Wenbin Liu’s research while affiliated with Fujian Medical University and other places

Background Multiple chronic conditions (MCC) have become a leading cause of low vitality and high mortality among the Chinese population. Although a series of policies has been implemented to promote patients’ rational access to health care, patients still prefer a higher level of inpatient service, hampering the efficient utilization of resources in county hospitals, which are the first point of contact for inpatient care. Thus, this study aimed to identify the factors that affect MCC patients’ inpatient preferences and the extent to which these factors influence their decisions, thereby guiding inpatient service utilization among MCC patients. Methods Five attributes (institution scale, waiting time for hospital admission, presence of acquaintances, travel time from residence to hospital, and out-of-pocket expenses per visit) were identified to estimate inpatient choice for MCC patients through a discrete choice experiment. A partial factor analysis was performed to generate selection sets. Data were collected from MCC patients aged between 35 and 75 years, in Fuqing City, China. A mixed logit model was used to analyse MCC patients’ preferences for each attribute. Willingness to pay was estimated by regression coefficients, and interaction terms were included in the model to estimate the heterogeneity of inpatient preferences among MCC patients. Results A total of 504 valid questionnaires were included in the analysis. The most important attribute of patients when choosing inpatient care is out-of-pocket expenses per visit, followed by travel time from residence to hospital, waiting time for hospital admission, institution scale, and presence of acquaintances. In addition, patients were willing to pay ¥1253, ¥434, and ¥323 for shorter times from the residence to the hospital, larger institutional scale, and beds available on the day, respectively. The findings of the interaction analysis indicated that age and gender also influence MCC patients’ inpatient preferences. Conclusion This study provides evidence of the inpatient preferences of MCC patients. Increasing inpatient insurance reimbursement rates, bolstering the leading role of district and county hospitals in the area, and strengthening information systems will empower district and county hospitals to effectively serve as the first point of contact for inpatient care.

Background Medical consortiums have been extensively established to facilitate the integration of health resources and bridge the technical gap among member institutions. However, some commonly appropriate technologies remain stagnant in subordinate hospitals, although they have been routinely applied in leading hospitals. Besides, the mechanism underlying differences in clinicians’ adoption behavior at different levels of institutions was unknown. Therefore, this study aimed to investigate the differences in influencing mechanisms of clinicians’ hepatic contrast-enhanced ultrasound technology (CEUS) utilization behavior between leading and subordinate hospitals within medical consortiums, thus providing clues for expanding effective and appropriate technologies within integrated care systems. Methods A self-designed scale was developed based on the theory of planned behavior (TPB). A multistage sampling method was applied to investigate clinicians who were aware of CEUS and worked in liver disease-related departments within the sampled medical institutions. The final sample size was 289. AMOS 24.0 software was used to construct multi-group structural equation modeling (SEM) to validate the hypotheses and determine the mechanism of hepatic CEUS utilization. Results It revealed that behavioral intention significantly influenced adoption behavior, regardless of whether it was in leading hospitals or subordinate hospitals (β = 0.283, p < 0.001). Furthermore, behavioral attitude (β = 0.361, p < 0.001) and perceived behavioral control (β = 0.582, p < 0.001) exerted significant effects on adoption behavior through behavioral intention. However, in leading hospitals, subjective norm had a significant positive effect on behavioral intention (β = 0.183, p < 0.01), while it had a significant negative impact on behavioral intention in the subordinate hospitals (β = -0.348, p < 0.01). Conclusion To effectively translate the adoption intention into actual behavior, it is recommended to elucidate the demand and facilitators involved in the process of health technology adoption across leading and subordinate hospitals. Additionally, bolstering technical support and knowledge dissemination within subordinate hospitals while harnessing the influential role of key individuals can further enhance this transformative process.

Background Multiple chronic conditions (MCC) have become a leading cause of hypovitalism and death among the population. Although the role of chronic disease management has been strengthened for primary health institutions, patients still have a preference for a higher level of inpatient service, leading to a considerable hindrance in the efficient utilization of healthcare resources. Thus, this study aimed to identify factors that affected MCC patients' inpatient preference and the extent to which these factors impact their decisions, guiding for inpatient service utilization among MCC patients. Methods Five attributes (institutional scale, waiting time for hospital admission, with or without acquaintances, time from residence to hospital, out-of-pocket expenses per time) were identified to estimate inpatient choice for MCC patients through a discrete choice experiment. Partial factor analysis was performed to generate selection sets. Data were collected from MCC patients between 35 and 75 years old, in Fuqing, Fujian Province. A mixed logit model was performed to analyze MCC patients' preferences for each attribute. Willingness to pay was estimated by regression coefficients, and subgroup analysis was conducted based on the patient’s demographic characteristics and overall perceived disease severity. Results Totally 504 valid questionnaires were included in the analysis. MCC patients preferred to have a shorter time from their residence to the hospital (β = 0.7602, p < 0.001), large provincial and municipal tertiary hospitals (β = 0.2635, p < 0.001), and have beds available on the day (β = 0.1962, p = 0.0028). Out-of-pocket expenses per time (β=-0.0006, p < 0.001) are a negative predictor of patients' inpatient preference. Additionally, Patients were willing to pay ¥1253, ¥434, and ¥323 for higher institutional scale, shorter waiting time, and shorter time from residence-to-hospital, respectively. The findings of subgroup analysis indicated that some demographic characteristics (age, gender, education and total household income) and overall perceived disease severity also influence MCC patients' inpatient preferences. Conclusion This study provides evidence on the inpatient preferences among MCC patients. To better meet patients’ needs, it is recommended to improve the geographical accessibility of medical and health services, strengthen the service capacity of medical personnel in county and community-level medical institutions, streamline the inpatient diagnosis and treatment process, and so on.

Background With the improper use of antimicrobials becoming a major public health concern globally, poor compliance of clinical practice guidelines(CPGs) on antimicrobials is still prominent, especially in less developed regions. Although social norms have received increasing attention as the determinants of physicians’ CPGs use, most studies set forth only a single level of social norms. Therefore, this study aims to investigate the impact of multifaceted social norms on physician’ use of CPGs on antimicrobials, and further reveal the temporal effects of social norms. Methods Based on integration of Theory of Planned Behavior and Theory of Normative Social Behavior, a questionnaire survey was conducted covering social norms at individual level (subjective norms), organizational level (organization criterion) and social level (social identity), as well as other potential factors (attitudes, behavioral intention, etc) for the use of CPGs on antimicrobials. Data were collected by multi-stage random sampling from 502 physicians in secondary and tertiary general hospitals in central-western China. Structural equation model (SEM) was used to link the three-level factors with physician's behavior. And with reflected by the moderating effects of professional titles in this study, the temporal effects of social norms were examined by multi-group SEM. Results Nearly 70% of the participants had a good practice of using CPGs on antimicrobials. Reliability and validity analysis shows that the questionnaire developed from the theoretical model is acceptable. Subjective norms, organization criterion and social identity were linked to higher behavioral intentions(β = 0.212, p < 0.01; β = 0.254, P < 0.01; β = 0.212, P < 0.01). The direct effect of behavior intentions on physicians' practice was 0.822, and the indirect effects of subjective norms, organizational criterion and social identity on practice were 0.308, 0.236 and 0.235. The effects of organization criterion and social identity on behavior were moderated by the professional title, and regarding effects would be weakened with the rise of professional title. Conclusion This study reveals the importance of multifaceted social norms in enhancing physicians’ use of CPGs on antimicrobials and the moderating effects of professional titles on the role of social norms at organizational level (organizational criterion) and social level (social identity).

Background Liver cancer is one of the malignant tumors worldwide, while the prevention and control situation is grim at present, and the diffusion of its early screening technology still faces some challenges. This study aims to investigate the influencing mechanism of perceived ease of use, organizational support mechanism, and industry competitive pressure on hepatic early screening technologies use by physicians, so as to promote the wider use of corresponding technologies. Methods Under the theoretical guidance of technology-organization-environment framework and mindsponge theory, this study took hepatic contrast-enhanced ultrasound as an example, and conducted a cross-sectional questionnaire by randomly selecting physicians from Fujian and Jiangxi provinces in China with a high and low incidence of liver cancer, respectively. Structural equation modeling was used to determine the correlation among perceived ease of use, organizational support mechanism, and industry competitive pressure, as well as their impact on the physicians’ behavior toward contrast-enhanced ultrasound use. Results The hypothesis model fits well with the data (χ²/df = 1.863, GFI = 0.937, AGFI = 0.908, RMSEA = 0.054, NFI = 0.959, IFI = 0.980, CFI = 0.980). Under technology-organization-environment framework, the perceived ease of use (β = 0.171, p < 0.05), organizational support mechanism (β = 0.423, p < 0.01), industry competitive pressure (β = 0.159, p < 0.05) significantly influenced physicians’ use of hepatic contrast-enhanced ultrasound. Besides, perceived ease of use and organizational support mechanism (β = 0.216, p < 0.01), perceived ease of use and industry competitive pressure (β = 0.671, p < 0.01), organizational support mechanism and industry competitive pressure (β = 0.330, p < 0.01) were all associated significantly. Conclusion From the lens of information processing (mindsponge theory) and technology-organization-environment framework, this study clarified the social and psychological influencing mechanism of perceived ease of use, organizational support mechanism, and industry competitive pressure on physicians’ use of hepatic contrast-enhanced ultrasound. The results will directly propose recommendations for expanding hepatic contrast-enhanced ultrasound utilization and indirectly promoting other appropriate and effective health technologies diffusion within the integrated health system.

Objective To compare the sex differences in cognitive function and its influencing factors among Chinese older adults. Method We conducted a cross-sectional study by using data from the China Longitudinal Healthy Longevity Survey (CLHLS). According to the 32 provinces and 4 municipalities directly under the Central Government of China, 3–5 counties or districts were randomly selected in each province or city (except Tibet), and then 1–3 villages or streets were randomly selected in each county or district, from which the target population was sampled. Mini Mental State Examination (MMSE) was used to assess the cognitive function of 9,262 older adults aged 65 and above in China. Descriptive analysis was applied to demonstrate the participants’ demographic characteristics, health-related behaviors, social and non-social activity, disease status, mental and sleep condition. And then, univariate and multifactor analyses were performed to validate different risk factors for cognitive function, respectively in the general population, male older adults and female older adults. Result The older adults with cognitive impairment accounted for 10.4% of the total population. There are significant differences in cognitive function between male and female older adults. The odds of cognitive impairment in older adult women was 1.291 times that of older adult men (OR = 1.291, 95%CI: 1.084–1.538). Among the male older adults, those who were older, highly educated, spouseless, had depressive symptoms, and lacked social activities were more likely to have cognitive impairment, whereas among the female older adults, those who were older, highly educated, and lacked social activities were more likely to have cognitive impairment. Conclusion Overall, there are subtle differences in potential influencing factors for cognitive function between the male older adults and female older adults. Attention should be paid to the different cognitive protection measures for the older adults with different sexes.

Abstract Background Although primary health care (PHC) has been proven to be effective in preventing and treating chronic diseases, the visits rate of PHC institutions is still not ideal. Some patients initially express a willingness to visit PHC institutions but end up seeking health services at non-PHC institutions, and the reasons for this behavior remain unclear. Therefore, the objective of this study is to analyze the factors that contribute to behavioral deviations among chronic disease patients who originally intended to visit PHC institutions. Methods Data were collected from a cross-sectional survey among chronic disease patients with original intention to visit PHC institutions in Fuqing City, China. The analysis framework was guided by Andersen’s behavioral model. Logistic regression models were employed to analyze the factors affecting the behavioral deviations among chronic disease patients with a willingness to visit PHC institutions. Results A total of 1,048 individuals were finally included and about 40% of the participants with the original willingness to seek care from PHC institutions finally chose non-PHC institutions in their subsequent visits. The results of logistic regression analyses indicated that at the predisposition factor level, older participants (aOR60-69 = 0.602, P

Background Despite growing evidence of health inequalities, equity of inpatient health service utilization(IHSU) among middle-aged and elderly people with multiple chronic conditions(MCCs) have received little attention. Therefore, this study aims to access the inequities of IHSU among middle-aged and elderly people with MCCs in China, and determine the contributing social factors and their influences by using the national data. Methods This study used two cross-sectional data from the 2013 and 2018 China Health and Retirement Longitudinal Study(CHARLS) The inequities of IHSU were illustrated and quantified by the concentration curve and normalized concentration index. Multivariate logistic regression was conducted to identify the associated factors of IHSU. And decomposition analysis was further applied to decompose the contribution of each determinant to the observed inequalities of IHSU. Results The study indicated that the rate of IHSU among Chinese middle-aged and elderly people with MCCs was 16.6% in 2013 and 17.7% in 2018. The overall concentration index for IHSU was − 0.0301 in 2013 and 0.0354 in 2018, which suggested a higher concentration of IHSU among economically disadvantaged middle-aged and elderly people with MCCs in recent year. The results showed the rate of IHSU was associated with age, sex, household income per capita, self-rated health, smoking, and drinking. Decomposition results further revealed the contributions of the determinants to the inequalities of IHSU. Specifically, age (43.16%), sex (-12.46%), household income per capita (-8.89%), self-rated health (-35.71%), smoking (63.70%), and drinking (59.90%) have varying degrees of contributions to the inequality in IHSU. Conclusion This study sheds light on the pro-rich inequality in IHSU among Chinese middle-aged and elderly people with MCCs. It suggests that policymakers should pay more attention to middle-aged and elderly adults who are male, old, economically disadvantaged, smoking, and drinking. In addition, more targeted interventions should be taken to improve the economic situation of these vulnerable individuals and strengthen their ability to cope with MCCs.

Background Multimorbidity has become an essential public health issue that threatens human health and leads to an increased disease burden. Primary care is the prevention and management of multimorbidity by providing continuous, comprehensive patient-centered services. Therefore, the study aimed to investigate the determinants of primary care utilization and out-of-pocket expenses (OOPE) among multimorbid elderly to promote rational utilization of primary care and reduce avoidable economic burdens. Methods The study used data from CHARLS 2015 and 2018, which included a total of 4,384 multimorbid elderly aged 60 and above. Guided by Grossman theory, determinants such as education, gender, marriage, household economy, and so on were included in this study. A two-part model was applied to evaluate primary care utilization and OOPE intensity in multimorbid populations. And the robustness testing was performed to verify research results. Results Primary care visits rate and OOPE indicated a decline from 2015 to 2018. Concerning primary outpatient care, the elderly who were female (OR = 1.51, P < 0.001), married (OR = 1.24, P < 0.05), living in rural areas (OR = 1.77, P < 0.001) and with poor self-rated health (OR = 2.23, P < 0.001) had a significantly higher probability of outpatient utilization, whereas those with middle school education (OR = 0.61, P < 0.001) and better household economy (OR = 0.96, P < 0.001) had a significantly less likelihood of using outpatient care. Rural patients (β = −0.72, P < 0.05) may have lower OOPE, while those with better household economy (β = 0.29, P < 0.05; β = 0.58, P < 0.05) and poor self-rated health (β = 0.62, P < 0.001) occurred higher OOPE. Regarding primary inpatient care, adults who were living in rural areas (OR = 1.48, P < 0.001), covered by Urban Employee Basic Medical Insurance (UEBMI) or Urban Rural Basic Medical Insurance (URBMI) (OR = 2.46, P < 0.001; OR = 1.81, P < 0.001) and with poor self-rated health (OR = 2.30, P < 0.001) had a significantly higher probability of using inpatient care, whereas individuals who were female (OR = 0.74, P < 0.001), with middle school education (OR = 0.40, P < 0.001) and better household economy (OR = 0.04, P < 0.001) had a significantly lower tendency to use inpatient care. Significantly, more OOPE occurred by individuals who were women (β = 0.18, P < 0.05) and with better household economy (β = 0.40, P < 0.001; β = 0.62, P < 0.001), whereas those who were covered by URBMI (β = −0.25, P < 0.05) and satisfied with their health (β = −0.21, P < 0.05) had less OOPE. Conclusion To prompt primary care visits and reduce economic burden among subgroups, more policy support is in need, such as tilting professional medical staff and funding to rural areas, enhancing awareness of disease prevention among vulnerable groups and so on.

Background: To confront the serious challenge of antimicrobial resistance, using clinical practice guidelines (CPGs) standardizing the prescription behavior is vital. However, the overall mechanisms remains largely unknown as to how guidelines' use behavior can be improved. This study aimed to identify the determinants and investigate their relationship to bridge the knowledge gap of overall influencing mechanism of the use behavior of CPGs on antimicrobials. Methods: By integrating theory of reasoned action (TRA) and organizational readiness for change (ORC), a structured questionnaire was developed to cover potential determinants that affect physicians' use behaviors of CPGs on antimicrobials at the individual-level (attitude, subjective norm, and behavioral intention) and organizational-level (top management support and organizational resource allocation). A multi-stage random sampling was implemented to collect data from physicians in secondary and tertiary hospitals from eastern, central and western China. Structural equation model (SEM) was used to test the proposed hypotheses, and to analyze the relationship and mechanism among the factors. Result: In total, 815 physicians were included. Most physicians demonstrated a positive tendency toward the use of CPGs on antimicrobials, with a mean score of 3.95 (SD = 0.70). The reliability and validity analysis showed the questionnaire constructed from the integrated theoretical model of TRA and ORC was acceptable. The SEM validation results also showed that the top management support (β = 0.688, P < 0.001), organizational resource allocation (β = 0.129, P < 0.001), individual attitudes (β = 0.164, P < 0.001), subjective norms (β = 0.322, P < 0.001), and behavioral intentions (β = 0.424, P < 0.001) were positively associated with physicians' use behaviors of CPGs on antimicrobials. Besides, top management support, organizational resource allocation, attitudes and subjective norms showed their mediating effects on regarding use behavior, which was 0.305, 0.129, 0.164 and 0.201, respectively. Conclusions: This study revealed the influence mechanism of the use of CPGs on antimicrobials from the individual and organizational perspectives. These findings will not only help formulate future strategies to promote the use of CPGs on antimicrobials, but also provide clues for more effective prescription interventions.