Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-04-03 Cooperative journals: 《中国全科医学》
Abstract： Background The promotion of appropriate traditional Chinese medicine（TCM）techniques in primary care institutions is an important measure emphasizing the co-development of Chinese and western medicine，and enhancing the inheritance and development of TCM. Objective To analyze primary health workers’preferences for the use of appropriate TCM techniques，providing policy recommendations for the promotion and use of such techniques in primary healthcare institutions. Methods This questionnaire survey was conducted between July and August 2021. A discrete choice model with seven attributes and 18 choice sets obtained through the use of an efficient orthogonal design were used to develop the questionnaire used in the survey，and the questionnaire has three versions（each version with evenly allocated six choice sets（including an opt-out option）. Additionally，the three versions have a common general demographic part（sex，age，education level，professional title，etc.）and one common consistency test question. A randomized multistage stratified cluster sampling was used to select 319 health workers on duty on the survey day from a total of 23 primary healthcare institutions in three counties in eastern，central and western China（one county was extracted from each region），and each worker was required to complete one version of the questionnaire extracted sequentially by themselves. Two hundred and ninety-five cases who returned a questionnaire passing a consistency test were included for analysis，resulting in a response rate of 92.5%. Primary health workers’ preferences for appropriate TCM techniques were analyzed using conditional Logit models and latent class models. Furthermore，the changes in utility of primary health workers due to attribute level changes were monetized using willingness to pay and presented accordingly. Results The conditional Logit analysis showed that medical insurance，the average duration of each operation with the TCM technique，the influence of operation with the TCM technique on income，work burden，the promotion of professional title，and patient healthcare cost，as well as effectiveness of the TCM technique were associated with primary health workers’ preferences for the use of appropriate TCM techniques（ P<0.05）. The latent class model revealed that the opt-out option coefficient for those holding a wait-and-see attitude toward the use of TCM techniques（16.2%）was -3.660（ P<0.001），while that for those supporting the use of TCM techniques（83.8%）was 2.189（ P<0.001）. Moreover，those holding a wait-and-see attitude toward the use of techniques exhibited a stronger preference for appropriate TCM techniques that have been proven to be efficacious （ β =1.275），and those supporting the use of TCM techniques showed no significant preference for those with unchangeable effectiveness（ β =0.054）. Conclusion Primary health workers prefer to use appropriate TCM techniques that can increase their income without workload increase，facilitate their professional title promotion，retain or reduce patient costs，and are covered by health insurance and have good efficacy. To effectively promote primary health workers’ enthusiasm in the use of appropriate TCM techniques，it is suggested to add these techniques to the medical insurance reimbursement list，and make a connection between the use of these techniques and title promotion. In addition，different incentive strategies should be adopted for different types of primary health workers.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-11-23 Cooperative journals: 《中国全科医学》
Abstract：
Background The number of patients with chronic diseases is increasing year by year in China. Health-related quality of life is an important indicator to evaluate the effect of prevention and treatment of chronic diseases. It is of great significance to select appropriate health-related quality of life measurement tools for patients with chronic diseases. Objective The aim of this study was to compare contemporaneous utility weights of three universal health utility scales of chronic disease patients, namely, the Quality of Life Assessment Scale of Traditional Chinese Medicine (CQ-11D), the First Edition of the Six dimensional Health Survey (SF-6Dv1) and the Three Level Five dimensional Health Scale (EQ-5D-3L), and to evaluate the validity, consistency and correlation of the three scales in measuring the health utility values of chronic disease patients. Methods Quota sampling was conducted according to the sex and age ratio of the Chinese population. The basic information of the respondents was collected through face-to-face surveys. The self-reported results of the three scales, CQ-11D, SF-6Dv1 and EQ-5D-3L, were collected in turn. Patients with chronic diseases were selected from them, and the measurement results of the efficacy of the three scales were analyzed, Bland-Altman chart and Intraclass Correlation Coefficient (ICC) were used to analyze the consistency and correlation of the three scales, and Kruskal Wallis test was used for univariate analysis of gender and age. Results a total of 692 patients with chronic diseases were included in this study. The mean (standard deviation) of utility scores of CQ-11D,SF-6Dv1 and EQ-5D-3L scales were 0.855 (0.168), 0.793 (0,132) and 0.876 (0.136), respectively.The top three chronic diseases were hypertension (N=275), arthritis (N=128) and hyperlipidemia (N=124). Histogram shows that EQ-5D-3L has obvious ceiling effect, and CQ-11D is more widely distributed; The Bland-Altman chart shows that the consistency between the three scales is relatively good, and the points within the 95% consistency interval (LOA) are all about 95%; The correlation between CQ-11D and visual analog score (VAS) is the highest. The ICC range among the three scales is 0.528-0.625, showing a moderate level of correlation. The results of Bland Altman diagram and ICC analysis show that SF-6Dv1 and EQ-5D-3L have the best consistency.The results of subgroup analysis for three different chronic diseases were similar to those of the total sample above.Univariate analysis showed that the utility scores of male patients with hypertension and hyperlipidemia was higher than that of female patients, and the utility scores of patients with hyperlipidemia over 60 years old was the lowest. Conclusion The ceiling effect of EQ-5D-3L scale is obvious in patients with chronic diseases.CQ-11D is relatively suitable for measuring the health-related quality of life of Chinese chronic disease population, as no ceiling effect was observed and its correlation with VAS was the strongest.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-07-09 Cooperative journals: 《中国全科医学》
Abstract：
Background: Sleep duration is closely related to the health of college students. There is no conclusion on the optimal sleep duration of college students. And there is a lack of research on the dose-response relationship between sleep duration and TCM constitution. Objective: To explore the relationship between sleep duration and TCM Constitution of college students, so as to provide reference for Health education on sleep duration of college students. Methods: Purposive sampling combined with snowball sampling was used for on-site questionnaire survey, 1003 valid samples were obtained. The TCM Constitution of college students was evaluated by Constitution in Chinese Medicine Questionnaire of 41-item(CCMQ-41）, a self-designed questionnaire was used to measure sociodemographic information and lifestyle of college students. Taking sleep duration as independent variable and TCM Constitution scores as dependent variable, and control related confounding variables, the dose-response relationship between sleep duration and TCM constitution was analyzed by restrictive cubic spline fitting multiple linear regression model. Results: The sleep duration of college students with different gender, grade, eating habits and past history was different (P < 0.05). Multiple linear regression analysis showed that there was no linear relationship between sleep duration and TCM Constitution score. The dose-response relationship of the sample population showed that the sleep duration of the highest score of gentleness combined with the lowest score of biases (except specific diathesis) was about 8h, the sleep duration was > 8.5h, the score of gentleness showed a decreasing trend and the scores of qi deficiency and qi depression showed an increasing trend. The dose-response relationship of gender stratification showed that the sleep duration of men and women with the highest score of gentleness and the lowest score of biases (except specific diathesis) was about 8h, which was consistent with the results of the total sample. Conclusion: Considering all types of TCM status, the optimal daily sleep duration of college students is about 8 hours; College students should control the sleep duration no more than 8.5 hours to avoid increasing the possibility of the biases.
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