Association of the barriers of pharmaceutical care perceived by clinical pharmacists and occupational stress in tertiary hospitals of China.

Objective: As an important member of the healthcare team, clinical pharmacists' occupational stress will lead to a decline in the quality of pharmaceutical care. According to person-environment fit theory, barriers of pharmaceutical care perceived by clinical pharmacists may be a potential factor influencing occupational stress. This study aimed to assess the association between the specific barriers of pharmaceutical care perceived by clinical pharmacists and their occupational stress in China. Method: A field-based questionnaire survey of tertiary hospitals was conducted in 31 provincial administrative regions in mainland China using a multi-stage stratified sampling method. Data on occupational stress, barriers of pharmaceutical care perceived by clinical pharmacists and other factors of job stress were collected using the Brief Job Stress Questionnaire and a self-administered instrument. The instruments have undergone multiple rounds of pilot investigations, and their reliability is acceptable. Ordinary least squares regression was used to evaluate the association of the perceived barriers and other factors with their occupational stress. Result: A total of 625 clinical pharmacists from 311 tertiary hospitals in China (response rate = 84%) participated. Perceived resource dimension barriers (p = 0.00) and self-improvement dimension barriers (p = 0.01) were associated with increased occupational stress of the participants. In addition, clinical pharmacists with senior professional titles and engaged in neurology and ICU have higher occupational stress. Conclusion: By removing barriers to pharmacists' resources and self-improvement, it is possible to better meet the work needs of clinical pharmacists and may effectively reduce occupational stress, thereby improving the quality of pharmaceutical services.

MXene-Coated Ion-Selective Electrode Sensors for Highly Stable and Selective Lithium Dynamics Monitoring.

Lithium holds immense significance in propelling sustainable energy and environmental systems forward. However, existing sensors used for lithium monitoring encounter issues concerning their selectivity and long-term durability. Addressing these challenges is crucial to ensure accurate and reliable lithium measurements during the lithium recovery processes. In response to these concerns, this study proposes a novel approach involving the use of an MXene composite membrane with incorporated poly(sodium 4-styrenesulfonate) (PSS) as an antibiofouling layer on the Li+ ion selective electrode (ISE) sensors. The resulting MXene-PSS Li+ ISE sensor demonstrates exceptional electrochemical performance, showcasing a superior slope (59.42 mV/dec), lower detection limit (10-7.2 M), quicker response time (∼10 s), higher selectivity to Na+ (-2.37) and K+ (-2.54), and reduced impedance (106.9 kΩ) when compared to conventional Li+ ISE sensors. These improvements are attributed to the unique electronic conductivity and layered structure of the MXene-PSS nanosheet coating layer. In addition, the study exhibits the long-term accuracy and durability of the MXene-PSS Li+ ISE sensor by subjecting it to real wastewater testing for 14 days, resulting in sensor reading errors of less than 10% when compared to laboratory validation results. This research highlights the great potential of MXene nanosheet coatings in advancing sensor technology, particularly in challenging applications, such as detecting emerging contaminants and developing implantable biosensors. The findings offer promising prospects for future advancements in sensor technology, particularly in the context of sustainable energy and environmental monitoring.

Association of the availability of pharmaceutical facilities provided in secondary and tertiary hospitals with clinical pharmacists' work performance.

BACKGROUND: Clinical pharmacists always work as the pivotal role in the process of facilitating the proper use of drug. Based on the person-environment fit theory, the availability of facilities required in pharmaceutical service may influence pharmacists' performance, but which of them may have positive or negative impact remains unclear. OBJECTIVES: This study aims to analysed the quantitative association of the availability of pharmaceutical facilities provided in Chinese hospitals and clinical pharmacists' work performance to assist hospitals formulating plans of the improving pharmaceutical working conditions to enhance clinical pharmacists' performance. METHOD: Demonstrated by the panel of expert and literature review, the questionnaire for administrators and clinical pharmacists of secondary and tertiary hospitals in China was formed. Then a mixed sampling was adopted to gather data on information of the participants, as well as evaluation indexes of the availability of facilities and clinical pharmacists' work performance. RESULTS: Overall, 625 questionnaires distributed to administrators of hospitals and 1219 ones distributed to clinical pharmacists were retrieved. As for the Pharmaceutical facilities, while the increased availability of Traditional Chinese medicine pharmacy (p = 0.02) has a significantly positive impact on clinical pharmacists' performance, the great availability of the preparation room (p = 0.07) negatively influences their work performance. CONCLUSION: Improving the availability of facilities that significantly influence clinical pharmacists' work performance possibly reduce their workload, enhance their efficiency and further promote progress in pharmaceutical service.

Exploring the training of chinese medical staff oriented to the need for clinical drug information services: from the perspective of drug information patients obtained and need.

BACKGROUND: There are some gaps between the training of drug information service competencies for medical staff and drug information patients need in China. OBJECTIVE: To investigate drug information patients obtained and need for further providing directions for the training of drug information service competencies among medical staff in China from patients' perspectives. METHODS: A face-to-face nationwide survey was conducted using a stratified sampling method. Data were analyzed descriptively using frequencies, percentages and mean. Several subgroup analyses using Chi-square tests were conducted to identify patients' need for drug information in China. RESULTS: A total of 1994 questionnaires from medical institutions in China were returned. Most of the drug information obtained by patients came from physicians, and different types of drug information were important to patients. Additionally, patients had different needs for drug information due to age, gender, diagnosis and treatment status, and education level. CONCLUSIONS: The training of medical staff needs to increase the presence of nurses and pharmacists in drug information services, enhance the awareness of "patient-centered" services, and improve the ability to provide information services specific to the characteristics of patients.

Development and validation of pharmaceutical care barriers scale in Chinese hospitals: a cross-sectional survey.

Introduction: Chinese hospitals still face various barriers to implementing pharmaceutical care. The quantitative instrument for measuring these barriers in China is scarce. This study aims to develop and validate a scale for measuring barriers to providing pharmaceutical care in Chinese hospitals from the perspective of clinical pharmacists. Methods: The scale was developed based on existing literature and qualitative interviews with 20 experts. The scale was included in a small-range pilot survey and then administered to a validation survey in 31 provinces in China. Exploratory factor analysis was used to identify the structure of the scale. Confirmatory factor analysis was applied to verify the structure of the scale and to validate the scale's convergent and discriminative validity. Known-group validity was also examined. Cronbach's alpha examined the internal consistency reliability of the scale. Results: 292 scales were completed and returned for a response rate of 85.6% in the pilot study. Exploratory factor analysis of the scale suggested a five-factor solution (Cognition and attitude, Knowledge and skills, Objective conditions, External cooperation, and Support from managers) accounting for 66.03% of the total variance. 443 scales were sent out in the validation study, with a response rate of 81.0%. Confirmatory factor analysis demonstrated a good fit of the structural model for pharmaceutical care barriers. It showed the scale's good convergent and discriminative validity (The average variance extracted >0.5 and composite reliability >0.7). The scale could also identify the differences in total score among the clinical pharmacists from different hospital grades (p < 0.05). Cronbach's alpha is between 0.658 and 0.896, indicating good internal consistency. Conclusion: From the perspective of clinical pharmacists, this study has developed a scale to assess obstacles to pharmaceutical care. The scale comprehensively encompasses barriers to clinical pharmacists' cognitive and ability-related aspects, hindrances encountered in collaborating with other health professionals and patients, and barriers to the working environment. The reliability and validity have been established through verification.

A Study on Influencing Factors of Physicians' Suboptimal Health Status in Primary Healthcare Institutions.

Purpose: This study aims to investigate the current health status of Chinese physicians in primary healthcare institutions (PHI) and the effects of personal characteristics, lifestyle, work-related environment and life-related environment on the subhealth status (SHS) of them. Methods: A conceptual framework of various influencing factors was constructed with reference to the concept of health-related quality of life before the convenience sampling. Self-administered questionnaires are distributed to acquire the cross-sectional information of nationwide PHI physicians. A logit regression model was constructed to investigate the influence of various factors on the SHS of PHI physicians. Results: Among 682 valid cases included in the logit regression, 457 physicians were in SHS, with an SHS rate of 67%. The regression results (R2=0.3934, chi-square=337.07, p<0.0001) showed that long working hours (p<0.05), personal income (p<0.05) and life stress (p<0.05) were protective factors for subhealth. The frequency of alcohol consumption (p<0.01), smoking (p<0.05), fear of making mistakes at work (p< 0.001), tension with colleagues (p < 0.0001), and job satisfaction (p < 0.05) were all risk factors. Other factors such as education (p < 0.1) also had an effect on the SHS of primary care physicians. Conclusion: A large proportion of PHI physicians in China are in SHS and many of them are not aware that they are in a poor health state. The logit regression model showed that factors including worries about the occurrence of accidents, strained relationships with colleagues, job satisfaction, and frequency of smoking and drinking negatively influence the SHS of PHI physicians, which should be paid more attention. Meanwhile, annual personal income, long working hours and life stress are protective factors, which means that these factors need to be encouraged.

The anchor design of anchor-based method to determine the minimal clinically important difference: a systematic review.

BACKGROUND: Positive results for clinical outcomes should be not only statistically significant, but also clinically significant. The minimum clinically important difference (MCID) is used to define the minimum threshold of clinical significance. The anchor-based method is a classical method for ascertaining MCID. This study aimed to summarise the design of the anchors of the anchor-based method by reviewing the existing research and providing references and suggestions. METHOD: This study was mainly based on literature research. We performed a systematic search using Web of Science, PubMed, CNKI, Wanfang, and VIP databases. Two reviewers independently screened titles and abstracts to identify relevant articles. Data were extracted from eligible articles using a predefined data collection form. Discrepancies were resolved by discussion and the involvement of a third reviewer. RESULT: Three hundred and forty articles were retained for final analysis. For the design of anchors, Subjective anchors (99.12%) were the most common type of anchor used, mainly the Patient's rating of change or patient satisfaction (66.47%) and related scale health status evaluation items or scores (39.41%). Almost half of the studies (48.53%) did not assess the correlation test between the anchor and the research indicator or scale. The cut-off values and grouping were usually based on the choice of the anchor types. In addition, due to the large number of included studies, this study selected the most calculated SF-36 (28 articles) for an in-depth analysis. The results showed that the overall design of the anchor and the cut-off value were the same as above. The statistical methods used were mostly traditional (mean change, ROC). The MCID thresholds of these studies had a wide range (SF-36 PCS: 2-17.4, SF-36 MCS: 1.46-10.28), and different anchors or statistical methods lead to different results. CONCLUSION: It is of great importance to select several types of anchors and to use more reliable statistical methods to calculate the MCID. It is suggested that the order of selection of anchors should be: objective anchors > anchors with established MCID in subjective anchors (specific scale > generic scale) > ranked anchors in subjective anchors. The selection of internal anchors should be avoided, and anchors should be evaluated by a correlation test.

Factors influencing clinical pharmacists' integration into the clinical multidisciplinary care team.

Objectives: To investigate the factors influencing clinical pharmacists' integration into the clinical multidisciplinary care team, using interprofessional collaboration between clinical pharmacists and physicians as the focus. Methods: Through stratified random sampling, a cross-sectional questionnaire survey was conducted among clinical pharmacists and physicians in secondary and tertiary hospitals in China from July to August 2022. The questionnaire, comprising the Physician-Pharmacist Collaborative Index (PPCI) scale to reflect the collaboration level and a combined scale to measure influencing factors, was made available in two versions for clinical pharmacists and physicians. Multiple linear regression was adopted to analyze the association between the collaboration level and influencing factors, as well as the heterogeneity of the significant factors in hospitals of different grades. Results: Valid self-reported data from 474 clinical pharmacists and 496 paired physicians were included, who were serving in 281 hospitals from 31 provinces. In terms of participant-related factors, standardized training and academic degree, respectively, exerted significant positive effects on the perceived collaboration level by clinical pharmacists and physicians. In terms of context characteristics, manager support and system construction were the main factors for improving collaboration. In terms of exchange characteristics, clinical pharmacists having good communication skills, physicians trusting others' professional competence and values, and both parties having consistent expectations had significant positive effects on collaboration. Conclusion: The study provides a baseline data set on the current level and associated factors of clinical pharmacists' collaboration with other professionals in China and other countries with a related health system, providing references for individuals, universities, hospitals, and national policymakers to facilitate the development of clinical pharmacy and multidisciplinary models and further improve the patient-centered integrated disease treatment system.

Mapping the Peds QLTM 4.0 onto CHU-9D: a cross-sectional study in functional dyspepsia population from China.

Objective: The study aims to develop a mapping algorithm from the Pediatric Quality of Life Inventory™ 4. 0 (Peds QL 4.0) onto Child Health Utility 9D (CHU-9D) based on the cross-sectional data of functional dyspepsia (FD) children and adolescents in China. Methods: A sample of 2,152 patients with FD completed both the CHU-9D and Peds QL 4.0 instruments. A total of six regression models were used to develop the mapping algorithm, including ordinary least squares regression (OLS), the generalized linear regression model (GLM), MM-estimator model (MM), Tobit regression (Tobit) and Beta regression (Beta) for direct mapping, and multinomial logistic regression (MLOGIT) for response mapping. Peds QL 4.0 total score, Peds QL 4.0 dimension scores, Peds QL 4.0 item scores, gender, and age were used as independent variables according to the Spearman correlation coefficient. The ranking of indicators, including the mean absolute error (MAE), root mean squared error (RMSE), adjusted R2, and consistent correlation coefficient (CCC), was used to assess the predictive ability of the models. Results: The Tobit model with selected Peds QL 4.0 item scores, gender and age as the independent variable predicted the most accurate. The best-performing models for other possible combinations of variables were also shown. Conclusion: The mapping algorithm helps to transform Peds QL 4.0 data into health utility value. It is valuable for conducting health technology evaluations within clinical studies that have only collected Peds QL 4.0 data.

Influencing factors of nonclinical pharmacists' willingness to transform: a cross-sectional survey in Xinjiang, China.

BACKGROUND: There is a serious shortage of clinical pharmacists in Xinjiang, China. A six-month to one-year on-the-job training programme can rapidly transition nonclinical pharmacists into clinical pharmacists to resolve this issue. However, not all nonclinical pharmacists are willing to become clinical pharmacists, and many factors may influence their willingness. This study aims to assess the transformation intention of nonclinical hospital pharmacists and the contributing elements to make recommendations to accelerate the transformation of hospital pharmacists to clinical pharmacists. METHODS: Cross-sectional survey was conducted in secondary and tertiary hospitals in Xinjiang. Taking 14 prefectures in Xinjiang as a cluster, 34 hospitals were randomly selected. By snowball sampling, the heads of pharmaceutical departments introduced non-clinical pharmacists to participate in an anonymous questionnaire survey, which included 41 questions about basic demographic information, cognition and attitudes towards pharmaceutical care, potential factors and willingness to transform, and it took an average of 10 min to complete. Using multifactor logistic regression, the contributing elements of transformation intention were analysed. RESULTS: The survey was conducted from May to October 2022. 338 valid responses were obtained, with a response rate of 91.85% and a willingness to transform rate of 81.67%. There were significant differences in the willingness to transform among nonclinical pharmacists of different ages (P < 0.05), marital statuses (P < 0.05), years of employment (P < 0.05), and technical titles (P < 0.05). There were significant differences between the two groups in the following four aspects: whether the setting of human resources in the pharmaceutical department was reasonable (P < 0.05), the educational level of clinical pharmacists (P < 0.05), the higher salary level of clinical pharmacists (P < 0.05), and whether they had experience in pharmaceutical care (P < 0.05). There was a significant difference in the total score of the pharmaceutical care attitude scale (P < 0.05) between the willing and unwilling groups. The results of multivariate logistic regression analysis revealed that the experience of providing pharmaceutical care (OR = 4.601, 95% CI: 1.13-18.69, P < 0.05) and attitude towards pharmaceutical care (OR = 3.302, 95% CI: 1.19-9.19, P < 0.05) had a statistically significant influence on the transformation intention of nonclinical pharmacists. CONCLUSIONS: One-fifth of nonclinical pharmacists were unwilling to transition to clinical pharmacists. The attitude towards and experience of pharmaceutical care affected pharmacists' transformation intention, so the suggestion is proposed to promote the transformation of nonclinical pharmacists into clinical pharmacists.

Association of pharmaceutical care barriers and role ambiguity and role conflict of clinical pharmacists.

Objectives: This study aimed to understand current status of pharmaceutical care barriers and explore the impact of them on the role ambiguity and role conflict of clinical pharmacists in secondary and tertiary hospitals in mainland China. Methods: The Chinese version of Role Conflict and Role Ambiguity Scale was used to measure clinical pharmacists' role ambiguity and role conflict. A questionnaire for clinical pharmacists' pharmaceutical care barriers was established to determine whether clinical pharmacists encounter barriers. Multiple linear regression model was used to analyze the influence of various pharmaceutical care barriers on the role ambiguity and role conflict of clinical pharmacists. Results: 1,300 clinical pharmacists from 31 provinces were eventually included. The results revealed that commonly perceived barriers to pharmaceutical care by clinical pharmacists include the lack of financial compensation and dedicated time for pharmaceutical care. Barriers such as clinical pharmacists' unawareness of the importance of pharmaceutical care increase the degree of clinical pharmacists' role conflict. And the lack of financial compensation for pharmaceutical care decreases the degree of role ambiguity, while barriers such as the lack of dedicated time for pharmaceutical care, the failure to standardize the service procedures and contents of related documents in healthcare institutions increase the degree of role ambiguity. Conclusion: Increased focus on enhancing financial compensation, responsibility cognition, education and training, and greater consideration of institutional factors could help clinical pharmacists better manage their work environments and provide higher-quality pharmaceutical care.

Mapping health assessment questionnaire disability index onto EQ-5D-5L in China.

Objective: This research aimed to develop the more accurate mapping algorithms from health assessment questionnaire disability index (HAQ-DI) onto EQ-5D-5L based on Chinese Rheumatoid Arthritis patients. Methods: The cross-sectional data of Chinese RA patients from 8 tertiary hospitals across four provincial capitals was used for constructing the mapping algorithms. Direct mapping using Ordinary least squares regression (OLS), the general linear regression model (GLM), MM-estimator model (MM), Tobit regression model (Tobit), Beta regression model (Beta) and the adjusted limited dependent variable mixture model (ALDVMM) and response mapping using Multivariate Ordered Probit regression model (MV-Probit) were carried out. HAQ-DI score, age, gender, BMI, DAS28-ESR and PtAAP were included as the explanatory variables. The bootstrap was used for validation of mapping algorithms. The average ranking of mean absolute error (MAE), root mean square error (RMSE), adjusted R 2 (adjR 2) and concordance correlation coefficient (CCC) were used to assess the predictive ability of the mapping algorithms. Results: According to the average ranking of MAE, RMSE, adjR 2, and CCC, the mapping algorithm based on Beta performed the best. The mapping algorithm would perform better as the number of variables increasing. Conclusion: The mapping algorithms provided in this research can help researchers to obtain the health utility values more accurately. Researchers can choose the mapping algorithms under different combinations of variables based on the actual data.

Exploring the training of pharmacists oriented to the demands for clinical pharmacy services: from the perspective of physicians.

BACKGROUND: To evaluate physicians' perceptions, experiences and expectations of clinical pharmacists in China from the perspective of physicians' demands, to improve the training of pharmacists. METHODS: A cross-sectional survey involving physicians (except for primary physicians) was conducted from July to August 2019 in China. Using a field questionnaire, this study gathered data on descriptive information about the respondents and their perceptions, experiences and expectations of clinical pharmacists. Data were analysed descriptively using frequencies, percentages and mean. Several subgroup analyses using Chi-square tests were conducted to identify physicians' demands for clinical pharmacists in China. RESULTS: A total of 1376 physicians from secondary and tertiary hospitals in China (response rate = 92%) participated. The majority of the respondents were comfortable with clinical pharmacists providing education to patients (59.09%) and detecting and preventing prescription errors (60.17%), but they appeared uncomfortable when asked about clinical pharmacists suggesting the use of prescription medications to patients (15.71%). Most respondents agreed that clinical pharmacists are a reliable source of general drug information (81.84%) instead of clinical drug information (79.58%). The majority of the respondents expected clinical pharmacists to be knowledgeable drug therapy experts (95.56%) and to educate their patients about the safe and appropriate use of medications (95.56%). CONCLUSION: Physicians' perceptions and experiences were positively associated with the frequency of their interaction with clinical pharmacists. They had high expectations of clinical pharmacists as knowledgeable drug therapy experts. Corresponding policies and measures are needed to improve the education and training system of clinical pharmacists in China.

Primary Healthcare Pharmacists' Perceived Organizational Support and Turnover Intention: Do Gender Differences Exist?

Purpose: This study aims to explore the relationship between the four-dimensional structured perceived organizational support (emotional support, instrumental support, supervisor support, and coworker support) and the turnover intention of pharmacists in primary healthcare institutions. The gender differences between perceived organizational support and turnover intention will also be examined. Methods: A cross-sectional study was conducted in primary healthcare institutions of 31 cities in China from 2 July to 1 September 2021. And the binary logistic regression model was employed for data analysis. Results: 937 valid questionnaires are allocated from pharmacists in primary healthcare institutions. The regression results indicated that emotional support (b=0.073, p<0.001) has a significant influence on pharmacists' turnover intention, and the effect of supervisor support (b=0.173, p=0.046) on pharmacists' turnover intention differs by gender. Conclusion: These findings offer suggestions for the management and stabilization of pharmacists in primary healthcare institutions. It is suggested that specific measures should be taken to increase pharmacists' perceived organizational support and reduce their turnover intention. At the same time, gender differences need to be taken into consideration by the managers when providing perceived organizational support to reduce their turnover intention through adaptive management.

The Influence of Social Capital: A Trigger for Increasing Job Satisfaction.

Purpose: Evidence suggests that social capital in medical and health institutions is associated with the job satisfaction of medical staff. We examined the relationship between the social capital of Primary Healthcare Institutions (PHI) and the job satisfaction of pharmacists within it. Materials and Methods: From August 24 to September 1, 2021, we visited a total of 253 PHIs in 31 provinces of China. The social capital of healthcare organizations reported by employees (SOCAPO-E) scale was used to measure the social capital level of PHIs. And the Minnesota short-form job satisfaction scale was used to obtain pharmacists' job satisfaction. We employed multiple linear regression to explore the relationship between the social capital of PHI and pharmacists' job satisfaction. We also examined the effects of pharmacists' individual characteristics and job-related factors on pharmacists' job satisfaction. Results: It was statistically significant that the higher the social capital stock of PHI, the higher the job satisfaction level of pharmacists becomes. In addition, the regression analysis revealed that work hours, employment form, license acquired condition, disputes with patients and training frequency were significantly associated with the job satisfaction of pharmacists in PHI. Conclusion: Social capital in PHI has a significant impact on pharmacists' job satisfaction, suggesting that investing in social capital in PHI is a valuable investment in China. Furthermore, trust, which can be divided into affective trust and cognitive trust, and reciprocity are vital to the fulfillment of pharmacists' job satisfaction as core elements of social capital.

Association between lifestyle behaviors and health-related quality of life among primary health care physicians in China: A cross-sectional study.

Background: Primary health care (PHC) serves as the gatekeeper of health system and PHC physicians take on significant obligations to provide health care services in the pursuit of Universal Health Coverage (UHC). PHC physicians' health-related quality of life (HRQoL) can have a strong impact on patients, physicians and the health care system. Lifestyle interventions are found to be effective to improve HRQoL. The purpose of this study was to evaluate the association between lifestyle behaviors and HRQoL among PHC physicians, so that lifestyle intervention can be tailored by policy makers for health promotion. Methods: A survey covering 31 provinces and administrative regions in China was conducted in 2020 using a stratified sampling strategy. Data on sociodemographic characteristics lifestyle behaviors and HRQoL were collected by a self-administered questionnaire. HRQoL was measured through EuroQol-five dimension-five level (EQ-5D-5L) instrument. A Tobit regression model was performed to evaluate the association between sociodemographic characteristics, lifestyle behaviors and HRQoL. Results: Among 894 PHC physicians who completed the survey, Anxiety/Depression (AD) was the dimension with the most problems reported (18.1%). Regular daily routine (ß = 0.025, 95%CI 0.004 to 0.045) and good sleep quality (ß = 0.049, 95% CI = 0.029 to 0.069) were protective factors for HRQoL, while smoking (ß = -0.027, 95% CI = -0.079 to -0.003) and frequency of eating breakfast (ß = -0.041, 95%CI = -0.079 to -0.003) were negatively associated with HRQoL. Physical activity and alcohol drinking were not significantly associated with HRQoL. Conclusion: These findings suggest that tailored interventions on daily routine, improving sleep quality, and tobacco control among PHC physicians may be effective strategies to improve their HRQoL.

Capturing What Matters with Patients' Bypass Behavior? Evidence from a Cross-Sectional Study in China.

Background: In China, bypassing is becoming increasingly prevalent. Such behavior, as going directly to upper-level health-care facilities without a primary care provider (PCP) referral when facing non-critical diseases, contrasts to "expanding the role of PCPs as the first-contact of care", may cause unneglectable damage to the healthcare system and people's physical health. Objective: To examine the relationship between patient experience in primary health-care clinics (PHCs) and their bypass behavior. Methods: A cross-sectional study was designed for data collection. From July 2021 to August 2021, we conducted a questionnaire survey nationally. Fifty-three investigators were dispatched to 212 pre-chosen PHCs, around which 1060 interviewees were selected to gather information, using a convenience sampling. The primary independent variable was scores measured by Chinese Primary Care Assessment Tool (PCAT-C) to quantify patients' experience at PHCs. The dependent variable was a binary variable measured by a self-developed instrument to identify whether participants actually practiced bypassing. Covariates were well-screened determinants of patients' bypass behavior including socio-demographic factors, policy factors, and health-care suppliers. Binary logistic regression analysis was employed to evaluate the association of patients' experience with their bypass behavior. Findings: A total of 928 qualified questionnaires were obtained. The first contact dimension (OR 0.961 [95% CI 0.934 to 0.988], P = 0.005) and continuity dimension (OR 1.034 [95% CI 1.000 to 1.068], P = 0.047) of patients' experience were significantly associated with patients' bypass behavior (P < 0.05). In addition, age (OR 1.072, [95% CI 1.015-1.132], P = 0.013) and gender (OR 2.044, [95% CI 1.139-3.670], P = 0.017) also made a statistically significant difference. Conclusion: Enhancement in patient experience at PHCs may help reduce their bypass behavior. Specifically, efforts are needed to improve primary care accessibility and utilization. The positive correlation between bypassing rates and continuity scores may require more attention on strengthening PCPs' technical quality besides the quality of interpersonal interactions.

Public preferences for online medical consultations in China: a discrete choice experiment.

Background: Online medical consultation (OMC) is significant to promote the utilization and accessibility of healthcare resources and save time on consultation. However, the usage and public acceptance rates of it are still low in China. Meanwhile, few studies have focused on consumers' demand of OMC services. This study aims to identify attributes that influence users' preference for OMC services, quantify the value of these characteristics, and compare their relative importance. Methods: A nationwide discrete choice experiment was conducted to survey Chinese residents' preference choices for six attributes of OMC services. Conditional logit model and mixed logit model were used to analyze respondents' preference. Willingness to pay and heterogeneity were estimated by the mixed logit model. Results: A total of 856 respondents completed the study, and 668 questionnaires passed the consistency test. All of 6 attributes in the study were statistically significant except for "Doctor's professional title - Associate Senior." When choosing OMC services, respondents preferred to spend as little time and money as possible on a large online medical platform to consult a high-rated physician with a senior title from a well-known Grade-A tertiary hospital. Besides, respondents valued doctor's evaluation score most and were willing to pay ¥107 to obtain the services of higher-scored doctors. Conclusion: The study measured Chinese residents' preferences for six attributes of OMC and showed the heterogeneity of attributes among subgroups. Our findings suggested that OMC services providers should reduce the customers' waiting time, improve the quality of services and enhance professional skills to meet the customers' requirements. More research on preferences for OMC needs to be conducted in China, especially for key populations such as patients with chronic diseases.

Association of education background with clinical pharmacists' clinical pharmacy workload in tertiary hospitals of China.

BACKGROUND: Workload of healthcare providers may affect the quality of healthcare. Practical evidences have indicated that healthcare providers are differentially associated with workload due to their different education and training background. Clinical pharmacists are an indispensable part of medical teams. Under the precondition that clinical pharmacists in China generally undertake uneven clinical pharmacy workload, the relationship of workload and clinical pharmacists' different education backgrounds remains unclear. This study aimed to assess the association between the education background of clinical pharmacists and their clinical pharmacy workload in China. METHODS: A field questionnaire survey using a stratified sampling was conducted to gather data on education background and clinical pharmacy workload through a self-developed instrument. Ordinary least squares regression was used to evaluate the association of the participants' education background with their clinical pharmacy workload. RESULTS: A total of 625 clinical pharmacists from 311 tertiary hospitals in China participated. Two levels of education: less than bachelor's degree in general pharmacy, or doctoral degree in clinical pharmacy was associated significantly with clinical pharmacy workload of the participants. Participants who had credentials of national level and provincial-level specialized training for clinical pharmacists had undertaken more work than those without. Moreover, the participants' specialized field, such as respiratory medicine and nephrology, was associated with their clinical pharmacy workload. CONCLUSION: Enhancing several aspects of education or training among clinical pharmacists in tertiary hospitals in China may help improve their capability to provide clinical pharmacy services. Efforts are needed to improve the education and training system of clinical pharmacists in China.

Electrospraying Zwitterionic Copolymers as an Effective Biofouling Control for Accurate and Continuous Monitoring of Wastewater Dynamics in a Real-Time and Long-Term Manner.

Long-term continuous monitoring (LTCM) of water quality can provide high-fidelity datasets essential for executing swift control and enhancing system efficiency. One roadblock for LTCM using solid-state ion-selective electrode (S-ISE) sensors is biofouling on the sensor surface, which perturbs analyte mass transfer and deteriorates the sensor reading accuracy. This study advanced the anti-biofouling property of S-ISE sensors through precisely coating a self-assembled channel-type zwitterionic copolymer poly(trifluoroethyl methacrylate-random-sulfobetaine methacrylate) (PTFEMA-r-SBMA) on the sensor surface using electrospray. The PTFEMA-r-SBMA membrane exhibits exceptional permeability and selectivity to primary ions in water solutions. NH4+ S-ISE sensors with this anti-fouling zwitterionic layer were examined in real wastewater for 55 days consecutively, exhibiting sensitivity close to the theoretical value (59.18 mV/dec) and long-term stability (error <4 mg/L). Furthermore, a denoising data processing algorithm (DDPA) was developed to further improve the sensor accuracy, reducing the S-ISE sensor error to only 1.2 mg/L after 50 days of real wastewater analysis. Based on the dynamic energy cost function and carbon footprint models, LTCM is expected to save 44.9% NH4+ discharge, 12.8% energy consumption, and 26.7% greenhouse emission under normal operational conditions. This study unveils an innovative LTCM methodology by integrating advanced materials (anti-fouling layer coating) with sensor data processing (DDPA).