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Objective To explore the effect of the utilization of National Basic Public Health Service (NBPHS) on the regular medication behavior and glycemic control of patients aged 35 and over with type 2 diabetes, and to provide support for the health management practice of type 2 diabetes patients in China. Methods Based on the multi-stage stratified sampling method, a questionnaire survey was conducted in 10 community health service centers or township health centers in Zhejiang Province, Shanxi Province and Chongqing City in China from November to December 2019. The data of socio-demographic characteristics, utilization of NBPHS in the last year, regular medication in the last six months and glycemic control were collected. The effect of NBPHS utilization on the regular medication rate and glycemic control rate of type 2 diabetes patients was analyzed by logistic regression. Sensitivity analysis was carried out using the multilevel logistic method and the total score calculation method for basic public health services in different countries. Results A total of 1 527 patients with type 2 diabetes aged 35 and over were recruited, 41.00% were male, 66.08% were aged 65 years old and above, and 39.64% were ill for 10 years and over. The survey showed that the regular medication rate was 89.26%, the glycemic control rate was 65.23%, and the score on utilization of NBPHS was 11.83±2.246 (range 0-15). With the more utilization of NBPHS, regular medication rate in patients with type 2 diabetes increased (χ2trend=4.816, P2trend=0.080, P>0.05). The multivariate regression analysis showed that secondary school and above (OR=2.20), longer duration of disease (OR5-9 years=1.62, OR10 year and above=3.92) and higher utilization score of NBPHS (ORQ3=2.01) were protective factors for the regular medication. Compared with the local household registration population, the local resident population (OR=0.54) was a risk factor for regular medication. Unmarried or divorced or widowed (OR=0.61) and longer course of disease (OR10 year and above=0.60) were risk factors for satisfactory glycemic control, while increased monthly income per household (OR2000-5000 yuan=1.52, ORMore than 5000 yuan=1.76) was a protective factor for satisfactory glycemic control. Conclusion The utilization of NBPHS has promoted the regular medication rate of patients with type 2 diabetes, and the higher utilization takes better effect. Emphasis should be paid on patients with low education level, non-local household registration, short course of disease, and no partner. At the same time, it is necessary to strengthen the utilization of NBPHS to promote the change of their health awareness and health behavior..
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Objective:The aim of this study is to explore the utilization of basic public health services by elder-ly migrants and its influencing factors, and to provide data support for the equalization of public health services. Methods:The framework of the Behavioral Model of Health Services Utilization elaborated by Anderson was used as the theoretical basis. Basing on the data of 2015 National Dynamic Monitoring of Mobile Population,the multivariate logistic regression model was used to analyze the materials coming from in-depth interviews. Results: The utilization rate of basic public health services by the elderly migrant was low and there are differences as compared to other groups. The type of household registration,living duration and the scope of mobility were the main factors influencing the utilization of health services by the elderly migrants. The allocation of funds to primary health care services is in-consistent with the workload,and other difficulties for the community service agencies. Conclusions:The accessibility of basic public health services for the elderly migrants is poor,the health consciousness is weak,and health education should be strengthened. The elderly migrants coming from rural areas,having long-term residence and migrating long distance should be paid more attention too. The administrative departments should strengthen the statistics on elderly migrants,ensure a fair allocation of funds for the basic public health service,and optimize the top-level design of in-formation technology to improve the use of the basic public health services for elderly migrants.
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Objective To explore the impact of health management programs on hypertension related to their cost of the hypertensive,so as to provide evidence for related policy-making.Methods Data was from the 2011 China Non-communicable and Chronic Disease Survey Project which was developed in 161 counties (districts) and Xinjiang production and Construction Corps.Information regarding hypertensive patients were collected through a questionnaire.Two-part model was used to analyze the influence from health management scheme.Results This study included 1 1 294 participants who were 35 years old or beyond,with 4 904 (43.42％) males and 6 390 (56.58％) females.The median cost from the outpatient was 100 (30-200) Yuan,and the cost of patients under management program were significantly lower than those without (P＜0.05).Median pharmacy cost appeared as 30 (15-100) Yuan but there was no significant difference noticed between the cost from the managed or unmanaged patients (P＞0.05).Regarding the calculation on the outpatient cost,results showed that the patients under the management program were more likely to practice ‘outpatient-medical-behavior’ (OR=2.50,95％CI:2.26-2.76) with nearly three quarters of the cost from the unmanaged patients.Hypertensive patients from the urban areas were more likely to adopt ‘medical behavior’ (OR=1.31,95％CI:1.18-1.45) which was 1.69 times of the costs from the rural patients.Results of the pharmacy cost showed that the urban hypertension patients were more likely to purchase medicine (OR=1.10,95％CI:1.01-1.20) and was 1.19 times the costs of the rural patients.Conclusion Health management program on hypertension showed preliminary but promising results in reducing the out-patient cost in the treatment of hypertension,thus should be promoted and implemented.
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Objective To explore the impact of health management programs on hypertension related to their cost of the hypertensive,so as to provide evidence for related policy-making.Methods Data was from the 2011 China Non-communicable and Chronic Disease Survey Project which was developed in 161 counties (districts) and Xinjiang production and Construction Corps.Information regarding hypertensive patients were collected through a questionnaire.Two-part model was used to analyze the influence from health management scheme.Results This study included 1 1 294 participants who were 35 years old or beyond,with 4 904 (43.42％) males and 6 390 (56.58％) females.The median cost from the outpatient was 100 (30-200) Yuan,and the cost of patients under management program were significantly lower than those without (P＜0.05).Median pharmacy cost appeared as 30 (15-100) Yuan but there was no significant difference noticed between the cost from the managed or unmanaged patients (P＞0.05).Regarding the calculation on the outpatient cost,results showed that the patients under the management program were more likely to practice ‘outpatient-medical-behavior’ (OR=2.50,95％CI:2.26-2.76) with nearly three quarters of the cost from the unmanaged patients.Hypertensive patients from the urban areas were more likely to adopt ‘medical behavior’ (OR=1.31,95％CI:1.18-1.45) which was 1.69 times of the costs from the rural patients.Results of the pharmacy cost showed that the urban hypertension patients were more likely to purchase medicine (OR=1.10,95％CI:1.01-1.20) and was 1.19 times the costs of the rural patients.Conclusion Health management program on hypertension showed preliminary but promising results in reducing the out-patient cost in the treatment of hypertension,thus should be promoted and implemented.
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Objective To explore regional variations of basic public health services implementation in Zhejiang Province at prefectural,county and township level,respectively.To find key problems which obstacle the equalization of basic public health services in Zhejiang Province.Methods Descriptive analysis was made on surveillance data of basic public health services in Zhejiang Province,2014.Gini coefficient of key indicators was calculated at prefectural,county and township level,respectively.To the key indicator with higher Gini coefficient,Lorenz curve was plotted and Gini coefficient of each prefectural-level city was calculated.Results An increasing tendency from prefectural to township level was showed in Gini coefficient of all twenty-five analyzed indicators.The Gini coefficient at township level was 0.497 for the average financial fund per migrant person,and the highest prefectural -level cities were Taizhou (0.709 ),Lishui (0.838 ), Quzhou(0.918).The Gini coefficient at township level of other indicators were 0.314 and 0.235 for the children and elderly health management of traditional Chinese medicine,and lower than 0.05 for maternal &children health care, immunization,and coverage rate of electronic health record,and between 0.066 to 0.179 for health management of chronic disease and severe mental illness patients.Conclusion Average financial fund per migrant person and health management of traditional Chinese medicine are current major problems which obstacle the equalization of basic public health services in Zhejiang Province.
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Objective To investigate and analyze the residents′knowledge and satisfaction on basic public health services in five districts of Gansu ,to judge the implementation effect of the current policy ,in order to provide the suggestion to improve the effect of the implementation of the policy of basic public health services .Methods Based on typical sampling method ,1 688 rural and urban residents had been investigated coming from five counties in Gansu by using questionnaires to survey .Results The de‐gree of residents′knowledge about the policy was low (57 .23% );the residents could know about the policy through a variety of ways ,and mainly for medical staff to promote by approaching their homes ;91 .94% of surveyed residents thought that policy service was more convenient when they were accepting ;90 .99% of surveyed residents thought that they satisfied with the service attitude of staff ;82 .35% of surveyed residents believed that the policy service effects was obvious ;90 .11% of surveyed residents overall satisfied with the service of policy .The above results were different in proportion in various counties(P<0 .05) .Conclusion The degree of residents′knowledge and satisfaction on basic public health services in five districts of Gansu still needs to be improved .
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Objective Estimate type I and type II error probability (α,β)of sampling deduction,using sample size set in national basic public health services supervision.Methods Assuming a series of population indicator value of supervised area,αand βwas calculated based on binomial & hypergeometric distribution theory according to the sample size and indicator requirements set in supervision plan.Results When the population indicator value of supervised area was just equal to indicator requirements,probability of type I error was as follows,health record utilization rate(0.41 ),health record qualification rate(0.26),children systematic management rate(0.32),postpartum visit rate(0.32),the elderly health examination form completion rate (0.35 ),standard administration rate of patients with hypertension or diabetes (0.37),control rate of blood pressure of hypertension patients(0.34),control rate of blood glucose of diabetes patients (0.43),standard administration rate of severe mental illness patients(0.50).When the population indicator value of supervised area was 0.05 lower than indicator requirements,probability of type II error of those indicator was as follows, 0.41,0.54,0.53,0.53,0.51,0.50,0.57,0.47,0.38.Conclusion Current sample sizes of all indicators result in weak sensitivity of unqualified area detection.In order to avoid mistake,the sample size should be improved.
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Objective To develop appropriate evaluation methods of local basic public health services which are suitable to county level and above.Methods Data on basic public health services of 1 1 cities in Zhejiang province in 201 2 was evaluated by different evaluation methods including weighted synthetic scored method,weighted synthetic index method, Weighted Technique for Order Preference by Similarity to Ideal Solution (Topsis ) and Weighted Rank -Sum Ratio (RSR).The consistency of evaluation results were tested by Kendall's coefficient of concordance W test.Combination evaluation was conducted to evaluate four single synthetic evaluation results through average method,weighted average combination evaluation method and hierarchical clustering analysis.Results Different synthetic evaluation methods had different evaluation results.However,in the order,the top two were all Hangzhou and Ningbo.Kendall's W test showed good consistence of four evaluation results.Rank of 1 1 cities were Hangzhou,Ningbo,Shaoxing,Jiaxing,Huzhou, Taizhou,Jinhua,Zhoushan,Lishui,Wenzhou and Quzhou based on combination evaluation value by average method, which was the same to the rank based on weighted average combination evaluation result.Eleven cities could be classified into four categories by hierarchical clustering analysis with statistical significance (P <0.01 ):Excellent (Hangzhou, Ningbo),Good (Huzhou,Jiaxing,Shaoxing),Middle (Zhoushan,Jinhua,Taizhou)and Poor (Wenzhou,Quzhou, Lishui).Conclusion These four synthetic evaluation methods used in this study are all suitable to county level and above in basic public health services evaluation.Various synthetic evaluation methods could be used in practice with combination evaluation of various evaluation results.Average method which is convenient and accurate is preferred when consistency of various synthetic evaluation results was testified.Hierarchical clustering analysis could be used for combination evaluation when no precise rank is needed.