Factors associated with the uptake of national essential public health service package for hypertension and type-2 diabetes management in China's primary health care system: a mixed-methods study.

Autor:	Xiong S; The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.; Global Health Research Centre, Duke Kunshan University, Kunshan, China., Jiang W; National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China., Meng R; Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China., Hu C; Yichang City Centre for Disease Control and Prevention, Yichang, China., Liao H; Wenchuan County Health Bureau, Wenchuan, China., Wang Y; Division of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China., Cai C; Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, UK., Zhang X; School of Public Health, Harbin Medical University, Harbin, China., Ye P; The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.; National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China., Ma Y; National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China., Liu T; School of Public Health, Harbin Medical University, Harbin, China., Peng D; Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China., Yang J; Yichang City Centre for Disease Control and Prevention, Yichang, China., Gong L; Wenchuan County Health Bureau, Wenchuan, China., Wang Q; Division of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China., Peiris D; The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia., Mao L; Centre for Social Research in Health, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia., Tian M; The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.; School of Public Health, Harbin Medical University, Harbin, China.
Jazyk:	angličtina
Zdroj:	The Lancet regional health. Western Pacific [Lancet Reg Health West Pac] 2022 Dec 14; Vol. 31, pp. 100664. Date of Electronic Publication: 2022 Dec 14 (Print Publication: 2023).
DOI:	10.1016/j.lanwpc.2022.100664
Abstrakt:	Background: China launched the primary health care (PHC) system oriented National Essential Public Health Service Package (NEPHSP) in 2009, to combat health challenges including the increasing burden from hypertension and type-2 diabetes (T2DM). In this study, the PHC system was assessed to understand factors influencing the uptake of the NEPHSP for hypertension and T2DM management. Methods: A mixed-methods study was conducted in seven counties/districts from five provinces across the mainland of China. Data included a PHC facility level survey and interviews with policy makers, health administrators, PHC providers, and individuals with hypertension and/or T2DM. The facility survey used the World Health Organisation (WHO) service availability and readiness assessment questionnaire. Interviews were thematically analysed using the WHO health systems building blocks. Findings: A total of 518 facility surveys were collected with over 90% in rural settings (n = 474). Forty-eight in-depth individual interviews and 19 focus-group discussions were conducted across all sites. Triangulating the quantitative and qualitative data found that China's continuous political commitment to strengthening the PHC system led to improvements in workforce and infrastructure. Despite this, many barriers were identified, including insufficient and under-qualified PHC personnel, remaining gaps in medicines and equipment, fragmented health information systems, residents' low trust and utilization of PHC, challenges in coordinated and continuous care, and lack of cross-sectorial collaborations. Interpretation: The study findings provided recommendation for future PHC system strengthening, including improving the quality of NEPHSP delivery, facilitating resource-sharing across health facilities, establishing integrated care systems, and exploring mechanisms for better cross-sectorial engagement in health governance. Funding: The study is supported by National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Disease funding (APP1169757). Competing Interests: The authors declare no conflict of interests for this study. (© 2022 The Author(s).)
Databáze:	MEDLINE
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