Practice and Enlightenment of Chronic Disease Management at the County Level in China from the Perspective of Professional Integration: A Qualitative Case Study of Youxi County, Fujian Province

Abstract

Background: It is currently the most cost-effective management model to have multiple professionals from relevant institutions collaborate so as to provide integrated chronic disease management services. The "classified, color-coded, hierarchical and regionalized" chronic disease management model in Youxi County, Fujian Province is a typical case in China. However, related research is limited. This paper aims to analyze the practice measures and lessons learned in Youxi County, focusing on the professional integration of service providers. Methods:From January to March 2021, interviews with 15 key informants in Youxi County were conducted to collect qualitative data, which was analyzed by the thematic framework method as well as the policy data, using the professional integration dimension in the evaluation framework of the integrated healthcare system.Results: A series of measures were taken, such as improving the professional division and collaboration mechanism, establishing the incentive and restraint mechanism geared toward chronic disease management, formulating norms and standards of chronic disease management for patients with different color labels, and promoting the compatibility of inter-professional value and culture under the governmental institutional supply and the organizational support of the tight county healthcare alliance in Youxi County, to prompt professionals of different levels and types to collaborate in order to provide integrated chronic disease management services. However, some problems remained, such as limited capacity of primary health care, the relatively narrow range and weak effect of the incentive and restraint mechanism, inadequate implementation of the norms and standards, and so forth. Conclusions:Our findings provide reference for other regions in China and other lowand middle-income countries in exploring the integrated chronic disease management model. Long-term follow-up surveys and mixed research designs are required in the future to enrich relevant evidence.

Qualification of Prenatal Care and Management in the Context of Primary Health Care

“…The professionals in this study, albeit in an incipient way, showed the need to achieve a new way of thinking about health. Studies corroborate this thinking by demonstrating the relevance of intuiting expanded and interprofessional approaches, capable of integrating, dialoguing and building knowledge and practices in a horizontal, collaborative and systemic way (22)(23)(24)(25).…”

Effects of medical consortium policy on health services: an interrupted time-series analysis in Sanming, China

“…Furthermore, despite receiving technical support from professionals at county-level or tertiary hospitals, the service capacity of grassroots medical institutions remains low. Consequently, professionals in grassroots medical institutions were in subordinate positions ( 33 ), thereby limiting the role of primary medical staff and diminishing their motivation to engage actively in the establishment of MCs. Another contributing factor could be patients’ lack of confidence in grassroots hospitals’ quality of care.…”

“…Moreover, some researchers have revealed that Sanming lacks attractive programs to motivate medical personnel to serve at the grassroots level (68). The demanding workload of grassroots health (33), thereby limiting the role of primary medical staff and diminishing their motivation to engage actively in the establishment of MCs. Another contributing factor could be patients' lack of confidence in grassroots hospitals' quality of care.…”

“…Some studies have examined the effects of MCs reform in a particular county. For example, Zheng et al interviewed 15 key informants and found that establishing compact MC in Youxi County helped prompt professional integration ( 33 ). Zhong ZD et al used an interrupted time-series analysis (ITSA) to report that the number of surgeries had decreased in county hospitals ( 34 ).…”