Care Services In China Research Articles

Research on the Present Situation, Dilemma and Countermeasures of the Institutional Old-Age Care Model of “CMHC”*<br/>—Taking Xinyu Yinhe Park Elderly Service Center as an Example

Based on the practical background of aging of the Chinese population and the “Separation of Medical and Health Care” and faced with the demand for health care services increasingly, this paper attempts to analyze the current development situation of the old-age care model of “CMHC” institutions, thus puts forward feasible suggestions for perfecting the old-age care model of “CMHC” institutions in China. This paper takes Xinyu Yinhe Park Elderly Service Center, Jiangxi Province as an example, adopts the method of questionnaire survey and interview, investigates the operation status of the center, the basic situation of nursing staffs, the basic situation of the elderly and their satisfaction of life, and analyzes the survey results by using the method of descriptive statistical. The study finds that the old-age care model of “CMHC” institutions in China is in the stage of exploration and development, which is faced with the lack of talents, low service level, the shackles of traditional old-age concept, the lack of government policy support, shortage of funds, the disordered management of government departments and other internal and external difficulties in “CMHC” institutions. Based on the previous study, this paper argues that we shall improve and develop the old-age care model of “CMHC” institutions in our country, and must support this patter with a long-term policy, attach importance to “CMHC”, encourage the active participation of social forces, and vigorously cultivate talents in “CMHC” under the guidance of the government, and then establish long-term care insurance system, so as to create a good internal and external environment for the development of “CMHC” old-age care service in China, and thus contribute to the development of China’s old-age care business.

Palliative Care Gains Roots in China

In China over the past decade, palliative medicine has emerged as a new program. Development of this program requires attention to current opportunities, obstacles and cultural concerns. A selected review showed that there is an urgent need for palliative care in mainland China. Several challenges to implementing palliative care service in China include: (1) cultural perception and misunderstanding of palliative care; (2) lack of professionally trained health-care providers; (3) administrative and policy problems; and (4) limited funding for palliative care and research. More efforts should be made in clinical practice, education and research to develop and implement palliative care in mainland China.

Changes of Job Burnout in Chinese Nurses over 2004–2013: Cross-Temporal Meta-Analysis

How nurse burnout changes over time with macro environmental factors remains unclear. The main purpose of this study is to investigate how burnout changes over 2004–2013 in Chinese nurses and its relationship with national-level patient-to-nurse ratio using cross-temporal meta-analysis. The results show that the mean scores of emotional exhaustion and depersonalization are positively related to the year of data collection, while that of personal accomplishment are negatively related to the year of data collection, indicating that burnout increases steadily over the recent years in Chinese nurses. National-level patient-to-nurse ratio may be a risk factor for the observed increase in nurse burnout over 2004–2013, and nurse staffing provided may be inadequate to meet the increasing demands of patients for high-quality medical care service in China. Thus, increasing the number and quality of nurses may hold promise for reducing nurse burnout on a national level.

Urban–rural disparity in utilization of preventive care services in China

Preventive care service is considered pivotal on the background of demographic ageing and a rise in chronic diseases in China. The disparity in utilization of preventive care services between urban and rural in China is a serious issue. In this paper, we explored factors associated with urban–rural disparity in utilization of preventive care services in China, and determined how much of the urban–rural disparity was attributable to each determinant of utilization in preventive care services. Using representative sample data from China Health and Nutrition Survey in 2011 (N = 12,976), the present study performed multilevel logistic model to examine the factors that affected utilization of preventive care services in last 4 weeks. Blinder–Oaxaca decomposition method was applied to divide the utilization of preventive care disparity between urban and rural residents into a part that can be explained by differences in observed covariates and unobserved part. The percentage of rural residents utilizing preventive care service in last 4 weeks was lower than that of urban residents (5.1% vs 9.3%). Female, the aged, residents with higher education level and household income, residents reporting self-perceived illness in last 4 weeks and physician-diagnosed chronic disease had higher likelihood of utilizing preventive care services. Household income was the most important factor accounting for 26.6% of urban–rural disparities in utilization of preventive care services, followed by education (21.5%), self-perceived illness in last 4 weeks (7.8%), hypertension (4.4%), diabetes (3.3%), other chronic diseases (0.8%), and health insurance (−1.0%). Efforts to reduce financial barriers for low-income individuals who cannot afford preventive services, increasing awareness of the importance of obtaining preventive health services and providing more preventive health services covered by health insurance, may help to reduce the gap of preventive care services utilization between urban and rural.

Can the Medical-nursing Combined Care Promote the Accessibility of Health Services for the Elderly in Nursing Home? A Study Protocol of Analysis of the Effectiveness Regarding Health Service Utilization, Health Status and Satisfaction with Care.

Currently, segmentation of healthcare and daily care for the elderly living in nursing homes usually results in the elderly not getting medical treatment timely and effectively. The medical-nursing combined care, which has been put into practice in several areas in China, is developed to enhance the accessibility of healthcare for the elderly. The aim of the study is to explore the effectiveness of the new care service, based on Andersen model, regarding health service utilization, health status and service satisfaction. The effectiveness of medical-nursing combined care will be measured in a cross-sectional study in nine nursing homes in Jianghan District, Wuhan, China, with 1067 old residents expected to participate. The questionnaire containing items of demographics, health service use, service satisfaction and instrument of SF-36 V2 is developed based on the conceptual framework of Andersen behaviour model of health service utilization. Descriptive analysis, variance analysis, multiple factors analysis, and correlation analysis will be performed to compare the sociological characteristics, health service use, health status and service satisfaction of the elderly living in different modes of nursing homes, to explore the influence factors of care effectiveness, as well as to study the relationship between health behaviour and health outcomes. The study design of analysing the effects of medical-nursing combined care and performing the horizontal comparison among the nursing homes under the framework of Andersen model is blazing new trails. Recruitment and design of questionnaire are important issues. Successful data collection and quality control are also necessary. Taking these into account, this study is estimated to provide evidence for the effectiveness of medical-nursing combined care service in China.

Hospice and Palliative Care: Development and Challenges in China.

Terminally ill patients can benefit from palliative care, including relief from physical and emotional suffering, improved quality of life, and longer survival rates. However, despite marked development in other countries, palliative care is still in its infancy in China. The general population and healthcare professionals in China have yet to realize the importance of palliative care services. This article describes the status of palliative care services in China, the historic development of palliative care, and the barriers to its advancement. The status quo of hospice and palliative care in China is reviewed, and suggestions are provided on how nurses can improve their abilities to care for patients with cancer at the end of life. A significant amount of work is needed in China to meet the standards of international palliative care societies. Palliative care training for nurses is still very limited. Nurses and other health providers who are engaged in palliative care should be well trained regarding the principles and procedures of palliative care to ensure quality care.

Research on the cultivation path of smart home-based care service mode in Internet+ vision

Home-based care for the aged is an effective method to solve the problem of caring the aged in China. This thesis analyzes some problems existing in the development of current home-based care service for the aged in our country and the positive effects brought by Internet+ in home-based care service. It proposes a new service mode of care for the aged--Internet+ home-based care service, and explains the establishment of this system and the responsibilities of the participants. Also, it explores the path to realize the establishment of Internet+ home-based care service mode so as to promote the healthy development of home-based care service in China.

Folic acid supplementation, preconception body mass index, and preterm delivery: findings from the preconception cohort data in a Chinese rural population.

BackgroundFolic acid (FA) supplementation before and during the first trimester can reduce the risk of occurrence of preterm delivery (PTD). Preconception body mass index (BMI) is also associated with PTD. This study aimed to investigate the combined effect of FA supplements and preconception BMI on the risk of PTD.MethodsThe data of a cohort from 2010–2011 that was obtained through a preconception care service in China was used (including 172,206 women). A multivariable regression model was used to investigate the association between maternal preconception conditions and the risk of PTD. The interaction of preconception BMI and FA supplementation was measured by a logistic regression model.ResultsTaking FA supplements in the preconception period or in the first trimester reduced the risk of PTD (odds ratio [OR] = 0.58 and OR = 0.61, respectively). Women with an abnormal BMI had an increased risk of PTD (OR = 1.09, OR = 1.10, and OR = 1.17 for underweight, overweight, and obese, respectively). Preconception BMI showed an interaction with the protective effect of FA supplementation for PTD. With regard to the interaction of FA supplementation, the adjusted odds ratio (aOR) was 0.57 (95 % CI: 0.51, 0.64) in underweight women, 0.85 (95 % CI: 0.73, 0.98) in overweight women, and 0.77 (95 % CI, 0.65, 0.91) in obese women. Preconception BMI also showed an interaction with the time of FA supplementation. Women with a normal BMI who began to take FA supplements in the preconception period had the lowest risk of PTD (aORs: 0.58 vs. 0.65 beginning in the first trimester). The aORs at preconception and the first trimester in the underweight group were 0.56 vs. 0.60. The aORs at preconception and the first trimester were 0.94 vs. 0.65 and 1.15 vs. 0.60 in the overweight and obesity groups, respectively.ConclusionsIn our study, FA supplements reduced the risk of PTD, while abnormal BMI raised the risk of PTD, although higher BMI categories did not have this higher risk once adjusted analysis was conducted. The protective effect of FA supplementation for PTD was reduced in women with overweight or obesity. To get better protection of FA supplementation, women with normal BMI or underweight should begin to use in preconception, while women with overweight or obesity should begin to use after conception.

Sexual dysfunction and its impact on quality of life in Chinese patients with schizophrenia treated in primary care

PurposeSexual dysfunction in schizophrenia patients is common. In China, maintenance treatment for clinically stable patients with schizophrenia is usually provided by primary care physicians. Illness- or treatment-related sexual dysfunction in this patient population has been never studied. This study describes the prevalence and correlates of sexual dysfunction and its impact on quality of life (QOL) in patients with schizophrenia treated in primary care in China. MethodA total of 607 patients with schizophrenia treated in 22 randomly selected primary care services in China formed the study sample. Patients' socio-demographic and clinical characteristics including sexual function and QOL were recorded using a standardized protocol and data collection. ResultsSexual dysfunction was present in 69.9% of all patients; 60.7% in males and 80.6% in females. Multiple logistic regression analysis revealed that female gender, being single, older age and use of first-generation antipsychotics were independently and significantly associated with more sexual dysfunction accounting for 23.5% of its variance (P<0.001). Unexpectedly, sexual dysfunction was not associated with lower QOL. ConclusionsHigh rate of sexual dysfunction was reported in the majority of patients with schizophrenia treated in primary care in China. Given its negative impact on social adjustment, QOL and treatment adherence, efforts should be made to address sexual dysfunction in this patient population.

Community pharmacy practice in China: past, present and future

In 2009, China launched a new healthcare system, with reform of the primary healthcare system as its foundation and focus, to enable residents to access primary healthcare for simple health problems instead of seeking help at hospitals. Community pharmacies and pharmacists were to have increased responsibility in primary healthcare by delivering pharmaceutical care services in China in addition to their traditional roles of dispensing prescriptions and selling medicines. To describe the current status of Chinese community pharmacy education and practice, and discuss future directions. A literature search was conducted using MEDLINE and International Pharmaceutical Abstracts. Additional articles were identified through the cross-referencing of articles and books. Additional data were found from relevant websites. From the 313 publications identified, 98 were included. China currently has 388,000 retail pharmacies, corresponding to one pharmacy per 3,532 population. All pharmacies provide prescription and over-the-counter products, as well as prescription dispensing and patient counselling. However, the lack of reimbursement mechanisms reduces the willingness of pharmacists to offer high-quality dispensing and counselling services. There is a shortage of qualified pharmacists to meet increasing patient needs. This, coupled with a shortage of pharmacist training, has resulted in pharmaceutical care being a low priority for delivery in routine pharmacy practice. To meet the increasing demand for pharmacists, 25 universities have been allowed to offer BS, MS and PhD degrees (3-7 years in length) in clinical pharmacy since 2008. The adoption of Good Pharmacy Practice as a recommended standard for community pharmacy practice provides pharmacists with a framework to aid them in service delivery. A number of undertakings still require development, including the enactment of the Chinese Pharmacist Law, development of a standard for pharmaceutical care activities, development of the pharmacy workforce, increasing public awareness of pharmacists, and proper reimbursement for care provision. Although pharmaceutical care services are underdeveloped in China, they will become an integral part of the professional work of all pharmacists in the future, particularly in community pharmacy settings.

Socioeconomic status and chronic diseases: The case of hypertension in China

China has undergone a rapid epidemiological transition from infectious to chronic diseases, a process characterized by widespread under-diagnosis of chronic diseases and low rates of treatment and control. This paper uses hypertension as an example and documents the association of socioeconomic status with various measures of this condition, i.e., prevalence, awareness, treatment and control. We find no wealth and education gradients in the prevalence of hypertension. Given education, wealth plays some roles in improving the treatment and control of hypertension. Some associations exist between education and diagnosis/treatment/control in urban areas but not in rural areas. We also find that the public health care services in China contribute little in informing patients of their hypertension status, suggesting that how to improve the effectiveness of the health care system in dealing with emerging chronic illnesses should be policy priority. ► Correlations between SES and various measures of hypertension are examined. ► We find no significant wealth and education gradients in hypertension prevalence. ► Wealth plays some roles in improving the treatment and control of hypertension. ► Associations between education and diagnosis/treatment/control exist in urban areas. ► China's health services contribute little in informing patients's hypertension status.

Neonatal Respiratory Failure: A 12-Month Clinical Epidemiologic Study From 2004 to 2005 in China

In the past decade, neonatal special care services in China have been established, during which time various therapies for neonatal respiratory failure have been introduced. The objective of this study was to investigate the incidence, management, outcome, and cost of neonatal respiratory failure treated by mechanical ventilation in 23 tertiary NICUs of major hospitals in southeastern and midwestern China. Data were collected over 12 consecutive months from 2004 to 2005 for neonates with neonatal respiratory failure. Eligible infants were those who required endotracheal intubation and mechanical ventilation and/or nasal continuous positive airway pressure for at least 24 hours and infants who died within 24 hours of ventilation during their first 7 days of life. Data characterized demographics, antenatal and perinatal history, illness severity score, primary disease, respiratory care, complications, survival, and clinical burden. From a total of 13,070 NICU admissions, there were 1722 (13.2%) cases of neonatal respiratory failure with respiratory distress syndrome, pneumonia/sepsis, and meconium aspiration syndrome as major causes. For infants who survived until discharge, the median length of ventilation was 70 hours. Overall, in-hospital mortality for neonatal respiratory failure was 32.1%. Logistic regressions showed that lower gestational age, vaginal delivery, fetal distress before delivery, presence of a major anomaly, and high severity score in preterm infants were associated with an increased risk for death. In term and postterm infants, only the presence of a major anomaly and a high severity score were significant risk factors for death. Mean length and cost of stay in hospital were 19.2 +/- 14.6 days and 14,966 +/- 13,465 Yuan in the survivors. Neonatal respiratory failure in the NICU of the provincial cities of China has high mortality and cost that are linked to geographic variability, a male predominance, and low proportion of very preterm infants, characteristic of sociocultural confounding background.