ABSTRACT Associations of multimorbidity and income with hospital admission were investigated in population samples from 3 widely differing health care systems: Scotland (n = 36,921), China (n = ...162,464), and Hong Kong (n = 29,187). Multimorbidity increased odds of admissions in all 3 settings. In Scotland, poorer people were more likely to be admitted (adjusted odds ratio aOR = 1.62; 95% CI, 1.41-1.86 for the lowest income group vs the highest), whereas China showed the opposite (aOR = 0.58; 95% CI, 0.56-0.60). In Hong Kong, poorer people were more likely to be admitted to public hospitals (aOR = 1.68; 95% CI, 1.36-2.07), but less likely to be admitted to private ones (aOR = 0.18; 95% CI, 0.13-0.25). Strategies to improve equitable health care should consider the impact of socioeconomic deprivation on the use of health care resources, particularly among populations with prevalent multimorbidity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract Purpose Current health care reforms in China have an overall goal of strengthening primary care through the establishment and expansion of primary care networks based on community health ...centers (CHCs). Implementation in urban areas has led to the emergence of different models of ownership and management. The objective of this study was to evaluate the primary care experiences of patients in the Pearl River Delta as measured by the Primary Care Assessment Tool (PCAT) and the relationships with ownership and management in the 3 different models we describe. Methods This cross-sectional study was conducted on-site at CHCs in 3 cities within the Pearl River Delta, China, using a multistage cluster sampling method. A validated Mandarin Chinese version of the PCAT–Adult Edition (short version) was adopted to collect information from adult patients regarding their experiences with primary care sources. PCAT scores for individual primary care attributes and total primary care assessment scores were assessed with respect to sociodemographic characteristics, health characteristics, and health care service utilization across 3 primary care models. Results One thousand four hundred forty (1,440) primary care patients responded to the survey, for an overall response rate of 86.1%. Respondents gave government-owned and -managed CHCs the highest overall PCAT scores when compared with CHCs either managed by hospitals (95.18 vs 90.81; P = .005) or owned by private and social entities (95.18 vs 90.69; P = .007) as a result of better first-contact care (better first-contact utilization) and coordination of care (better service coordination and information system). Factors that were positively and significantly associated with higher overall assessment scores included the presence of a chronic condition ( P <.001), having medical insurance (P = .006), and a self-reported good health status ( P <.001). Conclusions This study suggests that government-owned and -managed CHCs may be able to provide better first-contact care in terms of utilization and coordination of care, and may be better at solving the problem of underutilization of the CHCs as the first-contact point of care, one key problem facing the reforms in China.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract Background China is reshaping its health-care system to orient towards primary care. We developed a short instrument on the basis of the Primary Care Assessment Tool-Adult Edition (PCAT-AE) ...to assess patients' experiences of primary-care delivery in community health centres, the major primary-care provider in urban areas. Methods A multistage cluster sampling method was used to select seven geographical regions in southern China where the population's ageing and gender structure is similar to that of China's overall population. A validated PCAT-AE (Mandarin Chinese short version) with 33 PCAT items on a four-point Likert-type scale was used, with higher scores representing better primary-care experiences. This study was approved by the Ethics Committee of Guangzhou Medical University, Guangzhou, China, and the Survey and Behaviour Research Ethics Committee of The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China (TB106179/MD10606). All study participants provided written consent. Findings The overall response rate of adult subjects interviewed at community health centres was 85·8% (3360 of 3916). Both frequent (2237) and less-frequent service users (1123) were surveyed, among which 1122 (33%) patients had an optimum PCAT score (higher than the third quantile of the score range—ie, above 99 of 132). The proportion of subjects with optimum scores in individual primary-care domains ranged from 62·1% (95%CI 59·8–64·3) in the comprehensiveness of service attribute to only 16·6% (14·7–18·7) in the community orientation attribute. Among all subjects, those with social medical insurance were more likely to report optimum primary care experience (adjusted odds ratio 2·30, 95% CI 1·92–2·75) than those uninsured. In the stratified analysis among subjects who were uninsured, those attending community health centres owned and managed by the government as their usual source of primary care had the highest PCAT scores compared with other models of community health centres owned and managed by secondary or tertiary hospitals (95·16 vs 90·18; p=0·0001) or by private investors (95·16 vs 87·80; p<0·0001), as a result of better first-contact care and coordination of care. Interpretation The study suggests an urgent need to understand and address how social medical insurance coverage could affect patients' experiences. The community health centre model with a government-dominant top-down approach seems to be most effective in solving conundrums for China's health-care reform. Funding This study was funded by the Bauhinia Foundation Research Centre; Department of Health, Guangdong province (C2009006/2009–2013); Department of Education, Guangdong province (BKZZ2011047/2010–2013); Medical Research Fund, Chinese Medical Association (2010-08-05); and Community Health Research Fund, Community Health Association of China (2012-2-91). HHXW was supported by a postdoctoral research fellowship in the Hong Kong–Scotland Partners in Post Doctoral Research programme, Research Grants Council of Hong Kong and the Scottish Government (S-CUHK402/12). JJW is supported by Guangdong Exemplary Centres for Exploratory Teaching in Higher Education Institutions—General Practice Exploratory Teaching Centre (GDJG-2010-N38-35, Guangdong Department of Education) and The Ninth Round of Guangdong Key Disciplines—General Practice (GDJY-2012-N13-85, Guangdong Department of Education), both of which he leads.
Abstract Background: Although poor control of hypertension is a problem worldwide, most published studies of adherence to antihypertensive medications have involved only white subjects. Objective: ...This study examined levels of and factors associated with short-term adherence to β-blocker therapy among a representative sample of ethnic Chinese patients with hypertension from a large territory in Hong Kong. Methods: Data for all hypertensive patients aged ≥18 years who received a prescription for a β-blocker at a visit to any public primary care clinic in the New Territory East cluster of Hong Kong and made at least 1 subsequent visit for a refill of this prescription between January 2004 and June 2007 were obtained from a validated clinical database generalizable to the Chinese population. The proportion of patients who were adherent to β-blocker therapy was measured based on the medication possession ratio (MPR), calculated over 2 consecutive visits. Good adherence was defined as an MPR ≥80%. Factors potentially associated with adherence to β-blockers were investigated using multivariable logistic regression analysis, with adjustment for age, sex, payment status, service type, district of residence, visit type, and number of comorbidities. Results: Data were obtained for 15,918 eligible patients (62.2% female; mean age, 59.1 years). Of these patients, 81.3% were adherent to β-blocker therapy. Factors associated with a greater likelihood of good adherence to β-blocker therapy were age ≥50 years (adjusted odds ratio AOR, age 50–59 years = 1.53 95% CI, 1.38–1.70; AOR, age 60–69 years = 1.85 95% CI, 1.64–2.10; AOR, age ≥70 years = 1.88 95% CI, 1.66–2.12; all, P < 0.001); fee paid versus fee waived (AOR = 1.16 95% CI, 1.06–1.28; P = 0.001); attendance at a family medicine specialist clinic (AOR = 1.30 95% CI, 1.09–1.54; P = 0.003); and follow-up visit versus new-patient visit (AOR = 2.67 95% CI, 2.42–2.95; P < 0.001). Conclusion: Among these Chinese patients with hypertension, younger patients, those whose fees were waived, and those who were newly prescribed a β-blocker had a greater likelihood of being nonadherent.
Background Anticipated psychological responses and perceptions of risk have not been examined prior to the outbreak of an epidemic. Methods Using a cross-sectional, telephone survey, 805 Chinese ...adults in Hong Kong were interviewed anonymously in November, 2005 to examine beliefs related to H5N1 avian influenza and anticipated responses. Results Of respondents, 71.4% and 52.4%, respectively, believed that bird-to-human or human-to-human H5N1 transmission would occur in the next year. In the event of a bird-to-human or human-to-human outbreak in Hong Kong, many anticipated high fatality rates (70.5% and 74.4%, respectively), permanent physical damage (52.0% and 54.9%, respectively), inadequate vaccines (50.0% and 64.4%, respectively), insufficient medicine supplies (43.7% and 54.5%, respectively), inadequate hospital infection control (35.1% and 43.3%, respectively), high susceptibility of family members contracting H5N1 (13.9% and 24.3%, respectively), and impact on oneself/family worse than those of severe acute respiratory syndrome (21.2 and 25.0%, respectively). Most anticipated at least 1 of the 7 studied stress-related responses (e.g., panic) or the adoption of at least 1 of the 5 studied preventive behavioral measures (e.g., avoiding going out). Conclusion Panic and interruption of daily routines may occur in the event of a human avian influenza outbreak. Dissemination of accurate, timely information would reduce unnecessary distress and unwanted behaviors.
Abstract Background Dyslipidemia is a significant health problem, and persistent use of lipid-lowering agents among dyslipidemic patients is clinically important. However, few studies have evaluated ...the profiles of medication discontinuation among ethnic Chinese patients. Objective The objective of this study was to evaluate the level of medication adherence among Chinese patients who were prescribed a lipid-lowering drug and to investigate factors that could help physicians identify patients at risk for discontinuing their medication. Methods All patients who attended any primary care clinic in 1 territory of Hong Kong and were prescribed at least 1 lipid-lowering agent from January 2004 to June 2007 were included. The incidences of drug discontinuation within 180 days after drug prescriptions were measured, and the factors associated with discontinuation using binary logistic regression analyzes were evaluated. Results Of the 12,875 eligible patients, the majority were prescribed fibrates (54.4%) and statins (45.1%). Among the patients, 17.0% discontinued their medication. Older patients (adjusted odds ratio aOR = 0.72–0.79 for patients >50 years), male subjects (aOR = 0.87; 95% CI, 0.78–0.97; P = 0.009), fee payers (aOR = 0.88; 95% CI, 0.78–0.99; P = 0.029), attendees in family medicine specialist clinics (aOR = 0.82; 95% CI, 0.70–0.96; P = 0.013), residents in rural districts (aOR = 0.52; 95% CI, 0.44–0.60; P < 0.001), follow-up visitors (aOR = 0.60; 95% CI, 0.54–0.66; P < 0.001), patients with comorbidities (aOR = 0.39; 95% CI, 0.35–0.44; P < 0.001 for 1 comorbidity and aOR = 0.28; 95% CI, 0.25–0.33; P < 0.001 for at least 2 comorbidities), and persons who use fibrates (aOR = 0.56; 95% CI, 0.49–0.64; P < 0.001) were significantly less likely to discontinue their medication. Conclusions The findings of these associated factors were new for ethnic Chinese patients. These findings could help physicians identify patients who had been prescribed a lipid-lowering agent who were at higher risk of discontinuing their medication. Their medication-taking behavior should be monitored more closely, and future studies should evaluate the reasons of drug discontinuation.
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