Bmc Fam Pract
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Multimorbidity is frequently encountered in primary care and is associated with increasing use of healthcare services. The Andersen Behavioral Model of Health Services Use is a multilevel framework classifying societal, contextual, and individual characteristics about the use of healthcare services into three categories: 1. predisposing factors, 2. enabling factors, and 3. need factors. The present study aimed to explore multimorbid patients' use of ambulatory healthcare in terms of homecare and other allied health services, visits to GPs, and number of specialists involved. A secondary aim was to apply Andersen's model to explore factors associated with this use. ⋯ Multimorbid patients in primary care reported high use of ambulatory healthcare services variably associated with the Andersen model's factors: healthcare use was associated with objective medical needs but also with contextual or individual predisposing or enabling factors. These findings emphasize the importance of adapting care coordination to individual patient profiles.
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Observational Study
Characteristics of the skills of caregivers of people with dementia: observational study.
Due to demographic change within an aging population as announced by the WHO, the involvement of caregivers is essential. Caregivers are required to change their roles within the family unit. Such life transitions experienced by caregivers to people confronted with dementia-type pathologies are sometimes difficult, necessitating the acquisition and development of certain skills. Few studies have shown that caregivers develop specific and essential skills to promote quality care and safety. To characterize their skills, there is a need to identify the abilities, knowledge, resources, obstacles and constraints that contribute to caregivers' transitions. The research question for this study was: What skills do caregivers use to care for their loved one with dementia? ⋯ This study was able to point out that today's caregivers have developed more competency than their predecessors. This evolution can be explained by new paradigms of care requiring caregivers to be more involved. Although some caregivers need training, others through their experiences can act upon and provide knowledge. To improve the quality and safety of care for people with dementia, this expertise can be the subject of partnerships between caregivers and health care staff.
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Preliminary evaluations have found that family doctor contract services (FDCSs) have significantly controlled medical expenses, better managed chronic diseases, and increased patient satisfaction and service compliance. In 2016, China proposed the establishment of a family doctor system to carry out contract services, but studies have found the uptake and utilization of these services to be limited. This study aimed to investigate rural residents' preferences for FDCSs from the perspective of the Chinese public. ⋯ The present study suggests that strengthening and improving the quality of primary health care, including the competence and attitudes of family doctors, should be prioritized to increase the uptake of FDCSs. The contract service package, including the annual cost, the insurance reimbursement rate and individualized services, should be redesigned to be congruent with residents having different health statuses and their stated preferences.
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Epidemic chronic diseases pose significant challenges to the improvement of healthcare in China and worldwide. Despite increasing international calls for the inclusion of evidence-based decision-making (EBDM) processes in chronic disease prevention and control programming as well as policymaking, there is relatively little research that assesses the current capacity of physicians and the factors that influence that capacity in China. ⋯ This study provides quantitative evidence illustrating EBCDP practices among physicians in CHCs with various personal and organizational characteristics, respectively. More methods should be provided to increase the awareness of such physicians regarding EBCDP to stimulate the use of EBCDP for their patients and in connection with other public health priorities.
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The service capacity of primary care has improved in China. General practice also takes growing responsibility in the management of type 2 diabetes mellitus, but there are concerns about the paucity of evidence of the quality of care delivered. And there is an absence of systematic quality indicators of type 2 diabetes mellitus in general practice in China. This study aimed to develop a set of type 2 diabetes mellitus quality indicators to facilitate quality measurement in general practice in China. ⋯ A set of 38 potential quality indicators of type 2 diabetes mellitus in general practice were identified by an iterative Delphi process in Beijing, China. Preliminary approach for measurement and data collection were described. However, the indicators still need to be validated by testing in a further study.