Utilization of National Essential Public Health Services and Its Relationship with Management Effect in Chinese Type 2 Diabetic Patients
The national essential public health services (NEPHS) , which have been implemented since 2009, may be the largest population-based intervention practice for Chinese patients with diabetes currently. It is important to understand the utilization and management effect of such services in diabetic population over this period of more than 10 years of development.
To understand the utilization and management effect of NEPHS as well as their association in Chinese type 2 diabetics.
By use of multi-stage stratified sampling, 1 527 type 2 diabetics (≥35 years old) were selected from 20 community (township) health centers in 10 districts (counties) of 5 cities in eastern, central and western China during November to December 2019. Sociodemographic characteristics, utilization and management effect of NEPHS in these patients were collected by face-to-face surveys with a self-designed questionnaire.
According to the survey, patients' self-reported rates of creating health records, use of health records, undergoing standardized blood glucose tests, and receiving standard follow-ups were 90.34% (1 375/1 522) , 52.80% (725/1 373) , 83.69% (1 262/1 508) , and 90.18% (1 377/1 527) , respectively. Household follow-ups and hospital follow-ups accounted for 29.24% (443/1 515) and 61.06% (925/1 515) of the total last follow-ups, respectively. The analysis of management effect showed that patients' self-reported rates of home-based self-monitoring blood glucose and regular medication in the past 6 months were 53.57% (818/1 527) , and 89.26% (1 363/1 527) , respectively. The rates of patients who were satisfied with glycemic control, and overall medical services assessed in the last follow-up were 65.23% (996/1 527) , and 95.15% (1 453/1 527) , respectively. In those≥65 years old, the prevalence of home-based self-monitoring blood glucose differed significantly by the creation of health records and Chinese medicine services (P<0.05) . The prevalence of regular medication differed significantly by number of follow-ups (P<0.05) . The level of overall satisfaction with services differed significantly by the access to personal medical records at any time, Chinese medicine services, number of home-based self-monitoring blood glucose, and type of follow-up (P<0.05) . In those aged from 35 to 64, the prevalence of home-based self-monitoring blood glucose differed significantly by the creation of health records, access to personal medical records at any time, Chinese medicine services, number of blood glucose testing, and number of follow-ups (P<0.05) . The prevalence of regular medication differed significantly by the type of follow-up (P<0.05) . The satisfaction rate of blood glucose control differed significantly by access to personal medical records at any time (P<0.05) . The overall service satisfaction rate differed significantly by follow-up type and creation of health records (P<0.05) .
NEPHS have influenced community-based management of type 2 diabetic patients, the standard implementation of which has enhanced the management effect and the overall service satisfaction in these patients.
Changes in Beijing Residents' Primary Care Utilization during the New Round of Healthcare Reform：a Study Based on 2013 and 2018 Waves of the National Health Service Survey
Beijing has taken a series of measures to promote patients to use primary healthcare since the implementation of the new round of healthcare reform in 2009, especially after the comprehensive reform of separating medical treatment and drug sales, but there is a lack of evidence on the improvement in Beijing residents' use of primary healthcare. The features of users of primary healthcare are still unclear, and if the majority of them have low socioeconomic status, which may bring about the issue of inequity in healthcare use.
To examine the features of Beijing residents choosing a healthcare institution for treatment between 2013 and 2018, and analyze the changes over the period, to provide evidence for promoting the development of tiered diagnosis and treatment system.
This study was carried out from July to September 2020 using the data of Beijing part of the Fifth National Health Service Survey (2013) and Sixth National Health Service Survey (2018) , involving residents≥15 years old with medical experience in the two weeks prior to the survey. Residents' healthcare utilization behaviors were analyzed using Andersen's behavioral model of healthcare utilization, and the changes over the period were analyzed using multiple logistic regression and the Chow test.
The rate of using primary healthcare in the residents increased to 64.40% (4 125/6 405) in 2018 from 60.89% (1 527/2 508) in 2013, showing a statistical difference (χ2=9.61, P=0.002) . Compared to the year 2013, the year 2018 witnessed increased rates of primary healthcare utilization in females, those≥60 years old, living in urban areas, having non-low income, urban employee basic medical insurance, or two or more chronic diseases (P<0.05) . Multiple Logistic regression analysis showed that age, residential area, type of medical insurance and prevalence of chronic diseases were the influencing factors for the selection of medical institutions in Beijing in 2013 (P<0.05) , and gender, age, per capita income level of family, type of medical insurance and prevalence of chronic diseases were the influencing factors for the selection of medical institutions in Beijing in 2018 (P<0.05) . The Chow test demonstrated that increased rates of primary healthcare utilization were found mainly in residents with urban employee basic medical insurance〔OR (95%CI) =1.56 (1.24, 1.97) 〕 and those living in urban areas〔OR (95%CI) =1.27 (1.01, 1.58) 〕 (P<0.05) .
In general, the primary healthcare utilization behaviors of Beijing residents showed an increase trend from 2013 to 2018, and the majority of them were those living in urban areas and/or having urban employee basic medical insurance.
Utilization and Associated Factors of Community Health Management Services in Hypertensive and Diabetic Patients
Hypertension and diabetes have been included in the list of China's essential public health services since 2009. During these years, the use and associated factors of community health management services in community-living hypertensive and diabetic patients are not very clear and need to be further studied.
To investigate the use and potential associated factors of community health management services in Shenzhen community-living hypertensive and diabetic residents.
Data stemmed from the results of Shenzhen Epidemiological Survey on Chronic Non-communicable Diseases and Risk Factors conducted between September and November 2018. The chi-square test and multinomial Logistic regression were used to examine the association of sex, age, place of hukou registration (Shenzhen or not) , marital status, monthly household income per capita, occupation type, years of living in Shenzhen, prevalence of medical insurance enrollment, and the level of medical institutions making a definite diagnosis with the use of community health management services.
Altogether, 10 042 participants were finally enrolled, including 1 132 with self-reported hypertension, and 402 with self-reported diabetes. Among the hypertensive participants, 530 (46.82%) indicated that they received follow-up management of hypertension from the community health center. Specifically, 436 (82.31%) received blood pressure measurement by the doctor, and 399 (75.25%) received medication guidance from the doctor. Of the diabetic patients, 194 (48.26%) indicated that they received follow-up management of diabetes from the community health center. Specifically, 173 (89.37%) of the 193 cases (one case was excluded due to missed information) received blood glucose measurement by the doctor, and 154 (79.62%) received medication guidance from the doctor. The prevalence of hypertensive participants receiving guidance on smoking cessation or smoking less from the doctor was relatively low (lower than 40%) , and so was that of diabetic participants. The prevalence of hypertensive participants receiving guidance on drinking cessation or drinking less from the doctor was relatively low (lower than 40%) , and so was that of diabetic participants. Multinomial Logistic regression analysis revealed that sex, age, monthly household income per capita, years of living in Shenzhen, and prevalence of medical insurance enrollment were associated with the utilization of community health management services in hypertensive patients (P<0.05) . Age, occupational type, and monthly household income per capita were associated with the utilization of community health management services in diabetic patients (P<0.05) .
Less than half of the community-living hypertensive and diabetic participants used or were involved in community health management services. Being female, 18-44-year-old, low or moderate monthly household income per capita, and short years of living in Shenzhen were associated with lower rate of utilizing such services. Moreover, hypertensive cases without medical insurance, and diabetics engaging in a manual labor job were far less likely to utilize the services. In view of this, it is suggested to strengthen the publicity of essential public health services in the above-mentioned priority groups. Besides that, the awareness of doctors in community health centers should be strengthened to provide patients with guidance on developing healthy lifestyles, such as stopping smoking and drinking.
