Scoliosis Related Information on the Internet in China: Can Patients Benefit from This Information?

BackgroundThere has been an increasing popularity of searching health related information online in recent years. Despite that considerable amount of scoliosis patients have shown interest in obtaining scoliosis information through Internet, previous studies have demonstrated poor quality of online information. However, this conclusion may vary depending on region and culture. Since China has a restricted Internet access outside of its borders, the aim of this study is to evaluate the quality of scoliosis information available online using recognized scoring systems and to analyze the Internet as a source of health information in China.MethodsA survey-based questionnaire was distributed to 280 respondents at outpatient clinics. Information on demographics and Internet use was collected. Binary logistic analysis was performed to identify possible predictors for the use of Internet. In addition, the top 60 scoliosis related websites assessed through 4 search engines were reviewed by a surgeon and the quality of online information was evaluated using DISCERN score and JAMA benchmark.ResultsUse of the Internet as a source for scoliosis related information was confirmed in 87.8% of the respondents. College education, Internet access at home and urban residence were identified as potential predictors for Internet use. However, the quality of online scoliosis related information was poor with an average DISCERN score of 27.9±11.7 and may be misleading for scoliosis patients.ConclusionThe study outlines the profile of scoliosis patients who use the Internet as a source of health information. It was shown that 87.8% of the scoliosis patients in outpatient clinics have searched for scoliosis related information on Internet. Urban patients, higher education and Internet access at home were identified as potential predictors for Internet search. However, the overall quality of online scoliosis related information was poor and confusing. Physician based websites seemed to contain more reliable information.     

The Internet as a Mental Health Advisor in Germany—Results of a National Survey

The internet constitutes a popular source of health information. However, the use of the internet and other modern media in the domain of mental health remains widely unclear. This study aimed at exploring the readiness for seeking information online and making use of online counseling and media-assisted psychotherapy. A representative survey of N = 2411 Germans was conducted. Results indicated that more than one fourth of Germans would consider seeking help online in case of psychic strain. Participants reported that they would use the internet when needing to research about mental health topics and to communicate with persons concerned on internet forums. Only a small number of participants had already used psychological online-counseling. The majority of subjects reported not having known about the possibility of online counseling. However, the willingness to make use of this option in the future was in a medium range. Concerning the treatment of mental disorders, participants showed a clear preference toward conventional face-to-face treatment. Less than 10% of participants considered the use of treatment supported by mobile phones, the internet, or virtual realities as likely. Certainly, readiness was significantly higher in persons who were already using the relevant devices—mobile phones, computers, and the internet. In the future, there will presumably be an increasing demand for media-assisted psychological counseling and interventions. Members of the health care system should therefore prepare for current developments and help enlighten patients with regard to the possibilities, and also the potential risks of e-mental health.     

Social Determinants of Health Information Seeking among Chinese Adults in Hong Kong

Background

Health communication inequalities were observed in Western population but less is known about them among the Chinese. We investigated health information seeking behaviours and its social determinants among Chinese adults in Hong Kong.

Methods

Probability-based sample surveys over telephone were conducted in 2009, 2010/11 and 2012 to monitor family health and information use. Frequency of health information seeking from television, radio, newspapers/magazines and Internet were recorded and dichotomised as ≥1 time/month and <1 time/month (reference). Logistic regression was used to yield adjusted odds ratios (aOR) of health information seeking for different demographic characteristics, socioeconomic status (education, employment and income), chronic disease and behaviours (smoking, drinking and physical activity).

Results

Among 4553 subjects in all surveys, most (85.1%) had sought health information monthly from newspapers/magazines (66.2%), television (61.4%), radio (35.6%) or Internet (33.2%). Overall, being male, lower education attainment, lower household income, ever-smoking and physical inactivity were associated with less frequent health information seeking (all P <0.05). Compared with younger people, older people were less likely to search health information from Internet but more like to obtain it from radio (both P for trend <0.001). Having chronic diseases was associated with frequent health information seeking from television (aOR  =  1.25, 95% CI: 1.07–1.47) and Internet (aOR  =  1.46, 95% CI: 1.24–1.73).

Conclusions

This study has provided the first evidence on health information inequalities from a non-Western population with advanced mass media and Internet penetration. Socioeconomic inequalities and behavioural clustering of health information seeking suggested more resources are needed for improving health communication in disadvantage groups.     

Health Information Seeking Partially Mediated the Association between Socioeconomic Status and Self-Rated Health among Hong Kong Chinese

Background

Poor self-rated health (SRH) is socially patterned with health communication inequalities, arguably, serving as one mechanisms. This study investigated the effects of health information seeking on SRH, and its mediation effects on disparities in SRH.

Methods

We conducted probability-based telephone surveys administered over telephone in 2009, 2010/11 and 2012 to monitor health information use among 4553 Chinese adults in Hong Kong. Frequency of information seeking from television, radio, newspapers/magazines and Internet was dichotomised as <1 time/month and ≥1 time/month. Adjusted odds ratios (aOR) for poor SRH were calculated for health information seeking from different sources and socioeconomic status (education and income). Mediation effects of health information seeking on the association between SES and poor SRH was estimated.

Results

Poor SRH was associated with lower socioeconomic status (P for trend <0.001), and less than monthly health information seeking from newspapers/magazines (aOR = 1.23, 95% CI 1.07–1.42) and Internet (aOR = 1.13, 95% CI 0.98–1.31). Increasing combined frequency of health information seeking from newspapers/magazines and Internet was linearly associated with better SRH (P for trend <0.01). Health information seeking from these two sources contributed 9.2% and 7.9% of the total mediation effects of education and household income on poor SRH, respectively.

Conclusions

Poor SRH was associated with lower socioeconomic status, and infrequent health information seeking from newspapers/magazines and Internet among Hong Kong Chinese. Disparities in SRH may be partially mediated by health information seeking from newspapers/magazines and Internet.     

An exploration of information exchange by adolescents and parents participating in adolescent idiopathic scoliosis online support groups

Background

Research indicates that healthcare providers frequently fail to adequately address patients’ health information needs. Therefore, it is not surprising that patients or parents of a sick child are seeking health information on the internet, in particular in online support groups (OSGs). In order to improve our understanding of the unmet health information needs of families dealing with adolescent idiopathic scoliosis (AIS), this study assessed and compared the types of information that adolescents and parents are seeking in OSGs.

Methods

This study used two publicly accessible AIS-related OSGs on the National Scoliosis Foundation (NSF) website that targeted those who are receiving brace treatment and those under observation without treatment. Information exchanges were coded as providing or seeking information. Types of information being exchanged were categorized into several AIS-specific and brace-specific categories. Through a review of over 8,000 messages, 305 adolescents with AIS and 300 parents of a child with AIS were identified and categorized based on stage of illness/treatment. One message from each individual was randomly selected and coded for analysis.

Results

There were significantly more (p?<?0.001) parents that had a recently diagnosed child compared to recently diagnosed adolescents participating in the AIS-related OSGs, whereas there were significantly more (p?=?0.004) adolescents that experienced brace treatment compared to parents of a child that experienced brace treatment. The most frequent information exchanged by adolescents and parents was AIS-related concerns regarding causes, diagnosis, and progression of the condition. However, compared to adolescents, parents exchanged this AIS-related information significantly more (p?<?.001) in their posts. Finally, compared to parents, adolescents exchanged significantly more information about appearance-related concerns regarding both AIS-related deformity (p?<?0.002) and wearing a brace (p?<?0.001).

Conclusion

Families dealing with AIS are participating in OSGs to exchange information, in particular information related to the condition and to treatment. This study found similarities and differences regarding how information was exchanged (providing or seeking) and regarding frequency and types of information exchanged. Knowledge of these similarities and differences may be useful for improving health communication in the healthcare setting, at home, and for development and improvement of AIS-related website support.

     

Examining Associations between Health Information Seeking Behavior and Adult Education Status in the U.S.: An Analysis of the 2012 PIAAC Data

This paper presents data from the Program for the International Assessment of Adult Competencies with a focus on the interrelationships among health information seeking behavior (HISB), and health status or use of preventive health measures for U.S. adults both with and without a high school diploma. Key results of ordinal and binary logistic regression analyses indicated that, after controlling for demographic factors, (1) adults with a high school diploma use more text-based health information sources while adults without a high school diploma use more oral sources, (2) using the Internet as a source of health information is more strongly related to reporting excellent/very good health status than having a high school diploma, (3) those without a high school diploma who use the Internet report the largest increase in health status over any other health information source, and (4) for those with learning disability or vision problem, a high facility in reading English is an important predictor of whether the Internet is used as a health information source. The Internet appears to play a key role in both enhancing health status and enabling use of preventive measures for those with and without a high school diploma; although, individuals without a high school diploma who use the Internet for health information derive substantial benefit in health status.     

The Internet and medicine: past,present, and future.

The enormous growth of the Internet and the World Wide Web has made these two technologies an important potential adjunct to cost-effective health care research and delivery. This article surveys some recent developments in telecommunications, networking and artificial intelligence that are likely to have a significant impact on improving the efficiency and quality of future health care. Issues discussed include: clinical record keeping on the Internet, Internet-assisted medical diagnosis, privacy and security matters, financial transactions, digital money, bandwidth concerns, multimedia (music, audio and video) information delivery via the Internet, intellectual property, and the concept of Information Philanthropy.     

AN ANALYSIS OF THE QUALITY OF THYROID CANCER WEBSITES

Objective: This study evaluated online thyroid cancer patient information quality. This is essential, given increasing patient use of online health information.Methods: A total of 100 thyroid cancer websites, representing those patients find first, were identified using Google and two meta-search engines. Content accuracy and patient-evaluable quality markers, including attribution, currency, structure, and content comprehensiveness and readability, were assessed with a previously validated standardized rating tool, developed using design-based methods. Accuracy was defined compared to standard, peer-reviewed medical resources, UpToDate and the National Comprehensive Cancer Network. Responses to general and personal “patient” questions were evaluated for promptness and accuracy.Results: Of 100 websites, only 26% stated authorship, and 56% cited sources. Seventy-four percent had dates of creation or last update, with only half of those dates occurring within the past 2 years. Websites most often discussed the definition (94%), diagnosis (92%), and treatment (94%) of thyroid cancer, but diagnosis and treatment were also most frequently incomplete or inaccurate: diagnosis information was complete and accurate 50% of the time, and treatment 47%. Only 2% of websites were comprehensible without high school education. Of 83 websites contacted with “patient” questions, 50 replied, 48 within 1 week.Conclusion: Thyroid cancer information is widely available online, but quality varies. Sites often lack markers for patients to assess quality, and content may be difficult to understand. Information is frequently incomplete, particularly on topics important to patients, such as diagnosis and treatment. Educational resource developers may fill these gaps, and healthcare providers can direct thyroid cancer patients to reliable online resources.Abbreviation: NCCN = National Comprehensive Cancer Network     

Fighting cancer in the information age: the role of Internet

Cancer is a major health problem worldwide which is likely to assume alarming proportions in the next two decades. Communication and information have increasingly been considered important in helping people to cope with cancer. The arrival of Internet offers the opportunity to fundamentally reinvent medicine and health care delivery. Medical professionals can now use the Internet for continuing medical education, access latest medical information, for fast confirmation of diagnosis, exchange opinion on treatment strategies and in palliative care. Internet can provide cost-effective and timely ways to deliver a complex mix of interesting and high-quality information and expertise to cancer patients. Patients can also independently search the Internet to know about their illness and treatment options. However, of concern is the quality of information that is available in the 'Net'. Some Internet sites may contain erroneous information on cancer and can pose serious problems. There are also many good sites, which provide quality information on cancer for medical professionals, researchers and patients. This article focuses on how the Internet will aid us in fight against cancer.     

The acceptability of Internet-based treatment and characteristics of an adult sample with obsessive compulsive disorder: an Internet survey

Background

Obsessive-compulsive disorder (OCD) is a disabling anxiety disorder, but most individuals delay seeking treatment. Internet-based cognitive behavioural therapy (iCBT) is an innovative service delivery method that may help to improve access to care, but the acceptability to consumers of such programs has not yet been established.

Methodology

People with symptoms of OCD were invited to complete an online survey enquiring about demographic characteristics, symptom severity, and acceptability of Internet-based treatment. Demographic and symptom severity data were compared with people with OCD identified in a national epidemiological survey and with a sample of patients with OCD from a specialist outpatient anxiety clinic.

Participants

129 volunteers to an online Internet survey, 135 patients at a specialist anxiety disorders outpatient clinic, and 297 cases identified in a national epidemiological survey.

Main Measures

Demographic characteristics, and severity of symptoms as measured by the Kessler 10-Item scale, the 12-item World Health Organisation Disability Assessment Schedule - Second Edition and the Yale Brown Obsessive Compulsive Scale - Self Report Version.

Principal Findings

The Internet sample was similar demographically but reported more severe symptoms than the comparison groups, although had similar severity of symptoms of OCD compared with other clinical samples reported in the literature. Participants reported Internet-based treatment for OCD would be highly acceptable.

Conclusions

Internet-based treatment may reduce barriers to accessing treatment to people with OCD. Individuals in this study were similar demographically to other samples and had similar severity of symptoms as those identified in other clinical samples, suggesting that Internet-based treatment using techniques employed in face-to-face treatment may be effective in this group. Internet-based treatments for OCD need to be developed and evaluated.     

Treatment-resistant residual insomnia in patients with recurrent major depressive episodes

Residual symptoms are common in depression, and their presence is associated with poorer clinical outcomes of depression. We conducted a case series study of first-onset major depression to elucidate the clinical course of residual insomnia and examine the relationship between residual insomnia and recurrence of depression. Subjects were 128 patients (57 males; mean age 52.8 years) with first-onset major depression. For all patients, we continuously assessed the number and breakdown of residual symptoms listed on the 17-item Hamilton Rating Scale for Depression and quantities of prescribed psychotropic medications during the depressive and remission phases. Even during the first remission phase, 85.9% of the patients with first-onset major depression experienced an average of 2.95 residual symptoms. The most common residual symptom was insomnia (65.4%), followed by reduced work and interests (43.3%) and fatigue (39.4%). Each additional recurrence resulted in a significantly shorter remission phase as well as significant increases in antidepressant and hypnotics dosages. Hypnotics dosage during the first remission phase for patients with three or more recurrent episodes was significantly higher than that for those with only a single episode. Our findings suggest a possible link between treatment-resistant residual insomnia during the first remission phase and recurrence risk of depression. In particular, it is possible that presence of treatment-resistant insomnia during the first remission phase is related to later recurrence of depressive episodes. It is important to see patients with treatment-resistant insomnia of early stage carefully, with special attention to treatment adherence.

     

Patterns of Information-Seeking for Cancer on the Internet: An Analysis of Real World Data

Although traditionally the primary information sources for cancer patients have been the treating medical team, patients and their relatives increasingly turn to the Internet, though this source may be misleading and confusing. We assess Internet searching patterns to understand the information needs of cancer patients and their acquaintances, as well as to discern their underlying psychological states. We screened 232,681 anonymous users who initiated cancer-specific queries on the Yahoo Web search engine over three months, and selected for study users with high levels of interest in this topic. Searches were partitioned by expected survival for the disease being searched. We compared the search patterns of anonymous users and their contacts. Users seeking information on aggressive malignancies exhibited shorter search periods, focusing on disease- and treatment-related information. Users seeking knowledge regarding more indolent tumors searched for longer periods, alternated between different subjects, and demonstrated a high interest in topics such as support groups. Acquaintances searched for longer periods than the proband user when seeking information on aggressive (compared to indolent) cancers. Information needs can be modeled as transitioning between five discrete states, each with a unique signature representing the type of information of interest to the user. Thus, early phases of information-seeking for cancer follow a specific dynamic pattern. Areas of interest are disease dependent and vary between probands and their contacts. These patterns can be used by physicians and medical Web site authors to tailor information to the needs of patients and family members.     

Socioeconomic status and health communication inequalities in Japan: a nationwide cross-sectional survey

Background

Considerable evidence suggests that communication inequality is one potential mechanism linking social determinants, particularly socioeconomic status, and health inequalities. This study aimed to examine how dimensions of health communication outcomes (health information seeking, self-efficacy, exposure, and trust) are patterned by socioeconomic status in Japan.

Methods

Data of a nationally representative cross-sectional survey of 2,455 people aged 15–75 years in Japan were used for secondary analysis. Measures included socio-demographic characteristics, subjective health, recent health information seeking, self-efficacy in seeking health information, and exposure to and trust in health information from different media.

Results

A total of 1,311 participants completed the questionnaire, giving a response rate of 53.6%. Multivariate logistic regression revealed that education and household income, but not employment, were significantly associated with health information seeking and self-efficacy. Socioeconomic status was not associated with exposure to and trust in health information from mass media, but was significantly associated with health information from healthcare providers and the Internet.

Conclusion

Health communication outcomes were patterned by socioeconomic status in Japan thus demonstrating the prevalence of health communication inequalities. Providing customized exposure to and enhancing the quality of health information by considering social determinants may contribute to addressing social disparities in health in Japan.     

A Randomized Controlled Trial Comparing Neurofeedback and Cognitive-Behavioral Therapy for Insomnia Patients: Pilot Study

Insomnia is a common disease that negatively affects patients both mentally and physically. While insomnia disorder is mainly characterized by hyperarousal, a few studies that have directly intervened with cortical arousal. This study was conducted to investigate the effect of a neurofeedback protocol for reducing cortical arousal on insomnia compared to cognitive-behavioral treatment for insomnia (CBT-I). Seventeen adults with insomnia, free of other psychiatric illnesses, were randomly assigned to neurofeedback or CBT-I. All participants completed questionnaires on insomnia [Insomnia Severity Index (ISI)], sleep quality [Pittsburgh Sleep Quality Index (PSQI)], and dysfunctional cognition [Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16)]. The neurofeedback group showed decreases in beta waves and increases in theta and alpha waves in various areas of the electroencephalogram (EEG), indicating lowered cortical arousal. The ISI and PSQI scores were significantly decreased, and sleep efficiency and sleep satisfaction were increased compared to the pre-treatment scores in both groups. DBAS scores decreased only in the CBT-I group (NF p?=?0.173; CBT-I p?=?0.012). This study confirmed that neurofeedback training could alleviate the symptoms of insomnia by reducing cortical hyperarousal in patients, despite the limited effect in reducing cognitive dysfunction compared to CBT-I.

     

Patients’ Knowledge,Attitudes, Behaviour and Health Care Experiences on the Prevention,Detection, Management and Control of Hypertension in Colombia: A Qualitative Study

Hypertension is a leading cause of premature death worldwide and the most important modifiable risk factor for cardiovascular disease. Effective screening programs, communication with patients, regular monitoring, and adherence to treatment are essential to successful management but may be challenging in health systems facing resource constraints. This qualitative study explored patients’ knowledge, attitudes, behaviour and health care seeking experiences in relation to detection, treatment and control of hypertension in Colombia. We conducted in-depth interviews and focus group discussions with 26 individuals with hypertension and 4 family members in two regions. Few participants were aware of ways to prevent high blood pressure. Once diagnosed, most reported taking medication but had little information about their condition and had a poor understanding of their treatment regime. The desire for good communication and a trusting relationship with the doctor emerged as key themes in promoting adherence to medication and regular attendance at medical appointments. Barriers to accessing treatment included co-payments for medication; costs of transport to health care facilities; unavailability of drugs; and poor access to specialist care. Some patients overcame these barriers with support from social networks, family members and neighbours. However, those who lacked such support, experienced loneliness and struggled to access health care services. The health insurance scheme was frequently described as administratively confusing and those accessing the state subsidized system believed that the treatment was inferior to that provided under the compulsory contributory system. Measures that should be addressed to improve hypertension management in Colombia include better communication between health care professionals and patients, measures to improve understanding of the importance of adherence to treatment, reduction of co-payments and transport costs, and easier access to care, especially in rural areas.     

基于分级诊疗视角的就医行为分析及相关策略研究

通过国内外相关文献资料的患者门诊就医行为分析和研究,发现并总结出患者就医行为的影响因素、不同病种和不同人群的就医流向趋势。其研究结果可为我国分级诊疗的基层首诊、双向转诊等相关政策的制订和完善提供较为准确的理论依据,以促进分级诊疗的健康发展。     

Photosynthesis online

Online access to the Internet and the World Wide Web have become important for public awareness and for educating the world’s population, including its political leaders, students, researchers, teachers, and ordinary citizens seeking information. Relevant information on photosynthesis-related Web sites and other online locations is grouped into several categories: (1) group sites, (2) sites by subject, (3) individual researcher’s sites, (4) sites for educators and students, and (5) other useful sites.     

Exploring Consumer Perceptions and Economic Burden of Onchocerciasis on Households in Enugu State,South-East Nigeria

Introduction

Onchocerciasis or river blindness constitutes a major burden to households especially in resource-poor settings, causing a significant reduction in household productivity. There has been renewed interest from policy makers to reduce the burden of Neglected Tropical Diseases (NTDs) such as onchocerciasis on individuals and households. This paper provides new information on the patient’s perceptions of onchocerciasis and its economic burden on households in South-eastern Nigeria. The information will be useful to health providers and policy makers for evidence-informed resource allocation decisions.

Methods

Information was generated from a cross-sectional household survey conducted in Achi community, Oji River Local Government Area (LGA) of Enugu State, Southeast Nigeria. A pre-tested interviewer-administered questionnaire was used to collect data. A total of 747 households were visited randomly and data were collected using pre-tested interviewer administered questionnaire from 370 respondents. The respondents’ knowledge of the cause of symptoms of the disease, costs incurred for seeking treatment and productivity losses were elicited. Data were analyzed using tabulations and inferential statistics. A socio-economic status (SES) index was used to disaggregate some key variables by SES quintiles for equity analysis.

Results

Many people had more than one type of manifestation of onchocerciasis. However, more than half of the respondents (57%) had no knowledge of the cause of their symptoms. Male respondents had significantly more knowledge of the cause of symptoms than females (P = 0.04) but knowledge did not differ across SES (P = 0.82). The average monthly treatment cost per respondent was US$ 14.0. Drug cost (US$10) made up about 72% of total treatment cost. The per capita productivity loss among patients was US$16 and it was higher in the poorest (Q1) (US$20) and the third SES quintiles (Q3) (US$21). The average monthly productivity loss among caregivers was US$3.5.

Conclusion

Onchocerciasis still constitutes considerable economic burden on patients due to the high cost of treatment and productivity loss. Prioritizing domestic resource allocation for the treatment of onchocerciasis is important for significant and sustained reduction in the burden of the disease. In addition, focused health promotion interventions such as health education campaigns should be scaled up in onchocerciasis-endemic communities.     

Primary Menopausal Insomnia: Definition,Review, and Practical Approach

ObjectiveTo present a case of primary menopausal insomnia with hot flashes to introduce recent changes in technology and nomenclature of sleep medicine and to review presentation, diagnosis, and therapies for menopausal insomnia.MethodsClinical findings and results of sleep evaluation in the menopausal study patient are presented with details about polysomnography performed before and after therapy with pregabalin.ResultsA 56.5-year-old female athlete with severe hot flashes and insomnia of 12 years duration was treated with pregabalin, which ameliorated the hot flashes and sweats and improved sleep quality and architecture. Menopause is associated with hormonal and metabolic changes that disrupt sleep. Disruption of sleep can in turn lead to morbidity and metabolic sequelae. Hormonal treatment, although effective, carries risks unacceptable to many patients and physicians. To date, nonhormonal therapies of symptomatic menopause have not been objectively studied for effects on sleep efficiency and architecture. Primary menopausal insomnia is insomnia associated with menopause and not attributable to secondary causes. Polysomnographically, it seems characterized by a high percentage of slow-wave (N3) sleep, decreased rapid eye movement sleep, cyclic alternating pattern, and arousals.ConclusionsPrimary menopausal insomnia is probably mediated through a mechanism separate from hot flashes, and one can occur without the other. Thermal dysregulation and sleep abnormalities of menopause are probably related to more general changes mediated through loss of estrogenic effects on neuronal modulation of energy metabolism, and more clinical direction is expected as this research field develops. Identification of sleep disorders in menopausal women is important, and polysomnographic evaluation is underused in both clinical and research evaluations of metabolic disturbances. (Endocr Pract. 2011; 17:122-131)     

农村高血压患者协调性和连续性服务的利用现状研究

目的 分析高血压患者在农村医疗服务网络接受协调性和连续性服务的提供状况,为改进患者的整合服务利用提供决策参考。方法 根据国内外文献,以自行编制服务协调性和连续性提供的问卷为工具,调查数据采用描述性统计分析。结果 49.6%的患者伴有1种及以上疾病,约73.0%在乡镇卫生院有就医经历,到过2家及以上机构就医的占51.3%;在乡村两级治疗效果不佳的患者,能够获取村医和乡镇医生推荐转诊机构的比重最大,分别为28.4%和68.7%;上级医生能够根据下级机构相关诊疗信息连续诊疗的不到43.0%,下级医生能够根据前期诊疗信息继续诊疗的比例刚超4成;“上转容易、下转难”现象同样存在。 结论 农村慢性病患者的患病特点增加了在农村纵向医疗机构就诊的几率,但该网络提供连续性和协调性服务的程度却不高,应加强农村三级医疗机构间的全面整合。