Background: Understanding patients' medication experience is crucial for improving adherence, health outcomes, and medical safety. Currently, there is a lack of measurement tools for the medication experience of patients with chronic diseases in primary care facilities in China, which seriously restricts the research and practice of pharmaceutical service and management in primary care facilities.
Objective: This study aims to develop the Medication Experience Scale For Patients with Chronic Disease in Primary Care Facilities tailored to China's chronic disease management practices. The scale is intended to support research and practice in medication management for chronic disease patients.
Methods: A preliminary item pool for the scale was constructed through literature review, semi-structured interviews, and focus group discussions. The Delphi Method was employed to consult experts and refine the scale. A pilot survey was conducted with 313 chronic disease patients from primary care facilities, selected via random sampling. The reliability and validity of the scale were tested, and iterative adjustments were made to optimize its content.
Results: The finalized scale consists of 3 primary dimensions, 7 secondary dimensions, and 28 measurement items. Item analysis yielded P-values < 0.05. The Cronbach's α coefficients for the overall scale and all dimensions exceeded 0.8, with split-half reliabilities above 0.7 and intra-class correlation coefficients above 0.8, indicating high reliability. Post-rotation factor loadings for all items exceeded 0.5. The confirmatory factor analysis demonstrated excellent model fit: CMIN/DF = 1.485, GFI = 0.902, RMSEA = 0.039, RMR = 0.03, CFI = 0.981, NFI = 0.945, IFI = 0.981. Composite reliability values were above 0.7, and average variance extracted values exceeded 0.5, demonstrating strong validity.
Conclusion: The Medication Experience Scale For Patients with Chronic Disease in Primary Care Facilities developed in this study exhibits better reliability and validity. Its adaptability to local contexts make it a suitable tool for investigating the medication experiences of chronic disease patients in primary care facilities.
Primary care governance is a concrete manifestation of health governance and public governance. This discussion article explores the concepts and concerns of governance at different levels and fields from three perspectives: public management, health management, and primary health care. During the last three decades, governance has been talked in two different directions. One is to focus on the positioning and interrelationship of government, market, and network; the other is to focus on the management, accountability, rule of law, transparency, and performance control of the public sector. WHO defines governance as ensuring that a strategic policy framework is proposed and combined with effective oversight, coalition building, governance, and attention to system design and accountability. The 2018 Astana Declaration reaffirmed the commitment to primary health care as the “cornerstone” of achieving universal health coverage. Chinese scholars proposed the “Expert Consensus on Primary Health Governance” in 2024. Countries around the world have seen a lot of research efforts on primary care governance. The author suggests China engaging more in-depth research in this area.
Background: Patients' experience is a critical aspect for evaluating the quality of primary care services. However, research on patient experience in China started relatively late, with limited focus on patients in primary care facilities.
Objective: To reflect the status of primary care services in China based on the experience of patients visiting primary care facilities.
Methods: From March to April 2023, a cross-sectional survey was conducted using intercept sampling in 12 national pilot zones for primary healthcare reform. Investigators, trained in survey techniques, administered the Assessment Survey of Primary Care (ASPC) scale to 1,157 patients at 36 primary care facilities, including township health centers and community health centers.
Results: The average scores for five dimensions were: 69.5±20.5 for first visit/first-line care, 74.1±20.1 for service accessibility, 72.0±20.7 for continuity of doctor-patient relationships, 75.1±21.0 for comprehensive services, and 68.5±21.7 for coordinated services. The overall ASPC score was 71.8±17.3. Significant differences (P<0.05) were found based on age, education level, employment status, family doctor enrollment, self-reported chronic conditions and pilot zone. Multivariate regression analysis identified age, employment status, family doctor enrollment, and pilot zone as significant influencing factors for scores in various dimensions. Unemployed patients scored lower across all dimensions compared to employed patients (P < 0.05). Patients with a family doctor contract had higher scores across all dimensions compared to those without a contract (P < 0.05). Significant regional differences in scores were found, with higher scores in Changting and Xishui counties compared to Jiexiu city (P < 0.05), and lower scores in Haiyan, Lu, and Dongfang cities compared to Jiexiu (P < 0.05).
Conclusion: The ASPC scale effectively reflects the current state of primary care services in China. The family doctor contracted services improve patient experiences in primary care facilities, particularly in the dimensions of accessibility, doctor-patient continuity, and coordination. Regional variations in patient experiences are linked to “patient-centered” approaches and convenience measures.
Background: Community-based health education is widely recognized as a cost-effective means to improve public health. However, current research on health education needs lacks a framework that accounts for variations across different community types, limiting understanding of diverse health education needs in urban settings.
Objective: This study examines health education needs across various community types, aiming to identify significant differences that can inform community health education strategies.
Methods: Conducted in Hangzhou from April to June 2024, this mixed-method study used purposive sampling to select residents from heterogeneous, transformed, homogeneous, and system-based communities for interviews exploring health education needs and existing practices. Qualitative data from 14 interviews and 21 policy documents were coded at three stages and analyzed using Nvivo 12.0, resulting in themes that informed a survey design. In the quantitative phase, 299 residents completed a questionnaire assessing health education needs on a 5-point Likert scale. Descriptive statistics, non-parametric tests, and multivariate logistic regression models were employed to assess health education needs and analyze differences across community types.
Results: Eight primary health education topics were identified: major disease prevention, healthy lifestyles, maternal and child health, mental health, environmental health, medication safety, emergency response, and sexual health education, with 23 sub-topics. First aid knowledge education showed the highest demand [5 (4,5)], followed by cancer prevention education [4 (4,5)]. Non-parametric tests indicated significant influences on health education needs by education attainment, income, and community type (P < 0.05). Multivariate logistic regression model analysis revealed significant variation in needs based on education for diabetes prevention and life safety education, income for cardiovascular and infectious disease prevention, and community type for natural environmental pollution prevention, infectious disease prevention, diabetes and cardiovascular education, and first aid knowledge, life safety education (P < 0.05).
Conclusion: Differences in health education needs are shaped by factors such as residents' education attainment, income, and access to community health resources. Targeted health education should be developed to address specific needs of each community type while promoting equitable resource distribution.
Background: China is experiencing an accelerated aging process, with an increasing number of elderly individuals suffering from chronic diseases. The association between hypertension, its comorbidities, and dementia in the elderly requires further investigation.
Objective: To explore the prevalence of hypertension and its comorbidities in community dwelling older adults and their correlation with dementia, providing a reference for dementia prevention.
Methods: This study utilized cross-sectional data from the 2018-2023 China Multicenter Dementia Survey (CMDS), which included demographic, chronic disease, and cognitive function assessments of 14,732 elderly individuals aged 65 and above. A multivariate logistic regression model was applied to analyze the correlation between hypertension, its comorbidities, and dementia.
Results: Among the 14,732 elderly participants, 8,293 (56.3 %) had two or more comorbidities, and 7,786 (52.9 %) had hypertension with comorbidities. Of these, 2,569 (17.4 %) had one comorbidity, 2,064 (14.0 %) had two, 1,018 (6.9 %) had three, and 443 (3.0 %) had four. Dementia was present in 1,111 (7.5 %) participants. After adjusting for confounding factors, multivariate logistic regression revealed that the risk of dementia in individuals with hypertension was 1.516 times higher (95 % CI: 1.014-2.267) compared to those without hypertension. The risks of dementia for individuals with 1-4 comorbidities were 1.879 times (95 % CI: 1.312-2.692), 2.071 times (95 % CI: 1.428-3.004), 2.338 times (95 % CI: 1.612-3.392), and 2.591 times (95 % CI: 1.634-4.108), respectively. The highest risk (2.550 times, 95 % CI: 1.384-4.700) was observed in those with hypertension and cerebrovascular dementia. Stratified by gender and age, dementia risk increased significantly with the number of comorbidities, with statistical significance (P<0.05). The highest risks for males and females with hypertension and cerebrovascular dementia were 2.842 (95 % CI: 1.095-7.375) and 2.348 (95 % CI: 1.060-5.203), respectively. For individuals aged under 75 years, the highest risk was associated with hypertension and diabetes (OR=2.833, 95 % CI: 1.046-7.675), while for those aged 75 and above, hypertension combined with cerebrovascular disease showed the highest risk (OR=2.707, 95 % CI: 1.168-6.273). Among individuals with two comorbidities, hypertension with heart disease and cerebrovascular disease had the highest dementia prevalence (OR=3.559, 95 % CI: 1.338-9.468). In those with three comorbidities, hypertension combined with heart disease, cerebrovascular disease, and autonomic dysfunction had the highest dementia prevalence (OR=3.881, 95 % CI: 1.736-8.677).
Conclusion: The prevalence of hypertension and its comorbidities is high among the elderly in China, and the risk of dementia is significantly increased in those with hypertension and its comorbidities. This risk shows variations based on age and gender.
Background: The government funded bonded medical program for rural health for graduates of bonded medical program for rural health is an essential strategy to alleviate the shortage of healthcare professionals in rural areas of China and to enhance the quality of the primary care professionals. However, previous studies have lacked a comprehensive analysis of the educational methods, current state, and effectiveness across various institutions.
Objective: This study aims to examine the development, research quality, and future trends in the education of graduates of rural oriented general practice education program from 2010 to 2023, providing insights for future initiatives.
Methods: Literature on the training of graduates of rural oriented general practice education program published between January 1, 2010, and December 31, 2023, was retrieved from seven databases: CNKI, Wanfang, VIP, PubScholar, PubMed, Web of Science, and the Cochrane Library. Two researchers independently screened the literature, extracted data according to inclusion and exclusion criteria, and assessed the quality of studies using the Medical Education Research Study Quality Instrument (MERSQI) and the Newcastle-Ottawa Scale for Education (NOS-E). Descriptive analysis was performed to summarize and interpret the findings.
Results: A total of 37 studies were included, of which 36 were in Chinese and 1 in English. The most common research design was the pre-post test control group (46 %), followed by single-group post-test (22 %) and randomized controlled post-test (22 %). Only 8 % of studies employed a single-group pre-post test design. Of the studies, 97 % focused on undergraduate education, with the primary areas of focus being course adjustments (89 %), teaching method modifications (81 %), and the construction of training models(8 %). Notably, 8 % of training model studies and 19 % of course adjustment studies included courses specifically aimed at rural areas, primary care, or general practice. Outcome evaluations were primarily centered on student feedback (70 %) and improvements in knowledge and skills (86 %), with minimal attention given to behavioral changes (3 %) or benefits to patients and healthcare facilities (3 %). Overall, the quality of the studies was moderate, with a mean MERSQI score of 10.4±2.4 (maximum 14.0). Factors such as sample size, validity of evaluation tools, and outcome indicators contributed to lower scores. The NOS-E score averaged 2.5±1.5 (maximum 5.0), with low scores primarily due to control group comparability and blinding.
Conclusion: Although there has been an increase in research on the education and training of graduates of rural oriented general practice education program, the overall quality of the research remains low. Limitations such as insufficient cross-institutional and cross-regional studies, lack of research focusing on the unique characteristics of targeted training, and limited attention to postgraduate and continuing education remain prevalent. Future research should focus on enhancing multi-institutional cooperation, improving research design quality, establishing a unified evaluation system with a focus on rural and general practice education, and integrating continuous curriculum that includes postgraduate and continuing education.
Background: “lDirectly-entering-socialism ethnic groups” refer to certain ethnic minorities in Yunnan Province whose social structures shifted directly from primitive to socialist society after the founding of the People's Republic of China. This abrupt transition may lead to psychological maladaptation, such as anxiety and depression, affecting overall well-being. Additionally, their remote, mountainous residence limits access to healthcare services, potentially lowering health outcomes. While some studies have explored health utility among ethnic minorities, research specifically on these groups remains scarce.
Objective: To assess the health state utility and their influencing factors among six directly-entering-socialism ethnic groups in Yunnan Province, providing evidence for the development of health promotion and equity measures.
Methods: This study recruited individuals aged 15 and older from six ethnic groups: Va, Lisu, Nu, Jinuo, Lahu, and Blang in three counties of Yunnan Province from July to December 2022 by a multi-stage random cluster sampling method. Health state utility was measured using the EQ-5D-5-L scale and the EQ-5D-5-L Value Set for China. The Andersen model and Tobit regression analysis were used to identify the factors influencing health state utility among these groups.
Results: A total of 1921 participants were included: 293 Va (15.25 %), 378 Lisu (19.68 %), 300 Nu (15.62 %), 398 Jinuo (20.72 %), 280 Lahu (14.58 %), and 272 Blang (14.16 %). The overall health state utility was 0.958±0.092. Va had the highest health state utility (0.966± 0.059), while Lisu had the lowest (0.950±0.093). A higher proportion of participants reported difficulties in the "Pain/discomfort" and "Anxiety/depression". The Tobit regression model showed that depression was a significant barrier to health state utility across all six ethnic groups. For some groups, age over 60-(Va, Nu, Jinuo, Blang), two-week morbidity (Va, Nu, Jinuo), chronic diseases (Lisu, Nu, Lahu), and sleep disorders (Va, Lisu, Jinuo) were associated with lower health state utility. Physical exercise (Lisu, Nu), education level-(primary school or higher for Jinuo and Lahu), and alcohol consumption-(Lahu) promoted higher health state utility in certain groups.
Conclusion: This study enriches the relevant research objects of health state utility, and provides a basis for the measurement of burden of disease of ethnic minorities. The health state utility of these six ethnic groups is close to those of urban Chinese populations and higher than the general population in Yunnan. Addressing depression and improving health state utility in older adults, chronic disease patients, and those with sleep disorders should be prioritized in future health interventions for these groups.
Background: Hypertension has become a major health issue, impacting both health and quality of life. Due to its long course of illness, multiple and complex complications, and lack of a cure or correcting deviation, patients require lengthy and continuous support and medical management. Understanding the long-term journey and influencing factors of medical-help-seeking behaviour in hypertensive patients is crucial for developing targeted and patient-centred prevention and control strategies.
Objective: The study aimed to identify and analyze the long-term trajectories of medical-help-seeking behaviour among hypertensive patients who were managed by community health centres of Putuo District in Shanghai City. Using trajectory modeling to determine key behavioral patterns and the influencing factors, the study will inform hypertension prevention and treatment policies.
Methods: Continuous clinical records of 8,922 hypertensive patients were retrieved from Resident Electronic Health Record System of Putuo District in Shanghai from 2014 to 2021. The data include histories, encounters, diagnostic, management and follow-up information. The Group-Based Trajectory Model (GBTM) was applied to analyze the patterns of the medical-help-seeking behaviour change, simulate behavioural transitions, and identify the best fitting model. Multivariate logistic regression was employed to examine patient characteristics across different behavioural trajectories. The 'persistently irregular medical-help-seeking behaviour' group served as the reference group for comparing influencing factors among medical-help-seeking behaviour trajectory groups.
Results: A total of 444,126 outpatient records were retrieved. The GBTM analysis revealed five distinct medical-help-seeking behaviour trajectories: sustained regular (39.84%), regular with a slow decline (25.36%), U-shaped (11.43%), regular with slow increase (11.86%), and persistently irregular (14.86%). Statistical differences were observed between these groups, including gender, age, illness duration, diabetes history, transient ischemic attack (TIA) history, and family history (P < 0.05). Female patients and those aged 75 years or older were more likely to transition from irregular to regular medical-help-seeking behaviour. Patients with diabetes or a history of TIA were less likely to follow irregular medical-help-seeking behaviour. Longer duration of hypertensive history and a family history were associated with a less favorable shift in behaviour.
Conclusion: Less than 40% of hypertensive patients consistently follow a regular medical-help-seeking behaviour. However, appropriate management strategies can promote regular medical-help-seeking behaviour, particularly in females, patients aged 75 years or above, and those with diabetes or a history of TIA. Further research is suggested identifying factors that can encourage medical help-behavioral changes in other medical-help-seeking behaviour trajectory groups.