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The increasing concerns of the geographical maldistribution of medical resources have sparked worldwide interests in exploring the potential of telemedicine in the rural health system. This study aimed to investigate the application and effect of telemedicine as well as their regional heterogeneity in the primary care centres in rural China. Based on the stratified multistage cluster sampling, a cross-sectional study was conducted among 358 township health centres (THCs) from eastern, central and western China. A self-administered questionnaire was used and the data of the Health Statistical Annual Reports in 2017 were collected to investigate the implication of telemedicine as well as the performance and other characteristics of each THCs. Propensity score matching was used to estimate the effect of telemedicine application on the bed occupancy rate and the number of annual outpatient visits of the THCs, with comparison among the regions. The overall prevalence of telemedicine application was 58.66% in 2017, and it was found to increase the bed occupancy rate of the THCs in the national range (p < 0.1). When divided into different regions, telemedicine was found to improve the number of annual outpatient visits in western China (p < 0.05) and the bed occupancy rate in eastern China (p < 0.1). Disparities in the degree of remoteness and the capability of THCs among the regions were also found in this study, which may be the reasons for the regional heterogeneous effects of telemedicine. These findings suggested the potential of telemedicine in improving the utilization of primary care centres in rural areas. Further studies were needed to investigate the underlying reasons for its regional heterogeneous effects.
Wanchun Xu; Zijing Pan; Shan Lu; Liang Zhang. Regional Heterogeneity of Application and Effect of Telemedicine in the Primary Care Centres in Rural China. International Journal of Environmental Research and Public Health 2020, 17, 4531 .
AMA StyleWanchun Xu, Zijing Pan, Shan Lu, Liang Zhang. Regional Heterogeneity of Application and Effect of Telemedicine in the Primary Care Centres in Rural China. International Journal of Environmental Research and Public Health. 2020; 17 (12):4531.
Chicago/Turabian StyleWanchun Xu; Zijing Pan; Shan Lu; Liang Zhang. 2020. "Regional Heterogeneity of Application and Effect of Telemedicine in the Primary Care Centres in Rural China." International Journal of Environmental Research and Public Health 17, no. 12: 4531.
Background Self-treatment is a common and widespread behaviour, of which the risks are multiplied in old age. However, the determinants of self-treatment among elders in rural China remain unclear. This study aims to explore the prevalence and associated factors of self-treatment among elders in rural China, trying to discover the vulnerable groups as well as the service gaps among the rural elders. Methods Based on a multi-stage stratified random sampling method, a cross-sectional household survey was conducted among 30 villages in Sinan County, an impoverished county in western China. Data were collected through a household–individual combined questionnaires. The analysis was restricted to elders who reported illness within the last 2 weeks, and the final sample size was 330 (individuals). Bivariate and multiple logistic regression analysis were performed in the whole sample group and four subgroups to obtain the prevalence ratios regarding the associated factors. Results In the present study, 35.2% of the elders with illness within the last 2 weeks reported self-treatment. The variables associated with self-treatment in the whole sample group were health status (OR 6.75, 95%CI 1.93–23.60), recent alcohol consumption (OR 0.42, 95%CI 0.21–0.83) and the utilisation of family practice services (OR 0.59, 95%CI 0.36–0.96); the same predictors were found in the subgroup of elders with chronic diseases. No significant predictors were found in the subgroup of elders without chronic diseases. Empty-nest elders with higher affinity to traditional Chinese medicine (OR 0.39, 95%CI 0.18–0.86) or drinking alcohol recently (OR 0.28, 95%CI 0.09–0.82) were less likely to self-treat, while the non-empty-nest elders who were no less than 75 years old (OR 3.10, 95%CI 1.33, 7.22) or at better health status (OR 9.20, 95%CI 1.73–48.75) were more likely to self-treat. Conclusion Self-treatment was prevalent among the elders in rural China. Better health status, no recent alcohol consumption and no utilisation of family practice are associated with self-treatment among rural elders. Older elders in the non-empty nest group were more likely to self-treat, while the empty-nest elders with self-care habits in traditional Chinese medicine were less likely to self-treat. Deeper understanding of the self-treatment behaviour among rural elders may provide insights for identifying the potential service gaps and developing improvement strategies in the health care delivery system for the elderly in China.
Wanchun Xu; Zhong Li; Zijing Pan; Ruibo He; Liang Zhang. Prevalence and associated factors of self-treatment behaviour among different elder subgroups in rural China: a cross-sectional study. International Journal for Equity in Health 2020, 19, 32 -12.
AMA StyleWanchun Xu, Zhong Li, Zijing Pan, Ruibo He, Liang Zhang. Prevalence and associated factors of self-treatment behaviour among different elder subgroups in rural China: a cross-sectional study. International Journal for Equity in Health. 2020; 19 (1):32-12.
Chicago/Turabian StyleWanchun Xu; Zhong Li; Zijing Pan; Ruibo He; Liang Zhang. 2020. "Prevalence and associated factors of self-treatment behaviour among different elder subgroups in rural China: a cross-sectional study." International Journal for Equity in Health 19, no. 1: 32-12.
This study aims to identify the characteristics and trajectories of outpatient service utilisation for hypertensive patients in tertiary hospitals. This study also attempts to investigate the determinants of the trajectories of outpatient service utilisation. A total of 9822 patients with hypertension and hypertension-related medical utilisation were recruited in Yichang, China from January 1 to December 31 in 2016. The latent trajectories of outpatient service utilisation were identified through latent class growth analysis. Differences in the demographic characteristics and medical utilisation among patients in different trajectories were tested by one-way ANOVA and chi-square analysis. The predictors of the trajectory groups of outpatient service utilisation were identified through multinomial logistic regression. Four trajectory groups were determined as stable-low (34.7%), low-fluctuating (13.4%), high-fluctuating (22.5%), and stable-high (29.4%). Significant differences were observed in all demographic characteristics (p < 0.001) and medical service utilisation variables (p < 0.001) among the four trajectories except for inpatient cost (p = 0.072). Determinants for outpatient service utilisation patterns include the place of residence, education level, outpatient visit times, inpatient service utilisation, and outpatient cost. Overall, hypertensive patients visiting outpatient units in the tertiary hospital were middle-aged, elderly, and well-educated, and they received poor follow-up services. The four identified latent trajectories have different characteristics and medical utilisation patterns. Trajectory group-based measurements are necessary for hypertension management and economic burden reduction.
Zijing Pan; Wanchun Xu; Zhong Li; Chengzhong Xu; Fangfang Lu; Pei Zhang; Liang Zhang; Ting Ye. Trajectories of Outpatient Service Utilisation of Hypertensive Patients in Tertiary Hospitals in China. International Journal of Environmental Research and Public Health 2020, 17, 852 .
AMA StyleZijing Pan, Wanchun Xu, Zhong Li, Chengzhong Xu, Fangfang Lu, Pei Zhang, Liang Zhang, Ting Ye. Trajectories of Outpatient Service Utilisation of Hypertensive Patients in Tertiary Hospitals in China. International Journal of Environmental Research and Public Health. 2020; 17 (3):852.
Chicago/Turabian StyleZijing Pan; Wanchun Xu; Zhong Li; Chengzhong Xu; Fangfang Lu; Pei Zhang; Liang Zhang; Ting Ye. 2020. "Trajectories of Outpatient Service Utilisation of Hypertensive Patients in Tertiary Hospitals in China." International Journal of Environmental Research and Public Health 17, no. 3: 852.
The health workers in rural primary care systems are at the increasing risk of job burnout. To explore the prevalence and associated factors of the job burnout among the primary healthcare worker in rural China, a cross-sectional survey was conducted among 15,627 participants in 459 township hospitals from six provinces. A combination of stratified multi-stage sampling and cluster sampling method, and a self-administrated questionnaire with the Chinese version of the Maslach Burnout Inventory-General Scale (MBI-GS) were used in the investigation. Multilevel regression analyses were used to examine the potential associated factors on both individual and organisational levels. 47.6% of respondents were experiencing moderate burnout, and 3.3% were in severe burnout. Professionals working for over 40 h per week, at young age, with a college degree, and with professional titles at medium or high rank reported a higher degree of job burnout. At the institutional level, the high ratio of performance-based salary was associated with a higher level of depersonalization. Burnout has become prevalent among the primary healthcare workers in rural China, and multiple strategies are needed to reduce the work stress and some high-risk groups’ vulnerability to job burnout.
Wanchun Xu; Zijing Pan; Zhong Li; Shan Lu; Liang Zhang. Job Burnout Among Primary Healthcare Workers in Rural China: A Multilevel Analysis. International Journal of Environmental Research and Public Health 2020, 17, 727 .
AMA StyleWanchun Xu, Zijing Pan, Zhong Li, Shan Lu, Liang Zhang. Job Burnout Among Primary Healthcare Workers in Rural China: A Multilevel Analysis. International Journal of Environmental Research and Public Health. 2020; 17 (3):727.
Chicago/Turabian StyleWanchun Xu; Zijing Pan; Zhong Li; Shan Lu; Liang Zhang. 2020. "Job Burnout Among Primary Healthcare Workers in Rural China: A Multilevel Analysis." International Journal of Environmental Research and Public Health 17, no. 3: 727.
This study was conducted to investigate the trajectory of hospitalization costs, and to assess the determinants related to the membership of the identified trajectories, with the view of recommending future research directions. A retrospective study was performed in urban Yichang, China, where a total of 134 end-stage lung cancer patients were selected. The latent class analysis (LCA) model was used to investigate the heterogeneity in the trajectory of hospitalization cost amongst the different groups that were identified. A multi-nominal logit model was applied to explore the attributes of different classes. Three classes were defined as follows: Class 1 represented the trajectory with minimal cost, which had increased over the last two months. Classes 2 and 3 consisted of patients that incurred high costs, which had declined with the impending death of the patient. Patients in class 3 had a higher average cost than those in Class 2. The level of education, hospitalization, and place of death, were the attributes of membership to the different classes. LCA was useful in quantifying heterogeneity amongst the patients. The results showed the attributes were embedded in hospitalization cost trajectories. These findings are applicable to early identification and intervention in palliative care. Future studies should focus on the validation of the proposed model in clinical settings, as well as to identify the determinants of early discharge or aggressive care.
Zhong Li; Shan Jiang; Ruibo He; Yihan Dong; Zijin Pan; Chengzhong Xu; Fangfang Lu; Pei Zhang; Liang Zhang. Trajectories of Hospitalization Cost Among Patients of End-Stage Lung Cancer: A Retrospective Study in China. International Journal of Environmental Research and Public Health 2018, 15, 2877 .
AMA StyleZhong Li, Shan Jiang, Ruibo He, Yihan Dong, Zijin Pan, Chengzhong Xu, Fangfang Lu, Pei Zhang, Liang Zhang. Trajectories of Hospitalization Cost Among Patients of End-Stage Lung Cancer: A Retrospective Study in China. International Journal of Environmental Research and Public Health. 2018; 15 (12):2877.
Chicago/Turabian StyleZhong Li; Shan Jiang; Ruibo He; Yihan Dong; Zijin Pan; Chengzhong Xu; Fangfang Lu; Pei Zhang; Liang Zhang. 2018. "Trajectories of Hospitalization Cost Among Patients of End-Stage Lung Cancer: A Retrospective Study in China." International Journal of Environmental Research and Public Health 15, no. 12: 2877.
Home blood pressure telemonitoring (HBPT) has great potential in improving blood pressure (BP) control among patients with hypertension. However, the longitudinal use trajectories of HBPT have not been identified yet. In addition, there has been a lack of understanding of the relationship between developmental trajectories of HBPT and BP control over time. The primary goal of this study was to identify the longitudinal trajectories of using HBPT among hypertensive patients and to explore the relationship between longitudinal trajectories of HBPT use patterns and BP control. A total of 122 hypertensive patients were enrolled consecutively in Xiling, Huayan, Baisha and Xueyuan communities in Yichang City, Hubei Province, China. Each patient was provided with a portable monitoring device which has unlimited data service at the time of enrollment. Socio-demographics (e.g. name, age, sex, marital status) were collected at baseline. Real-time data including systolic and diastolic blood pressure were automatically uploaded to cloud platform through devices. Latent class growth analysis was conducted to determine the latent trajectory of HBPT use. Joint trajectory method was used to correlate the longitudinal trajectories of HBPT utilization and BP control status. Five trajectories were identified which are persistently low (47.1%), moderate with decreasing (23.9%), sharply decreasing (11.2%), high with decreasing (11.3%) and persistently high with increasing (6.6%). There was no statistically significant difference among 5 trajectories in the baseline survey in terms of age, marital status, BP (both SBP and DBP) and BP control status. However, there was a strong positive correlation between the HBPT utilization pattern and BP control status over time. The latent trajectories of HBPT utilization were identified in our study. However, no predictors of trajectory membership were identified. Nevertheless, we have demonstrated that HBPT was to some extent positively correlated with improved BP control, and this correlation still needs to be further proved.
Ting Ye; Pei Zhang; Zhaolian Ouyang; Jiajuan Yang; Chengzhong Xu; Zijing Pan; Zhouzhi Wu; Liang Zhang; Boyang Li. Multi-trajectory modeling of home blood pressure telemonitoring utilization among hypertensive patients in China: A latent class growth analysis. International Journal of Medical Informatics 2018, 119, 70 -74.
AMA StyleTing Ye, Pei Zhang, Zhaolian Ouyang, Jiajuan Yang, Chengzhong Xu, Zijing Pan, Zhouzhi Wu, Liang Zhang, Boyang Li. Multi-trajectory modeling of home blood pressure telemonitoring utilization among hypertensive patients in China: A latent class growth analysis. International Journal of Medical Informatics. 2018; 119 ():70-74.
Chicago/Turabian StyleTing Ye; Pei Zhang; Zhaolian Ouyang; Jiajuan Yang; Chengzhong Xu; Zijing Pan; Zhouzhi Wu; Liang Zhang; Boyang Li. 2018. "Multi-trajectory modeling of home blood pressure telemonitoring utilization among hypertensive patients in China: A latent class growth analysis." International Journal of Medical Informatics 119, no. : 70-74.
Introduction: The patient's understanding of the disease status after illness can help patients recover better. This study was to explore a new classification about the way to understand the disease status based on the National Resident Health Service Utilization Behavior Monitoring in 2016 using latent class analysis, moreover, finding out the factors associated with different latent classes.Methods: Data were from the National Resident Health Service Utilization Behavior Monitoring in 2016, using multi-stage stratified random sampling method. Two monitoring stations were rural and urban in Hubei province, ten communities (villages) of each monitoring station, each community (village) extracts 33 families. Latent class analysis was used to classify the way to understand the disease status after illness; Single factor analysis and multinomial logistic regression were used to find out factors associated with different latent classes. Result: The 3-class model was the best fit for the data (AIC = 5688.138, BIC = 5870.449, Entropy = 0.823). The size of class 3 was the biggest (n = 1159, 62.5%), followed by class 2 (n = 398, 21.5%) and class 1 (n = 296 16.0%). In the single factor analysis, the domicile, education, age and whether suffering from chronic disease were associated with different classes (p < 0.001). In the multinomial logistic regression comparison in class 3, class 1 were urban residents, younger, the higher educational level residents; class 2 were more chronic residents.Discussions: The class 3 uses face-to-face consultation to understand the disease status. Most of them are rural, low educated and older residents. Class 1 use face-to-face counseling, experience judgment and ask friends and family. Most of them are urban, high educated residents. Class 2 use various ways to understand disease status in addition to telephone consultation. Most of them are chronic patients. They have a good sense of health to use a variety of ways to understand their disease status due to their disease and primary health education. Studies have shown that chronic patients can receive better health education, they can pay more attention to disease status understanding the disease status from different ways. Though class 2 were high educated to comprehensive experience to understand the disease status, they didn’t use various ways to understand their disease status as chronic patients because of lacking of attention and health education. The primary health education should not only focus on the chronic patient, but for all residents.Conclusions: Face-to-face consultation is the main way for residents to understand the disease status, and the use of new media such as the Internet are still a minority. Residents with chronic diseases can understand the disease status in a variety of ways.Lessons learned: Health education and promotion strategies should be designed according to their charateristic of treament-seeking behaviors, rather than "one-fit-all"models.Limitation: This study didn’t associate the recover status with different patterns of residents and failed to confirm different classes of residents disease recover exist significant difference.Suggestions for further research: To find out different patterns of residents’ recover have significant difference.
Zijing Pan; Ting Ye; Xuejiao Liu; Liang Zhang. Patterns of the way to understand the disease status among Chinese residents: A latent class analysis. International Journal of Integrated Care 2018, 18, 1 .
AMA StyleZijing Pan, Ting Ye, Xuejiao Liu, Liang Zhang. Patterns of the way to understand the disease status among Chinese residents: A latent class analysis. International Journal of Integrated Care. 2018; 18 (s1):1.
Chicago/Turabian StyleZijing Pan; Ting Ye; Xuejiao Liu; Liang Zhang. 2018. "Patterns of the way to understand the disease status among Chinese residents: A latent class analysis." International Journal of Integrated Care 18, no. s1: 1.