Objective: To analyze the effect of intervention programs and influencing factors regarding the community "5+1" staged diabetes target management on patients with type 2 diabetes mellitus (T2DM) and to provide evidence for improving the quality of life (QOL). Methods: A total of 12 community health service centers from Shanxi province, Jiangsu province, and Ningxia Hui autonomous region were selected as intervention group and control group, by stratified cluster sampling method. "5+1" model was used in intervention groups and basic public health services model was applied in control groups for this two-year follow-up. Data was collected through a questionnaire on demographic and disease-related information, while the QOL was measured with SF-36. Multiple linear regression and conducted by SAS 9.4. Results: A total of 2 467 subjects were included at baseline and 1 924 had completed a two-year-long management service. After intervention programs being implemented, the net effect of PCS score between the intervention and the control groups was 13.6, with the net effect of MCS score as 29.8. Results from the multiple linear regression showed that the main factors affecting PCS scores included age, type of medical insurance, baseline PCS score and regions of residency. Main factors related to MCS score included age, type of medical insurance, baseline MCS score, hypertension, and region of residency. Conclusion: Community "5+1" staged diabetes target management model presented favorable effect of improving the QOL on T2DM patients.
Community Health Services/organization & administration* ; Diabetes Mellitus, Type 2/therapy* ; Humans ; Hypertension ; Program Evaluation ; Quality of Life ; Self Care ; Self-Management ; Surveys and Questionnaires

Objective: To assess the capacity of prevention and control on chronic non- communicable diseases (NCDs) in China. Methods: On-line questionnaire survey was adopted by 3 395 CDCs at provincial, municipal and county (district) levels and 3 000 primary health care units, and assess on capacity of policy, infrastructure, capacity of training and guidance, cooperation, surveillance, intervention and management, assessment and scientific research from September 2014 to March 2015. Results: (1) Capacity of policy: 23 (71.9%) provincial, 139 (40.6%) municipal and 919 (31.2%) county (district) governments or health administrative departments had existing plans for prevention and control of NCDs. (2) Capacity of infrastructure: 25 (78.1%) provincial, 136 (39.8%) municipal and 529 (18.0%) county (district) CDCs had set up departments dedicated to the prevention and control of NCDs, with 9 787 staff members, accounting for 5.0% of the total CDC personnel, working on NCDs prevention and control programs. 68.1% of the CDCs had special funding set for NCDs prevention and control. (3) Capacity of training and guidance: 2 485 CDCs (74.9%) held all kinds of training on prevention and control of NCDs. 2 571 (87.3%) CDCs at the county (district) level provided technical guidance for primary health care units. (4) Capacity of cooperation: 42.0% of the CDCs had experiences collaborating with the mass media. (5) Capacity of surveillance: 73.8% of the CDCs had set up programs for death registration while less than 50.0% of the CDCs had implemented surveillance programs on major NCDs and related risk factors. In terms of primary health care units, 32.4% of them had set up reporting system for newly developed stroke case and 29.9% of them having programs on myocardial infarction case reporting. (6) Capacity of intervention and management: 69.1% and 68.2% of the CDCs conducted individualized intervention programs on hypertension and diabetes, while less than 40.0% CDCs conducting intervention programs on other NCDs and risk factors. More than 90.0% of the primary health care units carried out follow-up surveys on hypertension and diabetes. However, only 17.4% and 13.7% of the CDCs working on hypertension and diabetes patient management programs while 83.7% and 80.4%, of them following the standardized guidelines for management, with successful rates of control as 59.2% and 55.2%, respectively. (7) Capacity of assessment: 32.4% of the CDCs or health administrations carried out evaluation programs related to the responses on NCDs. (8) Capacity of scientific research: the capacity on scientific research among provincial CDCs was apparently higher than that at the municipal or county (district) CDCs. Conclusions: Compared with the results of previous two surveys, the capacity on policies set for the prevention and control programs improved continuously, at all level NCDs, but remained relatively weak, especially at both county (district) and primary health care units.
China ; Chronic Disease/prevention & control* ; Community Health Services/organization & administration* ; Health Planning Organizations/organization & administration* ; Humans ; Noncommunicable Diseases/prevention & control* ; Public Health ; Risk Factors ; Surveys and Questionnaires ; Workforce

The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service (CHS) under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor-patient relationships, information and support, organization of care, and accessibility (P < 0.001). One or more factors such as gender and self-perceived health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients' satisfaction with CHS by strengthening their awareness of the gatekeeper policy.
Adolescent ; Adult ; China ; Community Health Services ; organization & administration ; Data Collection ; Female ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; statistics & numerical data ; Young Adult

OBJECTIVETo study the efficacy of community management model of bronchial asthma in children.

METHODThrough community outreach and clinic, 120 cases of children with asthma were enrolled from the 11 000 children aged 0 to 14 in Zhanlanlu area, and a community management model of asthma was established according to the Global Initiative for Asthma requirements combined with the actual situation of the community, both physicians and patients participated in case identification, file creation, and long-term standardized management. Through repeated medical education, the telephone hotline and interactive network of asthma among physicians, children and parents, a physician-patient relationship was established. The data of standardized medication, scheduled re-visit to the hospital, frequency of asthma attacks, antibiotic use, medical expenses, the loss of parents work hours etc. before and after the implementation of community management model were analyzed and compared.

RESULTAfter implementation of community management model, the use of systemic corticosteroids (19.4%), oral medication (31.6%) was significantly lower than those before implementation (68.3% and 90.0%) (χ(2) = 51.9, 41.1, P < 0.01), use of inhaled corticosteroids (76.5%) and oral leukotriene receptor antagonist (79.6%) was significantly higher compared with control and before management level (10.0%), χ(2) = 106.0, P < 0.01. The days of attacks of asthma (4.6 ± 2.3), the use of antibiotics (16.2 ± 6.1), (5.7 ± 2.9) and the cost of treatment significantly decreased. In 16 cases (13.3%) two-way referral was applied. In this study, the dropout rate was 18.3%, by telephone and network supervision of lost cases, re-education, made some children return to management, eventually the dropout rate was 9.2%.

CONCLUSIONEnrollment of children with bronchial asthma into community management model made the children adhere to the management regularly and a standardized management was achieved.

Adolescent ; Adrenal Cortex Hormones ; administration & dosage ; therapeutic use ; Anti-Asthmatic Agents ; administration & dosage ; therapeutic use ; Asthma ; drug therapy ; therapy ; Child ; Child Health Services ; methods ; organization & administration ; Child, Preschool ; Community Health Services ; methods ; organization & administration ; Community Networks ; Disease Management ; Drug Administration Schedule ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Patient Compliance ; Patient Education as Topic ; organization & administration ; Self Care

OBJECTIVETo assess the policies and programs on the capacity of prevention and control regarding non-communicable diseases (NCDs) at the Centers for Disease Control and Prevention (CDCs) at all levels and grass roots health care institutions, in China.

METHODSOn-line questionnaire survey was adopted by 3 352 CDCs at provincial, city and county levels and 1 200 grass roots health care institutions.

RESULTS1) On policies: 75.0% of the provincial governments provided special funding for chronic disease prevention and control, whereas 19.7% city government and 11.3% county government did so. 2) Infrastructure:only 7.1% county level CDCs reported having a department taking care of NCD prevention and control. 8 263 staff members worked on NCDs prevention and control, accounting for 4.2% of all the CDCs' personnel. 40.2% CDCs had special funding used for NCDs prevention and control. 3)Capacity on training and guidance:among all the CDCs, 96.9% at provincial level, 50.3% at city level and 42.1% at county level had organized training on NCDs prevention and control. Only 48.3% of the CDCs at county level provided technical guidance for grass-roots health care institutions. 4) Capacities regarding cooperation and participation: 20.2% of the CDCs had experience in collaborating with mass media. 5) Surveillance capacity: 64.6% of the CDCs at county level implemented death registration, compare to less than 30.0% of CDCs at county level implemented surveillance programs on major NCDs and related risk factors. In the grass roots health care institutions, 18.6% implemented new stroke case reporting system but only 3.0% implemented program on myocardial infarction case reporting. 6) Intervention and management capacity: 36.1% and 32.2% of the CDCs conducted individualized intervention on hypertension and diabetes, while less than another 20% intervened into other NCDs and risk factors. More than 50% of the grass roots health care institutions carried follow-up survey on hypertension and diabetes. Rates on hypertension and diabetes patient management were 12.0% and 7.9% , with rates on standard management as 73.8% and 80.1% and on control as 48.7% and 50.0%, respectively. 7) Capacity on Assessment: 13.3% of the CDCs or health administrations carried out evaluation programs related to the responses on NCDs in their respective jurisdiction. 8) On scientific research: the capacity on scientific research among provincial CDCs was apparently higher than that at the city or county level CDCs.

CONCLUSIONPolicies for NCDs prevention and control need to be improved. We noticed that there had been a huge gap between county level and provincial/city level CDCs on capacities related to NCDs prevention and control. At the grass-roots health care institutions, both prevention and control programs on chronic diseases did not seem to be effective.

China ; Chronic Disease ; prevention & control ; Community Health Services ; manpower ; organization & administration ; Humans

Aged, 80 and over ; Community Health Services ; Female ; Humans ; Male ; Pilot Projects ; Terminal Care ; organization & administration

OBJECTIVETo investigate the community-based management status of hypertensive patients aged 35 or over in China and provide basic data for evaluation by investigating the hypertensive patients managed in communities.

METHODSThe subjects in this study were recruited from the individuals of the 2010 China Non-communicable and Chronic Diseases. In September 2011, flow-up survey and a cross-section analysis has been done during the same people interviewed in 2010. Clustering sampling method was used to select 11 977 samples aged 35 or over and diagnosed by doctors from community level or above hospitals to be interviewed. A face to face questionnaire survey was carried out to collect information on general demographic characteristics, the treatment and control of blood pressure and risk factors of the hypertensive patients of community management.Sample was weighted according to complex sampling scheme and post-stratification to represent the population of Chinese hypertensive patients aged 35 or over and the rates with 95% confidence intervals (CI) were calculated for the subgroups according to different characteristics. The Rao-scott χ(2) test was performed to test for the differences of the rates of the subgroups.

RESULTSIn the survey, there were 11 977 patients aged 35 or over diagnosed as hypertension by doctors, and among them, a total of 5120 hypertensive patients had been under management in communities. After being weighted the rate of management of hypertensive patients in communities was 43.99% (95%CI:38.17%-49.81%). There was a significant difference in the proportion of patients receiving management services when comparing different age groups (χ(2) = 21.98, P < 0.01) and sex (χ(2) = 4.18, P < 0.05), the rate of management among the patients aged 65 or over was 46.97% (95%CI:40.44%-53.50%), while among the patients aged 35 to 44 was only 37.72% (31.78%-43.65%). The rate of management was higher among females (45.37%, 95%CI:39.24%-51.50%) than males (42.50%, 95%CI:36.71%-48.30%). The overall rate of standardized management of hypertensive patients managed in communities was 35.30% (95%CI:31.78%-38.81%). The research also found differences in the proportions of patients receiving standardized management services when comparing different age groups (χ(2) = 28.66, P < 0.05), gender (χ(2) = 235.85, P < 0.01), and regions (χ(2) = 9.29, P < 0.05). The rate of receiving standardized management services among the patients aged 65 or over was 40.52% (95%CI:36.21%-44.82%), while among the patients aged 35 to 44 was only 26.18% (95%CI:20.07%-32.29%), the rate was lower among males (16.78%, 95%CI:14.13%-19.42%) than females(51.29%, 95%CI:46.41%-56.16%) , the rate of patients living in urban areas (38.53%, 95%CI:34.34%-42.72%) was higher than patients living in rural areas (33.36%, 95%CI:28.17%-38.55%) . The differences of the treatment rates of hypertensive patients managed in communities were found among different age groups (χ(2) = 26.39, P < 0.01), gender (χ(2) = 13.91, P < 0.01), and regions (χ(2) = 4.27, P < 0.05), the rate of treatment was 94.67% (93.41%-95.93%) among the patients aged 65 or over , while 86.47% (95%CI:81.05%-91.89%) among patients aged 35 to 44, the rate of treatment was higher among females (94.35%, 95%CI:93.15%-95.55%) than among males (90.84%, 95%CI:88.99%-92.70%), and it was also higher among patients living in urban regions (94.17%, 95%CI:92.62%-95.71%) than among patients living in rural regions (91.86%, 95%CI:90.20%-93.52%). The rate of control of hypertensive patients managed in communities was 33.13% (95%CI:29.50%-36.76%) and the rate was higher among the subjects living in the urban areas (45.09%, 95%CI:38.73%-51.45%) than in rural areas (25.96%, 95%CI:21.63%-30.30%) (χ(2) = 22.40, P < 0.01).

CONCLUSIONResults from our study showed that community management of hypertension had been popularized across the country. And it could significantly improve the program on the treatment and control of hypertension at the community level in China.

Adult ; Aged ; China ; epidemiology ; Community Health Services ; organization & administration ; Disease Management ; Female ; Humans ; Hypertension ; epidemiology ; therapy ; Male ; Middle Aged ; Surveys and Questionnaires

INTRODUCTIONWe assessed the pedagogical value of a student-led community-based experiential learning project called the Public Health Screening (PHS) run by medical and nursing students of the National University of Singapore's Yong Loo Lin School of Medicine (NUS YLLSoM).

MATERIALS AND METHODSWe conducted a cross-sectional study using a self-administered anonymised questionnaire on medical and nursing students who participated in PHS using the Fund for the Improvement of Postsecondary Education (FIPSE) Survey Instrument. Participants also gave an overall score for their learning experience at the PHS.

RESULTSThe participation rate was 93.1% (576/619) for medical students and 100% (37/37) for nursing students. All participants gave the PHS learning experience a high rating (median = 8 out of maximum of 10, inter-quartile range, 7 to 9). A majority of participants felt that PHS had helped them to improve across all domains surveyed. For medical students, those in preclinical years and females were independently more likely to feel that PHS had helped them to improve in communication skills, teamwork, ability to identify social issues, taking action, and gaining and applying their knowledge than those in clinical years and males. Improved ability to interact with patients (β=1.64, 95%CI, 1.01-2.27), appreciation of challenges to healthcare faced by Singaporeans from lower income groups (β=0.93, 95%CI, 0.49-1.37), thinking of others (β=0.70, 95%CI, 0.04-1.37) and tolerance of different people (β =0.63, 95%CI, 0.17-1.10) were strongly associated with the overall rating score.

CONCLUSIONPHS was a positive learning experience in a wide range of domains for all students involved. This suggests that student-organised community-based experiential learning projects have potential educational value for both medical and nursing students.

Attitude of Health Personnel ; Community Health Services ; organization & administration ; Confidence Intervals ; Cross-Sectional Studies ; Data Collection ; Education, Medical ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Learning ; Logistic Models ; Male ; Mass Screening ; Models, Educational ; Odds Ratio ; Program Development ; Program Evaluation ; Public Health Practice ; Schools, Medical ; Singapore ; Students, Medical ; Students, Nursing ; Surveys and Questionnaires ; Teaching ; Volunteers

PURPOSE: This study was a part of a drive to develop a community health center-based hospice management model which is concerned with hospice care at a community health care setting and available resources of the local community. METHODS: Development of a community health center-based hospice management model involved evaluation of existing hospice-related research, including literature review, and research on hospice facilities at the study site, as well as evaluation of model operation. The latter involved community health center-based hospice test operation, and evaluation of test operation by a research team, including of a nursing professor majoring in hospice care and staffs from a community health center in Busan metropolitan city, regional cancer center, and regional terminal cancer patient medical institute. The study was conducted in the 2008 calendar year. RESULTS: The community health center-based hospice management model provides service linked with local community resources, focusing on the local community health center. Financial and administrative assistance is provided by the regional cancer center, with collaboration from academic health care professionals who guide the operation management. The community health center hospice nurse in consultation with a visiting nurse team registers terminally-ill cancer patients and, after assessment, the hospice team prioritize hospice care during team meeting. Care is delivered by staffs and volunteers. CONCLUSION: The developed community health center-based hospice operation management model maximally utilizes available community health resources to produce qualitative improvement of regional health and welfare policy through improving the lives of home-based cancer patients and their family who are in medical blind spot.
Community Health Centers ; Community Health Nursing ; Community Health Services ; Cooperative Behavior ; Delivery of Health Care ; Health Resources ; Hospice Care ; Hospices ; Humans ; Models, Organizational ; Optic Disk ; Organization and Administration ; Pilot Projects

AIMThe objective of this discussion paper is to investigate whether the experience gained through the German paradigm shift in dental care can be of benefit in China's deliberations on the introduction of universal dental care for its people. METHODOLOGY A comparison of representative oral health outcome data from China and Germany, two countries at different stages in their development, is presented here in order to analyse whether the findings meet expected outcome and confirm the presumption that more developed countries perform better.

RESULTSThe epidemiological comparison reveals surprising findings concerning the severity of dental diseases and, in particular, missing teeth per person in adults and rates of total edentulousness in seniors. In all of these areas German adults and seniors show significantly inferior outcomes compared with the Chinese population. The main reason for these striking discrepancies, as it turned out, is the decisive role played by the treatment philosophies and strategies of German dentists.

CONCLUSION AND RECOMMENDATIONSIf dentists take a less interventionist approach, checking as well as treating dental diseases with preventive and strictly tooth-preserving methods, dental treatment results in oral health. Under these conditions it can be assumed that modern dentistry is generally good for the teeth. These findings are important for developing countries that are seeking to integrate dental care into their health care system. On the basis of long-term experience from highly industrialized Western countries and especially from Germany we will attempt to put forward proposals for creating an effective and efficient dental care system in China.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; China ; epidemiology ; Community Dentistry ; Delivery of Health Care ; organization & administration ; Dental Caries ; epidemiology ; Dental Health Services ; organization & administration ; Dentists ; supply & distribution ; Germany ; epidemiology ; Health Care Reform ; Health Policy ; Health Priorities ; Health Transition ; Humans ; Insurance, Health ; Middle Aged ; Mouth, Edentulous ; epidemiology ; Oral Health ; Outcome Assessment (Health Care) ; Periodontal Diseases ; epidemiology ; Philosophy, Dental ; Preventive Dentistry ; Reimbursement Mechanisms ; Tooth Loss ; epidemiology ; Universal Coverage ; organization & administration ; Young Adult