Chinese General Practice

Signing a Contract with the Family Doctor： Does It Matter? What Is the Matter?

YANG Hui

2018, 21(31): 3785-3788. DOI: 10.12114/j.issn.1007-9572.2018.31.001

Asbtract ( )

PDF (1177KB) ( )

References | Related Articles | Metrics

The implementation of contracted family doctor services（CFDSs） in China has made positive achievements.Moreover，the refection of the contents and implementation significance of CFDSs becomes deeper，and the emphasis on improving the quality and contents of CFDSs is increasing.The supportive policies ensuring the implementation of CFDSs in a region should be formulated based on the local conditions，and have distinctive regional suitability.In order to further develop the CFDSs，the development goals，service contents，delivery patterns，and implementation of CFDSs still need to be considered intensively.We detailed the goals，significance and current status of the development of CFDSs in China，summarized the corresponding advanced experiences of other countries，and suggested specific directions for future research of domestic development of CFDSs，with a view to providing a reference for researchers in related fields.

Study of the General Practitioners' Policies in China from the Perspective of Policy Tools

FAN Zhuanzhuan，LIU Yuanyuan，YAO Dongming

2018, 21(31): 3788-3794. DOI: 10.12114/j.issn.1007-9572.2018.31.002

Asbtract ( )

PDF (996KB) ( )

References | Related Articles | Metrics

Objective　To analyze the policy tools in 31 policy texts related to general practitioners（GPs） issued by the Chinese central government，and probe the emphases and limitations of the policy system of GPs，providing a reference for the modifying and improvement of such policies.Methods　We searched the websites of the State Council of the People's Republic of China and its subordinated agencies such as National Development and Reform Commission，National Health and Family Planning Commission and so on for policy documents related to GPs issued during 2009 to 2018 with "general practitioners" in Chinese as the searching title or key words.The included 31 policy documents were numbered and extracted based on the perspective of policy tools.And the extracted policy tools were counted and studied with quantitative content analysis.Results　In the 174 policy codes，demand-side policy tools，supply-side policy tools，and environmental policy tools accounted for 5.2%（9/174），29.9% （52/174），64.9% （113/174），respectively.Of the demand-side policy tools，only demonstration projects were used，accounting for 5.2% （9/174）.Among supply-side policy tools，talent development was used most，accounting for 16.2% （28 /174），while information support and teachers were used least，each of them accounted for 1.1% （2/174）.Of the environmental policy tools，strategic measures were used most，accounting for 32.2%（56/174），financial support was used least，accounting for 4.6%（8/174）.Among 174 policy codes，internal submodule index and external submodule index accounted for 71.3%（124/174），28.7%（50/174），respectively.Among the internal submodules，the human system was used most，accounting for 39.1%（68/174），while the financing system was used least，accounting for 2.3%（4/174）.Among the external submodules，the political system was used most，accounting for 13.3%（23/174），whereas the technical system was used least，accounting for 1.7%（3/174）.Conclusion　In respect of dimension of policy tools，the proportion of environmental policy tools is too high，the attention to demand-side policy tools is low，the internal structure of each policy tool is unreasonable，some policy tools are ignored.In terms of the system dimension，the internal and external distribution of the system is imbalanced.Therefore，exploring the formulation of demand-side policies，optimizing the internal structure of each policy tool，considering all kinds of policy tools in an all-round way，and increasing the attention to the outside of the system are the direction of modifying and optimization of GPs' policies in China.

Rational Drug Use in Primary Care in Highly Focused Areas during the Comprehensive Reform of Primary Care System in China　#br#

ZHANG Lifang，LIU Zhihua，DONG Yali，LIN Chunmei，ZHANG Yanchun，QIN Jiangmei

2018, 21(31): 3795-3797. DOI: 10.12114/j.issn.1007-9572.2018.31.003

Asbtract ( )

PDF (995KB) ( )

References | Related Articles | Metrics

Objective　To investigate the status of rational drug use in highly focused areas during the comprehensive reform of primary care system in China.Methods　By stratified multistage random sampling，from 34 highly focused districts/counties，102 grassroots medical institutions were selected，and from each of these institutions，about 100 prescriptions were sampled in 2014，and in April or May 2016.Ration drug use was assessed by average number of drugs per prescription，percentage of antibiotic prescriptions，percentage of intravenous prescriptions，percentage of hormone prescriptions，and average cost per prescription for drugs.Results　In the sampled institutions in 2016，the average number of drugs per prescription （2.20 vs 2.52），percentage of antibiotic prescriptions （27.72% vs 34.62%）and percentage of intravenous prescriptions （19.82% vs 24.41%） showed significant decrease，while the average cost per prescription for drugs demonstrated significant increase （74.4 yuan vs 66.5 yuan） compared with 2014 （P<0.05）.In 2016，the average number of drugs per prescription in grassroots medical institutions was greatest in Chengdu （3.79） and Sanming （2.72），and least in Zhenjiang （1.59） and Jilin （1.61）.The percentage of antibiotic prescriptions in grassroots medical institutions was greatest in Chifeng （42.5%） and Nanchang（39.9%），and least in Shanghai（8.0%） and Beijing （13.0%）.The highest proportion of intravenous injection use was found in Chifeng，of 46.0%；Chengdu，Shanghai，Beijing ，Xiangtan and Sanming ranked the last five all below 10.0% .Grassroots medical institutions in Jilin had the highest percentage of hormone prescriptions（37.3%），while those in Shanghai （0.3%），and Beijing （0.8%） had the least.With regard to the average cost per prescription for drugs，the highest-ranked city was Beijing （219.1 yuan），while the three lowest-ranked cities were Guiyang，Xining and Linyi （all less than 30.0 yuan）.Conclusion　As a whole，rational drug use in primary care improved significantly.However，irrational drug use was also found in some of the sampled areas.Therefore，multiple targeted measures should be taken to promote rational drug use in primary care.

Bibliometric Analysis on the Research of Medical Treatment Partnership System in China from 2007 to 2016

KE Quqing，DU Qingfeng，ZHANG Peng，LI Zhao

2018, 21(31): 3798-3804. DOI: 10.12114/j.issn.1007-9572.2018.31.004

Asbtract ( )

PDF (1407KB) ( )

References | Related Articles | Metrics

Objective　To systematically evaluate the research of medical treatment partnership system in China from 2007 to 2016，so as to understand the research status，hotspots and the development trend of medical treatment partnership system in China.Methods　We used China National Knowledge Infrastructure（CNKI，from 1 January 2007 to 31 December 2016），VIP（from 1 January 2007 to 31 December 2016） and Wanfang Data（from 1 January 2007 to 31 December 2016） as data sources to systematically retrieve relevant literature from 2007 to 2016 on the study of medical treatment partnership system in China from 5 November 2017 to 10 May 2018.Ucinet 6.0 and Netdraw were used to visualize the high frequency words and draw a co-word network diagram.SPSS 22.0 was used to perform descriptive analysis，cluster and analyze high frequency words，and make clustering tree diagram.Results　A total of 685 articles published from 2007 to 2016 were included.In these studies，69 authors was found as core authors，and 50 of them had published 2 articles （100 articles） and 19 of them had published 3 or more articles （73 articles）．There were 11 core journals in the field of medical treatment partnership system in China.There were 37 high frequency words with a frequency of 7 times or more，6 of which had a frequency of more than 44 times，namely "medical treatment partnership system"，"hospital group"，"medical group"，"two-way referral"，"hierarchical diagnosis system" and "public hospital".The co-occurrence frequency of "medical treatment partnership system" and "hierarchical diagnosis system"，"medical treatment partnership system" and "two-way referral" was high，of 44 and 32，respectively.Cluster analysis showed that the research hotspots of medical treatment partnership system were researches on construction of medical treatment partnership system and hierarchical diagnosis and treatment，medical treatment partnership system and medical reform，medical treatment partnership system and medical resources，medical treatment partnership system and public hospital management.Conclusion　From 2007 to 2016，the number of papers published in the field of medical treatment partnership system in China increased gradually.It is at a stage of great development，but a high-impact core group of authors has not been formed in this field.The research hotspots focuses on the following four categories：construction of medical treatment partnership system and hierarchical diagnosis and treatment，medical treatment partnership system and medical reform，medical treatment partnership system and medical resources，medical treatment partnership system and public hospital management.

Role and Development Strategy of Department of General Medicine in Tertiary Hospitals

WANG Li，CHEN Qingwei，LI Guiqiong，LI Xingsheng，DENG Wei

2018, 21(31): 3805-3808. DOI: 10.12114/j.issn.1007-9572.2018.31.005

Asbtract ( )

PDF (966KB) ( )

References | Related Articles | Metrics

The department of general medicine is receiving more and more attention with the development of three-tier medical treatment system in China.It is an inevitable trend to set up a department of general medicine in tertiary hospitals in the development of general medicine.It is an important development strategy that meets our national conditions.In this article，we analyzed the current situation of general practice in China，and proposed that the department of general medicine in tertiary hospitals can provide support for developing general medicine in medical universities and a platform for continuing education and personnel training of general practitioners，and offer favorable resources for conducting general practice research.The government and hospitals should invest more in general medicine，establish a digital coverage network，improve training of general medical staff，strengthen the incentive mechanism for general practitioners，and enhance the publicity of general medical services，so as to improve the building of general practice medicine.

Influence of Neighborhood Center Health Unit on the Development of Family Doctor Services

LIU Mei，ZHAO Weizhong，LU Haifeng，SONG Meigui，HAN Yiping

2018, 21(31): 3809-3813. DOI: 10.12114/j.issn.1007-9572.2018.31.006

Asbtract ( )

PDF (1003KB) ( )

References | Related Articles | Metrics

Objective　To investigate the influence of neighborhood center health unit on the development of family doctor services.Methods　By use of simple random sampling，we enrolled 1 660 residents who received outpatient care from 3 subordinate institutions of Minhang District Maqiao Community Health Center located in Shanghai（830，270，560 from Jixiangfang Neighborhood Center Health Unit，Qizhong Community Health Station，Linsong Community Health Station，respectively） during January to September，2017.Then，from October to November 2017，we conducted a face-to-face household survey with a questionnaire developed by our research team，for collecting the demographic characteristics，use of the contracted family doctor services and satisfaction with care.Results　A total of 1 600 residents returned responsive questionnaires，with a response rate of 96.39%，including 800 from Jixiangfang Neighborhood Center Health Unit（neighborhood center health unit group），800 from other two community health stations （community health station group）．Both groups had similar distribution of sex and age and other general demographic characteristics（P>0.05）．In terms of signing a contract with family doctors and healthcare-seeking status，neighborhood center health unit group demonstrated higher rates of signing the "1+1+1" type of contract with family doctors，initial consultation in community healthcare settings，receiving upward referrals after making an appointment by the family doctor compared with community health station group（P<0.05），but the rates of healthcare-seeking in the health institutions designated in the "1+1+1" type of contract，illness-related hospitalization，and timely referral due to a serious illness were similar in both groups（P>0.05）．With regard to use of health management services，neighborhood center health unit group showed higher rates of receiving health assessment，receiving prescriptions that can be extended，receiving disease screening，and good adherence（P<0.05），but the rate of receiving prescriptions for chronic disease that can be extended was similar in both groups（P>0.05）．In regard to use of Chinese medicine and rehabilitation services，neighborhood center health unit group showed a higher rate of receiving such services than the community health station group（P<0.05）．In respect of satisfaction with health-seeking，neighborhood center health unit group presented higher mean scores of satisfaction with health-seeking，physicians' professional management，physicians' attitude toward patients during healthcare delivery，Chinese medicine and rehabilitation services，upward referrals after making an appointment by the family doctor，prescription services that can be extended，and self-examinations and lower mean scores of satisfaction with the waiting time for healthcare（P<0.05），but the scores of satisfaction with home-based care and physical examination were similar in both groups（P>0.05）．Conclusion　The establishment of neighborhood center health unit is convenient to seek healthcare，which also can effectively improve the level of residents' satisfaction with healthcare-seeking，and promote the implementation of family doctor system and hierarchical medical system.

Implementation Effect of the "1+1+1" Type of Contract on the Development of Family Doctor Services　#br#

CAI Liqiang，HOU Jin

2018, 21(31): 3814-3817. DOI: 10.12114/j.issn.1007-9572.2018.31.007

Asbtract ( )

PDF (982KB) ( )

References | Related Articles | Metrics

Objective　To assess the implementation effect of the "1+1+1" type of contract on the development of family doctor services，offering suggestions for further development of such services.Methods　From the electronic patient information system of Pudong New Area Datuan Community Health Center （PNADCHC），we sampled 6 390 community-dwelling residents who received the contracted "1+1+1" type of family doctor services，and reviewed the registered data of these residents concerning demographic characteristics，and selected district/municipal-level medical institutions for treatment，number and costs of visits to PNADCHC and the family doctor，use of initial healthcare services，dispensation of drugs for chronic conditions and referrals，and the assessment of the quality of family doctor services before and after receiving the contracted "1+1+1" type of family doctor services.Results　Compared with before receiving the contracted "1+1+1" type of family doctor services，after receiving such services，the participants demonstrated a higher ratio of number of visits to the family doctor to the number of visits to PNADCHC〔60.21% （66 901/111 120） vs 43.07%（47 891/111 204），χ2=22.328，P<0.001〕，an indistinctively changed median value of visits to PNADCHC〔15（25） vs 15（24）〕（Z=0.048，P=0.967），a higher median value of visits to the family doctor 〔9（16） vs 7（14），Z=24.641，P<0.001〕，spent less median annual medical costs 〔2 018.8（4 398.7）yuan vs 2 247.8（4 911.4）yuan，Z=10.542，P<0.001〕，and showed significant changes in the institutions selected for initial treatment，dispensation of drugs for chronic conditions and referrals （P<0.05），and presented higher ratios of seeking initial treatment and dispensation of drugs for chronic conditions in PNADCHC，and being transferred to district- or municipal-level hospitals or transferred to PNADCHC （P<0.05）．Moreover，they also displayed lower rates of receiving antibiotic prescriptions and fluid replacement in the clinic，but a higher rate of receiving rational antibiotic treatment（P<0.05）．Conclusion　The implementation of the contracted "1+1+1" type of family doctor services is conducive to the establishment of a stable family physician-patient relationship，development of hierarchical diagnosis and treatment，effective use of family doctor services，control of medical costs，amelioration of the healthcare-seeking behaviors and the improvement of the quality of family doctor services，so it is recommended to be promoted in community health centers.

Construction Analysis of the Family Doctor Studio Providing Treatment and Prevention Services from the Aspects of Signing a Contract，Making an Appointment and Implementing an Appointment

ZHONG Yu，LIU Luxia，NIE Xiaoxu，TAN Guoying，WANG Qian

2018, 21(31): 3818-3822. DOI: 10.12114/j.issn.1007-9572.2018.31.008

Asbtract ( )

PDF (988KB) ( )

References | Related Articles | Metrics

Improving the service capabilities to provide high-quality and high-efficient contracted family doctor services for residents，is a critical problem needed to be solved by grassroots medical institutions in China.The family doctor studio，one of the major healthcare suppliers，plays an important role in promoting family doctor services，effectively integrating and utilizing the medical resources within a region，strongly facilitating the implementation of the hierarchical medical system，and improving residents' sense of achieving health benefits and satisfaction with healthcare.Since 2016，Yuzhong District Daxigou Street Community Health Center（located in Chongqing） has been actively exploring the construction of family doctor studios.It has established a type of family doctor studio providing prevention and treatment services，with an emphasis on improving the construction of three aspects（signing a contract，making an appointment and implementing an appointment） associated with the implementation of the contracted family doctor services.Moreover，an effective service delivery mode has been developed by this community health center，which is characterized by "three-designation" （designation of positions，duties and performance assessment criteria），"three-optimization" （optimization of service contents，delivery procedure，and delivery channels），and "two-combination"（delivery of services by general practitioners from the studio in combination with medical experts from municipal level hospitals，and community-based care in combination with municipal level hospital-based telemedicine services）.We detailed the team construction，service contents and delivery modes of this studio，summarized and analyzed the corresponding construction strategies，with a view to offering a reference for the construction of family doctor studios in other regions.

Risk Factors for Type 2 Diabetes Combined with Metabolic Inflammatory Syndrome

LI Xin，WANG Mei，TONG Da，ZHANG Xuechen，ZHANG Dianhong

2018, 21(31): 3823-3826. DOI: 10.12114/j.issn.1007-9572.2018.31.009

Asbtract ( )

PDF (995KB) ( )

References | Related Articles | Metrics

Objective　To explore the risk factors of type 2 diabetes mellitus（T2DM） complicated with metabolic inflammatory syndrome（MIS）.Methods　We enrolled 1 014 T2DM inpatients from Department of Endocrinology，Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from March to October 2016，including 852 with MIS and 162 without（MIS was identified by the corresponding diagnostic criteria）.We collected their baseline clinical data and laboratory findings.Logistic regression analysis was used to explore the risk factors of T2DM combined with MIS.Results　The average body mass index，waist circumference，fasting C-peptide，2-hour postprandial C-peptide，triacylglycerol，total cholesterol and C-reactive protein levels，and prevalence rate of diabetic peripheral neuropathy differed significantly between the two groups（P<0.05），while gender，the average age，duration of T2DM with MIS，glycosylated hemoglobin，low-density lipoprotein cholesterol，prevalence rates of diabetic nephropathy and diabetic retinopathy did not（P>0.05）.Multivariate Logistic regression analysis found that increased CRP and BMI were risk factors for T2DM with MIS（P<0.05）.Conclusion　Increased CRP and BMI are risk factors for T2DM with MIS.The awareness of this is helpful for early screening，prevention，treatment，and prognostic improvement of T2DM.

Relationship between Nonalcoholic Fatty Liver Disease and Vulnerable Coronary Artery Plaques

YANG Xiaoyan，YANG Yong，ZHANG Xu，ZHONG Yuquan，CHEN Xikui，WANG Kang，TANG Guichao，LIN Dezhi，GUO Chuanyong

2018, 21(31): 3827-3831. DOI: 10.12114/j.issn.1007-9572.2018.31.010

Asbtract ( )

PDF (1005KB) ( )

References | Related Articles | Metrics

Objective　To determine whether nonalcoholic fatty liver disease （NAFLD） patients are at high risk of vulnerable coronary artery plaques.Methods　We enrolled the consecutive inpatients who underwent coronary artery CT angiography （CCTA） and abdominal CT （within 3 months before or after CCTA） in the First People's Hospital of Neijiang from January 1，2011 to January 30，2015.We collected their baseline and clinical data （including diagnosis and imaging results） and divided them into NAFLD and non-NAFLD groups according to the medical history and imaging findings.We performed an analysis of the CCTA results based on CAD-RADS（an expert consensus document issued by SCCT，ACR and NASCI in 2016）.Vulnerable plaques were determined，counted and recorded，and the CAD-RADS score was recorded.Results　Totals of 603 cases were included in the study，including 124 with NAFLD and 479 without.185 （30.7% of the total） presented vulnerable plaques in CCTA.Compared with non-NAFLD patients，NAFLD patients had a higher prevalence of vulnerable plaques（46.0% vs 26.7%，P<0.001），and a higher prevalence of multiple（≥2） vulnerable plaques （12.9% vs 5.4%，P=0.004），as well as a higher prevalence of carotid stenosis of ≥50% （caused by vulnerable plaques）（29.0% vs 13.6%，P<0.001）.Multivariate Logistic regression analysis suggested that NAFLD is a risk factor for vulnerable coronary artery plaques 〔OR（95%CI）=2.12（1.37，3.26），P=0.001）〕.Conclusion　NAFLD patients are a high-risk group for vulnerable coronary artery plaques.

Diagnosis Delay and Clinical Characteristics of Patients with Acute Pulmonary Embolism in Outpatient Clinics

SHI Yuheng，CHEN Yanyan，MA Jiayun

2018, 21(31): 3832-3836. DOI: 10.12114/j.issn.1007-9572.2018.31.011

Asbtract ( )

PDF (1030KB) ( )

References | Related Articles | Metrics

Objective　To compare diagnostic delays and clinical features between outpatient and non-outpatient patients with primary diagnosis of acute pulmonary embolism，so as to improve the diagnosis of acute pulmonary embolism in outpatient clinics.Methods　A total of 110 patients with acute pulmonary embolism admitted to Shanghai Ninth People's Hospital，Shanghai Jiao Tong University School of Medicine from January 2015 to August 2017 were selected as subjects.According to the first visiting department，they were divided into initial outpatient group（n=40） and initial non-outpatient group（n=70）.The general information，diagnosis，clinical manifestations，risk factors，cardiac damage and prognosis were recorded.Results　There was significant difference between two groups in gender，time from onset to diagnosis，the proportion of misdiagnosed patients in initial diagnosis，misdiagnosed as pneumonia and misdiagnosed as acute exacerbation of chronic obstructive pulmonary disease（P<0.05），but no significant difference in age，serum D-two dimer level and the proportion of patients who were misdiagnosed as coronary heart disease（P>0.05）.There was significant difference between two groups in the proportion of patients with dyspnea，chest tightness，cough and hypoxia（P<0.05）.but no significant difference in the proportion of patients with chest pain，fever，hemoptysis，syncope，shock，unilateral limb pain or swelling（P>0.05）.There was significant difference between two groups in the proportion of patients with recent operation history，short-term immobilization，and combination of tumor and stroke（P<0.05），but no significant difference in the proportion of patients combined with deep vein embolism，lower extremity fracture or trauma，infection，chronic cardiopulmonary disease，hypertension and diabetes mellitus（P>0.05）.There was significant difference between two groups in the proportion of patients with sinus tachycardia by electrocardiogram（P<0.05），but no significant difference in the proportion of patients with right ventricular dysfunction，elevated serum troponin T or B type natriuretic peptide，atrial fibrillation，ST-segment depression or T-wave inversion，complete right bundle branch block，SIQ3T3 and 30-day mortality（P>0.05）.Conclusion　The symptoms of patients with acute pulmonary embolism who are initially diagnosed at outpatient clinics are usually atypical and lack obvious predisposing factors，which may lead to delayed diagnosis or misdiagnosis.The proportion of patients with diagnosis delay in outpatient clinics was higher than non-outpatient patients.

Effect of Sitagliptin on Glycemic Excursion and Cognitive Function among Elderly Type 2 Diabetic Patients with Mild Cognitive Impairment

XIA Wei，ZHANG Ling，HU Ziying

2018, 21(31): 3837-3840. DOI: 10.12114/j.issn.1007-9572.2018.31.012

Asbtract ( )

PDF (998KB) ( )

References | Related Articles | Metrics

Objective　To explore the clinical effect of sitagliptin on glycemic excursion and cognitive function among elderly patients with type 2 diabetes mellitus （T2DM） and mild cognitive impairment.Methods　Seventy-eight elderly T2DM patients with mild cognitive impairment were equally randomized into treatment group and control group，receiving 24-week treatment with metformin combined with sitagliptin，metformin combined with gliclazide，respectively.BMI，fasting blood glucose（FG），2-hour postprandial blood glucose（2 hPG），and glycosylated hemoglobin（HbA1c） were measured at baseline and at the end of the 24th week of treatment.Blood glucose level was monitored over a 3-day period with continuous glucose monitoring system （CGMS） before and after treatment，and according to the monitored results，the mean amplitude of glycemic excursions（MAGE），mean of daily differences（MODD），standard deviations of blood glucose（SDBG），mean postprandial glycemic excursion（MPPGE） were calculated.Cognitive function was evaluated with Montreal Cognitive Assessment （MoCA） before and after treatment.Parameters of blood glucose，glycemic excursions and cognitive functions before and after treatment were compared.Results　The mean BMI，FBG，2 hPG，and HbA1c，MAGE，MODD，SDBG，MPPGE，and mean MoCA core were similar in both groups at baseline（P>0.05）．After 6 months of treatment，although mean BMI，FBG，2 hPG and HbA1c were still similar in both groups（P>0.05），MAGE，MODD，SDBG，and MPPGE were much lower and mean MoCA score was much higher in the treatment group compared with the control group（P<0.05）．Conclusion　Sitagliptin may improve the cognitive function by reducing glycemic excursions in elderly T2DM patients with mild cognitive impairment.

Effectiveness and Safety of Dabigatran Combined with Ticagrelor in the Treatment of Elderly Patients with Atrial Fibrillation and Unstable Angina

SUN Xiaoqiang，LI Heng，ZHANG Xiangling，HE Feng

2018, 21(31): 3841-3845. DOI: 10.12114/j.issn.1007-9572.2018.31.013

Asbtract ( )

PDF (1015KB) ( )

References | Related Articles | Metrics

Objective　To investigate the effectiveness and safety of dabigatran combined with ticagrelor in the treatment of elderly patients with atrial fibrillation and unstable angina but without revascularization.Methods　From February 2015 to February 2017，100 elderly patients with atrial fibrillation and unstable angina without revascularization were selected from The Fourth Center Clinical College of Tianjin Medical University.They were randomly divided into dabigatran group （n=50） and warfarin group （n=50），receiving oral administration of dabigatran （110 mg twice daily） combined with ticagrelor（90 mg twice daily），warfarin combined with ticagrelor〔warfarin dose could be adjusted for maintaining an international normalized ratio （INR） of 2.0-3.0〕，respectively，on the basis of the conventional treatment.Both groups were followed up for 1 year.Blood coagulation parameters measured at baseline，at the end of the 1st，3rd，and 12th months of treatment，and bleeding events and cardiovascular adverse events within the follow-up period were recorded.Results　There were significant differences in the overall mean values of prothrombin time （PT），INR，thrombin time （TT），activated partial thromboplastin time （APTT），fibrinogen （Fib），D-dimer between the two groups （P<0.05）．Mean values of PT，INR，TT，APTT differed significantly between the groups at different time points （P<0.05），but Fib and D-dimer did not （P>0.05）．Values of PT，INR and TT were affected by the interactive effect of treatment regimen and treatment duration （P<0.05）．The overall mean values of PT，INR，TT，APTT，Fib and D-dimer were similar in both groups at baseline （P>0.05），but after 1，3，and 12 months of treatment，the former 4 increased while the latter two increased significantly in dabigatran group （P<0.05）．There was no significant difference in the incidence of cardiovascular adverse events between dabigatran group and warfarin group 〔4.0% （2/50） vs 6.0% （3/50）；χ2<0.001，P=0.999〕 during the follow-up period.No serious bleeding event occurred in both groups，but the incidence of total bleeding events in dabigatran group was lower than that of the warfarin group （χ2=4.955，P=0.026）．Conclusion　Dabigatran combined with ticagrelor can effectively prevent thrombotic events in elderly patients with atrial fibrillation and unstable angina.Moreover，it has a lower incidence of bleeding events compared with warfarin in combination with ticagrelor，indicating that it has good safety.

Effectiveness and Safety of Spironolactone versus Terazosin and Bisoprolol in Patients with Refractory Hypertension

YANG Jingmin，YANG Wen，LIU Jieyun

2018, 21(31): 3845-3849. DOI: 10.12114/j.issn.1007-9572.2018.31.014

Asbtract ( )

PDF (1018KB) ( )

References | Related Articles | Metrics

Objective　We aimed to explore a better regimen for refractory hypertension patients by comparing the effectiveness and safety of spironolactone versus terazosin and bisoprolol.Methods　Totals of 120 patients with refractory hypertension were enrolled from January 1，2015 to June 30，2017.They were equally divided into groups 1，2，and 3 in a randomized order，receiving 12 consecutive weeks of once daily treatment with bisoprolol（5 mg），terazosin hydrochloride tablets（2 mg），spironolactone（20 mg），respectively，in addition to their baseline antihypertensive drugs.During this period，no drugs were changed.Blood pressure control status，glycosylated hemoglobin（HbA1c），low-density lipoprotein，serum potassium，estimated glomerular filtration rate（eGFR），urinary albumin to creatinine ratio （UACR） and so on were measured before and at the end of the intervention.Adverse events occurred during the intervention period were recorded.Results　The overall response rate differed significantly among the three groups（χ2=8.81，P<0.05）．Moreover，pairwise comparisons indicated that spironolactone group showed a significantly different overall response rate when compared with each of other two groups（P<0.017），but terazosin group demonstrated a overall response rate similar to bisoprolol group（P>0.017）．The overall antihypertensive effectiveness varied significantly among the three groups（P<0.05）．Moreover，pairwise comparisons found that the blood pressure was lowered more obviously in spironolactone group compared with each of other two groups（P<0.05），while similar reductions in blood pressure were found in both terazosin group and bisoprolol group（P>0.05）．Compared with baseline，at the end of intervention，UACR improved significantly in spironolactone group （P<0.05），but not in other two groups（P>0.05）．Conclusion　For refractory hypertension，spironolactone is superior to terazosin and bisoprolol in terms of antihypertensive effectiveness and renal function protection，which can be used as an optimal fourth-line drug for refractory hypertension and is worthy of clinical promotion.

Comparative Study on Demographic Characteristics，Antenatal Care and Perinatal Outcomes in Pregnant Women with Different Blood Glucose Levels in Kunming

ZHANG Yan，DU Mingyu，WANG Mingfang，MA Runmei，LIU LinObjective　

2018, 21(31): 3850-3854. DOI: 10.12114/j.issn.1007-9572.2018.31.015

Asbtract ( )

PDF (1007KB) ( )

References | Related Articles | Metrics

To compare the demographic characteristics，antenatal care and perinatal outcomes in pregnant women with different blood glucose levels in Kunming，so as to guide pre-pregnant preparation and antenatal care，reduce the occurrence of maternal and infant adverse events，and improve maternal and infant outcomes.Methods　From 2005 to 2013，21 767 pregnant women who underwent regular antenatal care and delivered a single baby in First Affiliated Hospital of Kunming Medical University，were enrolled and divided into three groups according to their blood glucose status：normal glucose tolerance （NGT），gestational diabetes mellitus （GDM） and pre-gestational diabetes mellitus （PGDM）.Demographic characteristics，antenatal care，general neonatal conditions and perinatal outcomes were compared between the three groups.Results　（1） NGT group had the lowest mean age.GDM group had lower mean height and higher mean pre-pregnancy BMI，BMI at the OGTT，and BMI immediately prior to delivery compared with NGT group.PGDM group had higher mean pre-pregnancy BMI，BMI at the OGTT，and BMI immediately prior to delivery and shorter mean years of schooling compared with other two groups（P<0.05）.The prevalence rates of ≥35 years old，pre-pregnancy BMI ≥25 kg/m2 and family history of DM in GDM group were higher than those of NGT group（P<0.016 7）．PGDM group had higher prevalence rates of ≥35 years old，BMI≥25 kg/m2，family history of DM and years of schooling ≤12 than other two groups（P<0.016 7）．（2） The gestational weight gain and gestational age of GDM group were less than those of NGT group （P<0.05）.The gestational weight gain，times of receiving antenatal care and gestational age of PGDM group were less than those of other two groups （P<0.05）.The proportion of pregnant women transferred from other hospitals to First Affiliated Hospital of Kunming Medical University was lower in NGT group compared with other two groups （P<0.016 7）．（3） GDM group had less neonatal birth weight and height than NGT group （P<0.05），as PGDM group did when compared with GDM and NGT groups （P<0.05）．（4） PGDM group showed higher incidence rates of maternal preeclampsia and pregnancy-induced hypertension，premature delivery，receiving neonatal ICU care，neonatal hypoglycemia，receiving neonatal blue light phototherapy （NBLP） due to newborn jaundice than both NGT and GDM groups，as did GDM group when compared with NGT group（P<0.016 7）.Moreover，NGT group showed lower incidence rates of large for gestational age，macrosomia and perinatal death than GDM group，and lower incidence rates of cesarean section and large for gestational age than PGDM group （P<0.016 7）.Conclusion The incidence rates of adverse maternal and infant events in PGDM group were higher than in NGT and GDM groups，even with standardized management.Therefore，the importance of pre-pregnancy care and early identification of PGDM should be emphasized.

Standards for General Practice Teachers：Current Development Status and Prospect

ZHAO Yiming，WANG Yongchen

2018, 21(31): 3855-3857. DOI: 10.12114/j.issn.1007-9572.2018.31.016

Asbtract ( )

PDF (985KB) ( )

References | Related Articles | Metrics

General practice is in the primary stage of its development in China.To develop general practice，high-quality general practice teacher teams are essential.In whatever country or region，the overall professional competence，teaching level and humanistic literacy of GP teachers directly associate with the overall qualities of general practitioners，so the development of standards for general practice teachers is the most critical part of the general practice system construction.On the basis of the review of the current standards for general practice teachers in several developed countries and China，we detailedly discussed the necessity and importance of strengthening the development of such standards in China，and gave targeted suggestions，and described the development directions.All these contribute to better and faster development of general practice in China.

Application of Balint Group Activities in the National Standardized Training of General Practitioners

LIU Chan，XU Yan，LUO Yingquan，ZHOU Yu

2018, 21(31): 3858-3862. DOI: 10.12114/j.issn.1007-9572.2018.31.017

Asbtract ( )

PDF (1027KB) ( )

References | Related Articles | Metrics

Objective　To explore the effect of Balint group activities applied to the national standardized training of general practitioners（GPs）.Methods　We enrolled a total of 54 GPs with an experience of participating in the national standardized training of GPs conducted in 2015 or 2016 from The Second Xiangya Hospital of Central South University，and enrolled 5 GP training teachers as the group leaders of the Balint group activity.From November 2016 to January 2018，we carried out 30 Balint group activities in them，and each GP attended 5-6 activities.When the activities ended，we surveyed the GPs by using a self-developed questionnaire for collecting their general demographic data，level of satisfaction with the arrangement of Balint group activities，benefits of participating in such activities and intentions to participate in such activities later.The survey achieved a response rate of 100.0%.Results　The percentages of GPs who reported being "satisfied" and "very satisfied" with the timing，frequency of Balint group activities，number of participants in the activity，selection of cases，organizing ability of the group leader，and atmospheric conditions during the activity，were 94.4%（51/54），88.9%（48/54），100.0%（54/54），96.3%（52/54），88.9%（48/54），and 100.0%（54/54），respectively.The percentages of GPs who reported that Balint group activities were "helpful" and "very helpful" to them in terms of "ensure effective communication with patients and their family members by improving the communication skills" "offer rational emotional support to patients and their family members when an emergency occurs" "learn to listen to the patients and their family members patiently and be able to independently identify and recognize emotional problems of their own independently" "understand the importance of GPs' role to patients and their family members and GPs' responsibilities" "release the working pressure through managing stress via mature methods and controlling and expressing the emotions via appropriate ways" "perceive the understanding and support and improve the occupational identity" "enhance the level of team collaboration and improve the ability of handling physician-patient relationships and physician-nurse relationships" "solve the perplexities concerning imbalance between work and personal life" "promote the development of clinical practice via using the harmonious physician-patient relationship " were 100.0%（54/54），94.4%（51/54），90.7%（49/54），98.2%（53/54），96.3%（52/54），100.0%（54/54），94.4%（51/54），90.7%（49/54），100.0%（54/54），respectively.48 GPs（88.9% of the total） intended to participate in the activities later.Conclusion　The GPs were highly satisfied with the arrangement of Balint group activities，and gained a lot from them.Moreover，most GPs were willing to participate in the activities later.

Effectiveness Evaluation of Jianpiyishenyaoshancijizhou for the Improvement of Frailty and Nutritional Status in Community-dwelling Frail Elderly Patients

HE Lianci，GAO Jing，XIANG Yuping，BAI Dingxi，WU Chenxi

2018, 21(31): 3863-3868. DOI: 10.12114/j.issn.1007-9572.2018.00.197

Asbtract ( )

PDF (1018KB) ( )

References | Related Articles | Metrics

Objective　To evaluate the effects of Jianpiyishenyaoshancijizhou（a type of congee with herbs，shredded female chicken breast and rice for invigorating the spleen and nourishing the kidney） on the frailty and nutritious status in community-dwelling frail elderly patients.Methods　From March to October 2017，a total of 72 community-dwelling frail elderly patients were sampled from Huachuan Community in Chengdu and equally divided into the experimental and control groups by the random number table.Both groups received four times of public combined with personalized health education at fortnightly intervals，the experimental group additionally ate 300-400 ml Jianpiyishenyaoshancijizhou on an empty stomach before breakfast，one time every other day，for 8 weeks（two courses of treatment）．Before the intervention and at the end of intervention，the frailty and nutritional status of both groups were evaluated by Fried's Frailty Phenotype （FP） and Mini-Nutritional Assessment （MNA），respectively.Results　Except for 4 dropouts in the control group and 3 dropouts and 1 exclusion case in the experimental group，the other 64 cases who completed the intervention were included in the final analysis.After intervention，the experimental group demonstrated lower mean scores of FP and its each item except for the unintentional weight loss compared with the control group（P<0.05）．Moreover，the experimental group demonstrated much higher mean scores of the MNA，and anthropometric measurements，dietary questionnaire，and subjective assessment except for the score of the global assessment （P<0.05）．Conclusion　Jianpiyishenyaoshancijizhou could significantly improve the frailty and nutritional status of community-dwelling frail elderly people，thus the quality of life of them was enhanced effectively.

Clinical Effect of Cupping and Acupoint Injection Therapies on Chronic Persistent Bronchial Asthma

GENG Limei，YAN Hongqian

2018, 21(31): 3869-3873. DOI: 10.12114/j.issn.1007-9572.2018.00.052

Asbtract ( )

PDF (1019KB) ( )

References | Related Articles | Metrics

Objective　To investigate the clinical curative effect and mechanism of action of cupping therapy combined with acupoint injection of inactivated mycobacterium phlei F.U.36 injecta on chronic persistent period of bronchial asthma（CPBA）patients.Methods　The enrolled 90 asthma outpatients were from Hebei Province Chinese Medicine Hospital between January 2016 and January 2017.By block randomization method，they were divided into the control and observation groups.Both groups received the conventional therapy〔inhaling a combination product containing fluticasone propionate（250 μg）and salmeterol（50μg），twice daily and salbutamol sulphate if necessary〕，the observation group additionally received cupping therapy（applying cupping at acupoints of dingchuan，feishu，geshu，dazhui and shenshu），once every two days，and mycobacterium phlei F.U.36 injection（first injecting it then externally using it at the aforementioned acupoints），once a week.Both groups were intervened for 2 months.The indicators for evaluating the treatment effect include Asthma Control Test（ACT）score，diurnal variation in peak expiratory flow（PEF），and levels of 3 serum parameters（IL-10，IL-17 and IgE）．Results　Both groups had no significant differences in the baseline ACT score and diurnal variation in PEF（P>0.05），but the observation group presented obviously higher ACT score and lower diurnal variation in PEF after intervention（P<0.05）．ACT score was found to be increased significantly and diurnal variation in PEF was found to be decreased significantly in both groups after intervention（P<0.05）．The baseline IL-10，IL-17 and IgE levels were similar in both groups（P>0.05），but IL-10 level increased and IL-17 and IgE levels decreased substantially in the observation group after intervention（P<0.05）．IL-10 grew while IL-17 and IgE levels declined significantly in the observation group after intervention（P<0.05）．Conclusion　Cupping therapy combined with injection of inactivated mycobacterium phlei F.U.36 could control the CPBA by reducing serum IgE，increasing IL-10 and inhibiting IL-17.

Clinical Research of Jinghua Weikang Capsule Given at Different Times on Patients with Chronic Gastritis Infected by Helicobacter Pylori

LUO Dengpan，ZENG Jie，HE Xueyun，XU Xiaoxun

2018, 21(31): 3874-3877. DOI: 10.12114/j.issn.1007-9572.2018.31.020

Asbtract ( )

PDF (996KB) ( )

References | Related Articles | Metrics

Objective　To investigate eradication rate of Helicobacter pylori （Hp） and remission of digestive tract symptoms with Jinghua Weikang Capsule given at different times on patients with chronic gastritis infected by Hp.Methods　A total of 360 patients with chronic gastritis accompanied by Hp infection admitted to the outpatient department of general medicine from July 2015 to December 2016 were selected as subjects.A total of 360 patients were divided into 4 groups by using random parallel control method.Group A：Esomeprazole + Amoxicillin + Furazolidone + Colloidal Bismuth Subcitrate，treatment course for 10 days （d1-d10）．Group B：Esomeprazole + Amoxicillin + Furazolidone + Colloidal Bismuth Subcitrate + Jinghua Weikang Capsule，treatment course for 10 days （d1-d10）．Group C：Jinghua Weikang Capsule，14 days （d1-d14）；Esomeprazole + Amoxicillin + Furazolidone + Colloidal Bismuth Subcitrate，treatment course for 10 days （d15-d24）．Group D：Esomeprazole + Amoxicillin + Furazolidone + Colloidal Bismuth Subcitrate，treatment course for 10 days （d1-d10）；Jinghua Weikang Capsule，14 days （d11-d24）．All patients took 13C urea breath test to check eradication of Hp in 28 days after all treatment courses.Digestive tract symptom assessment was used before，after treatment and 28 days after all treatment courses.Intention to Treat （ITT） analysis and Per-Protocol （PP） analysis were performed.Hp eradication rate，digestive tract symptom index and incidence of adverse reactions were compared between the 4 groups.Results　In group A，88 cases completed the study and 64 cases eradicated Hp （72.7%）；in group B，90 cases completed and 70 cases eradicated Hp （77.8%）；86 cases completed the study and 73 cases eradicated Hp （84.9%） in group C；in group D，88 cases completed and 79 cases （89.8%） eradicated Hp.ITT analysis and PP analysis showed no significant difference in Hp eradication rate between the 4 groups （P>0.05） .After treatment and 28 days of drug withdrawal，there were statistically significant differences in gastrointestinal symptoms index between the 4 groups（P<0.05）.There was no significant difference in the incidence of adverse reactions between the 4 groups （P>0.05）.Conclusion　Compared with traditional quadruple therapy，Jinghua Weikang Capsule can relieve more digestive tract symptoms.

Chronic Care Model in Long-term Management of Diabetes

SUN Xiaohong，LIU Keke，JIANG Hua，LI Mingzi

2018, 21(31): 3878-3881. DOI: 10.12114/j.issn.1007-9572.2018.00.043

Asbtract ( )

PDF (1030KB) ( )

References | Related Articles | Metrics

Chronic diseases have the characteristics of long duration，high incidence rate，high disability rate and high fatality rate，so the integrated management of chronic diseases is commonly concerned by the world.The chronic care model（CCM） is a system that has been widely used and recognized for long-term management of chronic diseases.This paper introduces CCM with its medical system/institutions，clinical information system，decision support system，service delivery system，self-management support system，and community resources and policies.At the same time，this paper describes the application of CCM in long-term management of diabetes at different levels of medical institutions and puts forward suggestions for the implementation of CCM in China in order to provide reference for the long-term management of diabetes in primary healthcare institutions in China.

Effect Evaluation of Concise Intervention and Group Chain Management on Dyslipidemia in General Clinics

MA Jia，ZHU Weihong，LIU Wenbin，LU Yuan，HUANG Chunmei，HUANG Chen，XIA Jin，ZHANG Shaowei

2018, 21(31): 3882-3885. DOI: 10.12114/j.issn.1007-9572.2018.31.022

Asbtract ( )

PDF (998KB) ( )

References | Related Articles | Metrics

Objective　To evaluate the effectiveness of concise intervention combined with group chain management on dyslipidemia in general clinics.Methods　A total of 203 patients with abnormal blood lipid levelvisited Dinghai Community Health Service Center，Yangpu district of Shanghai from April to June 2017 were selected and randomly divided into control group （n=102）and intervention group（n=101）.Subjects were further divided into very-high-risk，high-risk，intermediate-risk and low-risk groups according to different cardiovascular risk factors.The intervention group was treated with concise intervention and group chain administration for six months，whereas the control group received routine clinical treatment and community management.Lipid level and control rate were compared between two groups.Results　There were no significant differences between levels of serum total cholesterol（TC），triacylglycerol（TG），low density lipoprotein cholesterol（LDL-C），and high density lipoprotein cholesterol（HDL-C） before intervention.After intervention，levels of TC，TG and LDL-C in intervention group were significantly lower than those in control group（P<0.05），and there was no significant difference in HDL-C between the two groups（P>0.05）.Control rate of LDL-C in intervention group was significantly higher than that of control group（P<0.05） after intervention，while there was no significant difference before （P>0.05）.Before intervention，there was no significant difference in control rate of LDL-C between low-risk，intermediate-risk，high-risk and very-high-risk subgroups in control group and intervention group（P>0.05）．After intervention，control rate of LDL-C in high-risk and very-high-risk groups of intervention group were significantly higher than that in the same subgroups of control group（P<0.05）.There was no significant difference in the control rate of LDL-C between low-risk and intermediate-risk subgroups（P>0.05）.Conclusion　Our research proposes the mode of combining general clinical concise intervention and group chain management，which can improve the management of blood lipid level and facilitate the control rate of LDL-C in patients with dyslipidemia.

Cognitive Analysis of Comprehensive Quality Evaluation of General Practitioners from Both Doctors and Patients

ZHANG Baolu，LIU Gang，SUNZI Kejimu，LEI Jianbo，JU Mei

2018, 21(31): 3886-3891. DOI: 10.12114/j.issn.1007-9572.2018.31.023

Asbtract ( )

PDF (1012KB) ( )

References | Related Articles | Metrics

Objective　To explore cognition and needs of comprehensive quality evaluation of general practitioners from doctors and patients in China，so as to provide reference for the construction of a comprehensive quality evaluation system.Methods　A total of 192 doctors and 590 patients in 34 provincial administrative regions of China were selected as subjects by convenient sampling method.，A self-designed Cognition and Needs Questionnaire for Comprehensive Quality Assessment of General Practitioners was used to conduct surveys and collect data from 12 October 2017 to 31 October 2017，using Wenjuanxing，a professional questionnaire network platform.Doctors and patients used the same questionnaire.The questionnaire included basic situation of subjects，knowledge of comprehensive quality assessment of general practitioners，utilization of general practitioners，cognition of the importance and feasibility of comprehensive quality of general practitioners，and cognition of the way of evaluating the comprehensive quality of general practitioners.A total of 782 questionnaires were distributed，and 739 valid questionnaires were returned，with an effective recovery rate of 94.5%.Results　Among the 739 doctors and patients，19.9%（147/739）of them were aware of the comprehensive quality evaluation of general practitioners；59.0%（436/739） of them were more convenient/convenient to see general practitioners when they were sick；33.6%（248/739） of them selected general practitioners based on their own experience；the average score of craving for a convenient and efficient access to general practitioners was （4.35±1.00） points.There were significant differences between doctors and patients in terms of awareness of overall quality of general practitioners，the convenience of selecting general practitioners，and the basis for selecting general practitioners （recommendation from relatives and friends，self - experience judgment，Internet or media recommendation）（P<0.05）．The importance and feasibility scores of 739 doctors and patients for the comprehensive quality evaluation of general practitioners were （4.17±1.02） and （4.06±1.04） points respectively.The reliability scores of general practitioners' comprehensive quality evaluation by expert recommendation，peer evaluation，doctor self-evaluation，and patient evaluation were （3.84±1.03），（3.55±0.95），（3.29±1.06），and （4.02±1.05） points，respectively.There were significant differences between doctors and patients in terms of the importance and feasibility scores of comprehensive quality evaluation of general practitioners and the reliability scores of evaluation methods （P<0.05）．The importance scores of comprehensive quality evaluation between doctors and patients in different ages，education levels，identities，monthly income per capita，and total number of outpatient visits and hospitalization were significantly different （P<0.05）．Conclusion　The awareness rate of comprehensive quality evaluation of general practitioners among doctors and patients is low，and the importance and feasibility scores of the comprehensive quality evaluation are relatively high.In China，the establishment of an Internet-based comprehensive quality evaluation system for general practitioners using comprehensive evaluation methods will be the future development trend.

Residents' Awareness and Demand for Community Health Services Grid Management in Nanmofang Area of Beijing

BAI Xu，HU Shengxing，ZHANG Sha，LI Wenhan，NI Nana，REN Ju，LIU Baohua

2018, 21(31): 3892-3895. DOI: 10.12114/j.issn.1007-9572.2018.00.046

Asbtract ( )

PDF (993KB) ( )

References | Related Articles | Metrics

Objective　To understand residents' awareness and demand for community health services grid management in Nanmofang area of Beijing，and to provide suggestions for further optimizing grid management of community health services.Methods　 Using self-designed questionnaires，a questionnaire investigation was conducted among 357 adult residents selected by convenient sampling method in Nanmofang community health service center and its five affiliated community health service stations from October to November in 2016.The main contents of the questionnaire were the basic information of the residents and their awareness and demand for the community health service grid management and its approaches of practice.A total of 357 questionnaires were distributed，and 357 were recovered.The recovery rate was 100.0%.Results　A total of 147（41.2%） residents knew the community health services grid management.There was significant difference in awareness rate of community health services grid management among residents with different monthly household income，frequency of visits，and evaluation of grid management convenience（P<0.05）.There was no difference in awareness rate of community health services grid management among residents with different gender，age，marital status，education level，illness within two weeks，chronic diseases，occupations，medical expenses in 2015（P>0.05）.The top three methods among who knew the community health services grid management were from medical staff（49.6%，65/131），from bulletin boards/posters/brochures（20.6%，27/131），and from friends/family members（16.8%，22/131）．And 280（78.4%） residents had demand for community health services grid management.There was significant difference in the demand rate of community health services grid management among residents with different age，average monthly household income，education level，and evaluation of grid management convenience（P<0.05）.There was no significant difference in the demand rate of grid management among residents with different gender，marital status，illness within two weeks，chronic diseases，occupations，and medical expenses in 2015（P>0.05）.Conclusion　The awareness of community health services grid management is low among residents in Nanmofang area but the demand is high.Publicity should be further strengthened to optimize the grid management of community health services and improve service convenience.

Satisfaction with Community Health Services and Use of Contracted Family Doctor Services among Shijiazhuang's Community-dwelling Residents

WANG Rongying，ZHANG Jinjia，ZHAO Wenwen，WANG Yayi，WANG Jinyan，LI Feng，ZHI Xiao，HE Zhenyin

2018, 21(31): 3896-3900. DOI: 10.12114/j.issn.1007-9572.2018.31.025

Asbtract ( )

PDF (990KB) ( )

References | Related Articles | Metrics

Objective　To explore the satisfaction with community health services and its associated factors among Shijiazhuang's community-dwelling residents，providing a reference for the improvement of the quality of such services.Methods　We conducted this field survey in a stratified random sample of 1 047 patients from 8 community health centers in Shijiazhuang City during December 2016 to January 2017 with a self-administered questionnaire for obtaining the data regarding demographic characteristics，perceptions of the contracted family doctor services，and prevalence of signing the contract，and satisfaction with community health services.The survey results of 1 031 respondents were analyzed using statistical description，χ2 test and Logistic regression analysis by statistical software.Results　The signing rate of family doctors in 1 031 patients was 86.42% (891/1 031).The percentage of respondents who were satisfied with community health services was 97.09%（1 001/1 031）.Logistic regression analysis showed that physicians' professional level，satisfaction with the contracted family doctor and the total cost of community health services were significantly associated with community-dwelling residents' satisfaction with community health services（P<0.05）.Conclusion　Shijiazhuang's community-dwelling residents demonstrated a relatively high level of satisfaction with community health services，and a fair level of perception of hierarchical diagnosis and treatment and contracted family doctor services.Given these conditions，the implementation of contracted family doctor services should be promoted，and the capabilities of primary care should be improved to facilitate the development of the hierarchical medical system.

Recent Advances in Need Classification Instruments for Community-dwelling Patients with Chronic Disease

FENG Rongfang1，WANG Peng，ZHANG Zhenxiang，CHEN Zixiao，LI Mengmeng，JIAO Jiawei，LI Ling

2018, 21(31): 3901-3905. DOI: 10.12114/j.issn.1007-9572.2018.00.261

Asbtract ( )

PDF (1019KB) ( )

References | Related Articles | Metrics

Chronic diseases become the leading threat to the health of China's residents.Studies show that classification-based management can improve the prognosis and quality of life among community-dwelling patients with chronic disease（CDPCD）．In China，the need classification instruments for CDPCD are very insufficient，and its development is still in the initial stage.In order to provide a reference for domestic development of such instruments and chronic disease management，we introduced relatively well-developed need classification instruments for CDPCD in foreign countries，in particular，detailedly elaborated three main categories including clinical manifestation-based classification instruments，outcome-based classification instruments，and comprehensive classification instruments.

Current Situation of Nursing Needs Assessment Tools in Overseas Nursing Homes and Their Enlightenment to China：a Literature Review

GUI Qian，YAN Shuxia*，WANG Yanjun，ZHANG Qin

2018, 21(31): 3906-3910. DOI: 10.12114/j.issn.1007-9572.2018.31.027

Asbtract ( )

PDF (2310KB) ( )

References | Related Articles | Metrics

With the acceleration of aging process in China，the aging and disabled population has increased dramatically，resulting in a huge demand for nursing services.As nursing homes have become an important nursing mode for the elderly，it is important to evaluate the nursing needs of the elderly accordingly and comprehensively.This paper introduced and evaluated the inner structure and characteristics of some typical nursing needs assessment tools for elderly nursing in overseas nursing homes and their applicability，which may provide basis for the development of nursing needs assessment tools in nursing homes of China.

Table of Content