Primary Health Care Institutions Research Articles

Effects of work-family conflict, social support and burnout on job satisfaction among primary care physicians in Huaihai economic zone.

Primary care physicians (PCPs) are doctors in primary health care institutions, namely village clinics, township health centers and community health service centers (stations) who are the main providers of primary health care services in primary health care settings. Improving the overall health status of the population requires the support of a large number of primary care physicians; however, the job satisfaction of this group has not been sufficiently emphasized and recognized. The purpose of this study was to examine the effects of primary care physicians' work-family conflict on their job satisfaction, as well as the mediating role of burnout and the moderating role of social support. This cross-sectional study was conducted from February 2023 to March 2023. Participants were 749 primary care physicians from four cities of Xuzhou, Linyi, Huaibei, and Shangqiu in the Huaihai Economic Zone of China. SPSS statistical analysis was used to evaluate the relationship between work-family conflict, social support, burnout and job satisfaction among medical workers. Work-family conflict had a significant negative effect on job satisfaction (β = -0.36, p< 0.001), after adding burnout in the model, work-family conflict also negatively predicted job satisfaction (β = -0.32, p< 0.001). Social support had a moderating effect on the direct effect of burnout on job satisfaction (β = 0.00, t = 2.66, p< 0.01, 95%CI [0.001, 0.007]), the predictive effect of burnout on job satisfaction at high level of social support (β = -0.45, p< 0.001) was higher than a low level of social support (β = -0.33, p< 0.001). This study demonstrated the negative impact of work-family conflict on primary care physicians' job satisfaction, as well as the mediating role of burnout and the moderating role of social support on burnout and job satisfaction, which are important for improving primary care physicians' job satisfaction and enhancing the quality of primary care in the future.

What are the home care needs of Chinese healthcare workers: a latent class analysis.

The aging population has led to a surge in demand for home care, which has developed rapidly in China in recent years. However, there has been less empirical research into the needs of healthcare workers about providing home care. The purpose of this study was to explore the latent classes of healthcare workers' needs in primary health care institutions and to identify associated factors. From August 2021 to June 2022, a convenience sampling method was adopted to conduct a questionnaire survey on the workers of 62 primary healthcare institutions in Sichuan Province. Latent class analysis was used to categorize home care needs by Mplus 8.3. Multinomial logistic regression analysis was adopted to explore the influencing factors using SPSS 25.0. A total of 1,152 healthcare workers were included in the study. Their needs for home care were classified into four latent classes: overall high need group (18.0%); overall low need group (34.8%); high training and low support need group (29.9%), and the high security and low training need group (17.3%). The factors influencing the different need categories included working area, professional title, role of medical workers, had participated in training about home care, and feelings about home care, with Class 1 as the reference group. Our findings indicate that primary healthcare workers have multifaceted needs for providing home care. Paying attention to their diverse needs can help optimize home care and enhance service capacity. Exploring the factors affecting needs can provide targeted support to healthcare workers to ensure the quality and continuity of home care services.

Integrated health information system in the Republic of Serbia

The Republic of Serbia's integrated health information system (IHIS) serves as a central electronic repository for storing and processing various medical and health-related data. It encompasses patient records, institutional information, details of health interventions and services, electronic prescriptions, appointment scheduling for specialist consultations, diagnostic procedures, and surgical operations. The implementation of this system promises several benefits, including improved access to patient information, expedited diagnostics, enhanced medication selection processes, heightened patient safety measures, more comprehensive health-statistical reporting, and accelerated dissemination of biomedical knowledge. This paper aims to explore the advantages of employing information technologies in healthcare delivery within health institutions, contrasting it with traditional methods of data collection, analysis, and interpretation, specifically focusing on primary healthcare institutions. Drawing upon current professional and societal perspectives, the paper discusses the conceptual framework and objectives of IHIS, emphasizing the significance of leveraging information technologies in healthcare.

Common maternal health problems and their correlates in early post-partum mothers.

Mothers experience a wide range of maternal health problems after childbirth, which in turn, affect their well-being and ability to care for their newborn. These problems may be influenced by factors such as mode of delivery or socio-economic status. This study aims to investigate the prevalence of common maternal health problems and their correlates in a public primary healthcare institution in Singapore. This was a cross-sectional study, based on a self-administered questionnaire. A total of 373 mothers (mean age 31.9 years) who accompanied their infants for their 4- to 8-week development assessments at a public primary care clinic in Singapore completed a self-administered questionnaire from June 2021 to December 2021. The questionnaire assessed demographic factors, mode of delivery, number of children, number of individuals providing significant help, and the frequency of common physical and mental maternal health problems using a 5-point Likert-type scale. The five most common maternal health problems were fatigue (77.7%), lower back pain (59.3%), Caesarean wound pain (54.3%), upper back pain (53.0%) and vaginal pain (41.2%). The prevalence of depression and anxiety was 22.0% and 11.3%, respectively. With respect to the symptoms' correlates, pain on passing urine was more frequent after assisted vaginal deliveries than all other forms of deliveries (all pairwise p < 0.01), and pain on passing motion was more frequent in vaginal deliveries than in Caesarean deliveries (all pairwise p < 0.05). Mothers having a larger number of children more frequently experienced headaches (β = 0.17, SE = 0.05, p = 0.002) and less frequently experienced breastfeeding difficulties (β = -0.28, SE = 0.08, p < 0.001). Mothers experienced a high prevalence of maternal health problems in multiple domains during the first 8 weeks after childbirth. Mode of delivery and number of children were associated with increased prevalence of certain problems. Mothers' physical and mental well-being should be investigated early after delivery and addressed with adequate treatments and resources.

Mental health of primary health care physicians and nurses following prolonged infection control rules: a national survey in China.

This study examined the prevalence and correlates of probable mental health disorders, including psychological distress, somatization, depression, anxiety, phobic anxiety (PHO), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and insomnia among Chinese primary health care (PHC) physicians and nurses amid the post-pandemic period in 2022. Region-stratified sampling was conducted to recruit a national sample of 4,246 respondents from 31 July 2022 to 12 August 2022. A total of 692 primary healthcare institutions were identified in 30 provincial-level administrative regions of China. An online questionnaire was used for assessing probable mental health disorders using Symptoms Checklist-90-Revised (SCL-90-R) and PTSD Checklist for DSM-5 (PCL-5), and sleeping problems using Insomnia Severity Index (ISI). Data on demographics and work were also collected. Bivariate analysis and multiple logistic regression were conducted to identify significant correlates of probable mental health disorders. A total of 4,246 valid questionnaires were identified. Results showed that relative to the prevalence of probable mental health disorders among health care workers at the early stage of the pandemic in China, there was an overall decreased prevalence except for somatization, PHO, and OCD among the current PHC physicians and nurses. Multiple logistic regressions showed that significant risk factors of common probable mental health disorders, namely psychological distress, SOM, DEP, ANX, PHO, OCD, PTSD, and insomnia, were female gender, multimorbidity, history of psychiatric disorders, quarantine experience, never asking anyone for help, and overtime work. Attention should be given to preexisting psychiatric and multimorbid conditions, social support, and work-related stressors. Regular assessment and psychological interventions are needed to enhance the mental health of PHC professionals even after public health crisis.

Evaluation of the Behaviors of Physicians Working in Primary Healthcare Institutions About Secondhand Smoke

Evaluation of the Behaviors of Physicians Working in Primary Healthcare Institutions About Secondhand Smoke

Features of diagnosing ovarian tumors in women of pre- and postmenopausal age

Currently, one of the main ways to fight cancer, which can improve the results of treatment of ovarian neoplasms, is screening. Presently, the issue of organizing and conducting preventive examinations of women, including those of reproductive age, is one of the most urgent problems of primary health care institutions. The subjects of the study were 168 pre- and postmenopausal patients aged 20 to 60 years with ovarian tumors suspected of oncological pathology, who received treatment on the basis of the Tashkent city branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology for the period from 2018 to 2022, taking into account the selected age interval. An assessment was made of laboratory research methods, such as: general blood count, biochemical blood test, general urinalysis, tumor-associated marker CA-125, HE-4. In the comparative analysis of risk factors, when ovarian tumors develop in pre- and postmenopausal women, malignant and borderline ovarian tumors have complaints, parity, gynecological anamnesis, and the presence of extragenital diseases, which do not have specific characteristics for malignant or borderline tumors. therefore, it does not provide sufficient information in the process of diagnosing ovarian tumors. The sonographic characteristics associated with the degree of ovarian tumor malignancy were examined, and the tumor had a solid component (p &lt;0.001), the presence of obstructions (p = 0.0005), and the presence of growth on the inner surface of the capsule (p &lt;0.001), the presence of a significant amount of free fluid in the pelvic cavity (p &lt;0.001), the roughness of the surface of the tumor capsule (p &lt; 0.001) were observed to be characteristic of more dangerous processes.

Nursing care for diabetes mellitus

Background. Due to the global rise in diabetes patients, nurses of all specialties and positions are increasingly caring for these individuals on a daily basis. The purpose of this study was to examine the latest re­commendations and individual studies on diabetes management and to determine the place of nurses in a multidisciplinary team. Materials and methods. The article used descriptive methods and methods of comparative analysis to determine the characteristics of nursing practice in the management of patients with diabetes. Results. From the information studied, it became clear that nurses should be prepared to receive quality education associated with ongoing support and care in the community, primary health care institutions or in hospitals for such patients. Education in self-management and psychosocial problem solving are key elements of diabetes care and nursing. The Diabetes Self-Management Education and Support program is a crucial tool for patient-nurse communication, involving ongoing psychological support through educational techniques to address questions and concerns from individuals with diabetes and their families. Conclusions. Trained nurses can also perform screening for mental disorders and diabetes complications in order to timely diagnose or prevent their development. Regardless of new technologies or treatments, nurses must never lose their role as advocates for patients’ rights.

Premarital hemoglobinopathy screening program results of a province in the Black Sea region of Turkey: three years’ experience

ABSTRACT Objectives Hemoglobinopathies are a global public health problem with high mortality and morbidity and very expensive treatment. Disease can be reduced and prevented with hemoglobinopathy screening tests. It is possible to identify carriers with the hemoglobinopathy screening program applied in many countries of the world and in Turkey. This study aims to evaluate the results of the national premarital hemoglobinopathy screening program carried out in primary healthcare institutions. Methods The research is of epidemiological and cross-sectional type. Electrophoresis results examined within the scope of the premarital hemoglobinopathy screening program in Samsun between 1 January 2019 and 31 December 2021 were evaluated retrospectively. Age, gender, year of screening, and hemoglobinopathy screening results were obtained from the records. In the statistical analysis of the data, p < 0.05 was accepted. Results The median age of 52,338 people screened under the hemoglobinopathy screening program was 29.0 (16.0–86.0) years. About 54.1% (n = 28,309) of those who were screened were female, and it was found that the least screening was done in 2020 (n = 15,765 (30.1%)). As a result of the screening, the frequency of the β-thalassemia (β-thal) trait was 1.37% (n = 676), the frequency of the abnormal HbS was 0.04% (n = 20). The frequency of β-thal trait was statistically significantly higher in 2020 (1.5%) compared to other years (p = 0.029). When the results were analyzed by gender, the rate of women with abnormal HbS (3.7%) was significantly higher than the others (p = 0.017). Conclusions This study presents the results of the national hemoglobinopathy screening program in Northern Turkey and the β-thal and the abnormal HbS rates were found to be low. The data obtained will be useful in monitoring hemoglobinopathy disorders and evaluating the current program’s effectiveness in the future. It will allow decision-makers to implement policy changes and prioritize new programs.

The effects of COVID-19 event strength on job burnout among primary medical staff

BackgroundAs a global pandemic, The Corona Virus Disease 2019 (COVID-19) has brought significant challenges to the primary health care (PHC) system. Health professionals are constantly affected by the pandemic’s harmful impact on their mental health and are at significant risk of job burnout. Therefore, it is essential to gain a comprehensive understanding of how their burnout was affected. The study aimed to examine the relationship between COVID-19 event strength and job burnout among PHC providers and to explore the single mediating effect of job stress and work engagement and the chain mediating effect of these two variables on this relationship.MethodsMultilevel stratified convenience sampling method was used to recruit 1148 primary medical staff from 48 PHC institutions in Jilin Province, China. All participants completed questionnaires regarding sociodemographic characteristics, COVID-19 event strength, job stress, work engagement, and job burnout. The chain mediation model was analyzed using SPSS PROCESS 3.5 Macro Model 6.ResultsCOVID-19 event strength not only positively predicted job burnout, but also indirectly influenced job burnout through the mediation of job stress and work engagement, thereby influencing job burnout through the “job stress → work engagement” chain.ConclusionsThis study extends the application of event systems theory and enriches the literature about how the COVID-19 pandemic impacted PHC medical staff job burnout. The findings derived from our study have critical implications for current and future emergency response and public policy in the long-term COVID-19 disease management period.

Evaluation of prescription review and feedback policy on rational antibiotic use in primary healthcare settings in Beijing, China: a qualitative study using the Theoretical Domains Framework and the behaviour change wheel.

To decelerate antibiotic resistance driven by inappropriate antibiotic prescribing, a prescription review and feedback (PRF) policy is implemented in primary healthcare institutions (PHIs) in Beijing, China. However, evaluation of PRF implementation in PHIs is scarce. This study aims to systematically identify the barriers and facilitators of PRF policy implementation to provide evidence for antimicrobial stewardship. We conducted key informant interviews with 40 stakeholders engaged in the implementation of PRF in Beijing, including physicians, pharmacists and administrators. Interviews were audio recorded and transcribed verbatim. We coded the interview transcripts and mapped informant views to domains of the Theoretical Domains Framework. We then used a behaviour change wheel to suggest possible behavioural interventions. Procedural knowledge (Knowledge) and skills (Skill) of PRF were possessed by stakeholders. They felt responsible to promote the appropriate use of antibiotics (Social/professional role and identity) and believed that PRF could help to change inappropriate provider behaviours (Behavioural regulation) in prescribing antibiotics (Beliefs about consequences) under increased intention on antibiotic use (Stages of change). Moreover, informants called for a more unified review standard to enhance PRF implementation (Goals). Frequently identified barriers to PRF included inadequate capacity (Skill), using punishment mechanism (Behaviour regulation), reaching consistently lower antibiotic prescription rates (Goals), lack of resources (Environmental context and resources) and perceived pressure coming from patients (Social influences). Stakeholders believed that PRF implementation promoted the rational use of antibiotics at PHIs in Beijing. Still, PRF was hampered by inconsistencies in review process and resources needed for PRF implementation.

HEALTHCARE FROM THE CLASSROOM TO CLINICAL PRACTICE

Background: Nurses work in the fields of health promotion, disease prevention, treatment, and rehabilitation. After finishing high school, the title of nurse-technician is obtained, and they can be employed in primary, secondary, or tertiary healthcare institutions in basic medical care jobs up to the complex requirements of progressive care. The ability to transfer theory from the classroom to clinical practice is a key skill in nursing education. This transfer refers to students' ability to adapt classroom knowledge to different clinical practice situations. In order to provide nursing care that meets the standards of professional care, medical school students must accurately and effectively transfer theoretical knowledge to address specific patient care situations. Nursing education programs prepare students through a variety of learning opportunities that include simulated situations in healthcare offices and real-world situations in clinical hospital settings. Education takes place in classrooms, laboratories, and clinics. While the classroom environment provides students with mostly theoretical information, the clinical environment provides opportunities to put theoretical information into practice. Aim: To show the importance of practical teaching in the education of nurses. Method: Literature review, synthesis, and extraction of key professional and contemporary literature. Conclusion: Medical school students can acquire quality skills for patient care to the extent that they are able to implement them through theoretical knowledge in the clinical environment.

THE EDUCATION PATHWAY FOR NURSES IN MONTENEGRO

Nursing education in Montenegro has a relatively long tradition. Due to the great need for medical personnel in Montenegro, in 1946, a school for paramedics, caretakers, and nurses was opened in Cetinje, located in the facilities of the former Girls’ Institute. Since the establishment of the first school, there have been several reforms in nursing education. In Montenegro, nursing practice begins after the completion of nine years of general education. At both the secondary and higher education levels, there are two types of nursing education. After completing four years of secondary school, one can obtain the title of health technician. The educational program for the health technician was developed in accordance with occupational standards for pediatric and medical nursing. The development of a modular educational program for Health Technicians is currently underway. The Health Technician curriculum is based on occupational standards for various fields, including Health Technician for hospital work, Health Technician for primary healthcare institutions, Health Technician for preschool institutions, and Health Technician for geriatric and palliative care institutions. A person can acquire the title of nurse by completing a three-year higher education program, consisting of applied basic studies (bachelor’s degree). In addition to the basic studies, there are also one-year postgraduate applied specialist studies in healthcare and two-year Master’s studies in healthcare. In 2017, following the reaccreditation of the Faculty of Medicine in Podgorica, a study model was designed based on the 3+2 principle. This nursing education program, in alignment with European directives, enables the training of qualified personnel to provide healthcare services. Graduates of this program will have degrees recognized outside the borders of Montenegro.

Chronic disease management: Preventive care framework for migrant workers in Singapore

Abstract Chronic diseases, if unmanaged, can contribute to significant premature mortality and morbidity. Before the COVID-19 pandemic, there was limited data on chronic disease prevalence amongst migrant workers (MWs) in Singapore. The antecedent episodic and fragmented primary care for migrant workers also affected care continuity for common chronic diseases. In April 2022, a Primary Care Plan (PCP) was developed for migrant workers to improve access and affordability which included chronic disease detection and management and risk factor reduction. In addition, chronic disease screening was also enhanced in migrant workers’ pre-employment medical screening for those with risk factors or above 40 years old. Beyond disease management, interventions to address health gaps and strengthen the healthcare resilience of MWs are incorporated into a population-health based “Management of Oral and Chronic Conditions and Ailments - MOCCA” framework, anchored on three thrusts: 1. Address knowledge gaps and inculcate healthier habits - Improve health literacy via outreach programmes and culturally nuanced health materials 2. Mitigate risk factors - Build primary care providers’ capabilities to deliver alcohol/tobacco interventions 3. Treat and control disease progression - Set up referral pathways between primary and tertiary healthcare institutions including for post-discharge case management MOCCA was implemented in December 2022 through the collective efforts from the government, community, social service agencies and their employers. Key messages • Migrant workers have been receptive to interactive health programmes, regular health screening, follow up on chronic disease under the PCP and 324 workers attended basic dental screening. • The MOCCA framework is integral to the provision of care for MWs, through risk factor identification, empowerment of health ownership, and periodic assessment of health and behavioural outcomes.

Patients’ attitudes towards remote primary healthcare services in Lithuania

Abstract Background One of the largest changes that had to be implemented in the healthcare system worldwide in response to the COVID-19 pandemic was the introduction and expansion of remote healthcare services. The aim of this study is to evaluate attitudes of patients of primary healthcare institutions to the remote healthcare services in Lithuania. Methods A cross-sectional study was conducted in February - March 2023. A total of 313 patients of primary healthcare facilities in Vilnius city (Lithuania) aged 18-75 years were anonymously surveyed (response rate 78.3%). Chi-square and z tests were used to determine a relationship between two categorical variables (α = 0.05). Results 78.8% of respondents report satisfaction with the quality of remote healthcare services. 74% of did not experience any technical difficulties during their most recent consultation. Most of patients agree that remote healthcare services save time (85.9%) and money (60.7%), as well as reduce the risk of contracting infectious diseases (62%). However, 61.9% of patients believe that remote services may increase the risk of medical errors. 53% believe that the accessibility of healthcare has improved with the introduction of remote services, and 82% of patients think that such services should constitute up to 50% of all healthcare services. Patients believe that the quality of remote healthcare services would improve with the advent of video consultations. Patients’ opinions about remote healthcare services significantly depend on their gender, employment status, and education (P &amp;lt; 0.05). Conclusions Patients are satisfied with the quality of remote healthcare services. They have already discovered the benefits of remote healthcare, however, this requires changes to the existing legal framework. Key messages • Attitudes of patients towards the integration and quality of remote primary healthcare services are positive. • According to many respondents, remote healthcare services should make up to 50% of all services provided.

Optimizing the utilization of maternal and reproductive healthcare services among women in low-resourced Nigerian settings

IntroductionQuality care delivery is an essential lifesaving interventions for maternal healthcare and reduction in mortality from preventable reproductive conditions. In African countries like Nigeria, numerous perceptions and militating factors present unique challenges in optimizing the utilization of maternal and reproductive healthcare services. As women continuously evolve away from the utilization of healthcare services, achieving universal health coverage for all emerges as a matter of concern.MethodA phenomenological and descriptive research design was used. The study participants comprised a total of 38 women selected from primary and tertiary healthcare institutions. They were purposively selected from four healthcare institutions in Nsukka, Enugu State, Nigeria.ResultFindings revealed that most rural women at the prenatal stage, utilize maternal healthcare services, but at the postnatal stage, they reject reproductive healthcare services owing to certain perceptions. Concerns about sub-optimal utilization of maternal and reproductive healthcare services were found under enabling, predisposing and need factors. Evidence-based interventions included instituting health insurance policies, improving the healthcare sector, personnel, collaboration among stakeholders, and grass-roots community education. Participants showed little knowledge of social workers’ engagement in healthcare institutions.ConclusionFunctional network of care between private and public healthcare system is the key to optimizing maternal and reproductive healthcare utilization. The study recommends stakeholder and community engagement in achieving functional networks of care, strengthening relational linkages between frontline health workers and equip rural women with better knowledge. All these are geared toward achieving optimal utilization of maternal and reproductive healthcare services among women in low-resourced Nigerian settings.

Assessment of the Vitamin A supplementation protocol in primary health care settings: A case study of Mookgophong sub-district in South Africa

The Integrated Nutrition Programme in South Africa provides Vitamin A supplementation to targeted children. It began in 1994 when marginal vitamin A deficiency was 33 %. Since that time, malnutrition remains a serious problem in South Africa as one of the greatest contributors to childhood illness and death. It is estimated that about 27% of South African children are stunted from a lack of adequate nutrition in the early years of their lives. A poor intake of vitamin A is one of the cofactors in sight and contribute to blindness amongst children. In addition, it is required for cellular integrity. Furthermore, children with poor intake of vitamin A are underweight, fail to grow properly and are more likely to get infections and to die from them. The main purpose of this study was to assess the implementation process of the vitamin A supplementation protocol in primary health care institutions in the Mookgophong sub-district of Limpopo Province. The study design was descriptive and qualitative. All seven facilities, the clinics and the district hospital in the sub-district were purposefully selected. Data were collected from the seven health care facilities and 16 health care workers provided information on the implementation process of the Vitamin A programme, using a self-administered structured questionnaire. An observation questionnaire was also used by the researcher to validate some of the information and to check compliance with the protocol. The findings revealed poor availability of blue (100 000 IU), white (500 000 IU) and yellow (200 000 IU) capsules in stock (56.3%). Approximately half of the health care workers reported to know the preventative schedule, while most of them did not know the treatment schedule. There was generally good adherence to the implementation of preventative protocol. The health care workers complied with the Vitamin A protocol despite the lack of stock or resources in this low resource setting. Key words: Vitamin A supplementation protocol, health care workers, South Africa

Evaluation of Patients aged over 65 years who applied to Ankara Training and Research Hospital Family Medicine Outpatient Clinics: Comparison Before and After Covid-19 Pandemic

Aim: Taking into account the importance and priority of the geriatric age group, the aim of our study was to examine the reasons for and the number of visits to primary health care institutions, to compare them before and after the Covid-19 pandemic, and to draw attention to the importance of geriatric sciences in family medicine specialty training in the light of this evaluation.&#x0D; &#x0D; Materials and Methods: Patients who applied to the Ankara Training and Research Hospital (EAH) Family Medicine Outpatient Clinics between 01.03.2020-31.12.2022 constitute the population of the study. Patients were retrospectively evaluated before and after the Covid-19 pandemic according to their admission rates and diagnoses. The outpatient clinics they applied to were analyzed. Musculoskeletal system problems were analyzed under a separate heading according to diagnoses.&#x0D; Results: Out of 47014 diagnoses above the age of 65 during the pandemic period, I10 - Essential (Primary) Hypertension was the most common diagnosis, except for general medical examinations and screening examinations. In the post-Covid-19 period, 45928 diagnoses were made in 14398 patients over the age of 65. After general medical and laboratory examinations, the most common diagnose was I10 Essential Hypertension in both period. Musculoskeletal complaint during the pandemic period was the second most common with the diagnosis of M79.1 Myalgia in both period. Musculoskeletal complaints especially myalgia was more common in the pandemic period than the post-covid period (p

Evaluating the efficiency of primary health care institutions in China: an improved three-stage data envelopment analysis approach

BackgroundPrimary health care (PHC) institutions are key to realizing the main functions of the health care system. Since the new health care reform in 2009, the Chinese government has invested heavily in PHC institutions and launched favorable initiatives to improve the efficiency of such institutions. This study is designed to gauge the efficiency of PHC institutions by using 2012–2020 panel data covering 31 provinces in China.MethodsThis study applied an improved three-stage data envelopment analysis (DEA) model to evaluate the efficiency of PHC institutions in China. Unlike the traditional three-stage DEA model, the input-oriented global super-efficiency slack-based measurement (SBM) DEA model is used to calculate the efficiency in the first and third stages of the improved three-stage DEA model, which not only allows the effects of environmental factors and random noise to be taken into account but also deal with the problem of slack, super-efficiency and the comparability of interperiod efficiency values throughout the efficiency measurement.ResultsThe results show that the efficiency of PHC institutions has been overestimated due to the impact of external environmental factors and random noise. From 2012 to 2020, the efficiency of PHC institutions displayed a downward trend. Moreover, there are significant differences in the efficiency of PHC institutions between regions, with the lowest efficiency being found in the northeast region. The efficiency of PHC institutions is significantly affected by residents’ annual average income, per capita GDP, population density, the percentage of the population aged 0–14, the percentage of the population aged 65 and older, the number of people with a college education and above per 100,000 residents, and the proportion of the urban population.ConclusionsSubstantial investment in PHC institutions has not led to the expected efficiency gains. Therefore, more effective measures should be taken to improve the efficiency of PHC institutions in China based on local conditions. This study provides a new analytical approach to calculating the efficiency of PHC institutions, and this approach can be applied to efficiency evaluation either in other fields or in other countries.

Development and validation of a nomogram for arterial stiffness.

Even though as a gold standard for noninvasive measurementof arterial stiffness, carotid-femoral pulse wave velocity (cfPWV) is not widely used in primary healthcare institutions due to time-consuming and unavailable equipment. The aim of this study was to develop a convenient and low-cost nomogram model for arterial stiffness screening. A cross-sectional study was undertaken in the department of general practice, the First Affiliated Hospital of Fujian Medical University. Arterial stiffness was defined as cfPWV≥10m/s. A total of 2717 participants were recruited to construct the nomogram using the least absolute shrinkage and selection operator and logistic regressions. Receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis, clinical impact curve were used to evaluate the performance of the model. The model was validated internally and externally (399 participants) by bootstrap method. Arterial stiffness was identified in 913 participants (33.60%). Age, sex, waist to hip ratio, systolic blood pressure, duration of diabetes, heart rate were selected to construct the nomogram model. Good discrimination and accuracy were exhibited with area under curve of 0.820 (95% CI 0.803-0.837) in ROC curve and mean absolute error=0.005 in calibration curve. A positive net benefit was shown in decision curve analysis and clinical impact curve. A satisfactory agreement was displayed in internal validation and external validation. The low cost and user-friendly nomogram is suitable for arterial stiffness screening in primary healthcare institutions.