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Background
Family doctor contract services (FDCS) has played a key role in diabetes management in China since 2016. The influence of FDCS on the physiological indexes of individuals with diabetes has been examined. However, little attention has been paid to its effect on the Health-Related Quality of Life (HRQoL). This study aims to fill this knowl...
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Home and community care is an important way to actively respond to population aging and to promote healthy aging. This study aims to estimate the effect of using home and community care services on the multidimensional health of older adults. We used data from the China Health and Retirement Longitudinal Study conducted in 2018 and relied mainly on...
Citations
... Therefore, studying the impact of FDCS on migrant health is essential. Previous studies have primarily focused on the relationship between FDCS and the health status of the general population 29,30 , neglecting to explore the mechanisms through which these services affect migrant health. ...
This study investigates the impact of the family doctor contracted service system on the health of migrants in China, utilizing data from the 2018 China Migrants Dynamic Survey (CMDS). The study employs a double machine learning model to estimate the effect of family doctor contracted services (FDCS) on migrants’ self-rated health (MSRH). The sample consists of 137,851 migrants, with family doctor service contract status, health education, and health records as key variables. To address potential endogeneity issues, an instrumental variable approach using the regional family doctor contracting rate was implemented. Mediation analysis was conducted to examine the roles of health education and health records in this relationship. The findings indicate that FDCS significantly improve MSRH. This positive effect is robust across various machine learning models, including Lassocv, Random Forest, and Gradient Boost. The instrumental variable approach confirms the validity of these results, mitigating concerns about endogeneity. Mediation analysis reveals that the positive impact of FDCS on MSRH is fully mediated by health education and health records, highlighting their critical roles in enhancing health outcomes. The FDCS play a crucial role in improving the health of migrants by providing continuous and comprehensive care. Enhanced health education and effective health records management are significant pathways through which these services exert their positive effects. Policy recommendations include expanding access to family doctor services, enhancing health education programs, and improving health records management to optimize healthcare delivery for migrants. Future research should consider longitudinal studies to further validate these findings and explore their applicability to specific subgroups or regions.
... Moreover, different studies employ various tools to assess the same outcome dimension, which complicates the comparison and aggregation of findings, further contributing to the fragmented nature of research in this area. For example, tools for measuring "health" include a 5-point Likert scale 10 , the EQ-5D-5L scale 11 , and the SF-36 scale 12 , each reflecting different core constructs. ...
Background
Family doctor contract services in mainland China are designed to foster long-term relationships between family doctors and contracted residents, promoting the delivery of primary care services through teamwork and collaboration. By 2035, it is expected that the coverage of these services will exceed 75%, making it a key model for primary care in China. However, the outcome dimensions and measurement approaches used to evaluate the effectiveness of these services remain fragmented and lack a comprehensive framework. This scoping review aims to systematically investigate the outcome dimensions and measurement approaches previously used to evaluate the effectiveness of family doctor contract services in mainland China.
Methods
This scoping review will be conducted in accordance with the JBI methodology for scoping reviews. We will search electronic databases, including CNKI, Wanfang, PubMed, the Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, PROSPERO, and Google Scholar, for literature published since 2006. Eligible sources will include policy documents, quantitative studies, and qualitative studies that assess the outcomes of family doctor contract services. Data extraction will focus on the outcome dimensions and measurement approaches used in these evaluations. Two independent reviewers will screen and extract data from the literature, and any discrepancies will be resolved through group discussions with a third reviewer. Descriptive statistics will be used to analyze the extracted data, and the results will be presented through tables, charts, and a hierarchical tree diagram of outcome dimensions and measurement tools.
Discussion
This scoping review will provide a comprehensive overview of the outcome dimensions and measurement approaches used to evaluate family doctor contract services in mainland China. It will help to identify gaps in the existing literature and offer a clearer framework for future evaluations of these services. By mapping out the outcome dimensions and tools, this review aims to contribute to improving the quality and effectiveness of family doctor contract services in China. The findings will be particularly valuable for policymakers and researchers focused on enhancing primary care systems.
Systematic review registration
Registered in OSF on September 20, 2024 (osf.io/z3eju)
... In addition to this, previous studies have typically measured physical activity participation only through metrics such as exercise intensity, duration, and days of participation (27). Therefore, to reflect the level of physical activity participation of middle-aged and older adults people more comprehensively, the present study, based on combining previous studies and the CHARLS HRQOL scale (28,29) In this study, we chose to demonstrate the level of physical activity FIGURE 1 Sampling procedure table. ...
... Meanwhile, according to the scoring rules of the SF-36 scale, physical activities were divided into 4 dimensions, and each question item was assigned a score according to a scale of 1-4, while social activities were assigned a score of 1 for participation in an activity. Raw scores for the degree of participation in the 2 types of activities in their respective components were computed, and scores for the 2 types of activities were converted to a range of 0-100 for analyses (28,29). The total score for both physical activity and social activity was 100. ...
Background
Leisure activities serve as key measures to enhance the subjective happiness of middle-aged and older adults individuals and to positively address the challenges of an aging society; however, the trajectory of changes in their participation in leisure activities and how these changes relate to shifts in subjective happiness have not been adequately explored.
Methods
This study selected data from the China Health and Aging Longitudinal Study (CHARLS), which included a total of 5,190 middle-aged and older adults people. Linear and nonlinear latent growth models, parallel latent growth models and cross-lagged models were constructed to investigate the influence and lagged relationship between the trajectory of changes in the level of participation in leisure activities on the trajectory of changes in the subjective well-being of middle-aged and older adults people.
Results
The initial level of physical activity participation of middle-aged and older adults people significantly predicted the initial level (β = 1. 203, p < 0.001) and rate of change (β = −0.138, p = 0.016) of their subjective well-being, and the trajectory of change of middle-aged and older adults people’s physical activity also significantly predicted the rate of change of their subjective well-being (β = 0.582, p = 0.003). Meanwhile, the initial level of social activity of middle-aged and older adults people also effectively predicted the initial level of their subjective well-being (β = 0.048, p < 0.001). At the same time, the covariates (gender, age, level of education, marital status, chronic disease) also predicted the initial level and rate of change of leisure activity participation level and subjective well-being. Finally, the cross-lagged model test confirmed the predictive effect of leisure activity participation level on subjective well-being of middle-aged and older adults people.
Conclusion
This study confirms that the level of participation in leisure activities of Chinese middle-aged and older adults people has a significant predictive effect on their subjective happiness and that there is a significant correlation between the trajectory of changes in the level of participation in leisure activities and the trajectory of changes in subjective happiness.
... Given the high morbidity and mortality rates associated with chronic diseases, researchers have increasingly focused on assessing both patients' survival status and HRQoL [12,13]. Numerous studies have measured the HRQoL among chronic disease patients using various scales, such as the 36-Item Short Form Health Survey (SF-36) [15], the 3 or 5 Level Version of European Quality of Life 5 Dimensions [16], and questionnaire-based scales [17]. Furthermore, research has explored factors influencing the HRQoL of chronic disease patients, including demographic and socioeconomic characteristics [13,15,18], medication adherence, lifestyle behaviors [19], and the accessibility of healthcare programs such as public health insurance schemes [20,21]. ...
... However, the correlation between these PHS initiatives and HRQoL among chronic disease patients remains inadequately explored. To date, only two studies-one from Norway [29] and another from China [17]-have suggested that the family doctor system enhances the HRQoL of older patients dealing with polypharmacy or diabetes. Despite being a vital component of publicly funded PHS initiatives in China, there is a lack of evidence on evaluating the impact of community-based routine health examinations on the HRQoL of chronic disease patients. ...
Background
The growing prevalence of non-communicable chronic diseases poses a significant public health challenge globally, particularly impacting the well-being of aging populations. This study aims to assess the impact of community-based public health service (PHS) on the health-related quality of life (HRQoL) among middle-aged and older adults with chronic diseases in China.
Methods
Utilizing data from the China Health and Retirement Longitudinal Study, we constructed a novel scale based on the 36-Item Short Form Health Survey (SF-36) to measure the HRQoL of middle-aged and older patients with hypertension and/or type-2 diabetes. Multivariate linear regression models with Instrument Variables and Propensity Score Matching techniques were applied to examine the effect of PHS on the HRQoL of identified chronic disease patients.
Results
Among 8,403 hypertensive and/or diabetic patients, only 10.98% had received PHS. After adjusting for covariates, PHS exhibited a significant association with an elevated overall SF-36 score (β = 3.539, p < 0.001). Similar effects were observed in the physical and mental component summary scores, with increases of 1.982 (p < 0.001) and 5.095 (p < 0.001), respectively. Sensitive analysis affirmed the robustness of these findings. Heterogeneity analysis revealed significant HRQoL improvements among males, females, those aged 70 and older, patients with comorbidities, and urban residents, while the effect was less pronounced in the middle-aged, those without comorbidities, or rural dwellers.
Conclusion
Community-based PHS has exerted a positive impact on both the physiological and psychological aspects of HRQoL among middle-aged and older chronic disease patients, with effects varying among individuals with different characteristics. Our findings advocate for enhancing the delivery and utilization of government-funded PHS, increasing health literacy, and promoting early prevention strategies for chronic diseases. Furthermore, targeted health management initiatives for patients with comorbidities and enhancements in the quality of community healthcare services, particularly in rural areas, are deemed necessary.
... [5] The family doctor system has been established in over 50 countries and regions worldwide, including Britain, the United States, Australia, Brazil, etc. [6][7][8][9] It was also described as general practitioners or family physicians in some countries who play a valuable role in the primary health care system. [10][11][12] For example, previous studies have emphasized the role of "gatekeeper" played by the family doctor system, which could reduce healthcare costs, optimize the allocation of health resources, and finally positively promote the health outcomes of residents. [13,14] Since 2016, China has accelerated the implementation of family doctor contract service (FDCS) in nationwide areas, with a series of supportive policies. ...
A BSTRACT
Introduction
Family doctor contract service (FDCS) is a vital part of China’s primary health care system. This study aims to explore whether contracting with FDCS affects residents’ utilization of and satisfaction with primary health care.
Methods
A structured questionnaire was employed to collect data in January 2022. The questionnaire mainly included the following three parts: the social-demographic characteristics, health-related information, and utilization of and satisfaction with primary health care. Propensity score matching (PSM) was used to adjust for social-demographic differences between participants who contracted with a family doctor and those who did not. For the matched population, we used the Chi-square test to examine the differences in the utilization of and satisfaction with primary health care between contracted and non-contracted participants. Moreover, multiple logistic regression and linear regression were used to explore the influencing factors of the utilization of and satisfaction with primary health care.
Results
A total of 10,850 people were investigated and 10,419 participants were incorporated into the data analysis. After matching, there were no significant differences in most of the matching variables between the contracted and non-contracted groups ( P > 0.05). The utilization rate was significantly higher among the contracted population than of the non-contracted (96.3% vs 92.6%, P < 0.001). The quality of services (e.g., good service attitude, high medical level, and a trusted family doctor) was more likely to be cited as the main reasons for the contracted people to utilize primary health care than for the non-contracted. The contracted people were also significantly more satisfied than the non-contracted in all terms of satisfaction. Moreover, people who contracted with a family doctor were more likely to use primary health care with OR = 1.979 (95% CI, 1.511–2.593).
Conclusion
The contracted people were more likely to utilize and be satisfied with primary health care than the non-contracted. In addition, the contracted people tended to use primary health care because of the quality of services rather than because of the close distance or short waiting time. Therefore, it is important to further promote the high quality of FDCS to ensure residents’ sense of gain and improve their satisfaction.
... Therefore, as individuals age, the likelihood of medical expenditure increases, and the elderly are more likely to experience CHE in rural China. In China, the government provides targeted health management measures for patients with chronic diseases, such as the provision of chronic diseases management services [36,37], which can effectively reduce healthcare costs and the incidence of CHE in rural China. In addition, the higher the level of education, the greater the focus on health status. ...
Background
Catastrophic health expenditure (CHE) is an important indicator of measuring health inequality. Previous studies mainly focused on specific vulnerable populations rather than a wider range of vulnerable areas through panel data. Rural China is often associated with an underdeveloped economy and insufficient health resources. This study aims to update the information on the extent of and trends in the incidence and inequality of CHE among the households of rural China through longitudinal survey data.
Methods
Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2013, 2015, and 2018. In total, 2,575 households were included in the analysis. CHE was defined as household health expenditures exceeding 40% of non-food expenditures. Inequality in CHE was measured using the concentration curve and concentration index. The contribution to CHE inequality was decomposed using the concentration index decomposition method.
Results
The incidence of CHE was 0.2341 (95% CI: 0.22, 0.25) in 2013, 0.2136 (95% CI: 0.20, 0.23) in 2015, and 0.2897 (95% CI: 0.27, 0.31) in 2018 in rural China. The concentration curve lay above the equality line, and the concentration index was negative: −0.1528 (95% CI: −0.1941, −0.1115) in 2013, −0.1010 (95% CI: −0.1442, −0. 0577) in 2015, and −0.0819 (95% CI: −0.1170, −0.0467) in 2018. Economic status, age, and chronic diseases were the main contributors to inequality in CHE.
Conclusions
The incidence of CHE in rural China displayed an upward trend from 2013 to 2018, although it was not continuous. Furthermore, a strong pro-low-economic inequality in CHE existed in rural China. Mainly economic status, age, and chronic diseases contributed to this pro-low-economic inequality. Health policies to allocate resources and services are needed to satisfy the needs of rural households and provide more accessible and affordable health services. More concern needs to be directed toward households with chronic diseases and older persons to reduce the incidence of CHE and promote health equality.
... Yuan et al. showed that family doctors can provide high-quality comprehensive care services for the elderly [7]. The study of Yu et al. and Wang et al. showed that contracted residents strengthened the monitoring of chronic diseases and increased the utilization of primary care facilities [8,9]. Lai et al. showed that the healthrelated quality of life of contracted residents was significantly higher than that of uncontracted residents [10]. ...
... The MCCs can harm the physical and mental health of the elderly, with the impact increasing as the degree of MCCs increases [39,40]. FDCSs were helpful to improve the treatment effect of chronic diseases, improve the quality of comprehensive care, and improve the health-related quality of life [7,9,41,42]. Patients with chronic diseases may also be more willing to use health services to meet their health needs [43,44]. ...
Background
China's family doctor contracting service is an important part of deepening the reform of the healthcare systems, aiming to further develop chronic disease management services, enhance the capacity of primary health care services and improve the health of residents. The purpose of this study was to explore the influence of multiple chronic conditions in the elderly on family doctor contracting and whether socioeconomic status played a moderating role.
Methods
A cross-sectional survey was conducted in Beijing, China. A total of 1814 elderly people over 60 years old were included in this study using a whole-group sampling method. The univariate analysis and logistic regression analysis was used to analyze the data.
Results
21.72% of the elderly signed up with family doctors. The multiple chronic conditions was a factor influencing the elderly to sign up with family doctors (OR = 1.44, 95%CI = 1.28–1.61), and the higher the degree of multiple chronic conditions, the stronger willingness to sign up. Socioeconomic status positively moderates the effect of multiple chronic conditions on signing. Also, physical activity intensity (OR = 1.25, 95%CI = 1.03–1.54) and willingness to first visit primary care facilities (OR = 1.38, 95%CI = 1.25–1.54) influenced the elderly to sign up with family doctors.
Conclusions
The elderly with a high degree of multiple chronic conditions, high activity intensity, and a strong willingness to first visit primary care facilities were more likely to sign up with family doctors. The health literacy of the elderly should be further improved, and publicity on the family doctor contracting service policies for the elderly with lower socioeconomic status should be strengthened to guide them to sign up with family doctors. At the same time, the service capacity of primary care facilities should be further improved to meet the health needs of the elderly.
... All included studies were quasi-experimental studies, except for one matched-pair cluster RCT (Liu et al., 2016). The majority of studies employed difference-in-difference (DID) approaches (N = 38), with seven combining this with propensity score matching/weighting (Zhang et al., 2014a;Ding and Wu, 2015;Miao et al., 2018;Hu et al., 2021;Wang and Liu, 2022), eight using fixed-effect panel regression (Yi et al., 2015;Sun et al., 2016b;Yang et al., 2017;Duan et al., 2020;Xu et al., 2020a;Shen et al., 2021;Zhou et al., 2021;Pan and Yang, 2022), three adopting dynamic DID models (also known as event-study analysis) (Yao et al., 2020;Shen et al., 2020a;Yuan et al., 2021) and four without any statistical tests (Chen et al., 2013;He et al., 2014;Ma et al., 2014;Wang et al., 2014). Four studies were controlled interrupted time series studies Liang et al., 2014;Sun et al., 2016a;Tang et al., 2018). ...
... Of the five studies on reorganizing the health service delivery system, one assessed gatekeeping (Xu et al., 2020a) and four examined the integrated delivery system (Miao et al., 2016;Duan et al., 2020;Hu et al., 2021;Yuan et al., 2021). Policies on primary care provision were the least studied, with three studies on the family physician policy (Wang and Liu, 2022;Yin et al., 2016;Zhu et al., 2017) and one study on the NEPHS (Zhang et al., 2017). Additionally, two studies investigated two micro-level interventions on providers: (1) PHC workforce training (Yao et al., 2020) and ...
... Quality of care was examined by 13 studies from three aspects: antibiotic use (N = 8) (Jin et al., 2013;Yang et al., 2013;Chen et al., 2014;Liang et al., 2014;Gong et al., 2016;Liu et al., 2016;Sun et al., 2016a;2016b), satisfaction and perception of quality of care (N = 5) (Duan et al., 2020;Liu et al., 2014;Wei et al., 2015;Yin et al., 2016;Zhu et al., 2017) and the delivery of essential medicines (N = 1) (Yang et al., 2017). Ten studies investigated changes in health status using biomarkers (N = 8) (Duan et al., 2020;Jiang et al., 2016;Miao et al., 2016;Zhang et al., 2017;Hu et al., 2021;Yuan et al., 2021), mortality (N = 1) (Duan et al., 2020), self-reported health status (N = 2) (Jiang et al., 2016;Zhu et al., 2017) and health-related quality of life (N = 2) (Miao et al., 2016;Wang and Liu, 2022). Only one study assessed the reform effects on income-related health inequality (Pan and Yang, 2022) ( Table 2). ...
China's comprehensive primary health care (PHC) reforms since 2009 aimed to deliver accessible, efficient, equitable and high-quality health care services. However, knowledge on the system-wide effectiveness of these reforms is limited. This systematic review synthesizes evidence on the reforms' health and health system impacts. In August 2022, 13 international databases and three Chinese databases were searched for randomised controlled trials, quasi-experimental studies and controlled before-after studies. Included studies assessed large-scale PHC policies since 2009; had a temporal comparator and a control group; and assessed impacts on expenditures, utilisation, care quality, and health outcomes. Study quality was assessed using ROBINS-I and results were synthesized narratively. From 49,174 identified records, 42 studies were included - all with quasi-experimental designs, except for one randomised control trial. Nine studies assessed as at low risk of bias. Only five low to moderate quality studies assessed the comprehensive reforms as a whole and found associated increases in health service utilisation, whilst the other 37 studies examined single-component policies. The National Essential Medicine Policy (N=15) and financing reforms (N=11) were the most studied policies, whilst policies on primary care provision (i.e., family physician policy and the National Essential Public Health Services) were poorly evaluated. The PHC reforms were associated with increased primary care utilisation (N=17) and improved health outcomes in people with non-communicable diseases (N=8). Evidence on healthcare costs was unclear and impacts on patients' financial burden and care quality were understudied. Some studies showed disadvantaged regions and groups accrued greater benefits (N=8). China's comprehensive PHC reforms have made some progress in achieving their policy objectives including increasing primary care utilisation, improving some health outcomes, and reducing health inequalities. However, China's health system remains largely hospital-centric and further PHC strengthening is needed to advance Universal Health Coverage.
... At present, activity participation has become a hot topic in depression research. If the elderly cannot adapt to changes brought about by physical function (PF) decline or the change in social roles (eg, changes in activity participation), anxiety and depression will be an inevitable consequence [6]. Depression is a common mental disorder. ...
... In psychology, it mainly refers to the life cycle of people and the life cycle of the family and also refers to the process of birth, growth, aging, illness, and death. Life cycle theory holds that after middle-aged people enter old age, their physiological and psychological processes experience a series of changes [14], which leads to changes in activity participation [6]. In a nutshell, the activity participation of the elderly (eg, leisure activities) gradually becomes simpler and decreases over time [11,14]. ...
... Activity theory believes that middle-aged and older people can establish new roles to cope with the loss of their original roles so as to adapt to society and obtain psychological satisfaction [19]. In other words, older people can establish new roles through activity participation to alleviate the depressive symptoms caused by role changes [6]. This theory is also supported by the results of some clinical studies, which suggest that activity participation can prevent depression [20] and is becoming an effective treatment for depression [21]. ...
Background
More activity participation is an important means of handling depression and promoting positive aging, but the impact of changes in activity participation on the developmental trajectory of depression has not been fully studied.
Objective
The purpose of this study is to study the relationship between current activity participation and depression in middle-aged and older people (≥45 years old) and the relationship between activity participation and the developmental trajectory of depression in later life in China.
Methods
This study used data from the China Health and Retirement Longitudinal Study (CHARLS) across 7 years and included a total of 4818 middle-aged and older people (≥45 years old). Controlling for relevant control variables, the latent growth curve model and the cross-lag model were used to assess the effect of changes in activity participation on the depression trajectory in later life and the main lag relationship between activity participation and depression. Activity participation as well as depression were measured using the self-reported activity and health status based on the CHARLS questionnaire.
ResultsAmong the 4818 respondents, the mean values of physical activity participation, social leisure activity participation, and depression ranged from 76.98 (SD 15.16) to 83.95 (SD 5.72), from 7.43 (SD 8.67) to 9.25 (SD 10.16), and from 7.61 (SD 5.72) to 8.82 (SD 6.51), respectively. Our findings revealed that activity participation could be related to depression. Physical activity participation predicted initial depression (β=–0.631, P
... In addition, many foreign studies also showed that in less developed countries and regions such as sub-Saharan Africa, tribal culture similar to the family branch system was also critical in environmental protection and HIV prevention and control [15,16]. Meanwhile, Contracted Family Doctor Services [17,18] is conducted throughout the state in accordance with the unified requirements of the National Health Commission in Liangshan Prefecture. An important part of this work is to build an interactive platform for family doctors and contracted residents, providing services such as appointments, consultation, health management, and follow-up visits for NCDs. ...
Background
Improvement of health literacy constitutes a cornerstone to improving public health. However, the overall health literacy of Liangshan Yi Autonomous Prefecture (Liangshan Prefecture) in the southwest Sichuan Province of China has kept extremely low for a long time. How to improve health literacy of the Yi nationality residents is key to be urgently solved. Notably, Family Branch System is a distinctive patrilineal bloodline organization of Yi nationality, which plays an important role in the daily life of Yi nationality. Meanwhile, Contracted Family Doctor Services is conducted in Liangshan Prefecture. Therefore, this study proposes an intervention model of health education based on Family Branch System and Contracted Family Doctor Services, which is a Family-based Improvement for Health Literacy among the Yi nationality (FAMILY) in Liangshan, when improving traditional Innovative Care for Chronic Conditions Framework (ICCC) framework.
Methods
An open cohort stepped wedge cluster randomized trial design is used to implement health literacy education interventions including project preparation, core group building, promotion within family branch and competition between family branches while using Contracted Family Doctor Services as control measure. The study will be conducted among Yi nationality residents in Meigu County and Yanyuan County, with health literacy level of residents as the primary outcome. Finally, mixed-effects model and causal inference method will be used to evaluate intervention effect.
Discussion
This study highlights family, using the unique Family Branch System and Contracted Family Doctor Services in Liangshan Prefecture to design intervention among improved ICCC framework, and combines the mixed-effects model with complier average causal effects (CACE) to estimate the intervention effect under non-compliance for the first time. Besides, other key technologies to be adopted include construction of electronic questionnaire quality control system, with quality control based on artificial intelligence. This trial contributes to exploring an effective way to improve health literacy of Yi nationality residents in Liangshan Prefecture, which will provide reference for other areas, especially poor areas, to improve residents’ health literacy.
Trial registration
ISRCTN11299863 on June 1, 2022; https://www.isrctn.com/ .
