Chinese General Practice

Clinical Practice Guidelines for Exercise Interventions for the Prevention of Disability in Older Adults (2023)

Nursing Group of Chinese Society of Geriatrics, Committee on Geriatric Nursing of Chinese Association of Geriatric Research, China Gerontological Nursing Alliance, National Center of Gerontology, Institute of Geriatric Medicine of Chinese Academy of Medical Sciences, HU Huixiu, ZHAO Yajie, SUN Chao

2023, 26(22): 2695-2710. DOI: 10.12114/j.issn.1007-9572.2023.0223

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The prevention and delay of disability is important for promoting healthy aging. Exercise intervention is an efficient strategy for disability prevention. Besides, exercise intervention presents significant therapeutic advantages and broad application prospects due to low cost, low implementation difficulty, high acceptance and wide application scenarios. Therefore, Nursing Group of Chinese Society of Geriatrics, Committee on Geriatric Nursing of Chinese Association of Geriatric Research, China Gerontological Nursing Alliance, National Center of Gerontology, Institute of Geriatric Medicine of Chinese Academy of Medical Sciences jointly developed and published Clinical Practice Guidelines for Exercise Interventions for the Prevention of Disability in Older Adults (2023). According to the methodologies specified in WHO Handbook for Guideline Development, the guidelines finally involve 32 recommendations and 18 clinical issues containing exercise principles, effectiveness and plans of different types of exercise, facilitators and barriers during exercise, aiming to provide a reference for the development and implementation of exercise programs for older adults at risk of disability and standardize clinical practice, thus promoting the gateway to improving physical function of the older adults, reducing the prevalence of disability, improving quality of life, contributing to healthy aging.

Cooperated and Shared Care: Reflections on Treatment-prevention Integration

YANG Hui

2023, 26(22): 2711-2714. DOI: 10.12114/j.issn.1007-9572.2022.W0006

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The persistent elevation of the prevalence of chronic non-communicable diseases and sudden pandemic of COVID-19 infections have once again attracted the attention of the whole society to prevention activities closely associated with epidemic prevention. Although the correlation between prevention and treatment of health is a long-term topic, innovation and mechanism of treatment-prevention integration proposed by Chinese health administration after the peak of COVID-19 epidemic has attracted attention and reflections of the medical and academic fields. Medical treatment and prevention are inseparable. The questions such as how to achieve the coordination and balance between treatment and prevention, what is the solution of treatment-prevention integration, are worth further study and exploration. Beginning with clarifying the concept of treatment and prevention, this paper analyzes the reasons for the separation of treatment and prevention, explores the approaches for effective connection and cooperative interaction between the two, thus providing further research directions for general practice researchers, calling on colleagues in general practice to contribute their wisdom and promote the contribution of treatment-prevention integration to healthy China.

Practice Strategy of Treatment-prevention Integration of Family Doctor Team in China

ZHAO Linlin, SHAO Shuang, LUO Qi, CHEN Xiaolei, DU Juan

2023, 26(22): 2715-2719. DOI: 10.12114/j.issn.1007-9572.2023.0246

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The integration mechanism of medical treatment and prevention based on family doctor teams is a key way to break down the barrier between "medical" and "prevention". In this paper, we explain the definition and connotation of treatment-prevention integration, review the development history of family doctor teams, systematically review the typical practice strategies and the shortcomings of treatment-prevention integrationon family doctor teams in China. Measures should be taken to promote the treatment-prevention integration, including improve the talent training system, change views of "attaching importance to treatment and neglecting prevention", strengthen the organization and management, innovate the assessment and incentive mechanism, reform the medical insurance payment method, encourage diversified forms of services, etc. The study aims to provide reference for improving the quality of services and developing treatment-prevention integration in the future.

Construction of an Innovative Model of Chronic Disease Management in Compact County Medical Alliance with Treatment-prevention Integration

DENG Hongyu, WU Miaomiao, YANG Zheng, HE Yang, ZHU Linlin, ZHAO Qian, DAI Hua, WU Jia, LIAO Xiaoyang, ZHANG Yonggang

2023, 26(22): 2720-2725. DOI: 10.12114/j.issn.1007-9572.2023.0150

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Background

In 2019, the National Health Commission launched the construction of compact county medical alliance to strengthen chronic diseases management in primary care, and the construction of chronic disease management models varies among county medical alliance sites. Xindu District, as one of the first national compact county medical alliance sites in Sichuan Province, has explored both dimensions of theoretical and practical innovation in the construction of the innovative model of chronic disease management in compact county medical alliance with treatment-prevention integration, providing a new approach for the innovative development of primary compact county medical alliance in China.

Objective

To analyze the innovation model and its effectiveness of chronic disease management in compact county medical alliance with treatment-prevention integration of Xindu District with the experience of international integrated medical models.

Methods

The chronic disease management in compact county medical alliance with treatment-prevention integration of Xindu District was constructed with "one center, two integration, three reforms and four safeguard mechanisms" under the leadership of Xindu District Health Bureau, to strengthen the management of chronic diseases mainly including hypertension and diabetes.

Results

As of June 2022, the number of hypertension or diabetes patients under standardized management in the district increased by 50.87% compared with the initial stage of construction, the number of hypertension or diabetes patients increased by 55.28% and 49.04%, respectively; while the proportion of patients with HbA_1c<7% or BP<140/90 mmHg (1 mmHg=0.133 kPa) increased by 70.69% and 115.28% in the past year among them, respectively. The outpatient visits of primary care increased by 14.30% in one year, among which the outpatient visits for hypertension or diabetes increased by 36.01%; while downward referrals within medical communities increased by 14.55%, creating a number of demonstration units for the transformation of treatment-prevention integration in primary care.

Conclusion

The innovative model of chronic disease management in compact county medical alliance with treatment-prevention integration of Xindu District has a significant effect on improving the quality and efficiency of chronic disease management in primary care.

Progress and Effectiveness of the Health Status and Equity of Health Service Utilization of Rural Residents in Ningxia During 10 Years after the New Healthcare Reform

QIAO Hui, XIE Yongxin, XIAO Wenwen, GAO Baokai, CHEN Kexin

2023, 26(22): 2726-2733. DOI: 10.12114/j.issn.1007-9572.2023.0033

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Background

The health care and health system reform is a worldwide issue. In 2009, China launched a new round of health care and health system reform. Over the past ten years, especially since the 18th National Congress of the Communist Party of China, the reform has brought tangible benefits to nearly 1.4 billion people. The decade of the new medical reform, which concentrates the interests of all parties, is a highlight of China's medical and health services. The discussion and demonstration of the reform effectiveness has become a hot topic in the academic field.

Objective

To sort out and analyze the data changes of the health status and equity of health service utilization of rural residents in Ningxia during the process of new medical reform and the reflected development effectiveness.

Methods

The baseline data was collected from the "Family Health Interview Survey for Rural Residents" in Ningxia in 2009, and the follow-up data in 2015 and 2019. The self-rated unhealthy rate and prevalence of chronic diseases were selected as indicators to measure the health status of residents, and the two-week consultation rate and hospitalization rate were selected as indicators to measure the health service utilization of residents. The concentration index (CI) and its decomposition method were used explore the health status and equity of health service utilization of rural residents in Ningxia in the past decade of the new medical reform.

Results

During the decade of the new medical reform, the self-rated unhealthy rate of rural residents in Ningxia decreased, and the prevalence of chronic diseases increased year by year. The self-rated unhealthy rate in 2009, 2015 and 2019 was 20.37% (4 107/20 160), 17.75% (3 216/18 114) and 19.51% (3 527/18 074) ; the prevalence of chronic diseases was 13.01% (2 623/20 160), 19.45% (3 523/18 114) and 26.28% (4 750/18 074), respectively. The overall changes in health service utilization showed an upward trend, the two-week consultation rate in 2009, 2015 and 2019 was 6.43% (1 296/20 160), 5.66% (1 026/18 114) and 8.06% (1 457/18 074) ; the hospitalization rate was 8.89% (1 792/20 160), 10.66% (1 931/18 114) and 13.23% (2 392/18 074), respectively. Equity of health and health service utilization have been improved, the CI of the self-rated unhealthy rate of rural residents in Ningxia in 2009, 2015 and 2019 was -0.024 1, -0.095 2 and -0.098 0; the CI of the prevalence of chronic diseases in 2009, 2015 and 2019 was -0.001 3, -0.081 5 and -0.081 0, respectively; the CI of two-week consultation rate was 0.068 8, -0.011 3, -0.051 2, and the CI of two-week hospitalization rate was 0.039 0, -0.029 4, -0.061 2, respectively. The main influencing factors of equity gradually evolved from the relatively single phenomenon of economic income being the dominant factor to the situation where age, economic income, chronic diseases, education level and other factors interact in multiple ways.

Conclusion

The health status and equity of health service utilization of rural residents in Ningxia has been improved in the past decade of the new medical reform. However, more attention should be paid to new issues and inequities caused by the aging population and changes in social structure.

Changes and Equity of Health Service Utilization in Middle-aged and Elderly People in Rural Mountainous Areas of Southern Ningxia during 10 Years after the New Healthcare Reform

CHEN Kexin, WANG Wenlong, HU Zhaoyan, GAO Baokai, QIAO Hui

2023, 26(22): 2734-2739. DOI: 10.12114/j.issn.1007-9572.2023.0040

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Background

"Everyone enjoys essential medical and health services" and "achieving health equity" are core goals of the new healthcare reform initiated in 2009 in China. Rural middle-aged and elderly people are key target groups of healthy aging promotion, but there are few longitudinal studies on the equality in their use of health services during 10 years since the beginning of the new healthcare reform.

Objective

To understand the changes in health service utilization among middle-aged and elderly people in rural areas of Ningxia during 2009 to 2019, and to explore the factors affecting the equity of health service utilization.

Methods

The information related to health service utilization in middle-aged and elderly people aged 45 years and above in rural mountainous areas of southern Ningxia was obtained from the baseline survey conducted in 2009 and subsequent follow-up surveys in 2015 and 2019. The changes of health service utilization of this population before and after the new healthcare reform were analyzed by the χ² test. The concentration index (CI) and decomposition of CI technique were used to measure the equity in health service utilization and explore its associated factors.

Results

The two-week consultation rates in these middle-aged and elderly people in 2009, 2015 and 2019 were 13.14% (973/7 406), 10.14% (943/9 302), and 12.75% (1 066/8 360), respectively, showing statistically significant difference (χ²=46.340, P<0.001). The hospitalization rates in them in 2009, 2015, and 2019 were 13.27% (983/7 406), 18.07% (1 681/9 302), and 22.93% (1 917/8 360), respectively, with statistically significant difference (χ²=245.657, P<0.001). The first leading cause of non-seeking healthcare for an illness within two weeks was financial difficulties〔58.35% (353/605) 〕in 2009, and was self-perceived mildness of symptoms in 2015〔34.47% (121/351) 〕 and 2019〔34.21% (117/342) 〕. In the three surveys, financial difficulties were the top reason for those needing hospitalization but not being hospitalized, accounting for 83.82 % (228/272) in 2009, 60.98% (75/123) in 2015, and 41.22% (54/131), respectively. The values of CI of the two-week consultation rate in the three surveys were 0.056 5, 0.012 8, and 0.018 6, respectively, and those of the hospitalization rate were 0.045 8, -0.011 0, and 0.002 0, respectively. Economic level, chronic disease, age, and family size were main contributing factors to the inequity in health service utilization.

Conclusion

A significant increase was seen in the use rate of inpatient service utilization in this population during the 10 years after the healthcare reform, but their utilization rate of outpatient health services needed to be improved. Health service utilization tended to return to equity, but it was still higher in high-income individuals. Economic level was the primary factor affecting the equity of health service utilization.

Equity and Influencing Factors of Health Service Utilization among Middle-aged and Elderly Adults with Disabilities in Rural Mountainous Areas of Southern Ningxia During 10 Years after the New Healthcare Reform

WANG Wenlong, GAO Baokai, HU Zhaoyan, CHEN Kexin, QIAO Hui

2023, 26(22): 2740-2747. DOI: 10.12114/j.issn.1007-9572.2023.0042

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Background

As global aging advances, the number of people with disability is increasing. Disability seriously affects quality of life and increases the burden caused by healthcare expenditure. Most domestic studies focus on disabilities in middle-aged and elderly people, but there is a lack of longitudinal studies on the fairness of health service utilization and changes in its associated factors in rural middle-aged and elderly people with disability.

Objective

To analyze the fairness of health service utilization and major associated factors in middle-aged and elderly people with disability in rural mountainous areas of southern Ningxia.

Methods

This study used data from three waves of the Rural Household Health Survey (including the baseline survey in 2009 and two follow-up surveys in 2015 and 2019), and selected middle-aged and elderly adults (≥55 years old) with disabilities from the surveyees as the participants. The health service utilization equity of sample population before the new healthcare reform launched in 2009 and during 10 years after the reform was analyzed by using concentration index, and factors affecting the equity were analyzed by decomposing the concentration index.

Results

We selected 1 351 cases from the surveyees of 2009, 1 521 cases from the surveyees of 2015, and 685 cases from the surveyees of 2019. The concentration index for two-week visit rate in the participants was 0.119 9 for 2009, 0.052 1 for 2015, and 0.060 9for 2019. Women (CI=0.108 2, -0.084 1) had higher level of inequalities in heath service utilization than men (CI=-0.022 9, 0.029 5) in 2015, 2019 year. Upper-middle income and high income were major factors contributing to inequalities in health service utilization in this population in 2009, explaining 3.626 9% and 2.596 5% of the inequalities, respectively. In 2015, in addition to economic factors, marital status (married), degree of education (primary) and household size (moderate) were another major factor contributing to inequalities in health service utilization, explaining 0.478 6%、0.398 4%、-0.339 2% of the inequalities, respectively. And in 2019, besides economic factors, household size (advanced) and Age (70-74 years old) were major factor contributing to inequalities in health service utilization, explaining -0.953 4%、0.694 3% of the inequalities, respectively.

Conclusion

Rich-related inequalities were found in the use of care for an ill within two weeks in this group of people, in Ningxia the past decade of the new medical reform. The main influencing factors of equity gradually evolved from the relatively single phenomenon of economic income being the dominant factor to the situation where age, household size, economic income, and other factors interact in multiple ways. Moreover, the strength of association age, vocational type inequalities in health service utilization in women was greater than that in men.

Changes and Equity of Health Service Utilization in Married Women of Childbearing Age in Rural Mountainous Areas of Southern Ningxia after 10 Years of the New Healthcare Reform

GAO Baokai, HU Zhaoyan, WANG Wenlong, CHEN Kexin, QIAO Hui

2023, 26(22): 2748-2755. DOI: 10.12114/j.issn.1007-9572.2023.0041

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Background

The aim and mission of the new healthcare reform in China, namely, the healthcare reform initiated in 2009, are effectively implementing health policies to improve people's livelihood and well-being. As a domestic hot research topic, studies on the effectiveness of the new healthcare reform mainly focus on current cross-sectional data, but rarely involve longitudinal or panel data.

Objective

To explore the changes in health service utilization in married women of childbearing age in rural mountainous areas of southern Ningxia before and after 10 years of the new healthcare reform, and to identity the major causal factors of inequalities in the utilization.

Methods

This study used the results of the Rural Household Health Survey conducted in 2009 (baseline data) and in 2019 (10-year follow-up data). The direct standardization method was used to comparatively analyze the status of health service utilization in married female surveyees of childbearing age living in rural mountainous areas of southern Ningxia before and after the implementation of the new healthcare reform. The inequality in health service utilization and the contribution level of its associated contributory factors were measured by calculating and decomposing the concentration index (CI) .

Results

The number of eligible participants was 4 935 in 2009, and 3 509 in 2019. Compared with 2009, the two-week hospital visit rate showed a slight increase (1.29%) in 2019, but the rate of consultation for chronic diseases decreased significantly (18.77%). In addition, the rates of hospitalization for those requiring hospitalization, gynecological examination, antenatal examination, hospital delivery and postnatal visits increased significantly, by a factor of 10.44%, 8.53%, 24.05%, 36.52% and 23.62%, respectively. The CI values for all indicators in both surveys were greater than 0, except for those for postpartum visit rate in the 2009 survey (-0.034 5) and two-week hospital visit rate in the 2019 survey (-0.016 9). Economic income, literacy, family size and age were major contributory factors of the inequality in health service utilization.

Conclusion

After 10 years of the new healthcare reform, the utilization of health services in married women of childbearing age in the areas of Ningxia improved, and tended to be more equitable, but a slightly higher utilization rate was found in high-income individuals.

Analysis of Abnormal Detection Rates of Health Examination for the Older Adults in the National Essential Public Health Services

LI Mengyu, LIAN Juan, LIAO Zirui, ZAN Ziqing, LIU Lu, YOU Lili, LIU Yuanli

2023, 26(22): 2756-2762. DOI: 10.12114/j.issn.1007-9572.2022.0831

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Background

The contribution of geriatric health examination services of national essential public health services to the detection of abnormal health conditions in the elderly and the awareness of examination results of the elderly has been rarely reported in the current studies.

Objective

To investigate the abnormal detection of several common diseases including abnormal blood pressure, abnormal blood glucose, overweight and obesity, anemia, fatty liver disease, gallstones or cholecystitis in the health examination of the older adults aged 65 years and above.

Methods

The older adults aged 65 years and above who visited 20 primary care institutions in 5 cities of 3 provinces in eastern, central and western China were selected as study subjects (excluding those with unclear health examination results in this year) from November to December 2019 by using a multi-stage stratified sampling method, and divided into the general older adults (without hypertension or diabetes), older adults with hypertension, older adults with diabetes. A one-on-one questionnaire survey was conducted on all respondents (The questionnaire included the general demographic characteristics of the respondents and the abnormal detection in the health examination of the elderly) .

Results

Among 3 018 older adults, 2 033 (67.36%) reported abnormalities in the health examination. There were statistically significant differences in the abnormal detection rates of health examination for the older adults with different types of residence, population, and household registration (P<0.05). Among 3 018 older adults, 1 174 (38.90%) self-reported abnormal blood pressure detection, 747 (24.75%) self-reported abnormal blood glucose detection, 719 (23.82%) self-reported dyslipidemia detection, 445 (14.74%) self-reported fatty liver detection, 393 (13.02%) reported overweight and obesity detection, 238 (7.89%) reported gallstones or cholecystitis detection, and 60 (1.99%) reported anemia detection. Abnormal blood pressure was detected in 49.13% of the older adults diagnosed with hypertension during the annual health examination, with the blood pressure control rate of 50.87%. Abnormal blood glucose was detected in 60.48% of the older adults diagnosed with diabetes during health examination with the control rate of blood glucose of 39.52%. Multivariate Logistic regression analysis showed that the detection rate of abnormal blood pressure was 2.57 times〔95%CI (2.01, 3.29) 〕 higher in the older adults with diabetes than in the general older adults; the detection rate of dyslipidemia was 1.64 times〔95%CI (1.29, 2.08) 〕 and 1.42 times〔95%CI (1.10, 1.84) 〕 higher in the older adults with hypertension and diabetes than in the general older adults, respectively; the detection rate of overweight and obesity was 2.79 times〔95%CI (1.94, 4.00) 〕 and 2.64 times〔95%CI (1.80, 3.87) 〕 higher in the older adults with hypertension and diabetes than in the general older adults, respectively; the detection rate of fatty liver was 2.10 times〔95%CI (1.55, 2.85) 〕 higher in the the older adults with hypertension than the general older adults; while the detection rate of anemia was 0.25 times〔95%CI (0.13, 0.47) 〕 and 0.47 times〔95%CI (0.25, 0.86) 〕 higher in the older adults with hypertension and diabetes than in the general older adults; the detection rate of dyslipidemia, gallstones or cholecystitis was 0.76〔95%CI (0.64, 0.90) 〕and 1.32〔95%CI (1.01, 1.73) 〕 times higher in the rural older adults than the urban older adults, respectively (P<0.05) .

Conclusion

The physical examination program for the elderly in the national essential public health services plays an important role in early detection and wareness of health problems.

COVID-19 Vaccination Behavior and Its Influencing Factors among the Elderly in Four Regions of China

WU Jian, YU Chengcheng, YANG Yinmei, XIA Qingyun, LI Quanman, FU Xiaoli

2023, 26(22): 2763-2770. DOI: 10.12114/j.issn.1007-9572.2023.0131

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Background

The elderly are a priority population for COVID-19 vaccination. COVID-19 vaccination can effectively reduce the risk of developing severe and critically ill patients or even death in COVID-19 patients. However, the current vaccination rate of the elderly in China is relatively low, and the COVID-19 vaccination behavior among the elderly has been rarely reported in current studies.

Objective

To investigate COVID-19 vaccination behavior and its influencing factors among the elderly in China, and to provide a reference for improving the COVID-19 vaccination rate of the elderly.

Methods

A total of 1 323 older adults aged 60 years and above in Wujin District of Changzhou City, Zhongmu County of Zhengzhou City, Chengzhong District of Xining City and Linkou County of Mudanjiang City were selected as research subjects from August 3 to August 14 in 2022 by using a stratified random sampling method and investigated by self-designed questionnaires. Binary Logistic regression analysis was used to explore the influencing factors of the first dose of COVID-19 vaccination, full course of COVID-19 vaccination, and booster dose of COVID-19 vaccination.

Results

96.60% (1 278/1 323) of the elderly received the first dose of COVID-19 vaccine, 91.76% (1 214/1 323) completed the full course of COVID-19 vaccination, and 79.67% (1 054/1 323) received the booster dose of COVID-19 vaccine. The results of binary Logistic regression analysis showed that compared with the older adults aged 60-64 years, the older adults aged 75 years and above were less likely to receive the first dose of the COVID-19 vaccine〔OR (95%CI) =0.27 (0.11, 0.62), P<0.05〕; compared with the older adults with chronic disease, the older adults without chronic disease were more likely to receive the first dose of COVID-19 vaccine〔OR (95%CI) =2.07 (1.12, 3.84), P<0.05〕; the older adults with higher levels of perceived benefit were more likely to receive the first dose of COVID-19 vaccine〔OR (95%CI) =1.39 (1.07, 1.79), P<0.05〕. Compared with the older adults aged 60-64 years, who maintained regular physical exercise, those aged 75 years and above〔OR (95%CI) =0.34 (0.19, 0.59), P<0.05〕, who did not maintain regular physical exercise〔OR (95%CI) =0.64 (0.42, 0.96), P<0.05〕were less likely to complete the full course of vaccination; compared with the older adults with chronic diseases, the older adults without chronic diseases were more likely to complete the full course of the COVID-19 vaccination〔OR (95%CI) =1.59 (1.05, 2.40), P<0.05〕. Compared with older adults aged 60-64 years and from the central region, the older adults aged 75 years and above〔OR (95%CI) =0.55 (0.36, 0.86), P<0.05〕and from the eastern region〔OR (95%CI) =0.47 (0.34, 0.64), P<0.05〕were less likely to receive the booster dose of COVID-19 vaccine; compared with the older adults with chronic diseases, the older adults without chronic diseases were more likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =1.54 (1.15, 2.06), P<0.05〕; older adults with higher levels of perceived severity were more likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =1.06 (1.00, 1.11), P<0.05〕. Subgroup analysis showed that compared with the older adults with chronic diseases aged 60-64 years, from the central region, older adults with chronic diseases aged 75 years and above〔OR (95%CI) =0.35 (0.19, 0.65), P<0.05〕, from the eastern region〔OR (95%CI) =0.49 (0.29, 0.83), P<0.05〕were less likely to receive the booster dose of COVID-19 vaccine; older adults with chronic diseases who had higher levels of perceived severity were more likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =1.09 (1.01, 1.18), P<0.05〕. Compared with the older adults from the central region without chronic diseases, the older adults from the eastern region without chronic diseases were less likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =0.44 (0.29, 0.68), P<0.05〕.

Conclusion

More attention should be paid to the elderly who are senior and with chronic diseases in the process of COVID-19 vaccination. The vaccination rate of the elderly should be further increased by strengthening the publicity of COVID-19 vaccine knowledge.

Differences between the First and Another 3-day Blood Pressure Levels and Associated Factors in a Self-reported Non-hypertensive Population Aged 35-64 Years

ZUO Xu, HUANG Zhaolan, LU Biao

2023, 26(22): 2771-2777. DOI: 10.12114/j.issn.1007-9572.2022.0347

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Background

Previous studies have compared the first and another 3-day blood pressure levels in populations with no history of self-reported hypertension, but there have been few studies conducted in COVID-19 vaccine recipients.

Objective

To understand the blood pressure levels among 35-64-year-old COVID-19 vaccine recipients during regular COVID-19 containment, and to assess the differences between the first and another 3-day blood pressure levels and the factors affecting the fluctuation of blood pressure levels in the recipients with suspected hypertension, providing a reference and guidance for blood pressure measurement before COVID-19 vaccination.

Methods

In September 2021, 2 814 residents aged 35-64 with no history of self-reported hypertension were randomly selected for screening for hypertension before receiving COVID-19 vaccination at Qingling Community Health Service Center, Hongshan District, Wuhan City, Hubei Province. Blood pressure was measured and recorded as the first blood pressure measurement value, then based on this, those who were found with suspected hypertension〔systolic blood pressure≥140 mmHg and/or diastolic blood pressure≥90 mmHg (1 mmHg=0.133 kPa) 〕standardizedly measured their clinic blood pressure for another three times on different days without the use of any antihypertensive drugs. Based on the 3-day blood pressure measurement results, the proportions of those with blood pressure in the ideal range (systolic blood pressure<120 mmHg and diastolic blood pressure<80 mmHg), in the high normal range (systolic blood pressure: 120-139 mmHg and/or diastolic blood pressure: 80-89 mmHg), and in the hypertensive range (systolic blood pressure≥140 mmHg and/or diastolic blood pressure≥90 mmHg) were calculated, and the rate of hypertension diagnosis was compared between them by sex, age group, and the first blood pressure measurement level. The factors affecting the fluctuation of blood pressure levels (changes in blood pressure analyzed based on comparing the first blood pressure level and the 3-day blood pressure levels) in suspected hypertensive patients were analyzed using univariate and multivariate ordered Logistic regression.

Results

Of the 2 814 cases, 36.67% (1 032/2 814) were suspected hypertensive patients. Analysis of the 3-day blood pressure levels indicated that the proportions of suspected hypertensive patients with a blood pressure level in the ideal range, high normal range and hypertensive range were 8.82% (91/1 032), 14.34% (148/1 032), and 76.84% (793/1 032), respectively. Among the cases with confirmed hypertension, the prevalence of stages 1, 2, and 3 hypertension was 63.68% (505/793), 26.48% (210/793) and 9.84% (78/793), respectively. The hypertension diagnosis rate was higher in females〔80.68% (380/471) 〕than that in males〔73.62% (413/561) 〕, with statistical significance (χ²=7.173, P=0.007). The hypertension diagnosis rate increased with the increase in the first blood pressure level in suspected hypertensive patients (χ²_trend =23.443, P<0.001). The factors affecting the fluctuation of blood pressure levels in suspected hypertensive patients were gender, age, time period for first blood pressure measurement, psychological factors and environmental noise≥40 dB during first blood pressure measurement (P<0.05) .

Conclusion

There are significant differences between the first blood pressure measurement results and 3-day blood pressure measurement results among suspected hypertensive patients. To improve the reliability of blood pressure measurement results to ensure the successful implementation of COVID-19 vaccination, it is suggested for community medical workers to ensure the vaccine recipients are in good mental state, and pre-vaccination blood pressure measurement for them is performed in a quiet environment, and to pay more attention to verify the reliability of pre-vaccination blood pressure level in males, the 55-64 age group, or individuals receiving blood pressure measurement at community health centers between 11: 01 in the morning and 14: 00 in the afternoon.

Osteoporosis in Community-dwelling Elderly People: Prevalence and Associated Prevention and Control Strategies in General Practice

MENG Fan, DONG Minjie, GUO Jin, XU Songtao, YAN Wei, GU Jun, CHEN Yirong, YANG Cheng, WANG Jun, XIA Lifang, CHEN Jun, FU Lingjie

2023, 26(22): 2778-2784. DOI: 10.12114/j.issn.1007-9572.2022.0171

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Background

The continuous increase in numbers of people with osteoporosis, and individuals with low bone mass in the community, brings severe challenges to the prevention and treatment of osteoporosis in the community.

Objective

To investigate the basic conditions related to the prevention and control of osteoporosis in communities, including the basic process and cost of enrolling the target population, and the prevalence and risk factors of osteoporosis in the target population, so as to provide evidence for supporting a general practice team to develop precise osteoporosis prevention and control measures.

Methods

This study selected 322 cases (including outpatient patients and older physical examinees) from Waitan Community Health Service Center, Shanghai from May to August 2021. General information, bone density test results and risk factors of osteoporosis were collected by a questionnaire.

Results

The cost of enrolling the target population in the community was 57.344 yuan per person. Among the 322 cases, 27 (8.4%) had normal bone mass, 157 (48.8%) had low bone mass, and 138 (42.8%) had osteoporosis. The prevalence of bone density abnormalities (low bone mass and osteoporosis) reached 91.6%. There were statistically significant differences in gender ratio and BMI among normal bone mass, low bone mass and osteoporosis groups (P<0.05). The average bone mineral density (BMD) values of normal bone mass, low bone mass and osteoporosis groups were (-0.72±0.27) AU/mm³, (-1.88±0.38) AU/mm³, and (-3.17±0.53) AU/mm³, respectively. In terms of exercise habits, the prevalence of individuals doing little exercise in normal bone mass, low bone mass and osteoporosis groups was 37.0% (10/27), 49.7% (78/157) and 64.5% (89/138), respectively. In terms of exercise intensity, the prevalence of individuals exercising at moderate-intensity in normal bone mass, low bone mass and osteoporosis groups was 74.1% (20/27), 79.6% (125/157) and 80.4% (111/138), respectively. Three groups had no significant differences in the other osteoporosis risk factors, such as surgical treatment history, smoking history, allergy history and disease history. There was also no significant intergroup difference in dietary habits. Of all cases, 48.8% (157/322) never drank beer, liquor and red wine, 32.0% (103/322) drank coffee 4-6 times per week, and 31.4% (101/322) ate pickled vegetables, smoked foods, or sauces 4-6 times per week.

Conclusion

The community is a favorable setting for conducting prevention, treatment and clinically research programs regarding osteoporosis owing to short participant enrollment period and low cost. As the exercise and eating habits of the elderly in the community are unhealthy, the general practice team should accurately guide them to rapidly improve their dietary structure and develop a healthy exercise habit according to their own status, by which the onset and progression of osteoporosis can be proactively controlled.

Influencing Factors of Advance Care Planning Participation in Surrogate Decision Maker of Advanced Cancer Patients: a Mixed Methods Systematic Review

HAN Zhihao, MA Xiaoqin

2023, 26(22): 2785-2792. DOI: 10.12114/j.issn.1007-9572.2022.0708

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Background

The research field of advance care planning (ACP) for the surrogate decision makers of advanced cancer patients in China is still at the initial stage, and the relevant researches are fragmented and poorly targeted, lacking systematic analysis of the influencing factors.

Objective

To systematically review the influencing factors of ACP participation in surrogate decision makers of advanced cancer patients, so as to provide a reference for subsequent researches in this field.

Methods

This study was a mixed-methods systematic review. In April 2022, CNKI, Wanfang Data Knowledge Service Platform, PubMed, EmBase, the Cochrane Library, Web of Science, and CBM were searched by computer for the studies related to influencing factors of ACP participation in surrogate decision makers of advanced cancer patients from the inception to 2022-07-01. After evaluating the quality of literature and extracting information from the included studies, the method of JBI Hybrid System Evaluation Guide was used to integrate quantitative studies and qualitative studies after extracting data separately, and then the themes were summarized, obtaining the influencing factors of the final ACP participation in surrogate decision makers.

Results

A total of 11 papers were included after literature screening and evaluation of literature quality, including 5 qualitative studies and 6 cross-sectional studies. The final results were integrated into 4 categories of personal factors, external support, information access, and disease status, involving 22 influencing factors such as religious beliefs and clan culture, social network, ACP understanding, and disease development expectation after integrating the analysis results of quantitative and qualitative studies.

Conclusion

There are multiple influencing factors of ACP participation in surrogate decision makers of advanced cancer patients. Public perception, communication, policies and personal characteristics of surrogate decision makers can affect their ACP participation. Therefore, relevant education should be strengthened to improve public perception, an effective communication mechanism among patients, surrogate decision makers and health care providers should be established, the protection of relevant policies and regulations should be improved to strengthen guidance and intervention on variable factors.

Development of a Comprehensive Assessment System of Hospice Care

XU Yifan, JING Limei, WANG Lili, WANG Zhaolin, LI Yuhan, LU Wenyuan, ZHANG Qinhua, WANG Haoran, JING Jiaheng, LI Shuijing

2023, 26(22): 2793-2799. DOI: 10.12114/j.issn.1007-9572.2022.0663

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Background

In the initial promotion of pilot hospice care services (HCS) in China, there is an urgent need to evaluate the quality and effectiveness of HCS comprehensively in pilot institutions.

Objective

The purpose of this study was to establish a meso-level comprehensive assessment system of hospice care, and to provide a scientific measurement tool for assessing and comparing hospice care in various pilot institutions.

Methods

An item pool for establishing a comprehensive assessment system for HCS was constructed through a literature review and small-scale expert interviews from April to May 2021, then the items were rated using a 9-1 grading scheme (the highest grade is 9, while 1 is the lowest) in terms of three aspects (relevance, measurability and feasibility) during two rounds of expert consultation conducted using the RAND/UCLA modified Delphi panel method from June to July 2021.

Results

The Comprehensive Assessment System of Hospice Care (CASHC) was established finally after the items were revised and improved according to the results of two rounds of expert consultation, which consists of 3 primary indicators (structure, process and outcome), 9 secondary indicators (policy guarantee, service provision, patient burden, etc.), 25 tertiary indicators (institutional system guarantee, number of services, per capita cost, etc.) and 81 quaternary indicators (inclusion of institutional development plan, number of hospital discharges and per capita medical cost, etc.). The first round of consultation achieved a response rate of 93.3%, an authority coefficient of 0.900, with values of Kendall's W for the quaternary indicators calculated as 0.194, 0.115, and 0.126, respectively. The second round of consultation achieved a response rate of 92.9% and an authority coefficient of 0.900, with values of Kendall's W for the quaternary indicators of 0.417, 0.241, and 0.322, respectively.

Conclusion

The CASHC consisting of four-level indicators established using the Donabedian's structure-process-outcome framework is an innovative and practical tool, which can be used to quantify and compare the quality and effectiveness of HCS among different pilot institutions or different regions, contributing to the promotion of the standardization and homogenization of HCS in pilot regions.

Urban-rural Differences in Factors Associated with End-of-life Medical Expenditures among the Oldest-old in China

HU Yi, GUO Ruiqi, MIN Shuhui, CHENG Xiaofen, LI Bei

2023, 26(22): 2800-2808. DOI: 10.12114/j.issn.1007-9572.2022.0409

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Background

The cost of end-of-life care is an important topic in health and wellness sector. There are few studies focus on the end-of-life medical expenditures of older adults in China, especially the causes of urban-rural differences in end-of-life medical expenditures in this population.

Objective

To investigate the associated factors of medical expenditures of Chinese oldest old population (≥80 years) in the year before their death, and to analyze rural-urban differences in the medical expenditures as well as their causes.

Methods

In September 2021, 1 399 oldest-old adults who died in 2014—2018 with full data of medical expenditure and other key variables in the year prior to their death were selected from the participants of Chinese Longitudinal Healthy Longevity Survey 2018. Ordinary least squares regression was used to analyze the associated factors of the medical expenditures. The Oaxaca-Blinder technique was used to decompose urban-rural differences in the expenditures.

Results

The median medical expenses of the participants in the year prior to their death was 3 500.00 yuan, and the interquartile range was 9 000.00 yuan, the logarithmic mean value was (8.09±1.73) yuan. The residence, age at death, gender, marital status, living arrangement, prevalence of disability, prevalence of endowment insurance, place of death, accessibility of medical services, prevalence of being confined to bed, and annual household income per capita were factors associated with the medical expenditures in the year prior to death (P<0.05). After controlling for confounding factors, the medical expenses of the urban participants in the year prior to their death was 42.6% higher than that of participants living in rural areas. According to the findings of Oaxaca-Blinder decomposition, the explainable and unexplainable parts of the urban-rural differences accounted for 32.86% and 67.14%, respectively. Of the explainable part, 18.70% was caused by differences in endowment insurance participation, 30.18% by differences in place of death, and 40.42% by differences in annual household income per capita.

Conclusion

The medical expenditures in the year prior to death in the oldest-old were associated with complex factors, and showed large urban-rural differences. It is essential that efforts should be made to implement healthy aging strategies, balance the allocation of urban and rural medical resources, improve social security system for older adults, and to develop end-of-life care. All of these will help reduce the medical expenditures and improve the quality of life and death of older adults at the end of their life.

Advances in Resistance to Care in Patients with Dementia

WANG Xinyuan, LIU Yanli, ZHOU Lijun, ZHANG Qi, WEI Qifei, YAN Xingyu, LUO Jiao, LIU Xiaofei

2023, 26(22): 2809-2815. DOI: 10.12114/j.issn.1007-9572.2022.0570

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Resistance to care (RTC) is a common abnormal behavioral manifestation of behavioral and psychological symptoms of dementia. Although RTC is strongly associated with agitation or aggressive behavior, it is a specific behavioral response of dementia patients to caregivers, and may result in a negative feedback mechanism as it often directly, negatively impacts caregivers. Currently, there are rare studies on RTC in dementia patients or measuring RTC in these patients using relevant tools in China, which may be because domestic researchers easily confuse RTC with other behavioral concepts. While the concept of RTC was introduced earlier in foreign studies, and has been systematically explored and studied. In this paper, we reviewed available relevant studies, and gave a detailed description of the concept, impact, assessment tools, and interventions regarding RTC, with a view to providing ideas and strategies for the study of RTC in patients with dementia in China.

Advances in Evaluation Tools for Resistiveness to Care in Patients with Dementia

WANG Xinyuan, WANG Xiaolei, LIU Yanli, AN Ran, LUO Jiao, LIU Xiaofei, LI Yangyang, HU Chongdie, HOU Fuwen

2023, 26(22): 2816-2822. DOI: 10.12114/j.issn.1007-9572.2023.0132

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Resistiveness to care (RTC) is a common abnormal behavioral symptom in dementia patients during the care process, which seriously negatively impacts the patients and their caregivers. The research on assessment tools for RTC started earlier in foreign countries, and has explored relevant aspects more deeply and comprehensively. Since the Resistiveness to Care Scale for Dementia of the Alzheimer's Type (RTC-DAT) came out in 1999, overseas researchers have made several revisions to its content and methods, and have expanded it to include different scales for assessing RTC in different care settings. In this paper, we present a review of the tools developed overseas to assess RTC in patients with dementia, focusing on the differences in contents and methods of the tools, and the characteristics, strengths and weaknesses of each tool, which may offer insights into China's development of such a tool or introduction of a foreign tool applicable to China. The evaluation method of the assessment tools currently used in foreign research on RTC in patients with dementia is mostly based on the researcher-observed method used in the initial RTC-DAT, which faces many limitations in its practical application. The Refusal of Care Informant Scale (RoCIS) developed in 2022 attempts to use the method of evaluation by consulting caregivers, which is commonly used in other fields, providing a new way for China's introduction or development of a RTC assessment tool applicable to Chinese dementia patients. Considering various types of these tools, we recommend that the tool should be selected according to its applicability assessed comprehensively.

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