scholarly journals The impact of chronic diseases and primary care access on health status among elderly populations in rural China

2019 ◽  
Author(s):  
Yixing Yang ◽  
Tai zhang ◽  
Zhaoquan Huang ◽  
Dong Gao ◽  
Zhenyou Guo ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Status ◽  
Rural Areas ◽  
Chronic Conditions ◽  
Rural China ◽  
The Elderly ◽  
Primary Care Access ◽  
Care Access ◽  
Descriptive System ◽  
The Impact

Abstract Objective This study aimed to examine the patterns of chronic conditions and the role of primary care access on health status among rural elderly.Methods 6451 elderly aged ≥ 60 years from 5540 households in 116 villages in western rural areas of China were randomly selected and assessed the their health status using the EQ-5D-3L instrument. EQ-5D descriptive system and visual analogue scale (VAS) score were descriptive analyses by patterns of chronic conditions. We identified the impact of multimorbidity and primary care access on health status using multilevel linear model.Results 55% of the pooled sample reported at least one chronic condition, and 30.2% had more than one. Hypertension, rheumatoid arthritis and chronic bronchitis were the most frequently reported conditions. After adjustment for sociodemographic status and patterns of chronic conditions, primary care access significantly associated with health status for the elderly in late life.Conclusion Primary care access and health services should take priority action for rural elderly, especially elderly with multimobidity in lower household income, living in mountainous areas where distance to township hospital is long.

scholarly journals Does Social Support Affect the Health of the Elderly in Rural China? A Meta-Analysis Approach

2019 ◽  
Vol 16 (18) ◽  
pp. 3471 ◽  
Author(s):  
Natuya Zhuori ◽  
Yu Cai ◽  
Yan Yan ◽  
Yu Cui ◽  
Minjuan Zhao
Keyword(s):  
Social Support ◽  
Rural Areas ◽  
Rural China ◽  
Statistical Significance ◽  
Empirical Studies ◽  
Relevant Literature ◽  
The Elderly ◽  
Significant Difference ◽  
Meta Regression ◽  
The Impact

As the trend of aging in rural China has intensified, research on the factors affecting the health of the elderly in rural areas has become a hot issue. However, the conclusions of existing studies are inconsistent and even contradictory, making it difficult to form constructive policies with practical value. To explore the reasons for the inconsistent conclusions drawn by relevant research, in this paper we constructed a meta-regression database based on 65 pieces of relevant literature published in the past 25 years. For more valid samples to reduce publication bias, we also set the statistical significance of social support to the health of the elderly in rural areas as a dependent variable. Finally, combined with multi-dimensional social support and its implications for the health of the elderly, meta-regression analysis was carried out on the results of 171 empirical studies. The results show that (1) subjective support rather than objective support can have a significant impact on the health of the elderly in rural areas, and there is no significant difference between other dimensions of social support and objective support; (2) the health status of the elderly in rural areas in samples involving western regions is more sensitive to social support than that in samples not involving the western regions; (3) among the elderly in rural areas, social support for the older male elderly is more likely to improve their health than that for the younger female elderly; and (4) besides this, both data sources and econometric models greatly affect the heterogeneity of the effect of social support on the health of the elderly in rural areas, but neither the published year nor the journal is significant. Finally, relevant policies and follow-up studies on the impact of social support on the health of the elderly in rural areas are discussed.

scholarly journals How does Multimorbidity affect Middle-Aged Adults? A Cross-Sectional Survey in the Singapore Primary Healthcare Setting.

2020 ◽  
Author(s):  
Sai Zhen - Sim ◽  
Hui Li Koh ◽  
Sabrina Poay Sian Lee ◽  
Doris Yee Ling Young ◽  
Eng Sing Lee
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Healthcare Setting ◽  
The Elderly ◽  
Sociodemographic Factors ◽  
Health State ◽  
Middle Aged ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
The Impact

Abstract Background: Multimorbidity is of increasing prevalence and importance. It has been negatively associated with health-related quality of life (HrQoL) especially in the elderly population. Despite substantial multimorbidity for the middle-aged population, defined as those between 40-64 years old, there is a paucity of research investigating the impact of multimorbidity in this population. This study aimed to investigate the association between multimorbidity and HrQoL in the middle-aged primary care population in Singapore.Methods: A cross-sectional study was conducted at a primary care centre in Singapore. Interviewer-administered questionnaires were used to collect data regarding the participants’ sociodemographic characteristics, chronic conditions, and HrQoL, as measured by the EuroQol five dimensions 3-levels questionnaire (EQ5D). We defined multimorbidity as the presence of three or more conditions, out of a list of 14 chronic conditions. The associations between multimorbidity and the components of the EQ5D were assessed using multivariable regression analyses.Results: The study included 297 participants, aged 40-64 years, of which 124 (41.7%) had multimorbidity. After adjusting for sociodemographic factors, participants with multimorbidity had significantly lower EQ5D UI, (β-coefficient -0.064 (C.I -0.125, -0.003), p = 0.04), but not significantly lower EQ5D VAS, (β-coefficient -0.045 (C.I 0.102, 0.012), p = 0.12). Additionally, participants with multimorbidity had higher odds (OR = 2.41, p = 0.01) of reporting problems due to pain/discomfort.Conclusion: Multimorbidity was not significantly associated with the overall health state, as measured by the EQ5D VAS, in middle-aged primary care patients. However, it was associated with the EQ5D UI which is a composite measure of five specific domains of HrQoL. Specifically, there was a statistically significant association between multimorbidity and the pain domain. Further studies are required to understand the relationship between multimorbidity and pain to enable physicians to better manage pain and HrQoL in this population.

scholarly journals Actionable Analysis: Toward a Jurisdictional Evaluation of Primary Care Access in the Community Context

2019 ◽  
Vol 10 ◽  
pp. 215013271989197
Author(s):  
Mary M. Ford ◽  
Kirsten Weisbeck ◽  
Bonnie Kerker ◽  
Louise Cohen
Keyword(s):  
Primary Care ◽  
Health Status ◽  
Health Care Systems ◽  
Care Facility ◽  
Primary Care Providers ◽  
City Council ◽  
Community Context ◽  
Care Providers ◽  
Primary Care Access ◽  
Care Access

Primary care is the foundation of health care systems and has potential to alleviate inequities in population health. We examined multiple measures of adult primary care access, health status, and socioeconomic position at the New York City Council District level—a unit of analysis both relevant to and actionable by local policymakers. The results showed significant associations between measures of primary care access and health status after adjustment for socioeconomic factors. We found that an increase of 1 provider per 10 000 people was associated with a 1% decrease in diabetes rates and a 5% decrease in rates of adults without an influenza immunization. Furthermore, higher rates of primary care providers in high-poverty districts accepted Medicaid and had Patient-Centered Medical Home recognition, increasing constituent accessibility. Our findings highlight the significant contribution of primary care access to community health; policies and resource allocation must prioritize primary care facility siting and provider recruitment in low-access areas.

scholarly journals Social Engagement and Elderly Health in China: Evidence from the China Health and Retirement Longitudinal Survey (CHARLS)

2019 ◽  
Vol 16 (2) ◽  
pp. 278 ◽  
Author(s):  
Jin Liu ◽  
Scott Rozelle ◽  
Qing Xu ◽  
Ning Yu ◽  
Tianshu Zhou
Keyword(s):  
Health Status ◽  
Rural Areas ◽  
Social Engagement ◽  
Urban Areas ◽  
Healthy Aging ◽  
The Elderly ◽  
Health Behavior Change ◽  
Longitudinal Survey ◽  
Elderly Health ◽  
The Impact

This study examines the impact of social engagement on elderly health in China. A two-stage residual inclusion (2SRI) regression approach was used to examine the causal relationship. Our dataset comprises 9253 people aged 60 or above from the China Health and Retirement Longitudinal Survey (CHARLS) conducted in 2011 and 2013. Social engagement significantly improved the self-rated health of the elderly and reduced mental distress, but had no effect on chronic disease status. Compared with the rural areas, social engagement played a more important role in promoting the elderly health status in urban areas. Social engagement could affect the health status of the elderly through health behavior change and access to health resources. To improve the health of the elderly in China and promote healthy aging, the government should not only improve access to effective medical care but also encourage greater social engagement of the elderly.

scholarly journals How does Multimorbidity affect Middle-Aged Adults? A Cross-Sectional Survey in the Singapore Primary Healthcare Setting.

2020 ◽  
Author(s):  
Sai Zhen - Sim ◽  
Hui Li Koh ◽  
Sabrina Poay Sian Lee ◽  
Doris Yee Ling Young ◽  
Eng Sing Lee
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Healthcare Setting ◽  
The Elderly ◽  
Sociodemographic Factors ◽  
Health State ◽  
Middle Aged ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
The Impact

Abstract Background Multimorbidity is of increasing prevalence and importance. It has been negatively associated with health-related quality of life (HrQoL) especially in the elderly population. Despite substantial multimorbidity for the middle-aged population, defined as those between 40-64 years old, there is a paucity of research investigating the impact of multimorbidity in this population. This study aimed to investigate the association between multimorbidity and HrQoL in the middle-aged primary care population in Singapore. Methods A cross-sectional study was conducted at a primary care centre in Singapore. Interviewer-administered questionnaires were used to collect data regarding the participants’ sociodemographic characteristics, chronic conditions, and HrQoL, as measured by the EuroQol five dimensions 3-levels questionnaire (EQ5D). We defined multimorbidity as the presence of three or more conditions, out of a list of 14 chronic conditions. The associations between multimorbidity and the components of the EQ5D were assessed using multivariable regression analyses. Results The study included 297 participants, aged 40-64 years, of which 124 (41.7%) had multimorbidity. After adjusting for sociodemographic factors, participants with multimorbidity had significantly lower EQ5D UI, (β-coefficient -0.064 (C.I -0.125, -0.003), p = 0.04), but not significantly lower EQ5D VAS, (β-coefficient -0.045 (C.I 0.102, 0.012), p = 0.12). Additionally, participants with multimorbidity had higher odds (OR = 2.41, p = 0.01) of reporting problems due to pain/discomfort. Conclusion Multimorbidity was not significantly associated with the overall health state, as measured by the EQ5D VAS, in middle-aged primary care patients. However, it was associated with the EQ5D UI which is a composite measure of five specific domains of HrQoL. Specifically, there was a statistically significant association between multimorbidity and the pain domain. Further studies are required to understand the relationship between multimorbidity and pain to enable physicians to better manage pain and HrQoL in this population

scholarly journals Impact of the COVID-19 Pandemic on Primary Care Access for Patients with Hematologic Malignancies

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4011-4011
Author(s):  
Ying Ling ◽  
Kelvin Chan ◽  
Aditi Patrikar ◽  
Ning Liu ◽  
Aisha Lofters ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Care ◽  
Hematologic Malignancies ◽  
The United States ◽  
Myeloid Malignancy ◽  
Primary Care Access ◽  
Care Access ◽  
Virtual Visits ◽  
Unplanned Hospitalizations ◽  
The Impact

Abstract Introduction: Primary care physicians are essential to cancer care. They frequently identify signs and symptoms leading to a diagnosis of cancer, and provide ongoing support and management of non-cancer health conditions during cancer treatment. Both primary care and cancer care have been greatly affected by the COVID-19 pandemic. In the United States, cancer-related patient encounters and cancer screening decreased over 40% and 80% respectively in January to April 2020 compared to 2019 (London et al. JCO Clin Cancer Inform 2020). However, the impact of the COVID-19 pandemic on primary care access for cancer patients remain unclear. Methods: We undertook a population-based, retrospective cohort study using healthcare databases held at ICES in Ontario, Canada. Patients with a new lymphoid or myeloid malignancy diagnosed within the year prior to the COVID-19 pandemic, between July 1, 2019 and September 30, 2019 (COVID-19 cohort) were compared to patients diagnosed in years unaffected by the COVID-19 pandemic, between July 1, 2018 - September 30, 2018 and July 1, 2017 - September 30, 2017 (pre-pandemic cohort). Both groups were followed for 12 months after initial cancer diagnosis. In the COVID-19 cohort, this allowed for at least 4 months of follow-up data occurring during the COVID-19 pandemic. The primary outcome was number of in-person and virtual visits with a primary care physician. Secondary outcomes of interest included number of in-person and virtual visits with a hematologist, number of visits to the emergency department (ED), and number of unplanned hospitalizations. Outcomes, reported as crude rates per 1000 person-months, were compared between the COVID-19 and pre-pandemic cohorts using Poisson regression modelling. Results: We identified 2882 individuals diagnosed with a new lymphoid or myeloid malignancy during the defined COVID-19 timeframe and compared them to 5997 individuals diagnosed during the defined pre-pandemic timeframe. The crude rate of in-person primary care visits per 1000 person-months significantly decreased from 574.4 [95% CI 568.5 - 580.4] in the pre-pandemic cohort to 402.5 [395.3 - 409.7] in the COVID-19 cohort (p < 0.0001). Telemedicine visits to primary care significantly increased from 5.3 [4.8 - 5.9] to 173.0 [168.4 - 177.8] (p < 0.0001). The rate of combined in-person and telemedicine visits to primary care did not change from 579.8 [573.8 - 585.8] in the pre-pandemic cohort to 575.5 [566.9 - 584.2] in the COVID-19 cohort (p = 0.43). In-person visits to hematologists decreased from 504.1 [498.5 - 509.7] to 432.8 [425.3 - 440.3] (p < 0.0001), and telemedicine visits to hematologists increased from 6.6 [6.0 - 7.3] to 75.9 [72.8 - 79.1] (p < 0.0001). The rate of combined visits to hematologists did not change from 510.7 [505.1 - 516.4] to 508.7 [500.6 - 516.8] (p = 0.68). The rate of ED visits significantly decreased from 95.1 [92.7 - 97.6] in the pre-pandemic cohort to 84.7 [81.4 - 88.0] in the COVID-19 cohort (p < 0.0001). The rate of unplanned hospitalizations did not change from 64.8 [62.8 - 66.8] to 65.7 [62.9 - 68.7] (p = 0.60). Conclusions: Primary care visits for patients with hematologic malignancies did not significantly change during the pandemic, but there was a sizeable shift from in-person to telemedicine visits. Similar findings were seen for visits to hematologists. While the rate of visits to the ED decreased, potentially due to concern of being exposed to the COVID-19 virus, the shift in ambulatory practices did not seem to impact the rate of unplanned hospitalizations. Disclosures No relevant conflicts of interest to declare.

scholarly journals The Impact of Digital-First Consultations on Workload in General Practice: Modeling Study (Preprint)

2020 ◽  
Author(s):  
Chris Salisbury ◽  
Mairead Murphy ◽  
Polly Duncan
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Base Case ◽  
Medline Search ◽  
Face To Face ◽  
Primary Care Access ◽  
Care Access ◽  
Specialist Services ◽  
Key Variables ◽  
The Impact

BACKGROUND Health services in many countries are promoting digital-first models of access to general practice based on offering online, video, or telephone consultations before a face-to-face consultation. It is claimed that this will improve access for patients and moderate the workload of doctors. However, improved access could also potentially increase doctors’ workload. OBJECTIVE The aim of this study was to explore whether and under what circumstances digital-first access to general practice is likely to decrease or increase general practice workload. METHODS A process map to delineate primary care access pathways was developed and a model to estimate general practice workload constructed in Microsoft Excel (Microsoft Corp). The model was populated using estimates of key variables obtained from a systematic review of published studies. A MEDLINE search was conducted for studies published in English between January 1, 2000, and September 30, 2019. Included papers provided quantitative data about online, telephone, or video consultations for unselected patients requesting a general practice in-hours consultation for any problem. We excluded studies of general practitioners consulting specialists, consultations not conducted by doctors, and consultations conducted after hours, in secondary care, in specialist services, or for a specific health care problem. Data about the following variables were extracted from the included papers to form the model inputs: the proportion of consultations managed digitally, the proportion of digital consultations completed without a subsequent consultation, the proportion of subsequent consultations conducted by telephone rather than face-to-face, consultation duration, and the proportion of digital consultations that represent new demand. The outcome was general practice workload. The model was used to test the likely impact of different digital-first scenarios, based on the best available evidence and the plausible range of estimates from the published studies. The model allows others to test the impact on workload of varying assumptions about model inputs. RESULTS Digital-first approaches are likely to increase general practice workload unless they are shorter, and a higher proportion of patients are managed without a subsequent consultation than observed in most published studies. In our base-case scenarios (based on the best available evidence), digital-first access models using online, telephone, or video consultations are likely to increase general practitioner workload by 25%, 3%, and 31%, respectively. An important determinant of workload is whether the availability of digital-first approaches changes the demand for general practice consultations, but there is little robust evidence to answer this question. CONCLUSIONS Digital-first approaches to primary care could increase general practice workload unless stringent conditions are met. Justification for these approaches should be based on evidence about the benefits in relation to the costs, rather than assumptions about reductions in workload. Given the potential increase in workload, which in due course could worsen problems of access, these initiatives should be implemented in a staged way alongside careful evaluation.

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