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      New models for chronic disease management in the United States and China


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          In the United States (US) the role of the general practitioner in primary care is changing rapidly as the team leader in the new “Patient-centered Medical Home” model of care that is designed to improve the management of chronic disease. The “Collaborative Care Model” is an integrated model of treating multiple medical and behavioral conditions. These new approaches include a nurse case manager who serves as the key point of contact to provide education, facilitate treatment adherence, and guide the patient to improvements in nutrition and physical activity that cause obesity and chronic disease. A gap analysis was conducted comparing the US and Chinese general practitioner models for providing care to patients with chronic diseases. The results of the analysis were used to make recommendations for adding components of these models that are feasible and effective for Chinese general practitioners in community health centers.

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          Prevalence, awareness, treatment, and control of hypertension in China: results from a national survey.

          Hypertension is one of the major risk factor for cardiovascular disease worldwide. The objective of this study was to investigate the prevalence, awareness, treatment, and control of hypertension in China. A multistage, stratified sampling method was used to obtain a representative sample of persons aged 18 years or older in the general population of China. Blood pressure (BP) was measured by sphygmomanometer 3 times at 5-minute intervals. Hypertension was defined as a systolic BP ≥ 140mm Hg, or diastolic BP ≥ 90mm Hg, or self-reported use of antihypertensive medications in the last 2 weeks irrespective of the BP. Altogether 50,171 subjects finished the survey across the entire country. The adjusted prevalence of hypertension was 29.6% (95% confidence interval (CI) = 28.9%-30.4%) and was higher among men than among women (31.2%, 95% CI = 30.1%-32.4%; vs. 28.0%, 95% CI = 27.0%-29.0%). The awareness, treatment among all hypertensive participants, control among all hypertensive participants, and control among treated hypertensive participants were 42.6%, 34.1%, 9.3%, and 27.4%, respectively. Multiple lifestyle factors were independently associated with presence of hypertension, including physical inactivity, habitual drinking, chronic use of nonsteroidal anti-inflammatory drugs, high body mass index, and central obesity. Hypertension is an important public health burden in China, and control of hypertension is still suboptimal. Several modifiable lifestyle activities were associated with hypertension and thus should be considered potential targets for intervention, with special attention to socioeconomically disadvantaged subpopulations in China. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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            Changes in health expenditures in China in 2000s: has the health system reform improved affordability

            Background China's health system reform launched in early 2000s has achieved better coverage of health insurance and significantly increased the use of healthcare for vast majority of Chinese population. This study was to examine changes in the structure of total health expenditures in China in 2000–2011, and to investigate the financial burden of healthcare placed on its population, particularly between urban and rural areas and across different socio-economic development regions. Methods Health expenditures data came from the China National Health Accounts study in 1990–2011, and other data used to calculate the financial burden of healthcare were from China Statistical Yearbook and China Population Statistical Yearbook. Total health expenditures were divided into government and social expenditure, and out-of-pocket payment. The financial burden of healthcare was estimated as out-of-pocket payment per capita as a percentage of annual household living consumption expenditure per capita. Results Between 2000 and 2011, total health expenditures in China increased from Chinese yuan 319 to 1888 (United States dollars 51 to 305), with average annual increase of 17.4%. Government and social health expenditure increased rapidly being 22.9% and 18.8% of average annual growth rate, respectively. The share of out-of-pocket payment in total health expenditure for the urban population declined from 53% in 2005 to 36% in 2011, but had only a slight decrease for the rural population from 53% to 50%. Out-of-pocket payment, as a percentage of annual household living consumption, has continued to rise, particularly in the rural population from the less developed region (6.1% in 2000 to 8.8% in 2011). Conclusions The rapid increase of public funding to subsidize health insurance in China, as part of the reform strategy, did not mitigate the out-of-pocket payment for healthcare over the past decade. Financial burden of healthcare on the rural population increased. Affordability among the rural households with sick members, particularly in the less developed region, is getting worse. It needs effective measures on cost control including healthcare provider payment reform and well developed health insurance schemes to offer better financial protection for the vulnerable Chinese seeking essential healthcare.
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              Depression care management for late-life depression in China primary care: Protocol for a randomized controlled trial

              Background As a major public health issue in China and worldwide, late-life depression is associated with physical limitations, greater functional impairment, increased utilization and cost of health care, and suicide. Like other chronic diseases in elders such as hypertension and diabetes, depression is a chronic disease that the new National Health Policy of China indicates should be managed in primary care settings. Collaborative care, linking primary and mental health specialty care, has been shown to be effective for the treatment of late-life depression in primary care settings in Western countries. The primary aim of this project is to implement a depression care management (DCM) intervention, and examine its effectiveness on the depressive symptoms of older patients in Chinese primary care settings. Methods/Design The trial is a multi-site, primary clinic based randomized controlled trial design in Hangzhou, China. Sixteen primary care clinics will be enrolled in and randomly assigned to deliver either DCM or care as usual (CAU) (8 clinics each) to 320 patients (aged ≥ 60 years) with major depression (20/clinic; n = 160 in each treatment condition). In the DCM arm, primary care physicians (PCPs) will prescribe 16 weeks of antidepressant medication according to the treatment guideline protocol. Care managers monitor the progress of treatment and side effects, educate patients/family, and facilitate communication between providers; psychiatrists will provide weekly group psychiatric consultation and CM supervision. Patients in both DCM and CAU arms will be assessed by clinical research coordinators at baseline, 4, 8, 12, 18, and 24 months. Depressive symptoms, functional status, treatment stigma and clients' satisfaction will be used to assess patients' outcomes; and clinic practices, attitudes/knowledge, and satisfaction will be providers' outcomes. Discussion This will be the first trial of the effectiveness of a collaborative care intervention aiming to the management of late-life depression in China primary care. If effective, its finding will have relevance to policy makers who wish to scale up DCM treatments for late-life depression in national wide primary care across China. Study Registration The DCM project is registered through the National Institutes of Health sponsored by clinical trials registry and has been assigned the identifier: NCT01287494

                Author and article information

                Family Medicine and Community Health
                Family Medicine and Community Health & American Chinese Medical Education Association (USA )
                December 2014
                December 2014
                : 2
                : 4
                : 13-19
                [1] 1Nicholas A. Cummings Doctor of Behavioral Health Program, College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
                Author notes
                CORRESPONDING AUTHOR: Ronald R. O’Donnell, Ph.D., Director, Nicholas A. Cummings Doctor of Behavioral Health Program, College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA, E-mail: ronald.odonnell@ 123456asu.edu
                Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
                Copyright © 2014 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

                : 10 October 2014
                : 5 December 2014

                General medicine,Medicine,Geriatric medicine,Occupational & Environmental medicine,Internal medicine,Health & Social care
                Patient-centered medical home,Integrated behavioral health or integrated behavioral care,Telehealth,Population health management,Disease management,Primary care behavioral health


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