care institutions(PHCs). A cross-sectional survey was conducted in 2010. A total of 201 PHCs from six provinces of China were selected, and 39 181 prescriptions were extracted from January to June, 2010. Six indicators were used and tested by independent-samples T test. We found that the average number of drugs per prescription in PHCs with NEMP implementation(the treatment group) was significantly higher than that of the group without NEMP implementation(the control group)(3.37 vs. 2.83, P<0.01). There was no significant difference in the average cost per prescription(81.43 vs. 75.02). The percentage of prescriptions, including an antibiotic(53.40% vs. 36.48%, P<0.01) or an injection(40.54% vs. 27.94%, P<0.01), was higher in the treatment group, and the percentage of drugs prescribed by general name was significantly lower(83.71% vs. 93.11%, P<0.01). For the percentage of drugs prescribed from essential medicines list, the treatment group exhibited the higher ratio(76.12% vs. 53.45%, P<0.01). From this study, the NEMPs were not likely to have a positive impact on RUMs. China still needed efforts to improve the selection, the absence of physicians’ active involvement, and the patients’ habits of irrational medication use.

Enlightenment of German social health insurance system reform on China

According to the latest Chinese Healthcare Reform .Plan, the medical insurance system is one ofthe four components of the healthcare sector. The Healthcare financing and payment in China are mainly based on medical insurance. So it is important to learn the experiences of the developed countries. This paper examines the key issues of the German Healthcare system and reforms, with a particular emphasis on basic social medical insurance, which has the broadest coverage in Germany. It reviews the evolution of the background of the German social medical insurance system, describes how the system functions, and analyzes the existing and emerging problems with the system which push the Germany government to adapt a series of reforms.

中国基层医疗服务发展对老年人健康的影响

实现健康老龄化是我国积极应对人口老龄化的一项重要战略任务。老年人的健康状况和医疗服务需求特点决定了基层医疗服务在促进老年健康中的重要地位。基层医疗服务发展对老年人健康具有重要影响。分析评估我国基层医疗服务发展的成就和不足,更好地发挥基层医疗服务在促进健康老龄化和建设健康中国中的作用具有重要的现实意义。本文从老年人感知的基层医疗服务可及性、服务可得性和服务适配性三个维度构建反映基层医疗服务发展水平的综合指标,利用2015年和2018年中国健康与养老追踪调查(CHARLS)数据,实证检验和分析我国基层医疗服务发展水平对老年人健康的影响及其作用机制。研究发现老年人感知的基层医疗服务发展水平越高,自评健康水平就越高,自评健康改善状况也越好,说明基层医疗服务发展对老年人健康具有积极作用,且结论具有稳健性。基层医疗服务发展会改善医疗服务便利性,降低医疗服务费用,促进老年人的医疗服务利用,降低老年人医疗服务需求未满足的程度;基层医疗服务还担负着向辖区居民开展疾病预防与控制、健康教育、居民健康档案管理、慢性病患者健康管理、老年健康与医养结合服务等初级卫生保健服务的职责,可以改善老年人健康管理水平;基层医疗服务发展能够提高老年人健康素养,有助于培养健康生活方式与行为,最大限度消除健康危险因素,从而促进老年人健康。机制检验发现医疗服务需求满足程度、健康管理状况、健康素养与行为在基层医疗服务发展影响老年人健康过程中发挥了部分中介作用。异质性分析结果表明基层医疗服务发展对老年健康的影响在不同地区、不同年龄阶段、不同收入水平和健康状况的老年群体之间存在显著差异。中西部地区和农村地区老人、中低龄老人、低收入老人和罹患慢性病的老人从基层医疗服务发展中受益更大。政府应进一步优化基层医疗资源配置,增强基层医疗服务能力,增加服务供给,在提高老年人医疗服务需求满足程度的同时提高老年人健康管理水平,提升老年人健康素养,培养健康行为方式,更好地发挥基层医疗服务促进老年人健康的作用。

Mobile EMR Use for Epidemiological Surveillance on a Medical Service Trip in Honduras: A Pilot Study

Rationale: Medical treatment on short-term primary care medical service trips (MSTs) is generally symptom-based and supplemented by point-of-care testing. This pilot study contributes to the effective planning for such austere settings based on predicted symptomology. Objective: We aimed to prospectively document the epidemiology of patients seen during two low-resource clinics on a MST in Honduras and apply predefined case definitions adapted from guidelines used by international healthcare organizations (e.g. World Health Organization). Methods: An observational design was used to track the epidemiology during two clinics on an MST in Limon, Honduras in March 2015. The QuickChart mobile electronic medical record (EMR) application was piloted to document diagnoses according to predefined case definitions. Results: The most commonly diagnosed syndromes were upper respiratory complaints (20.19%), nonspecific abdominal complaints (20.19%), general pain (15.38%), hypertension (9.62%), pruritus (6.73%), and asthma/ COPD (4.81%). The case definitions accounted for 94% of all complaints and diagnoses on the brigade. Discussion: The distribution of common patient diagnoses on this MST was similar to that which had been reported elsewhere. The use of broader symptom-based case definitions for epidemiologic surveillance could also facilitate the syndromic management of patients seen on MSTs, and improve the consistency of treatment offered. Conclusion: Case definitions for common syndromes on primary care MSTs may be a feasible method of standardizing patient management. Preliminary use of the QuickChart EMR was acceptable for documentation of epidemiology in the field. Further study is necessary to investigate the reliability of syndromic diagnostic criteria between different clinicians and in a variety of MST settings.

基于SERVQUAL模型的基层医疗卫生服务质量评价研究

目的:在县域医共体的建设背景下,评价社区卫生服务中心服务质量及影响因素,提出基层医疗卫生服务质量改善对策。方法:运用SERVQUAL模型,从社区卫生服务中心服务质量的有形性、可靠性、响应性、信任性、移情性方面,形成问卷条目;通过多因素二分类logistic回归探索筛查服务质量差距的影响因素;借助IPA象限图呈现居民对社区卫生服务中心的SERVQUAL模型各维度服务质量重要性的分布情况。结果:问卷各项条目的服务质量差距均为负值,服务保证性和移情性维度的服务质量差距得分最高,分别为-0.47±0.59分和-0.47±0.65分;服务有形性维度的服务质量差距得分最低,为-0.40±0.55分。年龄、收入情况和慢病年限是服务质量差距的影响因素。结论:当前基层医疗卫生服务质量与居民的期望之间存在一定差距,基层医疗卫生服务机构应重视对低年龄、高收入和慢病病程较长的居民的服务需求。

综合医疗制度改革对中国家庭财务脆弱性的影响

健康风险作为背景风险的重要组成部分,会给一般家庭造成明显的财务脆弱性。医疗制度作为重要的社会保障基础,可以为家庭提供关键的健康保障,从而有效缓解家庭财务脆弱性。引入2010—2020年中国家庭追踪调查数据(CFPS),构建准自然实验研究体系,采用双重差分法检验了综合医改政策对家庭财务脆弱性的影响特征及其作用机制。研究发现,综合医改政策的实施显著缓解了家庭财务脆弱性,并且这一效应在城镇家庭、有老年人的家庭、儿童健康风险高的家庭、弱社会网络家庭、使用互联网的家庭以及社会信任度高的家庭中表现更加明显。同时,综合医改政策可以通过降低家庭医疗负担、提升家庭劳动参与、改变家庭风险态度等途径缓解家庭财务脆弱性。本文为评估综合医改政策及其对家庭财务影响的有效性提供了新视角,为进一步从微观层面深化医疗卫生体制改革提供了重要的政策启示。

健康中国背景下的“看病贵”与政府支出——基于资源配置结构性失衡视角的分析

“看病贵”意味着医疗卫生资源转化为医疗卫生服务的成本高,有限资源下医疗卫生服务供给的数量和质量难以满足公众健康需求,从而直接影响健康中国建设。同时,人口快速老龄化带来的医疗卫生需求爆发式增长,将形成医疗卫生体系的额外压力,加剧供求矛盾。基于医疗卫生资源配置结构性失衡视角研究“看病贵”与政府支出之间的关系发现:政府增加卫生支出会通过加剧人力资源配置的结构性失衡而加剧“看病贵”问题;只有将增加政府卫生支出与深化医疗卫生体制改革相结合,才能真正缓解全社会“看病贵”问题。因此,应深化公立医院改革,优化政府对医疗卫生资源的配置方式,加强基层医疗卫生体系建设,重塑医疗卫生服务治理模式,构建专业化治理模式,系统性重构中国医疗卫生领域人才建设。