COVID-19 vaccine acceptance and its association with knowledge and attitude among patients with chronic diseases in Ethiopia.

COVID-19 vaccine acceptance is crucial for patients with chronic diseases, but previous studies in Ethiopia have yielded inconsistent and inconclusive findings. To fill this gap, we conducted a systematic review and meta-analysis following established guidelines. Our search included relevant articles published between 2019 and 2023 from various sources. We assessed study heterogeneity and publication bias, and performed subgroup and sensitivity analyses. Our findings indicate that the COVID-19 vaccine acceptance rate among patients with chronic diseases in Ethiopia was 55.4%. We also found that good knowledge and a favorable attitude toward the vaccine were positively associated with the acceptance rate. Based on these results, we recommend that healthcare professionals, policymakers, and healthcare guide developers should work more to address the relatively low acceptance rate. Improving the knowledge and attitude further about the COVID-19 vaccines is crucial. Future research should include community-based and qualitative studies to enhance our understanding of vaccines acceptance.

Strategies that enabled access to chronic care during the COVID-19 pandemic and beyond in South Africa.

Background: The COVID-19 epidemic has revealed disturbing information about how chronic diseases are treated globally. Healthcare providers and coronavirus response teams have primarily reported on how individuals with chronic conditions sought care and treatment. However, individuals' experiences of patients are yet unknown. Aim: This study aimed to explore those strategies that enabled patients with chronic diseases access to chronic care and treatment during and beyond the COVID-19 pandemic. Setting: The study was conducted in the predominantly rural district of the Northwest Province, South Africa. Methods: An explorative qualitative research design was followed. Information-rich participants were chosen using a purposive sampling technique. Individual face-to-face interviews were used to gather data. Data saturation was achieved after interviewing n = 28 people in total. The six steps of Braun and Clarke thematic data analysis were used to analyse the data. Results: The study revealed three themes, which includes improved healthcare structural systems, shift from traditional chronic care to digital care services and medication refill and buddy system. Conclusion: The findings of this study revealed a range of effective and noteworthy approaches that facilitated access to treatment and continuity of care. As a result, enhancing telemedicine as well as structural systems such as appointment scheduling, decanting choices, mobile and medication home delivery can improve access to care and treatment. Contribution: The burden of disease and avoidable death will be eventually addressed by maximising the use of telemedicine and sustaining the new norm of ongoing care through digital and remote care and decanting strategies.

The mediation effect of health literacy on social support and health lifestyle of patients with chronic diseases.

BACKGROUND: Previous studies have identified the antecedents of the lifestyle of many patients with chronic diseases. However, the mechanism of social support affecting the lifestyle of patients with chronic diseases is unclear, and the role of health literacy in social support affecting the lifestyle of patients with chronic diseases has not been found. Therefore, this study aims to explore the status quo of social support, health literacy and healthy lifestyle of patients with chronic diseases in China and the relationship among them. METHODS: Through convenient sampling, 356 patients with chronic diseases were surveyed using a health promoting lifestyle scale, a chronic disease patients' health literacy scale and a social support scale. RESULTS: There was a pairwise positive correlation between social support, health lifestyle and health literacy (R = 0.397,0.356,0.556, P < 0.01). After controlling gender, age and education level, it is found that social support has a positive impact on health lifestyle, and health literacy plays an intermediary role between social support and health lifestyle, accounting for 45.78 % of the total effect. CONCLUSION: To promote the healthy lifestyle of patients with chronic diseases and delay the development of the disease, we should strengthen social support for patients with chronic diseases; We should simultaneously take various measures to improve their health literacy.

Understanding the impact of chronic diseases on COVID-19 vaccine hesitancy using propensity score matching: Internet-based cross-sectional study.

AIMS AND OBJECTIVES: To investigate whether chronic diseases are associated with higher COVID-19 vaccine hesitancy and explore factors that influence COVID-19 vaccine hesitancy in patients with chronic diseases. BACKGROUND: Vaccine hesitancy has been acknowledged as one of the greatest hazards to public health. However, little information is available about COVID-19 vaccine hesitancy among patients with chronic diseases who may be more susceptible to COVID-19 infection, severe disease or death. METHODS: From 6 to 9 August 2021, we performed an internet-based cross-sectional survey with 22,954 participants (14.78% participants with chronic diseases). Propensity score matching with 1:1 nearest neighbourhood was used to reduce confounding factors between patients with chronic diseases and the general population. Using a multivariable logistic regression model, the factors impacting COVID-19 vaccine hesitancy were identified among patients with chronic diseases. RESULTS: Both before and after propensity score matching, patients with chronic diseases had higher COVID-19 vaccine hesitancy than the general population. In addition, self-reported poor health, multiple chronic diseases, lower sociodemographic backgrounds and lower trust in nurses and doctors were associated with COVID-19 vaccine hesitancy among patients with chronic diseases. CONCLUSIONS: Patients with chronic diseases were more hesitant about the COVID-19 vaccine. Nurses should focus on patients with chronic diseases with poor health conditions, low socioeconomic backgrounds and low trust in the healthcare system. RELEVANCE TO CLINICAL PRACTICE: Clinical nurses are recommended to not only pay more attention to the health status and sociodemographic characteristics of patients with chronic diseases but also build trust between nurses and patients by improving service levels and professional capabilities in clinical practice. PATIENT OR PUBLIC CONTRIBUTION: Patients or the public were not involved in setting the research question, the outcome measures, or the design or implementation of the study. However, all participants were invited to complete the digital informed consent and questionnaires.

Influence of social support on subjective well-being of patients with chronic diseases in China: chain-mediating effect of self-efficacy and perceived stress.

Introduction: The well-being of patients with chronic diseases is an issue of widespread concern in public health. While social support is thought to have a positive effect on it, the mechanisms of its influence have not been fully addressed. Thus, we explored the possible mediating effects of self-efficacy and perceived stress to determine the relationship between social support and well-being in these patients. Methods: A cross-sectional study was conducted among 4,657 patients with chronic diseases in China. The PROCESS Macro model 6 of SPSS was employed to explore the intermediary role between variables. Results: Self-efficacy and perceived stress played a partial intermediary role between social support and subjective well-being, with an effect ratio of 48.25% and 23.61%, respectively. Self-efficacy and perceived stress had a chain intermediary effect (28.14%) between social support and subjective well-being. Discussion: This study suggested that improving the self-efficacy of patients with chronic diseases to cope with the changes in social support caused by the disease could reduce stress and enhance subjective well-being.

Experiences of patients with chronic diseases during the COVID-19 pandemic in the North West province, South Africa.

BACKGROUND: Patients with chronic diseases (PWCDs) were severely affected by the coronavirus disease 2019 (COVID-19) pandemic, as they were prevented from making the necessary visits to health facilities for medical review and to collect their medication. The emergence of the health crisis and inadequate access to quality care affected chronic care management. The perspectives of PWCDs are not known, and therefore the research on which this paper is based sought to investigate the lived experiences of these patients during the COVID-19 pandemic. METHODS: A qualitative phenomenological design was used to obtain the lived experiences of PWCDs identified for participation in the study by means of purposive sampling. Patients' experiences were obtained during individual structured interviews, and a checklist was used to gather patient characteristics from their files. RESULTS: Three themes emerged from the study findings, namely poor healthcare services, the socio-economic impact of the COVID-19 pandemic, and the psychological impact of the COVID-19 pandemic. The COVID-19 pandemic had devastating effects on PWCDs, in that they experienced barriers to accessing quality chronic care services and suffered psychological and financial difficulties that affected their health, life, needs and expectations. CONCLUSION: Policymakers should consider PWCDs when responding to a public health concern in the future.Contribution: The study findings may have an impact on future policies regulating the management of chronic diseases during epidemics, in order to improve patient health outcomes and satisfaction with healthcare services and the chronic care model based on the experiences of PWCDs.

The influence of price value on purchase intention among patients with chronic diseases in medical e-commerce during the COVID-19 pandemic in China.

Background: During the COVID-19 pandemic, medical e-commerce (MEC) has provided a way for patients with chronic diseases to purchase drugs online to maintain social distancing, decrease the risk of infection and community transmission, and relieve the burden on medical resources. Therefore, research which seeks to elucidate the drivers of purchase intention (PI) among patients with chronic diseases in MEC is vital. This study extended the theory of planned behavior (TPB) by integrating the price value (PV) variable into the original TPB framework and explored the effect of PV on patients' PI in MEC during the coronavirus pandemic. Methods: Empirical data was gathered from 414 Chinese participants. Structural equation modeling was applied to explore the mechanism of chronic patients' PI in MEC. In addition, this study also estimated the moderating effect of gender, income, and region and the mediating role of attitude (ATT), subjective norm (SN), and perceived behavioral control (PBC) between PV and PI. Results: Patients' PI in MEC is significantly affected by ATT, SN, and PBC. PV delivers significant influence on ATT, SN, PBC, and PI, with PV having the strongest effect on ATT. Gender, income, and region can significantly moderate the relationship between PV and ATT. Conclusion: These findings can contribute to design targeted interventions to increase the adoption of MEC for patients with chronic diseases, decrease infection rates, and alleviate the strain on medical resources in the COVID-19 era.

It is time to improve the acceptance of COVID-19 vaccines among people with chronic diseases: A systematic review and meta-analysis.

This study aims to investigated COVID-19 vaccine acceptance among people with chronic diseases and the factors correlating with their vaccination hesitancy. The articles were searched in PubMed, Ovid, EMBASE, and web of science databases between December 2019 and October 2022. Cross-sectional studies, including the acceptance of the COVID-19 vaccine by patients with chronic diseases (≥18 years old), were included in this study. The outcomes included the proportion and 95% confidence interval (95% CI) of chronic disease patients willing to be vaccinated and the odds ratio (OR) and 95% CI of correlating factors. The source of heterogeneity was analyzed through meta-regression and subgroup analysis. We included 31 studies involving 57 875 patients with chronic disease. The overall COVID-19 vaccine acceptance among patients with chronic disease was 0.65 (95% CI, 0.59-0.72). The acceptance among the elderly patients was 0.53 (95% CI, 0.26-0.80). South America had the highest COVID-19 vaccine acceptance rate and Asia the lowest, while on a country level, the United Kingdom had the highest acceptance rate among patients with chronic diseases. People with rheumatic immune diseases had the lowest rate of COVID-19 vaccine acceptance. Concerns about vaccine safety had a statistically different effect on acceptance. Overall, the health systems ought to focus on educating specific groups of individuals on the benefits of COVID-19 vaccination and addressing safety concerns.

Effects of a theory-based exercise intervention on physical activity levels and health-related outcomes in older people with chronic diseases.

BACKGROUND: The benefits of physical activity are well-documented, and the prevalence of physical inactivity is high in older patients with chronic diseases. This study aimed to investigate the impact of an aerobic exercise intervention based on the capacity, opportunity, motivation-behavior (COM-B) model on physical activity and health-related outcomes in this population. METHODS: Thirty-five participants were randomly assigned to the intervention group (IG) for an exercise intervention based on the COM-B model, and 33 were assigned to the control group (CG) for usual care. Physical activity levels, daily steps and bone mineral density T-value, body mass index, waist-hip ratio, subendocardial myocardial viability rate, central arterial pressure, growth index, brachial-ankle pulse wave velocity, ankle-arm index were measured at baseline, during the 12-week intervention, and after the 12-week follow-up. RESULTS: Compared with the CG and pre-intervention, total physical activity in the IG increased significantly (P < 0.05); however, after the 12-week follow-up, total physical activity decreased. At the same time, the average daily steps of the elderly in both groups increased. Compared with the CG, at the 12-week follow-up, the bone mineral density T-value in the IG was significantly improved (P < 0.05). Compared with the pre-intervention values, during the 12-week intervention, bone mineral density T-value, body mass index, waist-hip ratio, subendocardial myocardial viability rate and central arterial pressure were significantly improved (P < 0.05); after the 12-week follow-up, brachial-ankle pulse wave velocity and ankle-arm index were significantly improved (P < 0.05). No statistically significant changes in the growth index were detected, independent of the group and time. CONCLUSION: Theory-based exercise interventions can change the physical inactivity behavior of older people with chronic diseases, effectively promoting physical activity and improves bone mineral density T-value, controls body weight, and reduces cardiovascular risk and physiological indicators related to atherosclerosis. Geriatr Gerontol Int 2023; 23: 78-84.

Study on the Utilization Status and Influencing Factors of Health Management Services for Floating Elderly Population with Chronic Diseases:a Comparative Analysis based on the Differences between Urban and Rural Areas / 中国卫生统计

Objective Our study systematically analyzed the utilization status and influencing factors of health management services for floating elderly patients with chronic diseases in China,and compares the differences between urban and rural areas,in order to provide countermeasures and suggestions for realizing the equalization of basic public health services and improving the quality of life and health level of floating elderly population.Methods We used the dynamic monitoring survey data of China's floating population in 2017,floating elderly aged 60 and above with chronic diseases diagnosed by doctors were selected as the research objects.Under the guidance of social ecological theory,the binary logistic regression model was used to analyze the influencing factors of the utilization of health management services by floating elderly patients with chronic diseases in the whole,rural and urban areas.Results Among the 2158 floating elderly patients with chronic diseases,the utilization rate of health management services was 46.6%,47.2%in rural areas and 45.9%in urban areas.The results of binary logistic regression showed that gender,age,self-rated health status,two-week visiting rate,family monthly income,whether they had heard of national basic public health projects,flow range,flow time and inflow region had an impact on the utilization of health management services by floating elderly patients with chronic diseases(P<0.05).Conclusion The utilization rate of health management services for floating elderly patients with chronic diseases in China is low.Service utilization is affected by multidimensional factors such as personal characteristics,individual behavior,interpersonal level,social environment and mobility characteristics,and there are some differences between urban and rural areas.

Acceptance of COVID-19 vaccines in patients with chronic diseases: A cross-sectional study.

AIMS AND OBJECTIVES: This study aimed to clarify the attitudes, knowledge and vaccination willingness of patients with chronic diseases toward COVID-19 vaccines and the influencing factors. BACKGROUND: Vaccination against COVID-19 is an important way to protect patients with chronic diseases, but the vaccination acceptance varies across diseases and populations. A better understanding of this condition will lead to tailored intervention strategies and high vaccination rates. DESIGN: Cross-sectional study. METHODS: Data were collected between March 2021 and May 2021 in China. A self-compiled questionnaire was used in the survey. Two independent-samples t-tests/one-way analysis of variance or U test/H test was used to measure the differences between groups. Multivariate regression analysis was used to identify the influencing factors. The study adhered to the EQUATOR checklist, STROBE. RESULTS: A total of 998 patients participated in the study. Score rates of attitudes, knowledge and vaccination willingness were 69.9%, 68.4% and 70.6% respectively. Age, vaccination status of family members, education levels, vaccine side effects and economic level were positive factors that could influence patients' vaccination acceptances, while time of illness, type of disease and political affiliations were negative predictors. The top reasons for willingness toward vaccination were supporting national strategies, belief on the vaccines and fearing of contracting COVID-19, while physical reasons, side effects and having a wait-and-see attitude were unwillingness factors. CONCLUSIONS: Patients' attitudes, knowledge and vaccination willingness were medium. Nurses should pay attention to patients who are from lower socioeconomic backgrounds, under 30 or over 70 years old, have no political affiliations, have damage to vital organs, have a long course of illness, family members have not received COVID-19 vaccines and had no side effects after receiving other vaccines. RELEVANCE TO CLINICAL PRACTICE: Clinical nurses are recommended to take measures from patients' duration of illness, damaged organs, demographic characteristics and families to improve patients' vaccination acceptances.

The Gap Between Self-Rated Health Information Literacy and Internet Health Information-Seeking Ability for Patients With Chronic Diseases in Rural Communities: Cross-sectional Study.

BACKGROUND: The internet has become one of the most important channels for residents to seek health information, particularly in remote rural areas in China. OBJECTIVE: In this study, we aimed to explore the gap between self-rated health information literacy and internet health information seeking ability for patients with chronic diseases in rural communities and to preliminarily evaluate their barriers when seeking health information via the internet. METHODS: Residents from rural communities near Bengbu City and with chronic diseases were included in this study. A self-rated questionnaire was used to evaluate their health information literacy, 3 behavioral competency tasks were designed to preliminarily evaluate their ability to seek health information on the internet and semistructured interviews were used to investigate their barriers to obtaining health information via the internet. A small audiorecorder was used to record the interview content, and screen-recording software was used to record the participants' behavior during the web-based operational tasks. RESULTS: A total of 70 respondents completed the self-rated health information literacy questionnaire and the behavioral competence test, and 56 respondents participated in the semistructured interviews. Self-rated health information literacy (score out of 70: mean 46.21, SD 4.90) of the 70 respondents were moderate. Although 91% (64/70) of the respondents could find health websites, and 93% (65/70) of the respondents could find information on treatment that they thought was the best, 35% (23/65) of respondents did not know how to save the results they had found. The operational tasks indicated that most articles selected by the respondents came from websites with encyclopedic knowledge or answers from people based on their own experiences rather than authoritative health information websites. After combining the results of the semistructured interviews with the DISCERN scale test results, we found that most interviewees had difficulty obtaining high-quality health information via the internet. CONCLUSIONS: Although the health information literacy level of patients with rural chronic disease was moderate, they lack the ability to access high-quality health information via the internet. The vast majority of respondents recognized the importance of accessing health information but were not very proactive in accessing such information.

Effectiveness of smoking cessation interventions for smokers with chronic diseases: A systematic review.

AIMS: To systematically summarize seminal studies on the design and effectiveness of smoking cessation interventions targeted at patients with chronic diseases through a critical appraisal of the literature. DESIGN: A systematic review. DATA SOURCES: This review included literature identified through a search of six databases up to June 2020. REVIEW METHODS: This review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. The literature search was limited to English-language articles on the effectiveness of smoking cessation interventions for smokers who were aged ≥18 years and diagnosed with chronic diseases. Data were extracted using the Cochrane Data collection form for intervention reviews of randomized controlled trials and non-randomized controlled trials. The articles were subjected to a quality assessment. RESULTS: Ten relevant articles were identified. The designs of the interventions were highly heterogeneous, and only six articles reported a significant increase in smoking abstinence among patients with chronic diseases. In the target population, an intervention delivered by healthcare professionals on an intensive schedule was shown to more effectively induce smoking cessation, compared with minimal counselling. However, methodological flaws were identified in most of the included studies. CONCLUSION: The findings of this review suggest that additional efforts are needed to design smoking cessation interventions for patients with chronic diseases and that further examination of the effectiveness and feasibility of these interventions is warranted. IMPACT: What problem did the study address? This review evaluated the effectiveness of smoking cessation interventions targeted at patients with chronic diseases. What were the main findings? An intervention with an intensive schedule that was delivered by healthcare professionals was shown to more effectively induce smoking cessation in patients with chronic diseases, compared with minimal counselling. More attention and resources should be directed towards smokers with no intention to quit, especially those with chronic diseases. There is an urgent need for generic smoking cessation interventions that use novel approaches to address the unique needs of this population and to integrate such evidence-based interventions into routine care. Where and on whom will the research have impact? The findings of this review may guide nurses, who play a prominent role in raising the issue of smoking cessation with patients, to design appropriate smoking cessation interventions for patients with chronic diseases. The resulting improvements in patients' health would not only benefit patients themselves but also reduce the burden of chronic diseases on healthcare systems.

Do Drug Accessibility and OOP Burden Affect Health-Related Quality of Life of Patients With Chronic Diseases? - EQ-5D-5L Evaluation Evidence From Five Districts in China.

Purpose: The dependence of patients with chronic diseases on drugs may affect their health-related quality of life (HRQoL). This study aims to assess the relationship between the direct economic burden caused by out-of-pocket (OOP) payments, drug accessibility, sociodemographic characteristics, and health-related quality of life. Methods: 1,055 patients with chronic diseases from Gansu, Hebei, Sichuan, Zhejiang, and Tianjin were investigated. Data collection included basic conditions and economic and health insurance conditions of patients with chronic diseases. The CLAD and Tobit regression models were used to analyze and compare the health-related quality of life and influencing factors of patients with chronic diseases in five districts. Differentiated analysis was conducted through sub-sample regression to explore the variable health effects of patients with single and multiple diseases. Results: A total of 1,055 patients with chronic diseases participated in the study, 54.4% of whom were women. The overall average utility score was 0.727, of which Sichuan Province was the highest with 0.751. Participants reported the highest proportion of pain/discomfort problems, while patients reported the least problems with self-care. The improvement of drug accessibility and the reduction of the burden of out-of-pocket expenses have significant positive effects on HRQoL. Various sociodemographic factors such as age and gender also have significant impact on HRQoL of patients with chronic diseases. HRQoL of patients with multiple chronic diseases is more affected by various influencing factors than that of patients with single disease. Conclusion: In order to improve the quality of life of patients with chronic diseases, it is of great importance to ensure the accessibility of drugs and reduce patients' medication burden. Future focus should shift from preventing and controlling chronic diseases as individual diseases to meeting the comprehensive health needs of people suffering from multiple diseases.

Measurement of the Equality of the Drug Welfare Induction Level of Chinese Patients With Chronic Diseases in Gansu, Sichuan, Hebei, and Zhejiang Based on the Bivariate Theil-T Index Method.

Objectives: This study aimed to measure the induction level of drug welfare in Chinese patients with chronic diseases using a bivariate Theil index. Design: The bivariate Theil-T index was used to hierarchically decompose the relevant survey data, and the contribution rate of the intragroup gap and the intergroup gap to the total gap was investigated to better understand the current drug welfare induction level of Chinese patients with chronic diseases. Setting: The study was based in Gansu, Sichuan, Hebei, and Zhejiang provinces in China. Participants: Survey data was from patients with chronic diseases in 20 hospitals in four provinces. Primary and secondary outcome measures: Data was collected through a questionnaire designed by the research team after expert consultation. Using the variables represented by the index system to decompose the Theil index from the two dimensions of the region and urban and rural areas. SPSS 22.0 was used for reliability and validity analysis and Theil index calculation. Results: The overall level of drug welfare induction in Chinese patients with chronic diseases had a high degree of equalization. The overall Theil index was 0.0003, but there were still some differences among groups. Conclusions: To improve the drug welfare equalization induction level of patients with chronic diseases in China, the government should start from western rural areas, and policy should target the provinces that were in a disadvantaged position within the region to promote the equalization of drug welfare induction level for patients with chronic diseases in China.

Effect of medical insurance and family financial risk on healthcare utilisation by patients with chronic diseases in China: a cross-sectional study.

OBJECTIVE: To assess the joint cumulative effects of medical insurance and family health financial risk on healthcare utilisation among patients with chronic conditions in China. DESIGN: A nationwide population-based case-control study with multinomial logistic regression was conducted and used to estimate the ORs of healthcare utilisation against type of medical insurance and family health financial risk using the Anderson model as a theoretical framework. SETTING: China Family Panel Studies (CFPS) database. PARTICIPANTS: The study sample included 5260 patients with chronic conditions identified from the 2014 CFPS database. MAIN OUTCOME MEASURES: The participants were classified by their health insurance coverage: urban employee basic medical insurance (UEBMI), Gong Fei Medical Insurance (GFMI), new rural cooperative medical scheme (NCMS) and urban residents basic medical insurance. Healthcare utilisation was measured by assessing the care level provided by the health institutions selected by patients when they were sick. Health financial risk was measured using the cost of medical expenditures and annual family income over the past year. RESULTS: Patients were more likely to choose hospital care than care from primary health centres. Patients with NCMS preferred primary healthcare, compared with patients with no medical insurance (OR 1.852, 95% CI 1.458 to 2.352). Patients with UEBMI and GFMI made use of hospital healthcare services (OR 2.654, 95% CI 1.85 to 3.81; OR 1.629, 95% CI 1.15 to 2.30, respectively). Patients who had medium or high financial risk were more likely to choose tertiary/specialised hospital care, compared with those at low financial risk (OR 1.629, 95% CI 1.15 to 2.30; OR 1.220, 95% CI 1.04 to 1.43, respectively). CONCLUSIONS: The majority of patients chose hospital care in our sample. There was a joint effect and relationship between degree of family health financial risk and medical insurance on healthcare utilisation.

Quality of life predictors in informal caregivers of seniors with a functional performance deficit - an example of home care in Poland.

Background: There is insufficient research into informal caregivers' quality of life (QoL) in Poland. The purpose of this work is to study predictors that considerably affect QoL of informal caregivers (IC) providing home care for seniors with chronic diseases and a functional performance deficit. Materials and methods: In the cross-sectional research design, ICs were randomly chosen among the geriatric population receiving care in 5 primary health care settings. The WHOQoL-AGE questionnaire was used to assess QoL of ICs (n=138). The Barthel scale and Polish version of the Abbreviated Mental Test Score (AMTS) were applied to assess individuals with chronic diseases and functional and mental performance deficits (n=138). The Geriatric Depression Scale Short Form (GDS-SF) was used to measure the extent of risk of depressive symptoms in care-receivers. A hierarchical regression analysis was carried out to determine predictors of caregivers' QoL. Results: Mean values in the group of seniors provided with home care were as follows: the Barthel scale M=43.20, SD=27.06, the AMTS M=7.78 (SD=1.65), and the GDS-SF M=7.34 (SD=3.10). QoL of ICs (the WHOQoL-AGE) was M=70.14 (SD=15.31). Significant predictors of caregivers' QoL turned out to be support in care given by others ß =0.605, p<0.001, experience in care ß =-0.220; p<0.001, caregivers' health self-assessment ß =0.174, p<0.001, and depressive disorders in care-receivers GDS ß = -0.178, p<0.001. Conclusions: The QoL of ICs who provide care for individuals with chronic diseases and a functional performance deficit improves with an increase in the support they receive from others, their higher health self-assessment, and greater experience in care. An increase in depressive symptoms in care-receivers determines a lower level of caregivers' QoL.

Relation Survey between Medication “Knowledge-Attitude-Practice”and Depression Mood in Elderly Patients with Chronic Diseases in Community / 中国药房

OBJECTIVE： To explore the situation of knowledge-attitude-practice of medication （shorted for medication KAP） of elderly patients with chronic diseases and its relationship with depression mood. METHODS： Through using scale of medication KAP in elderly adults with chronic diseases and Self-rating Depression Scale （SDS）， a face to face questionnaire survey was conduceed among elderly patients with chronic diseases examined in two community service centers of Lanzhou. The Pearson correlation analysis was used to verify the correlation between the score of medication KAP and the score of depression mood，and multivariate stepwise linear regression was used to analyze the influential factors （including the items in the general data table and depression mood with statistical significance after single factor analysis） of the score of medication KAP. RESULTS： Totally 300 questionnaires were sent out， and 289 valid questionnaires were returned with effective feedback rate of 96.3％. The results of questionnaire investigation showed the average score of the KAP was （31.12±6.20）； the scores of medication knowledge， attitude and practice was （18.39±4.85）， （3.18±1.24） and （9.55±2.08）， respectively. The average score of depression mood was （39.99±6.06）， compared with 48.4％ （140 patients） with depressive symptoms. Pearson correlation analysis showed that the score of medication knowledge （r＝－0.356）， the score of medication compliance （r＝－0.465） and the score of medication KAP （r＝     －0.490） were negatively correlated with depression mood （all P＜0.01）. Multiple stepwise regression analysis indicated that the score of the KAP were affected by depression mood and demographic factors including family occupation， detailed monthly income in a family， the difference was statistically significant（P＜0.05）. CONCLUSIONS： In the community， the level of the medication KAP in elderly patients is mainly affected by depression mood and also by demographic factors. In the work of health care education for elderly patients with chronic diseases， medical staff should pay more attention to patients with depression mood and timely take targeted nursing measures to improve the level of the medication KAP.

Effects of Rural Medical Insurance on Chronically Ill Patients' Choice of the Same Hospital Again in Rural Northern China.

The emergence of rural health insurance plays a crucial role in alleviating the pressure on rural medical expenditure. Under the current medical system in northern China, rural medical insurance may reduce the free referral of patients with chronic diseases among hospitals. This study was carried out based on the results of an investigation of rural chronically-ill patients in eight county hospitals in northern China, as well as through the comparison and analysis of patients with chronic diseases, considering whether they were with or without rural health insurance. The main results showed that both age (χ2 = 22.9, p < 0.000) and income level (χ2 = 18.5, p < 0.000) had considerable impact on the rural peoples' willingness to buy health insurance. Meanwhile, both the quality of the hospital's treatment (B = 0.555, p < 0.000), and service quality (B = 0.168, p < 0.000) had a significant positive correlation with the likelihood of a given patient choosing the same hospital on the next visit, but the medical costs had a significant negative correlation (B = -0.137, p < 0.000). Eventually, it was found that the provision of rural health insurance had weakened the three relationships upon which the aforementioned correlations were based.

Analysis on the Humanistic Care of Rational Drug Use in Elderly Patients with Chronic Diseases / 中国医学伦理学

The rational drug use of elderly patients with chronic diseases had many problems which seriously affect the live and life safety of patients.To convey the importance of rational drug use from the perspective of humanistic care for patients can help to improve the treatment compliance of patients,promote the ability of self-management and build a harmonious doctor-patient relationship.Medical staff should pay attention to enhance the care for the elderly patients,optimize drug treatment programs,improve diversified social support systems and use various medium and forms to propaganda the knowledge of rational drug use.