Research On Supplier’s And Acquirer’s Perspective Of Integrated Medical And Nursing Care Provided By Community Health Centers

【Objective】 To investigate the status and problems of integrated medical and nursing care delivered by community health centers(CHCs)from supplier’s perspective,and the status of need and utilization of integrated medical and nursing care provided by CHCs of the elderly in Beijing Chaoyang district,and to explore the influence factors from acquirer’s perspective,providing feasible suggestions for better development of elderly care services.【Methods】 Methods of the research include policy review and field investigation.In terms of policy review,policies on integrated medical and nursing care issued by relevant departments since 2013 were inquired online,reviewing according to the content of the policies.In terms of field investigation,self-designed interview or E-mail investigation was used to conduct personal interviews or E-mail investigations between September and November,2019 with mangers or workers engaging in integrated medical and nursing care from 40 CHCs in Beijing’s Chaoyang District.The interview or investigation data were analyzed by Colaizzi’s seven-step method.Self-designed questionnaires were used with electronic questionnaires to investigate 713 elderly people who had visited or been hospitalized in CHCs of Chaoyang District from September to November,2020.The data were analyzed by Single Factor and Multiple-factor Analysis to explore the influence factors of the need and utilization of the elderly.【Results】 Since September,2013,the State,Beijing,and Chaoyang District have successively issued more than 100 policies,covering various aspects such as improving medical insurance mechanisms,developing traditional Chinese medicine elderly care services,and fully opening on the elderly care market.The response rate of the personal interviews and E-mail investigations was 97.5%.Among them,38 CHCs(97.44%)have provided integrated medical care and nursing care services.In addition to the basic public health services provided by all CHCs,centers providing medical services such as pipeline nursing(76.32%),targeted health guidance(34.21%)and one-touch calling services(31.58%)accounted for more proportion.While the proportion of CHCs that carried out elderly care services such as nutritious meals(2.63%)and guidance on fall prevention(7.89%)was relatively low.The top three risk issues faced in the development of integrated medical and nursing care were: insufficient medical staff(66.67%),medical and personal risks in the door-to-door service(58.97%),and policy issues such as lack of implementation rules(56.41%).A total of 580 valid questionnaires were collected,and the response rate was 81.35%.In terms of demand,the demand rate of the elderly for each service was more than 60%.The rate of traditional Chinese medicine service was the highest(99.8%),while the rate of life service was the lowest(66.4%).In terms of utilization,the utilization rate of different services by the elderly varies greatly.The rate of traditional Chinese medicine service was the highest(97.0%),while the rate of psychological support service(5.7%)and life service(1.4%)was extremely low.Non-conditional Logistic regression analysis showed that the influence factors of the demand and utilization of different kinds of integrated medical and nursing care service were different.The influence factors of utilization of basic medical services included junior high school education(OR=3.106),high school/vocational high school/technical secondary school education(OR=5.827),and so on.The influence factors of the utilization of traditional Chinese medicine service included general approval(OR=16.786)and approval(OR=6.899)that the integration of medical and nursing care can improve the convenience of medical treatment.The influence factors of the demand of rehabilitation and nursing service included general understanding(OR=4.013)and understanding(OR=14.996)of integrated medical and nursing care,financial assistance from partners in out-patient/in-patient services(OR=6.568),and so on;the influence factors of the utilization of rehabilitation and nursing service included the life care of children and their spouses in out-patient/in-patient services(OR=2.867)and good or very good self-perceived health status(OR=0.218).The influence factors of the demand of psychological support service included living with children and family members(OR=0.147),two or more chronic diseases(OR=6.402),and so on;the influence factors of the utilization of psychological support service included ethnicity(OR=3.513),general self-perceived health status(OR=0.306),and so on.The influence factors of the need of life service included living with children and family members(OR=0.125),living with family members but not with children(OR=0.281),and so on.The influence factors of the need of guidance service included financial assistance from the partner(OR=106.193)and children and children’s spouse(OR=0.119)in out-patient/in-patient services,and so on;the influence factors of the utilization of guidance service included over the age of 80(OR=3.297),general understanding(OR=3.796)and understanding(OR=8.345)of integrated medical and nursing care,and so on.The influence factors of the need of terminal/palliative care included acute diseases or chronic diseases onset in the past two weeks(OR=0.424),hypertension(OR=6.413),and so on.【Conclusion】 Policies of integrated medical and nursing care mostly stays at the macro level,and the content mainly focuses on encouragement,guidance and suggestions.There are problems such as lack of implementation rules and incomplete insurance mechanism.From the perspective of the suppliers,CHCs face seven risk problems,including shortage of nursing personnel,unbalanced construction of rehabilitation facilities,and low proportion of providing elderly care services.From the perspective of acquirers,the demand rate of the elderly for all kinds of integrated medical and nursing care services is at a relatively high level.Except for traditional Chinese medicine services,the utilization rate of other integrated medical and nursing care services is significantly lower than the demand rate.The need and utilization of integrated medical and nursing care is affected by various factors.Awareness,dwelling status,sources of financial assistance in out-patient/in-patient services,health status and satisfaction with integrated medical and nursing care are the main influence factors of the need of services;health status,economic status,life care and sources of financial assistance in out-patient/in-patient services and satisfaction with integrated medical and nursing care are the main influence factors of the utilization of services.