Availability and social determinants of community health management service for patients with chronic diseases: An empirical analysis on elderly hypertensive and diabetic patients in an eastern metropolis of China

Abstract

Objective: This study aimed to determine the availability of community health management services and the relevant social determinants for elderly patients with chronic diseases.Methods: All data were obtained from the 2013 random sampling household survey on an elderly population conducted by the School of Public Health of Peking University in an eastern metropolis in China. Information from the database of the above survey involving 1495 hypertensive or diabetic patients >60 years of age, as representatives of the city, were included. The study described the availability of follow-up services by community doctors among elderly hypertensive and diabetic patients during the 12 months before the survey. An ordinal multinomial logistic regression model was used to conduct the analysis on the influence of socio-economic background upon such availability.Results: Eighty-one percent of hypertensive patients and 84.7% of diabetic patients had not received any follow-up service from community doctors within 12 months prior to the survey. Among elderly hypertensive patients, those registered as non-agricultural household members, those with high and above-average income, as well as management personnel of government agencies, enterprises, and social programs have a greater chance of accepting follow-up service by community doctors because of their relatively higher socio-economic rankings. Among elderly diabetic patients, such socio-economic factors had no significant influence on the availability of the follow-up service for chronic diseases. Conclusion:The coverage of community health management services for elderly hypertensive and diabetic patients needs improvement. More effort should focus on promoting the availability of community health management services for elderly hypertensive patients, especially those with lower socio-economic status.

Examining inequality in utilisation of health management services for the elderly in rural Henan China

“…The pro-rich finding of HMS utilisation for the elderly in rural areas of Henan is consistent with some studies but different from others [ 15 – 17 ]. The utilisation of HMS varies in different regions or countries possibly due to differences in the health management system and financial investment [ 25 ].…”

“…However, challenges still exist; unequal access to HMS for the elderly is one of the most important issues to be addressed. Some studies show that the utilisation of HMS for the elderly is associated with gender, income, education level, occupation and so on [14,15]. However, few studies have examined inequality in HMS utilisation for the elderly; seniors in rural areas are more likely to be ignored.…”

Assessment of type 2 diabetes mellitus patients' behavioral characteristics associated with integrated treatment and prevention services in community health centers in China

“…Besides, most of these patients in the “Low” cluster had better family and social support, were more likely to be married or cohabiting and in employment, and had higher instances of health insurance, which encouraged patients to have more confidence and motivation to adopt healthy maintenance behaviors and often meant that these patients were more likely to have adequate resources and support when coping with adverse events ( 49 , 50 ). Research has proven that the employed and patients with health insurance tend to seek higher quality health services and technology at high-level hospitals and have less trust in community health centers ( 51 , 52 ), which also gives some support to our regression results “compared with the uninsured, the UEBMI and URRBMI groups had 18.095 and 15.085 lower behavior scores, respectively.” Based on the above factors, we considered that better self-condition and adequate psychosocial coping resources increased to some extent the possibility of cross-level medical treatment and health care in the “Low” cluster of patients, which results in low utilization of primary health services (PHS). The low score for diabetic foot care in this study is consistent with previous research ( 53 ).…”

“…. tend to seek higher quality health services and technology at highlevel hospitals and have less trust in community health centers (51,52), which also gives some support to our regression results "compared with the uninsured, the UEBMI and URRBMI groups had 18.095 and 15.085 lower behavior scores, respectively." Based on the above factors, we considered that better self-condition and adequate psychosocial coping resources increased to some extent the possibility of cross-level medical treatment and health care in the "Low" cluster of patients, which results in low utilization of primary health services (PHS).…”

<p>The Influencing Factors of Health-Seeking Preference and Community Health Service Utilization Among Patients in Primary Care Reform in Xiamen, China</p>

“…Although CHCs have played an increasingly important role in the prevention, treatment and rehabilitation of chronic diseases, patients with chronic diseases prefer to go higher-tier hospitals for routine treatment. 12,13 This phenomenon in China has resulted in considerable wastage of high-quality medical resources in not only tertiary hospitals but also in unused CHCs and further aggravated health inequity among residents. 14,15 To optimize patients' current healthcare-seeking preferences and improve the efficiency of the healthcare system, the Chinese government initiated the "Healthy China 2020 Plan" in 2012 and subsequently implemented a series of pilot projects across the country.…”