Evaluation of the association between presenteeism and perceived availability of social support among hospital doctors in Zhejiang, China.

BACKGROUND: This study investigated the association between presenteeism and the perceived availability of social support among hospital doctors in China. METHODS: A questionnaire was administered by doctors randomly selected from 13 hospital in Hangzhou China using stratified sampling. Logit model was used for data analysis. RESULTS: The overall response rate was 88.16%. Among hospital doctors, for each unit increase of the perceived availability of social support, the prevalence of presenteeism was decreased by 8.3% (OR = 0.91, P = 0.000). In particular, if the doctors perceived availability of appraisal support, belonging support and tangible support as sufficient, the act of presenteeism was reduced by 20.2% (OR = 0.806, P = 0.000) 20.4% (OR = 0.803, P = 0.000) and 21.0% (OR = 0.799, P = 0.000) respectively with statistical differences. CONCLUSION: In China, appraisal support, belonging support and tangible support, compared to other social support, had a stronger negative correlation with presenteeism among hospital doctors. The benefits of social support in alleviating doctors' presenteeism warrant further investigation.

Does an economic incentive affect provider behavior? Evidence from a field experiment on different payment mechanisms.

AIMS: This study analyzed discrepancies in the quantity of medical services supplied by physicians under different payment systems for patients with different health statuses and illnesses by means of a field experiment. METHODS: Based on the laboratory experiment of Heike Hennig-Schmidt, we designed a field experiment to examine fee-for-service (FFS), capitation (CAP), and diagnosis-related group (DRG) payment systems. Medical students were replaced with 220 physicians as experimental subjects, which more closely reflected the clinical choices made by physicians in the real world. Under the three payment mechanisms, the quantity of medical services provided by physicians when they treated patients with different health statuses and illnesses were collected. Finally, relevant statistics were computed and analyzed. RESULTS: It was found that payment systems (sig. = 0.000) and patient health status (sig. = 0.000) had a stronger effect on physicians' choices regarding quantity of medical services than illness types (sig. = 0.793). Additionally, under the FFS and CAP payment systems, physicians overserved patients in good and intermediate health while underserving patients in bad health. Under the DRG payment system, physicians overserved patients in good health and underserved patients in intermediate and bad health. Correspondingly, under FFS and CAP, the proportional loss of benefits was the highest for patients in bad health and the lowest for patients in good and intermediate health; while under DRGs, patients in good and intermediate health had the largest and smallest loss of benefits, respectively. LIMITATIONS: In order to increase external effects of experiment results, we used the field experiment to replace laboratory experiment. However, the external effects still existed because of the blurring and abstraction of the parameters. CONCLUSIONS: Medical treatment cost and price affected the quantity of medical services provided by physicians. Therefore, we proposed that a mix of payment systems could address the common interests of physicians and patients, as well as influence incentives from payment systems.

Community pharmacists' opinions and practice of pharmaceutical care at chain pharmacy and independent pharmacy in China.

Background Whether Chinese community pharmacists in chain pharmacies and independent pharmacies provide the same type and quality of pharmaceutical care has not been fully investigated. Objective This study aimed to investigate community pharmacists' understanding, attitude, practice and perceived barriers of pharmaceutical care at chain pharmacies and independent pharmacies in China. Setting Community pharmacies in China. Method A questionnaire survey was conducted in 27 provinces (autonomous regions) and 4 municipality cities in China. Main outcome measure Chinese community pharmacists' understanding, attitude, practice and perceived barriers of pharmaceutical care. Results The respondent pharmacists' understanding of pharmaceutical care was only moderate, though they showed a positive attitude towards providing the service. The respondent pharmacists from both chain and independent pharmacies provided more basic pharmaceutical service than advanced pharmaceutical care. Regarding barriers to providing pharmaceutical care, the respondent pharmacists identified the main barriers as a lack of physical space, slow introduction of pharmacist law, lack of patient acceptance of pharmaceutical care, and lack of face-to-face communication with patients. Pharmacists at chain pharmacies had a better understanding of and attitude toward pharmaceutical care and practiced more advanced pharmaceutical care than pharmacists at independent pharmacies. Conclusion Chinese community pharmacists' understanding and practice of pharmaceutical care in China needs improvement. Compared with pharmacists at chain pharmacies, pharmacists at independent pharmacies face more challenges in providing pharmaceutical care. Specific efforts should be made to improve pharmacist competence, increase patient acceptance and shape a better operative environment for community pharmacies, especially for independent pharmacies.

Doctor's presenteeism and its relationship with anxiety and depression: a cross-sectional survey study in China.

OBJECTIVES: The impact of presenteeism on doctors' health, quality of patient care and overall performance of health institutions has been reported. The study aimed to investigate the prevalence of presenteeism among doctors, the association between presenteeism and anxiety/depression, and aspects that can help alleviate presenteeism. DESIGN: A cross-sectional anonymous survey study was conducted between 2017 and 2018. SETTING: 30 hospitals in Hangzhou city, Zhejiang Province, China including 10 category 1 hospitals (20-99 beds), 10 category 2 hospitals (100-499 beds) and 10 category 3 hospitals (> 500 beds) which had the highest population coverage. PARTICIPANTS: At least 3 doctors from each department in the studied hospitals participated. Each participant received a gift worth around US$5 at completion of the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: The prevalence of presenteeism and its relationship with anxiety or depression were evaluated as the primary outcomes. Secondary outcomes included the prevalence of abnormal cases of anxiety and depression. RESULTS: The survey was completed by 1153/1309 hospital doctors (response rate 88.1%). Presenteeism was reported by 66.4% of participants. Using the Hospital Anxiety and Depression Scale, 68.8% and 72.3% of participants had abnormal cases of anxiety and depression, respectively. Logistic regression analysis showed that participants with abnormal cases of anxiety, borderline cases of depression or abnormal cases of depression were more likely to practice presenteeism (all p<0.05). Other significant work-related contributing factors included: time working at the current hospital, management duty, monthly salary and ease of replacement (all p<0.05). CONCLUSION: Presenteeism was prevalent among doctors in China and the association of presenteeism with abnormal cases of anxiety or depression was significant. Considering the modifiable work-related contributing factors, appropriate measures at the healthcare institutions to support doctors' mental health, help them develop and reinforce management skills, and ensure appropriate manpower are important to alleviate presenteeism behaviour.