Health Services In China Research Articles

Research on Optimizing National Mental Health Literacy from the Perspective of Health in China: Significance and Approach

Improving the level of national mental health and strengthening the construction of social psychological service system are the necessary and important ways to promote the implementation of the Healthy China strategy. However, the gap between the requirements of Healthy China strategy for social mental health service system and the current situation of mental health service in China is still widespread. Promoting the public to form an effective demand for psychological help and establishing a new mental health service model is the key to bridge this gap. Optimizing mental health literacy is an important starting point and breakthrough to solve this problem. At present, the research on mental health literacy is undergoing a transformation from the paradigm of psycho-epidemiology to the paradigm of psychology and sociology. Taking contemporary China as the background, the reconceptualization of mental health literacy and the exploration of the current situation of Chinese mental health literacy in the new era is one of the core task of current psychological path research. The significance of this study is mainly reflected in: (1) promote the formation of effective demand for help and improve the level of public mental health; (2) enhance cultural selfconfidence and construct the theory of mental health literacy of contemporary Chinese people; (3) guide the supply side structural reform of mental health services and promote mental health equity; (4) reduce the burden of mental illness and help build a well-off society in an all-round way; (5) help build a social and psychological service system.

Caring for patients in mental health services during COVID-19 outbreak in China

This article reflects on some radical changes made in mental health services in China which include the implementation of the initial triage system and the special isolation ward, the early screening and testing for both patients and staff, the smaller teams working on rotating shifts on-site, and the adequate provision of PPE. These measures would be of great value as a reference to the effective delivery of mental health services in other countries through this pandemic.

Current status and demand of health services in primary and middle school clinic in 16 provinces of China

Objective To analyze the current situation and needs of primary and secondary school health clinic services, and to provide a reference for strengthening school health service in China. Methods Investigation provinces were selected according to China’s three major economic zones, 1 or 2 survey centers were selected from each province, 16 provinces and 26 survey centers were selected. In each survey centers, six schools from primary and secondary schools, junior high schools and high schools in urban and rural areas were randomly selected as research sites. Each research site randomly selected 10 students in each grade (grade three, four, five from primary schools) to fill in the questionnaire anonymously. A total of 4 661 valid questionnaires were collected. Results Among the services provided by the school clinics to students, “trauma treatment” “consulting health problems” physical examination” accounted for 49.4%, 40.5% and 39.0% respectively. Within the past one year, 45.1% students went to the school clinic for consultation or consultation 1一3 times, 6.4% for 4-5 times, and 3.7% for 6 times or more. When students were sick in school, 65.8% (primary school), 64.0% (junior high school), and 54.4% (high school) of them selected to go to the school clinic. When suddenly suffered trauma in school, 78.2% (primary school) , 73. 2% (junior high school) and 69. 6% (high school) of the students went to the school clinic. Conclusion Primary and middle school students have a great demand for school health services, and it is necessary to continue to strengthen the construction of primary and secondary school health clinics. 【摘要】 目的 了解中国中小学校卫生室服务现状与需求, 为加强学校卫生服务提供参考。 方法 采用分层随机抽样的 方法, 按照中国三大经济地带划分, 分层选择调研省份, 每个调研省份选择 1〜2 个调研点, 共抽取 16 个省 26 个调研点。每 个调研点内随机选择城乡小学、初中、高中各1所共6所学校作为调研点校, 每个调研点校每个年级 (小学选择三〜五年 级) 随机选择 10 名学生匿名填写“全国中小学校卫生人员队伍建设调研学生问卷”。共回收有效问卷 4 661 份。 结果 学 校卫生室提供的服务中, “外伤处理”占 49.4%、“咨询身体健康问题”占 40.5%、“体检”占 39.0%;调查对象过去 1 年时间 内, 去学校卫生室看病或咨询次数 1〜3 次的占 45.1%, 4〜5 次的占6.4%, ≥6次的占 3.7%。在学校生病时, 选择去学校卫 生室看病的分别占65.8% (小学) 、64.0%(初中) 、54.4%(高中) ；在学校突然发生外伤时, 选择去学校卫生室的分别占 78.2%(小学) 、73.2%(初中) 、69.6%(高中)。 结论 中小学生对学校卫生室服务需求大, 需要继续加强中小学学校卫生室 建设。

Is it worth outsourcing essential public health services in China?-Evidence from Beilin District of Xi'an.

Essential public health services (EPHS) is general welfare public health interventions led by the Chinese government and provided by the primary medical institutions to all residents. In Beilin District, Xi'an, EPHS producers can be divided into outsourced institutions and public institutions. Can outsourcing EPHS reduce costs and improve efficiency and quality? There is still no definite answer to this question. This paper compares the performance of outsourced institutions and public institutions in terms of efficiency and quality, explains the reasons for this phenomenon. This paper uses a theoretical and two-stage DEA model Based on a "triple subject" research framework. The results show that the difference between public institutions and outsourced institutions is mainly reflected in service quality. When the quality is not measured, outsourced institutions' production efficiency is higher than that of public institutions. When there are quality measurements, the production efficiency of outsourced institutions is lower than that of public institutions. Outsourced institutions perform worse than public institutions. The reason is that a bilateral monopolistic market structure has formed between local governments and outsourced institutions. This situation makes it difficult for the government to replace poor quality outsourced institutions under the constraints of a limited budget.

Managers in the publicly funded health services in China - characteristics and responsibilities

BackgroundHealth service managers are integral to supporting the effective and efficient delivery of services. Understanding their competencies is essential to support reform and improvement of healthcare provision in China. This paper examines the characteristics and educational background of senior managers working in the community health and hospital sectors in China. We also examine their levels of commitment to continued professional development and continuous education.MethodsA self-administered paper-based questionnaire was administered to 477 level I, II and III managers in community health services and public hospitals in China. The response rate was over 80%.ResultsFindings demonstrate significant differences in terms of educational background and commitment to ongoing professional development between the managers in China across levels of management, and between the community and hospital sectors. Hospital managers tend to be older; hospital managers at higher management levels are predominantly male but predominantly female in the community health services. A greater proportion of hospital managers have postgraduate qualifications. In addition, the participants identified specific management tasks that they considered important.ConclusionsThis is the first large scale study examining the educational background and commitment to professional development of senior health service managers in China. This study determined that there are differences between the demographics of managers in China across levels of management, but more importantly between the CHC and the hospital sectors. The identification of important managerial tasks will facilitate the development of appropriate education and training for Chinese healthcare managers. All sectors and levels reported the need for informal education focussed on the core roles of developing organisation image and public relations, improving quality and safety of service provision and provision of leadership. Further research to explore the underlying reasons for the above differences is needed to design appropriate professional development for China’s health services managers. In addition, the importance of managerial tasks across sectors and management levels requires further investigation.

Health Service Utilization of International Immigrants in Yiwu, China: Implication for Health Policy.

International immigrants' health is receiving increasing attention, reflecting the need for health systems to adapt to diverse migrant populations. To better inform health policies suited for the needs of international immigrants living in China, empirical evidence on the health service utilization of these international immigrants living in China is urgently needed. Our study included 5459 international immigrants including inpatients and outpatients, who were treated over a 4-year period (2015-2018) in one of the most frequented hospitals by international immigrants in Yiwu, Zhejiang province. Data (e.g., demographic information, outpatient costs, inpatient costs, length of stay, and the average number of visits per patient) were extracted from the Health Information System at the hospital. Descriptive analysis was performed to analyze the basic characteristics of international immigrants living in China (e.g., medical costs, length of stay and the average number of visits per patient) during the study period. Multiple regression analysis was conducted to assess the factors that influence the health service utilization of international immigrants. International immigrants tended to use outpatient services (accounting for 97.22% of the whole sample) compared with inpatient services (only 2.78% of the whole sample). Most international immigrants visited the hospital because of orthopedics, otolaryngological diseases, pediatric-related diseases and skin-related diseases, followed by maternity and general surgery. The average number of visits to the outpatient department per patient was 2.1 in 2015 to 2.5 in 2018, and the length of stay increased from 3.45days to 5.81days during last four years. The outpatient costs increased from RMB 800.43(112.22 US$) to RMB 1756.98(246.33 US$), and inpatient costs rose from RMB 10,958.89(1536.44US$) to RMB 20,912.55(2931.94US$) during 2015-2018. The average number of visits and outpatient costs of international immigrants were both lower than those of local Chinese people (P < 0.05). However, there was no statistic difference in inpatient costs and LOS between international immigrants and Chinese. Having health insurance in China was significantly related with higher medical costs. Our results indicate that international immigrants living in China make greater use of outpatient services rather than hospitalization health services. Health services utilization is increasing in the last four years, but it was lower than that of local Chinese people especially outpatient service utilization. Moreover, more attention should be garnered toward specific health issues experienced by international immigrants, such as orthopedic health, maternal and child health, occupational diseases or accidents, and infectious diseases with skin-related symptoms. The policy implications from the results of this study are as follows. First, in order to improve international immigrants' health and access to health services in China, the government needs to pay more attention to incorporating international immigrants' health services to the current health system. Second, health policy is an important determining factor of access to health care, as policy can influence aspects of health services delivery such as the availability of resources, organization, and financing. Therefore, specific framework for the content of health policies focused on international immigrant populations should be developed.

Sleep health service in China during the coronavirus disease outbreak.

Citation:Zhang XL, Xiao Y. Sleep health service in China during the COVID-19 outbreak. J Clin Sleep Med. 2020;16(7):1221–1222.

Effects of the Global Coronavirus Disease-2019 Pandemic on Early Childhood Development: Short- and Long-Term Risks and Mitigating Program and Policy Actions

Effects of the Global Coronavirus Disease-2019 Pandemic on Early Childhood Development: Short- and Long-Term Risks and Mitigating Program and Policy Actions

Insomnia and psychological reactions during the COVID-19 outbreak in China.

Citation:Li Y, Qin Q, Sun Q, Sanford LD, Vgontzas AN, Tang X. Insomnia and psychological reactions during the COVID-19 outbreak in China. J Clin Sleep Med. 2020;16(8):1417–1418.

Predictors of patient satisfaction and outpatient health services in China: evidence from the WHO SAGE survey.

Patient satisfaction is an essential indicator in medical practise and research. To monitor the health and well-being of adult populations and the ageing process, the World Health Organization (WHO) has initiated the Study on Global AGEing and Adult Health (SAGE), compiling longitudinal information in six countries including China as one major data source. The objective of this study was to identify potential predictors for patient satisfaction based on the 2007-10 WHO SAGE China survey. Data were analysed using random forests (RFs) and ordinal logistic regression models based on 5774 responses to predict overall patient satisfaction on their most recent outpatient health services visit over the last 12 months. Potential predictor variables included access to care, costs of care, quality of care, socio-demographic and health care characteristics and health service features. Increase of the mean-squared error (incMSE) due to variable removal was used to assess relative importance of the model variables for accurately predicting patient satisfaction. The survey data suggest low frequency of dissatisfaction with outpatient services in China (1.8%). Self-reported treatment outcome of the respective visit of a care facility demonstrated to be the strongest predictor for patient satisfaction (incMSE +15%), followed by patient-rated communication (incMSE +2.0%), and then income, waiting time, residency and patient age. Individual patient satisfaction in the survey population was predicted with 74% accuracy using either logistic regression or RF. Patients' perceived outcomes of health care visits and patient communication with health care professionals are the most important variables associated with patient satisfaction in outpatient health services settings in China.

Collaboration and Cooperation of Public Health Service Management in China.

Collaboration and cooperation are critical for public health management. Nevertheless, collaboration and cooperation between government departments, as well as other entities, are still in a weak condition in China. This article analyzes the status of collaboration and cooperation in the management of public health services in China and explores the problems and gives strategic suggestions for strengthening collaboration and cooperation in the development of public health service systems in China, in order to provide a reference for improvement of public health management in the future. This study uses a qualitative case study approach, including documents review, in-depth interview, and focus group. The main problems of collaboration and cooperation in public health service management in China include problems of effective collaboration and cooperation between institutions and relevant departments, public information platform, and implementation of public health and health promotion. On this basis, several relevant policy recommendations are put forward. Collaboration and cooperation are critical for the overall coordination and sustainable development of public health in China, and there is still work to be done in order to achieve appropriate cooperation and collaboration between different entities in the provision of public health services.

Cogitation on the Mental Health Service System during the COVID-19 Outbreak in China

The spread of the novel coronavirus disease (COVID-19) in China from December 2019 to April 2020 caused serious social panic and other psychological problems among the Chinese public. Thus, reducing the public panic of and the long-term adverse psychological effects on individuals and society resulting from the epidemic became the priority task for mental health professionals in China. Based on the experiences in providing mental health services during SARS outbreak, the perspectives and strategies for targeted mental health services are reported. Furthermore, the cogitation on the problems with mental health services in China during the outbreak of COVID-19 are discussed.

Progression of Mental Health Services during the COVID-19 Outbreak in China.

The novel coronavirus disease (COVID-19) has been rapidly transmitted in China, Macau, Hong Kong, and other Asian and European counterparts. This COVID-19 epidemic has aroused increasing attention nationwide. Patients, health professionals, and the general public are under insurmountable psychological pressure which may lead to various psychological problems, such as anxiety, fear, depression, and insomnia. Psychological crisis intervention plays a pivotal role in the overall deployment of the disease control. The National Health Commission of China has summoned a call for emergency psychological crisis intervention and thus, various mental health associations and organizations have established expert teams to compile guidelines and public health educational articles/videos for mental health professionals and the general public alongside with online mental health services. In addition, mental health professionals and expert groups are stationed in designated isolation hospitals to provide on-site services. Experts have reached a consensus on the admission of patients with severe mental illness during the COVID-19 outbreak in mental health institutions. Nevertheless, the rapid transmission of the COVID-19 has emerged to mount a serious challenge to the mental health service in China.

Effect of social integration on the establishment of health records among elderly migrants in China: a nationwide cross-sectional study

ObjectivesEssential public health service use among the migrants is the key obstacle of the equalisation of public health service in China. This study aims to investigate the status of the...

The Effect of a Nurse-Led Cognitive Behavioral Protocol on Depressive Symptoms and Coping Strategies of Dementia Caregivers.

Family caregivers of patients with dementia (PWD) often experience depressive symptoms and use poor coping strategies. Cognitive behavioral interventions may enhance positive appraisals of caregiving-related issues and the utilization of active coping strategies among caregivers, which may help prevent caregiver depression. However, there is a shortage of primary, community-based mental health services in China, and little research has been conducted on the effect of nurse-led mental health programs in this population. This study explored the effect of a nurse-led cognitive behavioral intervention on depressive symptoms and coping strategies among family caregivers of PWD in China. This randomized controlled trial used data from a sample of 112 caregivers screened from 276 potential participants in a city in southeastern China. The sample was randomly assigned to an intervention group (n = 56) and a control group (n = 56). The intervention group received five monthly in-home, nurse-led cognitive behavioral sessions and telephone consultations after each session. The control group received five monthly, short, general conversations with nurse interventionists at the participants' homes, in the hospital, or via telephone. Depressive symptoms, coping strategies, and the demographics of caregiving dyads were collected at Time 1 (baseline), Time 2 (the end of the 5-month intervention), and Time 3 (2-month follow-up). IBM SPSS Statistics Version 19.0 was used for data analysis. Eighty-two participants (intervention group: n = 47, control group: n = 35) completed the three evaluations. No significant group differences were found in baseline characteristics between the two groups. The general linear model repeated-measures analysis of variance indicated a significant difference in depressive symptoms and active coping between groups over time, with p < .001 for the interaction between depressive symptoms and groups and p < .01 for the interaction between active coping and groups. A similar result did not occur for passive coping. The t tests further supported a significant interventional effect on participants' depressive symptoms and active coping. This nurse-led cognitive behavioral intervention was effective in decreasing depressive symptoms and improving active coping among study participants. The findings suggest the improvement of mental health services and social policies in China to support family caregivers of PWD.

Does a Different Household Registration Affect Migrants' Access to Basic Public Health Services in China?

On the basis of the China Migrants Dynamic Survey Data of 2015, the author provides an analysis of how a different household registration impacts migrants’ access to preventive care provided by public health services, such as health records and medical knowledge, in areas of immigration. This study shows that eliminating the distinction between agricultural and non-agricultural permanent residence registration could raise the rate of establishing health files, but it has no significant effect on migrants’ health knowledge. In fact, encouraging those with non-agricultural registration to move to different counties that belong to the same city or to different cities that belong to the same province can notably eliminate the impact of a different household registration status. Improving the income level of low-income migrants can have the same impact. Recommendations to enable migrants to obtain basic public health services include abolishing the separation of agricultural and non-agricultural household registration, increasing the permanent settlement rate of resident migrants, promoting basic medical security systems across the whole country, strengthening career training, and enhancing the education level of migrants.

Assessment of essential public health services in China based on WHO′s comprehensive evaluation model

Objective To understand the current equalization in essential public health services in China, and to provide recommendations for health resource allocation and public health policy making. Methods WHO′s comprehensive evaluation model, and the Rank Sum Ratio (RSR) method were used to analyze, rank and categorize essential public health services. Results Thirty-one provinces (cities, autonomous regions) in China were grouped into five categories, namely, relatively balanced area, low input area, resource shortage area, over utilization area and resource waste area. Conclusions The equalization of essential public health services in China is gradually being realized, but there are still setbacks such as mismatch between health needs and resource input, waste and over-utilization of resources. To correct these problems, relevant recommendations on health policy making for different areas were given. Key words: Health services administration; Essential public health services; Comprehensive evaluation; Rank sum ratio method; World Health Organization

Significant Stroke Knowledge Deficiencies in Community Physician Improved with Stroke 120

Background and Purpose: In the existing model of community health service in China, community general practitioners play important roles in health promotion as well as prehospital stroke recognition and management. We recently engineered Stroke 120 based on FAST for China. This investigation aimed to investigate its acceptance in community physicians and promote their stroke related knowledge. Methods: We conducted an stroke education session to community physicians or family doctors (total of 435 participants), teaching both FAST and Stroke 120. Online survey was distributed to the participants before and after the education session to evaluate the awareness of stroke and the acceptance of the stroke recognition tool. Results: Significant stroke knowledge deficiencies were found in community physicians. After the education session, percent of the participants knew that the thrombolytic therapeutic window (<4.5 hours) was improved from 54.0% to 91.6% (P < .001). A total of 88.5% of them would send their patients who had stroke to the nearest hospital with stroke center by emergency medical service, compared to baseline (64.4%, P < .001). In total, 95.2% of them would recommend thrombolytic therapy in the treatment of acute ischemic stroke compared to 82.7% (baseline P < .001). Although majority mastered both FAST (95.5%) and Stroke 120 (98.0%) through our education session, 96.3% of them believe that Stroke 120 is the most suitable for Chinese in stroke education. Conclusions: Stroke 120 strategy was well accepted by the community physicians in China and in the meantime improved knowledge regarding stroke was observed.

Depressive Symptoms in Elderly Chinese Primary Care Patients: Prevalence and Sociodemographic and Clinical Correlates.

To estimate the prevalence of depressive symptoms (depression thereafter) and to identify the sociodemographic and clinical correlates of depression in a sample of elderly patients treated in the primary care setting in Wuhan, China. Primary care is an opportune setting for the management of late-life depression in China, but there have been no representative studies on the clinical epidemiology of depression in elderly Chinese primary care patients. In total, 752 elderly patients (≥ 65 years) were consecutively recruited from 13 primary care centers in Wuhan, China, and interviewed with a standardized questionnaire. Depression was assessed with the 15-item Geriatric Depression Scale (GDS-15). Of the elderly Chinese primary care patients, 30.6% had depression (GDS-15 ≥ 5). Correlates of depression were an education level of primary school or less (odds ratio [OR]: 1.94, 95% confidence interval [CI]: 1.36-2.77, P < .001), poor financial status (OR: 2.19, 95% CI: 1.16-4.15, P = .016), lack of an exercise habit (OR: 1.40, 95% CI: 1.06-1.74, P = .023), 2 or more chronic medical conditions (OR: 1.90, 95% CI: 1.34-2.69, P < .001), and loneliness (OR: 3.53, 95% CI: 2.46-5.08, P < .001). Depression is prevalent among elderly Chinese primary care patients, indicating that elderly patients treated in primary care have a high level of need for mental health services in China. There is an urgent need to integrate mental health services into primary health care.

Prevalence of verbal and physical workplace violence against nurses in psychiatric hospitals in China

ObjectiveWorkplace violence (WPV) is common in mental health services in China, but its multi-center prevalence measured using standardized rating scales has rarely been reported. This study aimed to explore the prevalence of verbal and physical violence against nurses working in psychiatric hospitals and examine its independent socio-demographic correlates in China. MethodsThis was a cross-sectional study conducted in 11 major psychiatric hospitals in China using a 9-item self-reported workplace violence scale. ResultsA total of 1906 psychiatric nurses were recruited to participate in this study. The one-year prevalence of verbal and/or physical workplace violence (WPV) was 84.2% (95% CI: 82.4–85.8). The prevalence rates of verbal abuse, threats and physical violence were 79.3% (95% CI: 77.4–81.1), 70.9% (95% CI: 68.8–73.0) and 57.9% (95% CI: 55.7–60.2), respectively. Multiple logistic regression analysis revealed that working in department of psychiatry (OR = 3.42, P < 0.001), having moderate (OR = 2.05, P = 0.009), severe (OR = 2.04, P = 0.015) or extremely severe (OR = 3.21, P < 0.001) anxiety level of WPV and working in hospitals with a WPV reporting system (OR = 1.88, P < 0.001) were significantly associated with WPV. ConclusionWPV against nurses is a serious occupational and public health concern in Chinese psychiatric hospitals. Appropriate preventive measures should be undertaken to reduce the risk of WPV in healthcare settings.