Capacity of primary hospitals for diabetes treatment in six Chinese provinces: a cross-sectional survey

Abstract

BackgroundEstablishment of a hierarchical medical system is one of the major tasks outlined in China's ambitious health reform, and the ultimate success of this system depends on the treatment capacity of primary hospitals. Among the priorities of primary hospitals is the provision of quality services for chronic diseases, including diabetes, atypical and epidemic chronic disease in China. We aimed to estimate the capacity of primary hospitals for diabetes treatment in six Chinese provinces. MethodsWe did a cross-sectional survey in China using qualitative and quantitative methods. First, we interviewed 24 related experts (five primary hospital principals, six general practitioner, five drug experts, five medical device experts, two clinical experts, and one health system expert) to establish the capacity standard of primary hospital for diabetes treatment in the hierarchical medical system. Next, we surveyed the treatment capacity with regards to human resources, drug supply, and medical equipment in 28 primary hospitals (17 urban and 11 rural) in six provinces in China (Shanghai, Fujian, Hubei, Hunan, Sichuan, and Guizhou) between May 20 and July 12, 2016. Finally, we compared the survey results against the standard. We adopted purposive sampling, and used χ2 test and rank sum test for data analyses. Ethics approval was granted by Sichuan University, and all participants provided oral informed consent. FindingsThe primary hospitals surveyed had a mean of 1·76 general practitioners (SD 2·03) per million residents. The mean number of general practitioners per million residents was 1·48 (1·18) for rural hospitals and 1·92 (2·41) for urban hospitals, which were lower than the standard (2–3, based on the expert interviews and policy review). 11 (65%) urban primary hospitals provided three or more types of drugs, compared with four (36%) rural primary hospitals. Urban primary hospitals had a mean of 8·35 (SD 4·44) types of diabetes drugs and rural ones had 4·45 (3·33), although expert interviews and policy reviews indicated that primary hospitals need provide seven types of drugs that are often used in the clinic. 27 (96%) primary hospitals provided metformin, 26 (93%) sulfonylureas, 18 (64%) alpha-glucosidase inhibitors, 16 (57%) insulin, 15 (54%) hypoglycaemic proprietary Chinese medicine, 11 (39%) glinides, and nine (32%) thiazolidinediones; newer antidiabetic drugs such as DPP-4 inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists were scarcely supplied. All 28 primary hospitals were equipped with blood glucose meters, blood pressure instruments, and electrocardiograph machines; 25 (89%) had biochemical analysers, 27 (96%) B ultrasound machines, 20 (71%) colour Doppler ultrasound machines and x-ray machines, and eight (29%) fundus mirrors, while expert interviews showed that primary hospitals should have with all of these equipment. No significant difference in availability of medical equipment was recorded between rural and urban primary hospitals (p>0·05). InterpretationPrimary hospitals in China, especially those in rural areas, do not have sufficient human resources and drugs for diabetes treatment, although they generally have adequate medical equipment. Strategies to enhance the capacity of primary hospitals for diabetes treatment need to increase the number of health-care workers and drug supply. FundingNational Institute of Hospital Administration of China.