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1.
BMJ ; 377: o1415, 2022 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-35672046
2.
Front Public Health ; 10: 750722, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35548082

RESUMO

Background: Previous studies have reported a relatively low utilization of family doctor contract services (FDCS) in China, while the associated factors are unknown. The current study aimed to explore the factors associated with the utilization of FDCS, and then developed and validated a predictive model based on these identified factors. Methods: We conducted a nationwide cross-sectional study using an online questionnaire, from March 2019 to April of 2019. Routinely collected variables in daily practice by family doctors were used to develop a derivation model to determine the factors associated with FDCS utilization, and then the external performance of the model was tested. Results: A total of 115,717 and 49,593 participants were included in the development and validation datasets, respectively. Nearly 6.8% of the participants who signed a contract with FDCS received healthcare services from family doctors in China. Factors associated with the utilization of FDCS included age, male sex, self-reported household income, education attainment, insurance status, self-reported health status, smoking, drinking, self-reported physical activity status, chronic disease, walking distance from the nearest community center, and illness in the last 2 weeks, with an area under the receiver operating characteristic curve (AUC) of 0.660 [95% confidence interval (CI), 0.653-0.667] and good calibration. Application of this nomogram in the validation dataset also showed acceptable diagnostic value with an AUC of 0.659 (95% CI, 0.649-0.669) and good calibration. Conclusion: Twelve easily obtainable factors in daily practice of family doctors were used to develop a model to predict the utilization of FDCS, with a moderate performance.


Assuntos
Serviços Contratados , Médicos de Família , China , Estudos Transversais , Serviços de Saúde , Humanos , Recém-Nascido , Masculino
3.
Front Public Health ; 10: 865653, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35602141

RESUMO

Background: Family doctor contract services (FDCS) has played a key role in diabetes management in China since 2016. The influence of FDCS on the physiological indexes of individuals with diabetes has been examined. However, little attention has been paid to its effect on the Health-Related Quality of Life (HRQoL). This study aims to fill this knowledge gap by evaluating the effect of FDCS on the HRQoL of individuals with diabetes. Methods: We identified 382 individuals with diabetes receiving all follow-up surveys in 2013, 2015, and 2018 from the China Health and Retirement Longitudinal Study (CHARLS). The HRQoL of the included individuals was estimated using results from the Short Form 36 (SF-36) questionnaire. The propensity score matching with the difference-in-differences (PSM-DID) approach was applied to quantify the effect of FDCS on the HRQoL among individuals with diabetes. A robust test was performed by setting the 2015 data as the treatment group for the placebo test. Results: The mean score of role-emotional (RE) increased from 54.25 to 61.63 among those who signed up to receive FDCS, while the corresponding score decreased from 57.77 to 51.04 among those who did not receive FDCS. Results from the regression analysis indicated that the use of FDCS was associated with significant improvement in RE (+14.10, p = 0.04) among individuals with diabetes. We did not find a statistically meaningful association between the FDCS and any of the other HRQoL domains: physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), and mental health (MH), respectively. The robustness analysis of the model indicated that the results were robust. Conclusion: The FDCS for diabetes in China was associated with a significant improvement in RE. Due to a limited time since the launch of FDCS (i.e., 2016), the recipient's physical health did not show marked improvement. In the future, FDCS should pay more attention to the physiological health of individuals with diabetes. Moreover, psychological services also need to be maintained and not slackened. At the same time, it is strongly recommended to pay more attention to the HRQoL of individuals with diabetes and more comprehensive health.


Assuntos
Diabetes Mellitus , Qualidade de Vida , China , Serviços Contratados , Diabetes Mellitus/terapia , Humanos , Estudos Longitudinais , Qualidade de Vida/psicologia , Aposentadoria
4.
Front Public Health ; 10: 757481, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35372224

RESUMO

Background: Some studies found that family doctor contract services (FDCSs) had positive impact on the self-measurement behaviors of hypertension patients. However, evidence concerning the association between FDCSs and blood pressure measurement awareness among hypertension patients is not clear. Objective: This study aims to explore the relationship between FDCSs and blood pressure measurement awareness among the hypertension patients, and examine whether there is a difference in this relationship among middle-aged and aged adults in rural Shandong, China. Methods: A multi-stage stratified random sampling was adopted in 2018 in Shandong Province to conduct a questionnaire survey among the sample residents, in which 982 hypertension patients were included in the study. Pearson chi-square test and logistic regression model were employed using SPSS 24.0 to explore the association between FDCSs and blood pressure measurement awareness. Results: 76.8% of hypertension patients would measure blood pressure regularly. The blood pressure measurement awareness of the signing group was significantly higher than that of the non-signing group when controlling other variables (P < 0.001, OR = 2.075, 95% CI 1.391-3.095). The interaction of age and contracting status were significantly correlated with blood pressure measurement awareness (P = 0.042, OR = 1.747, 95% CI 1.020-2.992; P = 0.019, OR = 2.060, 95% CI 1.129-3.759). Factors including gender (P = 0.011, OR = 0.499, 95% CI 0.291-0.855), household income (P = 0.031, OR = 1.764, 95% CI 1.052-2.956), smoking status (P = 0.002, OR = 0.439, 95% CI 0.260-0.739), sports habits (P < 0.001, OR = 2.338, 95% CI 1.679-3.257), self-reported health (P = 0.031, OR = 1.608, 95% CI 1.043-2.477), distance to the village clinic (P = 0.006, OR = 1.952, 95% CI 1.208-3.153) and medications (P < 0.001, OR = 3.345, 95% CI 2.282-4.904) were also found to be associated with the blood pressure measurement awareness of hypertension patients. Conclusion: The government should take efforts to strengthen publicity and education of family doctors and pay more attention to uncontracted, middle-aged, female patients and patients with unhealthy life behaviors to improve the blood pressure measurement awareness.


Assuntos
Pressão Sanguínea , Serviços Contratados , Conhecimentos, Atitudes e Prática em Saúde , Hipertensão , Adulto , China , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico , Pessoa de Meia-Idade , Médicos de Família , População Rural
5.
BMJ Open ; 12(3): e053277, 2022 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-35241465

RESUMO

OBJECTIVE: A number of factors contribute to the utilisation of family doctor contract services (FDCS) in China. This study aims to measure the preferences of the elderly for the FDCS and identify the key factors (and their relative importance) that may guide policymakers in more accurately providing the FDCS. PARTICIPANTS AND METHODS: A discrete choice experiment was performed to elicit the preferences for FDCS among the rural elderly in China. Attributes and levels were established based on qualitative methods. Four attributes were included: service type, service package, physician's reputation and annual contract costs. A D-efficient design was used to create a set of profiles that represented FDCS. The survey was conducted face to face using a sample of participants aged 60 and above in rural areas of Anhui Province. The data were analysed using a latent class logit (LCL) model. RESULTS: A total of 545 valid questionnaires were included in the analysis. The average age of the participants was 69.44 (SD 5.80). Two latent classes were identified with the LCL model. All four attributes proved statistically significant at the level of both the population mean and the two classes. The rural elderly showed a preference for FDCS with a relatively good reputation, lower annual contract costs, the basic service with the add-on of chronic disease service and home visit. Age, gender, education, self-reported health status and the number of chronic diseases were found to be associated with latent class membership. CONCLUSION: In this study, the physician's reputation had the largest impact on the rural elderly's choice of FDCS. Policy recommendations included the need to strengthen family doctor team training, devote greater attention to improving the family doctor's medical skills and service approaches, and increased FDCS efficiency for the care of the rural elderly.


Assuntos
Médicos de Família , Serviços de Saúde Rural , Idoso , China/epidemiologia , Doença Crônica , Serviços Contratados , Feminino , Humanos , População Rural , Inquéritos e Questionários
6.
Rev. adm. pública (Online) ; 56(1): 176-190, jan.-fev. 2022. tab, graf
Artigo em Português | LILACS | ID: biblio-1365462

RESUMO

Resumo Evitar sobrepreços e preços manifestamente inexequíveis são dois objetivos principais da recém-promulgada Lei nº 14.133, de 1º de abril de 2021. O presente artigo demonstra que, ao tentar alcançar o primeiro objetivo, a nova lei de licitações promove o segundo, pois um comando específico tende a reduzir os preços até congelá-los nos menores valores possíveis, conduzindo os contratados à maldição do vencedor. Alerta-se os agentes públicos sobre o fato de que a manutenção desse comando levará a descumprimentos generalizados de contratos e a uma eventual falência de competidores. O método Monte Carlo é utilizado para demonstrar que um mecanismo abrangente de pesquisa de preços evitará o problema e garantirá o efeito pretendido pela lei.


Resumen Evitar los sobreprecios y los precios manifiestamente inviables son dos de los principales objetivos de la recién promulgada Ley 14.133/2021 de Brasil. Este artículo demuestra que, al intentar lograr el primer objetivo, la nueva ley de licitaciones promueve el segundo, ya que un comando específico tiende a reducir los precios hasta congelarlos a los valores más bajos practicables, llevando a los contratados a la maldición del ganador. Se advierte a los funcionarios públicos que mantener este comando conducirá a incumplimientos generalizados de contratos y eventual quiebra de los competidores. Se utiliza el método Monte Carlo para demostrar que un mecanismo integral de investigación de precios evitará el problema y garantizará el efecto buscado por la ley.


Abstract Avoiding overpricing and irresponsible pricing are two central objectives of the recently enacted Law 14133/2021. This article shows that when trying to achieve the first objective, the new Brazilian public procurement law promotes the second, since a specific command reduces maximum prices until they freeze to the lowest possible values, leading the contractors to the winner's curse. Public officials are warned that maintaining this command will lead to widespread breaches of contracts and eventual bankruptcy of contractors. The Monte Carlo method is adopted to show that a comprehensive price database will avoid the problem and guarantee the effect intended by the law.


Assuntos
Proposta de Concorrência/legislação & jurisprudência , Comércio , Serviços Contratados , Legislação , Administração Financeira , Brasil
7.
Front Public Health ; 10: 800042, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35223735

RESUMO

OBJECTIVE: Few are known on how and to what extent residents and healthcare providers have different preferences for family doctor contract service (FDCS). This study aimed to elicit and compare the residents' and healthcare providers' preferences for FDCS through a discrete choice experiment (DCE). METHODS: Residents and healthcare providers recruited for the DCE were asked to choose repeatedly between two hypothetical service plans, which differed in six attributes: cost, service package, service delivery, type of service, accessibility of medicine, and level of healthcare team. We use mixed logit regression models to determine preferences for potential attributes. RESULTS: A total of 2,159 residents and 729 healthcare providers completed valid DCE questionnaires. The mixed logit model results suggested that cost, service package, service delivery, type of service, accessibility of medicine, and level of healthcare team all had a significant impact on residents' and healthcare providers' preference. The level of healthcare team was the most important characteristic of FDCS to both residents and healthcare providers, followed by types of service. They have different preferences on the cost and way of service delivery. CONCLUSIONS: This study provides new evidence on how and to what extent residents and healthcare providers have different preferences for FDCS by determining their perception of various service attributes. These findings suggested that the optimal design and improvement of FDCS plans should consider not only residents but also healthcare providers' preferences to maximize contract service uptake.


Assuntos
Pessoal de Saúde , Preferência do Paciente , Serviços Contratados , Atenção à Saúde , Humanos , Inquéritos e Questionários
8.
PLoS One ; 17(1): e0262678, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35041715

RESUMO

Economic globalization has swept the whole world. To focus on their main business, enterprises that are referred to as original equipment manufacturers (OEMs) outsource non-core production activities to contract manufacturers (CMs). By constructing a two-level supply chain consisting of two competing OEMs and one upstream CM, the strategic interaction of the OEMs between outsourcing and purchasing is studied. Specifically, the CM can offer custom- and predefined modes of original equipment manufacturing (namely, CO mode and PO mode, respectively). The former mode enables OEMs to determine product quality, while the latter only allows them to purchase from several quality configurations. The results show that, first, since the CO mode allows the adopter to lead the product design, whether to choose this mode depends on the required R&D cost. Interestingly, however, a lower R&D cost does not necessarily result in the adoption of the CO mode if the product quality difference is small under the PO mode. Second, the optimal purchasing strategy of an OEM is indifferent to the outsourcing mode (CO and PO) of its rival but significantly affected by the quality cost. However, compared to the PO mode, choosing the CO mode would cause the competitor to suffer more profit losses. Third, differing from the prior literature, this paper finds that when the downstream OEM can make quality decisions, although this may lead to profit loss of the contract manufacturer in some channels, it could benefit the CM overall.


Assuntos
Comércio/métodos , Comportamento do Consumidor , Serviços Contratados/organização & administração , Competição Econômica , Serviços Terceirizados/organização & administração , Controle de Qualidade , Humanos
9.
Lima; Perú. Ministerio de Salud. Dirección General de Personal de la Salud. Observatorio de Recursos Humanos en Salud del Perú; 1 ed; Ene. 2022. 334 p. ilus.(Serie Bibliográfica Recursos Humanos en Salud, 33).
Monografia em Espanhol | MINSAPERÚ, LILACS, LIPECS, MINSAPERÚ | ID: biblio-1366177

RESUMO

En la presente publicación, se incorpora información de los diferentes niveles de atención de los establecimientos de salud y sedes administrativas, quintiles de pobreza, zonas alejadas y frontera, zonas de friaje, heladas, en emergencia, del VRAEM, etc. Se describen también las importantes intervenciones realizadas por el Ministerio de Salud para la dotación de recursos humanos en el marco de la pandemia, como la contratación de Ex-Serumistas y del Residentado Médico, entre otras. Asimismo, consta de seis capítulos, que a continuación se detallan de manera concisa. El Capítulo I proporciona información de los recursos humanos contratados en el marco del Decreto Legislativo N° 1057 ­ CAS COVID, destacándose la información descriptiva de los profesionales médicos, enfermeros, obstetras, etc., según departamentos, por grupo ocupacional y categoría de establecimiento. El segundo, un panorama global de los recursos humanos contratados en el marco del Decreto Legislativo N° 1057 ­ CAS COVID en el Ministerio de Salud y los Gobiernos Regionales, segmentados por una serie de variables de interés según los departamentos. El tercero, detalla la información de disponibilidad de médicos CAS COVID, en los establecimientos de salud del Ministerio de Salud y de los Gobiernos Regionales 2020 según departamento; destacándose la evolución por meses, por género y especialidad. El cuarto, la información de disponibilidad de enfermeros CAS COVID, en los establecimientos de salud del Ministerio de Salud y de los Gobiernos Regionales 2020-2021 según departamento; destacándose la evolución por meses, por género y especialidad. El quinto, un panorama sobre la disponibilidad de recursos humanos en salud CAS COVID por Pliego y Unidad Ejecutora de contrato, en el Ministerio de Salud y gobiernos regionales. Asimismo, la clasificación por tipo de brigadas de intervención contratados por el MINSA (Brigada Cubanos, Brigada Ena LLamosas, Ex Residentes, Ex Serumistas, Hospitales Modulares y Vacunación) en los establecimientos de salud de destino, según departamentos. El sexto, proporciona información sobre el análisis por antecedente de régimen o condición laboral del personal CAS COVID, como Servicios de Terceros, CAS Regular, Régimen 276, Ex Serumistas, Residentado médico, que migraron a un contrato CAS COVID, destacándose la información por género, grupos de edad, ámbito geográfico, por zonas alejadas y frontera, de pobreza, tipo de establecimiento y por zonas del VRAEM.


Assuntos
Ocupações Relacionadas com Saúde , Pessoal de Saúde , Impactos na Saúde , Serviços Contratados , Recursos Humanos , Pandemias , Observatório de Recursos Humanos em Saúde , COVID-19 , Necessidades e Demandas de Serviços de Saúde , Descrição de Cargo , Categorias de Trabalhadores
10.
Int J Health Plann Manage ; 37(2): 734-754, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34697826

RESUMO

BACKGROUND: The Chinese government has taken many incentives to promote the implementation of the family doctor (FD) contract service; however, whether primary health care providers establishing a strong relationship with patients that shapes their loyalty is still unknown. Under this circumstance, drawing the public attention to patient loyalty in primary care and clarifying the underlying mechanism of loyalty is imperative to the development of primary care. OBJECTIVE: To analyse the effect of patient perceived involvement on patient loyalty in primary care, investigate the mediating role of patient satisfaction, and explore the moderating role of the FD contract service on the relationship between patient perceived involvement and patient loyalty. METHODS: A cross-sectional questionnaire survey of patients in primary health facilities was conducted in Jilin province of China. Participants comprised 1334 patients selected via a multi-stage sampling method. RESULTS: Patient perceived involvement not only had a direct positive impact on patient loyalty but also had an indirect effect on patient loyalty via patient satisfaction. Furthermore, for patients who contracted with FDs, patient perceived involvement had a higher direct effect and indirect effect on patient loyalty when compared with patients who did not contract with FDs. CONCLUSIONS: Our findings suggest that health managers should encourage patients to participate in medical visits to improve patient satisfaction. Additionally, customised and tailored health services that meet individuals' specific needs and preferences should be designed and implemented to attract more patients to contract the FD contract service.


Assuntos
Satisfação do Paciente , Médicos de Família , Serviços Contratados , Estudos Transversais , Humanos , Atenção Primária à Saúde
11.
Rofo ; 193(11): 1360-1362, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34710932
13.
Int J Equity Health ; 20(1): 191, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34445998

RESUMO

PURPOSE: Few studies explored the relationship between the family doctor contract services (FDCS) and health-related quality of life (HRQOL) among patients with chronic diseases in rural China. This study aims to explore the relationship between the status of signing on FDCS and HRQOL among patients with chronic diseases and examine whether there are differences in the relationship between different socioeconomic status (SES). METHODS: A total of 1,210 respondents were included in this study. HRQOL was measured by EQ-5D-3L. The contracting status was divided into uncontracted and contracted. Tobit regression and Logistic regression were employed to explore the association between contracting status and HRQOL. The interaction terms were included to explore the differences in the association among different SES. RESULTS: Contracting with family doctors was associated with HRQOL (coefficient = 0.042; 95%CI 0.008 to 0.075). The association was different among different socioeconomic levels that the contracting status was only associated with HRQOL in sub-high-income (P < 0.01) and highly educated patients (P < 0.05). Compared with uncontracted patients, contracted patients reported higher ED-5D-3L utility value in the sub-high-income group (coefficient = 0.078; 95%CI 0.017 to 0.140) and high educational attainment (coefficient = 0.266; 95%CI 0.119 to 0.413). CONCLUSIONS: This study found a significant association between FDCS and HRQOL among chronic patients in rural Shandong, China. This relationship varied by income levels and educational attainment. The government should take efforts to formulate a variety of measures to encourage chronic patients to contract with family doctors, with special attention to people with low SES.


Assuntos
Doença Crônica , Serviços Contratados , Médicos de Família , Qualidade de Vida , Idoso , China , Doença Crônica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Classe Social
14.
BMC Public Health ; 21(1): 1282, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193114

RESUMO

BACKGROUND: In China, some previous studies have investigated the signing rate and willingness of residents to sign the family doctor contract services (FDCS). Few studies have explored residents' willingness to renew the FDCS. This study is designed to understand the family characteristics difference towards rural households' willingness of maintaining the FDCS. METHODS: A total of 823 rural households were included in the analysis. A descriptive analysis was conducted to describe the sample characteristics. The binary logistic regression model was used to explore the family characteristics that influence the renewal willingness for FDCS among rural households in Shandong province, China. RESULTS: Our study found that about 95.5% rural households had willingness to maintain the FDCS in Shandong, China. Those households with catastrophic health expenditures (CHE) (OR = 0.328, 95%CI = 0.153-0.703), with highest level of education at graduate or above (OR = 0.303, 95%CI = 0.123-0.747) were less willing to maintain the FDCS. Those whose households have more than half of the labor force (OR = 0.403, 95%CI = 0.173-0.941) and those households living in economically higher condition were less willing to maintain the FDCS. CONCLUSIONS: This study demonstrates a significant association between family characteristics (CHE, highest education in households, proportion of the household labor force) and willingness to maintain FDCS among rural households in Shandong, China. Targeted policies should be made for rural residents of identified at-risk families.


Assuntos
Características da Família , População Rural , China , Serviços Contratados , Estudos Transversais , Humanos
15.
Front Public Health ; 9: 572311, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34169052

RESUMO

This study aims to explore the attitude, willingness, and satisfaction with contracted service (CS) among staff in community health service (CHS) centers in urban China and to explore the associated factors of satisfaction with CS. From August 2016 to July 2017, five CHS centers in three provinces of China were selected. Setting-level information was collected by official document review; and personal information on demographic characteristics, awareness, willingness, and attitude of CS among staff was collected by questionnaire survey. Univariate and multivariable logistic regression models were fitted to explore the associated factors of satisfaction with CS. Multiple correspondence analysis (MCA) was used to visually demonstrate the correlations among category data related with satisfaction with CS. The CS signing rates were 30.78, 12.72, 22.20, 14.32, and 21.19% in the five CHS centers. A total of 286 staff included family doctors (40.91%), nurses (31.12%), and others (27.97%) completed the survey. For the sense of self-worth, 86.01% (246/286) participants hold a positive attitude. The predominant barrier of CS signing was caused by the work pressure due to CS performance assessment (48.60%, 139/286). About 30% of family doctors and nurses reported a heavy work pressure, and more than 30% of doctors had great feeling of fatigue. Notably, 51.69% family doctors would like to change their job in the future. Compared with other staff, family doctors were more likely to be unsatisfied with CS (OR: 2.793, 95% CI: 1.155-6.754, p = 0.022). Participants in Sichuan province have lower satisfaction than other places. The MCA yielded similar factors consistent with multivariable results of clustering with different levels of CS satisfaction. Our study revealed that the CS coverage and satisfaction among staff from the primary healthcare system varied geographically and are associated with professional field, workload, and pressure. Measures that aim to promote the stability of primary care human resource should be considered in the future.


Assuntos
Serviços Contratados , Clínicos Gerais , China , Serviços de Saúde Comunitária , Estudos Transversais , Humanos
16.
BMC Fam Pract ; 22(1): 117, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-34148556

RESUMO

BACKGROUND: The family doctors' contract service problem is not about government management alone, but an interaction of a complex social environment. Consequently, the effect of contracted services of family doctors not only depends on policy incentives but also needs to win the participation, acknowledgement, and confidence of community residents. The purpose of this integrative review is to examine whether there is any significant evidence that social capital in the form of social networking groups and other forms of social groups have any positive impact on the acceptance and the effectiveness of family doctors' contractual services. METHOD: Research on qualitative, quantitative and hybrid methods published in peer-reviewed journals on the social capital role in the process of contract service of family doctors were eligible for inclusion. In view of the increasing attention paid to the contract service effect of family doctors during this period, a 10-year time scale was selected to ensure full coverage of relevant literature in the same period. In total, 809 articles were determined in the database retrieval results which were downloaded and transferred to the Mendeley reference application software. RESULTS: Twelve articles met the inclusion criteria for this integrative review and the quality of the included studies were assessed using the published criteria for the critical appraisal of quantitative and qualitative research methods. Majority of the articles assessed reported that there was evidence of a positive link between social support, especially a sense of belonging and the presence of regular family doctors. The influencing factors of patients' contract behavior of studies conducted in China were social interaction of social capital, acceptance of the first contact in the community, year of investigation, and exposure to the public. CONCLUSION: The study affirms previous studies that suggest that social resources have the propensity to improve relationship between patients and clients and between doctors and peers for the benefit of the patients and the stability of the overall healthcare system. Through the integration of various social resources family doctor systems accelerate the development of community construction. These social capital (social network groups) can guide residents to use family doctor services to maintain health. Social capital can also help residents have a regular and reliable family doctor.


Assuntos
Capital Social , China , Serviços Contratados , Humanos , Médicos de Família
17.
Inquiry ; 58: 469580211009667, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33870745

RESUMO

Studies globally have provided substantial evidence that PHC could conduct doctor-visiting behaviors, control medical expense, and improve population health. This study aimed to map how family doctor (FD) in Shanghai achieved gate-keeper goals including health management, medical expense control, and conducting ordered doctor-visiting behavior. A total of 2754 and 1995 valid questionnaires were collected in 2013 and 2016 respectively in Shanghai. The data were analyzed using structural equation modeling (SEM). Invariance analysis was also performed for 2 waves of data. We found that the coefficient of cognition on health management (ß5 = 0.26, P < .05) was larger than that of signing with FD (ß4 = 0.06, P < .05). SEM model also showed that first-contact at community health service center (CHSC) had a positive effect on health management (ß6 = 0.30, P < .05), and the latter also affected health management results positively (ß8 = 0.39, P < .05), suggesting that the path for FD was through first-contact and health management. Besides, the gate-keeper role of medical expense control was significant through the first-contact (ß10 = -0.12, P < .05) mediation rather than health management (ß9 = 0.03, P > .05). The model fit was acceptable (RMSEA = 0.033). A "cognition-behavior-outcomes (health and medical expense)" path of FD's gate-keeper role was found. It is necessary to consolidate FD contracted services rather than reimbursement discount the latter of which is proved to be unsustainable.


Assuntos
Serviços Contratados , Médicos de Família , China , Serviços de Saúde Comunitária , Humanos , Análise de Classes Latentes
18.
Lima; Perú. Ministerio de Salud. Dirección General de Personal de la Salud. Observatorio de Recursos Humanos en Salud; 1 ed; Abr. 2021. 270 p. ilus.(Serie Bibliográfica Información de Recursos Humanos en Salud, 29).
Monografia em Espanhol | MINSAPERÚ, LILACS, LIPECS, MINSAPERÚ | ID: biblio-1343722

RESUMO

La publicación consta de seis capítulos, que a continuación de detallan de manera concisa. El Capítulo I proporciona información Recursos Humanos Contratados en el Marco del Decreto Legislativo N° 1057 ­ CAS COVID, destacándose la información descriptiva de los profesionales médicos, enfermeros, obstetras, etc. Según departamentos por grupo ocupacional y categoría de establecimiento. El Capítulo II presenta un panorama global de los recursos humanos Contratados en el Marco del Decreto Legislativo N° 1057 ­ CAS COVID en el Ministerio de Salud y los Gobiernos Regionales, segmentados por una serie de variables de interés según los departamentos. Así, tenemos la información de recursos humanos por sexo, quintil de pobreza, grupos de edad, por ruralidad, por zonas alejadas y de frontera, por zonas del VRAEM, por su condición de zonas de friajes, por zonas de Heladas y por zonas con comunidades nativas (amazónicas y campesinas) según departamento. El Capítulo III detalla la información de disponibilidad de médicos CAS COVID, en los establecimientos de salud del Ministerio de Salud y de los Gobiernos Regionales 2020 según departamento; destacándose la evolución por meses, por género y tipo de especialidad. El Capítulo IV detalla la información de disponibilidad de enfermeros CAS COVID, en los establecimientos de salud del Ministerio de Salud y de los Gobiernos Regionales 2020 según departamento; destacándose la evolución por meses, por género y tipo de especialidad. El Capítulo V presentan un panorama sobre la disponibilidad de recursos humanos en salud CAS COVID por pliego, Unidad Ejecutora de contrato, Ministerio de Salud y Gobiernos Regionales clasificados por tipo de brigadas en los establecimientos de salud de destino según departamentos. El Capítulo VI proporciona información sobre de análisis por antecedente de régimen o condición laboral del personal CAS COVID, como Servicios de Terceros, CAS Regular, Régimen 276, Ex Serumistas Residentado médico, que migraron a un contrato CAS COVID, destacándose la información por sexo, grupos de edad, por ruralidad, por zonas alejadas y de frontera, quintil de pobreza, tipo de establecimiento y por zonas del VRAEM


Assuntos
Ocupações Relacionadas com Saúde , Pessoal de Saúde , Impactos na Saúde , Serviços Contratados , Pandemias , Observatório de Recursos Humanos em Saúde , COVID-19 , Necessidades e Demandas de Serviços de Saúde , Categorias de Trabalhadores
20.
Int J Equity Health ; 20(1): 15, 2021 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407523

RESUMO

BACKGROUND: Family physician-contracted service (FPCs) has been recently implemented in Chinese primary care settings. This study was aimed at measuring the effects of FPCs on residents' health-related quality of life (HRQoL) and equity in health among the Chinese population. METHODS: The study data was drawn from the 2018 household health survey (Shaanxi Province, China) using multistage, stratified cluster random sampling. We measured HRQoL using EQ-5D-3L based on the Chinese-specific time trade-off values set. Coarsened exact matching (CEM) technique was used to control for confounding factors between residents with and without a contracted family physician. The concentration index (C) was calculated to measure equity in health. RESULTS: Individuals with a contracted family physician had significantly higher HRQoL than those without, after data matching (0.9355 vs. 0.8995; P <  0.001). Additionally, the inequity in HRQoL among respondents with a contracted family physician was significantly lower than those without a contracted family physician (Cs of EQ-5D utility score: 0.0084 vs. 0.0263; p <  0.001). CONCLUSIONS: This study highlights the positive effects of FPCs on HRQoL and socioeconomic-related equity in HRQoL. Future efforts should prioritize the economically and educationally disadvantaged groups, the expansion of service coverage, and the competency of family physician teams to further enhance health outcome and equity in health.


Assuntos
Serviços Contratados/estatística & dados numéricos , Medicina de Família e Comunidade/organização & administração , Medicina de Família e Comunidade/estatística & dados numéricos , Equidade em Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Qualidade de Vida/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
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