Community Health Centers In China Research Articles

Availability and use of primary care facilities in China: a nationwide representative survey

BackgroundChina introduced a national policy to develop primary care in 2009, with 8669 community health centres (CHCs) established by 2014, employing more than 300 000 staff. However, against a background of the “barefoot doctor” legacy in rural China, mistrust of doctors, and over-reliance on specialist care, these facilities have been underused. This study aimed to evaluate the current quality of CHCs in China, including the organisation and infrastructure, as well as the use and training of the health-care professionals within primary care. MethodsWe selected a random sample of 189 community health centres, stratified on the basis of geographical distribution and urban-suburban ratios, from throughout China between September and December, 2015. Two questionnaires, one for lead clinicians and another for primary care practitioners, covered the demographics of the clinic and clinical and training activities. Responses to the survey were obtained from 149 lead clinicians in community health centres and 3580 primary care practitioners (response rates 79% and 86%, respectively). Ethics committee approvals from a local board (HKU/HAW IRB: UW15-350) and the WHO Regional Office for the Western Pacific (2016.4.CHN.1.HSI) were obtained. FindingsCommunity health centres employed a median of eight doctors (IQR 4–14) and thirteen nurses (8–21) but only half of the doctors were registered as primary care practitioners (798 of 1734, 46%) and very few nurses had training specifically for primary care (92 of 1846, 5%). Most community health centres were in buildings previously designated as hospitals (86 of 149, 58%) and 87% (130) had inpatient beds. Although clinics were equipped with stethoscopes (146, 98%) and sphygmomanometers (145, 97%), only 83% (124) had otoscopes, 43% (64) had ophthalmoscopes, and 64% (95) had facilities for gynaecological examination. Clinical care was selectively skewed towards certain chronic diseases. Doctors saw a median of 12·5 (IQR 5·0–25·8) patients per day. Multivariate analysis showed that community health centres organised by private enterprises (β=11·1, 95% CI 1·3–20·8) and those which had pharmacists (1·9, 0·7–3·1) and nurses (0·32, 0·1–0·5) were associated with higher number of daily patients seen by doctor. Further, doctors saw fewer patients per day in clinics who opened 7 days a week (−3·8, 95% CI −7·2 to −0·3) and in those which provided a wider range of services (−3·3, −5·8 to −0·8). InterpretationThe survey shows that China has established a large, mostly young primary-care workforce and provided ongoing professional training. However, facilities are basic, with few clinics providing comprehensive primary care for a wide range of common physical and mental conditions. Use of community health centres by patients remains low. FundingThis project was supported by three funding sources: RGC seed fund for basic research, University Grant Council, HK SAR Government, entitled “Survey of the attitudes and needs of integrated HIV and STI services in community health centres in China (2015–16)” (project number 201411159004); Shanghai Key Discipline Construction Program in Public Health (Shanghai Municipal Commission of Health and Family Planning, project number 12GWZX1001); and Shanghai Excellent Academic Leaders Training Program in Public Health (Shanghai Municipal Commission of Health and Family Planning, project number GWDTR201210).

Comparison of three models of ownership of community health centres in China: a qualitative study.

Community health centres are the main form of provision of primary care in China. There are three models: government managed, hospital managed and private. Our aim was to describe and compare primary care under the three ownership models. Four aspects of primary care were studied: services, organization, financing and human resources. Interviews were undertaken with 60 managerial and professional staff in 13 community health centres in the Pearl River Delta region in 2010. Three community health centres were selected in the capital city and two were selected from each of the other five cities. Thematic framework analysis was conducted. Government-managed community health centres received the largest public funding, followed by hospital-managed community health centres, while private community health centres received the least. Private community health centres were the smallest in scale and provided lower quality public health services compared with the other two models. Patient out-of-pocket costs accounted for the majority of the revenue in all models of community health centres despite improved government funding for preventive services. General challenges such as the shortage of public funding, the exclusion of migrants in the funding for preventive services, low capacity in human resources and the separation of clinical and preventive care in community health centres were identified in all three models of community health centres. The ownership and management of a community health centre greatly influence the service it provides. Private community health centres are in a disadvantaged position to deliver high quality clinical and preventive care.

Attributes of primary care in community health centres in China and implications for equitable care: a cross-sectional measurement of patients' experiences.

China has been undergoing a health-care reform, and community health centres (CHCs) are being established as primary care provider across urban areas. To evaluate primary care attributes in CHCs by measuring patients' experiences. Cross-sectional surveys of 3360 adult service users with multistage cluster sampling. We developed a short assessment tool consisting of 33 items derived from the short version of the original Primary Care Assessment Tool-Adult Edition (PCAT-AE). The reliability and validity of the instrument were evaluated. Score distributions were assessed using descriptive statistics with 95% confidence interval (CI). The overall PCAT scores were categorized into three quantile groups (lower score, medium score and optimal score). Ordinal logistic regression analysis was performed to explore patient characteristics associated with optimal score after controlling for demographic, socio-economic, health conditions and health-care utilization characteristics. One-third (33.4%, 95% CI: 31.0-35.9%) of subjects had optimal overall PCAT scores, while the majority (83.4%) reported medium-to-lower score in the community orientation scale. Patients' characteristics with respect to health-care utilization had major effects on PCAT scores. Subjects with the presence of social medical insurance had higher odds of having greater experience in most primary care attributes and tended to report optimal primary care experience (aOR 2.30, 95% CI: 1.92-2.75) compared with those without social medical insurance. Equitable primary care is yet to be strengthened with regard to the community orientation attribute, and particularly among patients without social medical insurance, as they tend to have inferior experiences in the primary care sector.

Effects of a randomized intervention to improve workplace social capital in community health centers in China.

ObjectiveTo examine whether workplace social capital improved after implementing a workplace social capital intervention in community health centers in China.MethodsThis study was conducted in 20 community health centers of similar size in Jinan of China during 2012–2013. Using the stratified site randomization, 10 centers were randomized into the intervention group; one center was excluded due to leadership change in final analyses. The baseline survey including 447 staff (response rate: 93.1%) was conducted in 2012, and followed by a six-month workplace social capital intervention, including team building courses for directors of community health centers, voluntarily public services, group psychological consultation, and outdoor training. The follow-up survey in July 2013 was responded to by 390 staff members (response rate: 86.9%). Workplace social capital was assessed with the translated and culturally adapted scale, divided into vertical and horizontal dimensions. The facility-level intervention effects were based on all baseline (n = 427) and follow-up (n = 377) respondents, except for Weibei respondents. We conducted a bivariate Difference-in-Difference analysis to estimate the facility-level intervention effects.ResultsNo statistically significant intervention effects were observed at the center level; the intervention increased the facility-level workplace social capital, and its horizontal and vertical dimensions by 1.0 (p = 0.24), 0.4 (p = 0.46) and 0.8 (p = 0.16), respectively.ConclusionsThe comprehensive intervention seemed to slightly improve workplace social capital in community health centers of urban China at the center level. High attrition rate limits any causal interpretation of the results. Further studies are warranted to test these findings.

Rehabilitation for the management of knee osteoarthritis using comprehensive traditional Chinese medicine in community health centers: study protocol for a randomized controlled trial

BackgroundIt is becoming increasingly necessary for community health centers to make rehabilitation services available to patients with osteoarthritis of the knee. However, for a number of reasons, including a lack of expertise, the small size of community health centers and the availability of only simple medical equipment, conventional rehabilitation therapy has not been widely used in China. Consequently, most patients with knee osteoarthritis seek treatment in high-grade hospitals. However, many patients cannot manage the techniques that they were taught in the hospital. Methods such as acupuncture, tuina, Chinese medical herb fumigation-washing and t’ai chi are easy to do and have been reported to have curative effects in those with knee osteoarthritis. To date, there have been no randomized controlled trials validating comprehensive traditional Chinese medicine for the rehabilitation of knee osteoarthritis in a community health center. Furthermore, there is no standard rehabilitation protocol using traditional Chinese medicine for knee osteoarthritis. The aim of the current study is to develop a comprehensive rehabilitation protocol using traditional Chinese medicine for the management of knee osteoarthritis in a community health center.Method/designThis will be a randomized controlled clinical trial with blinded assessment. There will be a 4-week intervention utilizing rehabilitation protocols from traditional Chinese medicine and conventional therapy. Follow-up will be conducted for a period of 12 weeks. A total of 722 participants with knee osteoarthritis will be recruited. Participants will be randomly divided into two groups: experimental and control. Primary outcomes will include range of motion, girth measurement, the visual analogue scale, and results from the manual muscle, six-minute walking and stair-climbing tests. Secondary outcomes will include average daily consumption of pain medication, ability to perform daily tasks and health-related quality-of-life assessments. Other outcomes will include rate of adverse events and economic effects. Relative cost-effectiveness will be determined from health service usage and outcome data.DiscussionThe primary aim of this trial is to develop a standard protocol for traditional Chinese medicine, which can be adopted by community health centers in China and worldwide, for the rehabilitation of patients with knee osteoarthritis.Trial registrationClinical Trials Registration: ChiCTR-TRC-12002538

Cost-Effectiveness of a Hypertension Control Intervention in Three Community Health Centers in China

Hypertension and associated chronic diseases impose enormous and growing health and economic burdens worldwide. The objective of this study was to investigate the cost-effectiveness (CE) of a hypertension control program in China. We collected information on program costs and health outcomes in three community health centers over a 1-year period. The participants were 4902 people with hypertension (systolic blood pressure [SBP] ≥140 mm Hg and/or diastolic blood pressure [DBP] ≥90 mm Hg, or on hypertension medication) aged 18 years and older. The SBP and DBP changes in the populations were estimated from a random sample of 818 participants by conducting face-to-face interviews and physical examinations. We derived CE measures based on the costs and effects on health outcomes. The total cost of implementing the intervention was Renminbi (RMB) 240 772 yuan (US$35 252), or 49 yuan (US$7.17) per participant in 2009. On average, SBP decreased from 143 to 131 mm Hg (P < .001) and DBP decreased from 84 to 78 mm Hg (P < .001), the SBP decreases ranged from 7.6 to 17.8 mm Hg and DBP decreases ranged from 3.9 to 8.3 mm Hg. CE ratios ranged from RMB 3.6 to 5.0 yuan (US$0.53-US$0.73) per person per mm Hg SBP decrease, and from RMB 6.3 to 9.7 yuan (US$0.92-US$1.42) per person per mm Hg DBP decrease. Per capita costs varied widely across the communities, as did changes in SBP and DBP, but CE was similar. The findings suggest (a) a positive correlation between per capita costs and program effectiveness, (b) differences in intervention levels, and (c) differences in health status. CE results could be helpful to policy makers in making resource allocation decisions.

Comparative study of the primary healthcare systems in China and Mali

Background: Community health centres (CHCs) are an important component of the health system in Mali and China. Despite patient support and commitment from the authorities, the management and the quality of care of these structures need to be improved. This research aimed to compare the management style of the relevant boards with users’ satisfaction pertaining to CHC services in Mali and China. Method: Between September 2009-January 2010, a study was conducted in eight CHCs in Mali and in 16 CHCs in China. A total of 480 householders, [60 (Mali) and 320 (China)]; and 24 management committee members (Mali) and 48 management committee members (China) were interviewed. An in-depth interview technique was used on members of the management committee, while a structured interview was carried out to collect data during face-to-face contact with householders in their residences. In residences in which there were two or more households, the first willing householder was interviewed. Questions about the level of satisfaction were coded from 1-5 and ranged from “excellent” to “very bad” respectively. Results: The CHCs in China were managed by the government, whereas in Mali, they were overseen by the local population. The most satisfied people in both countries were those living in the poorest socioeconomic conditions, the elderly, and those who attended the healthcare meetings. Chinese households were more satisfied with the quality of the CHC services than those in Mali. The Chinese management boards proposed standardisation of rules and more funding, whereas those in Mali advocated that government provide more funding and human resources allocation. Conclusion: A high level of satisfaction regarding the CHC services was observed. However, users reported on deficits in the quality of care, whereas management suggested a need for greater resource allocation. Key words: primary health care system, householders’ satisfaction, management board, China, Mali

Service utilization in community health centers in China: a comparison analysis with local hospitals

BackgroundBeing an important part of China's Urban Health Care Reform System, Community Health Centers (CHCs) have been established throughout the entire country and are presently undergoing substantial reconstruction. However, the services being delivered by the CHCs are far from reaching their performance targets. In order to assess the role of the CHCs, we examined their performance in six cities located in regions of South-East China. The purpose of this investigation was to identify the utilization and the efficiency of community health resources that are able to provide basic medical and public health services.MethodsThe study was approved by Peking University Health Science Center Institutional Reviewing Board (NO: IRB00001052-T1). Data were collected from all the local health bureaux and processed using SPSS software. Methods of analysis mainly included: descriptive analysis, paired T-test and one-way ANOVA.ResultsThe six main functions of the CHCs were not fully exploited and the surveys that were collected on their efficiency and utilization of resources indicate that they have a low level of performance and lack the trust of local communities. Furthermore, the CHCs seriously lack funding support and operate under difficult circumstances, and residents have less positive attitudes towards them.ConclusionThe community health service must be adjusted according to the requirements of urban medical and health reform, taking into account communities' health needs. More research is required on the living standards and health needs of residents living within the CHC's range, taking into consideration the users' needs in expanding the newly implemented service, and at the same time revising the old service system so as to make the development of CHCs realistic and capable of providing a better service to patients. Several suggestions are put forward for an attainable scheme for developing a community health service.