The effect of family doctor–contracted services on noncommunicable disease self‐management in Shanghai, China

Abstract

Summary Background Noncommunicable diseases (NCDs) are a major threat to population health worldwide. In Shanghai, China, a new pattern of NCD management—self‐management—has been developed in community health service centres (CHSCs). Objective To clarify how contracting with CHSC‐based family doctors (FDs) influences the engagement in and effectiveness of self‐management behaviour among NCD patients. Method We conducted two waves of a questionnaire survey (in 2013 and 2016) to collect data on patients with NCDs. Separate logistic regression models and longitudinal analysis were performed to examine the effect of contracting with an FD on NCD self‐management and the effectiveness of this self‐management. Results Nearly all contracted patients (80.79%) had implemented NCD self‐management, while only 55.57% of non‐contracted patients did so. The self‐management effectiveness rate was also higher among contracted patients than among non‐contracted ones (86.66% vs. 54.79%). In the population‐averaged models, contracted patients had 2.25 and 2.91 times greater odds of implementing self‐management and reporting that the self‐management was effective, respectively, after controlling for all related variables. Additionally, awareness of FD‐contracted services, satisfaction with CHSCs, and experiencing first contact at CHSCs had positive impacts on the implementation and effectiveness of self‐management. Conclusions FDs were important for ensuring that NCD patients engaged in self‐management behaviour, the most common form of which was focus group. Participation in NCD focus groups may be key for attaining the effects of self‐management, including improved health knowledge, greater health awareness, more frequent engagement in health behaviour, and, most importantly, greater practice of self‐monitoring. Self‐management might help to achieve greater NCD control.

A WeChat-Based Self-Management Intervention for Community Middle-Aged and Elderly Adults with Hypertension in Guangzhou, China: A Cluster-Randomized Controlled Trial

“…Moreover, in recent years, family-doctor-contracted services have been put into practice in many community health care centers in China, whereas each community center is still struggling to manage patients with chronic disease among family doctors. Research in Shanghai, China [33] reported that group management achieved effective results for self-management in noncommunicable diseases. It is possible that our group-based self-management intervention via WeChat could be a more feasible and accessible method for family doctors.…”

Government health expenditure, out‐of‐pocket payment and social inequality: A cross‐national analysis of China and OECD countries

“…53 The treatment of NCDs can also be expensive, and these are a critical threat to public health worldwide. The medical sector in Shanghai developed a new approach of using community health service centers (CHSCs) to manage NCDs, 54 Other parts of China could not develop this system completely and could not contribute to easing personal medical expenditure. The health institute and resident patient combinative model supports a patient in accessibility, communication, service integration, and emotional improvement, 55 but the mechanism increases OOP payment.…”

The Effects of Family Physician–contracted Service on Health-related Quality of Life and Equity in Health Among the Chinese Population

“…Family physician-contracted services can improve the continuity, comprehensiveness, and coordination of primary care services [13][14][15]. This service also helps individuals with chronic diseases to improve their health-related awareness, self-management behaviors, and treatment compliance [16,17]. In terms of the health impact, for example, a randomized controlled trial study in Norway indicated that when a patient's family physician and geriatrician cooperate in clinical assessments and collaborative medication reviews, health-related quality of life (HRQoL) improved in older patients exposed to polypharmacy [18].…”