Table of Content

05 October 2019, Volume 22 Issue 28

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Monographic Research

Comprehensive Scientific Research Performance Evaluation System for Community Health Centers：a Specificity Analysis-based Optimization Study　WANG

Zhaoxin1，YU Dehu2*，SHI Jianwei1，LU Yuan2，XU Kangjie3，LIU Qian3，JIN Hua2，YANG Sen2，HAN Jianjun4*

2019, 22(28):  3401-3405.  DOI: 10.12114/j.issn.1007-9572.2019.00.503

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Background　The Scientific Research Performance Ranking for Community Health Centers in China released in 2016 and 2018 have sparked huge responses among the communities.The practice and feedback of the scientific research performance ranking demonstrate that it is urgently to dynamically optimize the scientific research performance evaluation system for community health centers（CHCs）．Objective　To optimize the comprehensive scientific research performance evaluation system for CHCs based on specific analyzing the system with reference to community-based surveys and experts' revisions，to evaluate the scientific research performance of CHCs more scientifically.Methods　On the basis of systematically reviewing the studies about scientific research performance evaluation，and scientific research performance evaluation systems for institutions，as well as brainstorming，the scientific research performance evaluation system for CHCs was optimized preliminarily.Then its two-level indicator system was modified and improved by using the Delphi method and analytic hierarchy process.Results　The optimized indicator system includes 4 first-level indicators，20 second-level indicators and 41 third-level indicators.The weights of the indicators were adjusted by using the analytic hierarchy process.Conclusion　Dynamic optimization of the indicators in the comprehensive scientific research performance evaluation system for CHCs，and updating and adjusting their weights，are of great significance for scientifically assessing the scientific research performance of CHCs.The optimized system provides basis for the new round evaluation of CHCs' scientific research performance.

Evaluation and Prospect of Scientific Research Capacity of Community Health Service Centers in China（2019）

YU Dehua，WANG Zhaoxin，LU Yuan，XU Kangjie，HUANG Jiaoling，HAN Jianjun

2019, 22(28):  3406-3410.  DOI: 10.12114/j.issn.1007-9572.2019.00.511

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Background　At present，the development of community health service and general practice in China has entered a special period in which rapid development coexists with bottlenecks.The impact of scientific research on community health service centers has been paid more attention.However，the existing empirical research on scientific research capacity evaluation lacks scientific and systematic studies.This study focused on the change of research capacity，realistic demand and policy orientation.Objective　To construct a ranking of scientific research capacity of community health service centers in 2019 to reflect their changes and current situation in China in recent years.Methods　From December 2018 to March 2019，we searched both Chinese and English database platforms，using keywords related to community health centers such as “community” “community health center” and so on.On the basis of outcome variables quantifying the impact of the articles, data mining and data cleaning, we developed the indicators measuring research findings of these community health centers, and by which we screened the initial sample for the 2019 evaluation. Then, we contacted some regional health commissions and primary care associations or institutions to conduct a questionnaire survey among 673 community health centers in the initial sample who volunteered，and 500 of them returning responsive questionnaires were determined as the final sample.Analytic hierarchy process was used to construct the evaluation system，from four aspects of scientific research input，scientific research output，scientific research management and scientific research efficiency，so as to obtain the ranking of scientific research capacity of community health service centers in China.Results　In 2019，more than 70% of the top 100 community health service centers in the ranking of scientific research capacity were located in Jiangsu，Zhejiang and Shanghai.Per capita research funding and the number of papers published have increased significantly compared with those in last year.The three most progressive community health service centers were located in Shanghai.Conclusion　The ranking of scientific research capacity of community health service centers has played a positive role in guidance，but there is a huge gap between regions.The evaluation system used in this study has a high theoretical and practical significance.

Recognition of the 2019 Comprehensive Scientific Research Performance Evaluation System for Community Health Centers and the Results：a Survey　

LIU Qian，LIU Rui，HUANG Jiaoling，SHI Jianwei，CHEN Ning，YANG Yan，YANG Sen， ZHANG Hanzhi，WANG Zhaoxin

2019, 22(28):  3411-3414.  DOI: 10.12114/j.issn.1007-9572.2019.00.504

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Background　The comprehensive scientific research performance evaluation system for community health centers（CHCs） initially developed in 2017 and the scientific research performance ranking of CHCs launched in the same year，have been verified and improved in practice.However，there is no large-scale survey on whether the evaluation system and results have gained subjective recognition from general medicine experts and the evaluated CHCs.Objective　To explore the subjective recognition for the 2019 Comprehensive Scientific Research Performance Evaluation System for CHCs and the evaluation results among general medicine experts from CHCs，offering a reference for further optimization and dynamic adjustment of the system.Methods　From March to May，2019，a questionnaire survey was conducted among general medicine experts and scholars from representative CHCs participating in the comprehensive scientific research performance evaluation for CHCs.Their subjective recognition for the 2019 evaluation system and subjective ranking of the CHCs were collected.Kappa test was carried out to assess the agreement between the objective ranking results and expert ranking results.Results　 The survey showed that 71.4% of the respondents gave their approval for the evaluation system.In terms of the ranking of CHCs，high-level consistency of agreement was found between the objective ranking and the subjective ranking by experts from Beijing and Shanghai （Kappa=0.600，Kappa=0.400），while low-level consistency of agreement was identified between the objective ranking and the subjective ranking by experts from Jiangsu and Zhejiang provinces，and the Pearl River Delta （Kappa=0.317，Kappa=0.200）．Conclusion　The 2019 evaluation system has gained recognition from general medicine experts and scholars from CHCs to a certain extent.The objective ranking results have obtained wide recognition in some regions，indicating that the evaluation system is practical and feasible，in part，and the evaluation results can be used for reference.


Impact of Collaborative Drug Therapy Management Mechanism on the Utilization Structure of Outpatient Care in Medical Institutions in Shanghai，China：an Interrupted Time Series Analysis　

TANG Zhenqing，HE Jiangjiang，TANG Mi，ZHANG Tianye，ZHONG Heng，LI Lili，WAN Heping，JIN Chunlin，YANG Yan

2019, 22(28):  3415-3419.  DOI: 10.12114/j.issn.1007-9572.2019.00.428

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Background　In order to attract residents to sign a health service contract with the family doctor，and satisfy their individualized medication needs，on the basis of the National Essential Drug System，Shanghai Municipality Health Commission issued the extended prescription policy，which means that family doctors can prescribe the same drugs（except narcotic drugs and psychotropic substances） prescribed by a higher level medical institution for their contracted residents with the experience of being transferred upward via their appointment if the residents need to use the drugs continually.In this way，a collaborative drug therapy management mechanism of "basic therapy + supplementary therapy" is developed，which aims to improve the convenience of dispensing drugs in the community health center（CHC），reduce the dispensing workload in the clinic of higher level hospitals，and decrease the economic burden of residents and medical insurance funds.Objective　The aim of this study was to estimate the impact of collaborative drug therapy management mechanism on the utilization structure of outpatient care in different levels of medical institutions.Methods　From Shanghai Community Informatization Platform （Shanghai Community Health Comprehensive Reform Cloud Management Platform），we collected two-year（2016—2017，the period before and after the implementation of extended prescription policy） healthcare data（output indicators included cumulative number of extended prescriptions，cumulative costs of the extended prescribed drugs，types of diseases，successful rate and cycle of dispensing，and outcome indicators included visits in hospitals and CHCs，healthcare costs，number of prescriptions，and costs of drugs） of contracted hypertensive patients who received healthcare services from 243 CHCs in Shanghai during January 2015 to December 2017.Interrupted time series model（ITS） was used to analyze the change trend of aforementioned indictors after （January 2017 was defined as the intervention timing of related policies） the implementation of policy.Results　The number of extended prescriptions showed a fast increase between 2016 and 2017.By the end of 2017，the cumulative number of extended prescriptions was more than 0.9 million，and the cumulative costs of extended prescribed drugs were over 19 million yuan.Most extended prescriptions were written for managing chronic diseases，involving a total of 45 types.Most（over 90.00%） drugs were dispensed successfully.The dispensing cycles of all drugs were implemented within 5 days basically，except that the cycles were longer in the initial stage of implementation（from January to March 2016 ） of the policy.Compared with before the implementation of the policies，after the policy intervention，the number of visits，number of prescriptions，therapeutic and treatment costs and costs of medicines for hypertensive patients in secondary and tertiary hospitals showed a downward trend （P value of β3 representing the slope change was less than 0.05）．However，the number of visits，number of prescribing，average cost of per consultation，and average cost of prescribed drugs per visit in CHCs showed no significant changes （P value of β3 representing the slope change was greater than 0.05）．Conclusion　Phased evaluation results of the implementation of extended prescription policy and contracted residents' multiple needs of pharmacological treatment show that the implementation of the policy could relieve the stress of secondary and tertiary hospitals in addressing challenges of great number of chronic disease visits，so it can be implemented continuously and be promoted further，and is suggested to be used as an incentive for guiding contracted residents in actively utilizing family doctors services，as a measure for satisfying the rational needs of pharmacological treatment in community-dwelling residents，and for optimizing the order of diagnosis and treatment via guiding residents' seeking healthcare in a scientific way.


Empirical Research on the Per Diem Payment for Hospitalization of Hospice Care in Community Health Service Center　

WU Yumiao，PENG Ying，LIU Tongyin，WANG Linan

2019, 22(28):  3420-3423.  DOI: 10.12114/j.issn.1007-9572.2019.00.413

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Background　Hospice care is one of the important livelihood issues，which is related to the life quality of patients，medical value orientation，and social civilization progress.Hospice care inpatient wards have been set in Shanghai since 2012 and "hospice care" has been included in the municipal government's practical projects.And a hospice care model with community health service centers as the main body has been formed at present.Objective　To explore the feasibility of paying for per bed day of hospitalization of hospice care in community health service centers and to further promote the continuous development of hospice care by taking Changzheng Community Health Service Center as an example.Methods　The homepage information on medical records of discharged patients from hospice care department in Changzheng Community Health Service Center from 2013 to 2017 were collected.A questionnaire was developed for gathering the cost data.A one-week follow-up survey was conducted among physicians，nurses，medical social workers and social volunteers in the department of hospice care.Direct cost per bed day of hospice care was calculated using relevant cost accounting method.Results　There were 491 discharged patients from hospice care department in Changzheng Community Health Service Center during 2013 and 2017.Two of them，who were hospitalized for 1 522 days（2017） and 191 days（2014），respectively，were excluded from the analysis and finally included 489 people.There were 435（88.96%） patients with tumor，15（3.07%） with circulation system diseases，12（2.45%） with respiratory system diseases.Length of stay of the 489 discharged patients spread over 0.5 to 89.0 days，with an average of 15.60 days.Medical expense of the 489 discharged patients ranged from 35 yuan to 23 628.56 yuan，with an average of 4 827.29 yuan.Medical expense per bed day of the 489 discharged patients spread over 67.47 yuan to 2 594.96 yuan，with an average of 309.40 yuan.Direct cost per bed day of hospice care in the Changzheng Community Health Service Center in 2017 was 530.05 yuan，including human cost of 309.11 yuan（58.32%），medicine cost of 144.60 yuan（27.28%），depreciation cost of equipment of 25.81 yuan（4.87%），material cost of 22.40 yuan（4.23%），building depreciation of 17.39 yuan（3.28%） and other costs of 10.74 yuan（2.02%）．Conclusion　The expenses per diem of inpatient in hospice care department in Changzheng Community Health Service Center are relatively stable，which meets the requirements of per diem payment.

Studies on Transformation Cases of Chinese and American Medical Service Modes Based on Transformative Learning Collaborative Theory　

HUANG Yanli，CAO Peiya，LUO Xiaolu，ZHU Xingyue

2019, 22(28):  3424-3431.  DOI: 10.12114/j.issn.1007-9572.2019.00.414

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Background　The contracted family doctor service mode is the main carrier of medical service after the transformation of primary medical service mode，and it is an important way to develop general practice at the primary level.However，how to promote the contracted family doctor service mode and truly show the connotation of contracted service in practice is an important problem faced by all localities.Objective　By comparing two transformative healthcare practices based on the related theory and tools of Transformative Learning Collaborative（TLC） in China and the United States，we aim to explore how to effectively use TLC for promoting new healthcare mode，contracted family doctor service mode，at district/county level in China.Methods　From September 2017 to March 2019，the case of transformative contracted family doctor service mode（hereinafter referred to as Wuhou case） in Wuhou District of Chengdu in China and transformative primary medical service mode〔hereinafter referred to as Veterans Health Affairs（VHA）〕 used by People Allied Care Team（PACT）in VHA case were selected.On the basis of typical case study and combined with literature review，structured interview，questionnaire investigation and expert consultation，we analyzed the theoretical support，transformation goals，activity structure，organizational management structure（including organizational management structure in the healthcare system，and TLC architecture and faculty in service mode transformation），performance of participants and the monitoring indexes and effects in the service mode transformation based on the TLC theory，and completion situation of targeted goals in the medical system transformation.Results　Both the Chinese and American cases adopted the classic organizational structure and activity organization mode of TLC，and used TLC as the only transformation learning method to achieve good transformation promotion effects in completing the transformation goals of their systems respectively.All the trainees recognized the contribution of TLC to the transformation resources and were able to complete PDSA improvement plan well.However，there were great differences between two cases in the theoretical support，goal setting of transformation and TLC，and management structure.Conclusion　TLC plays a clear role in the transformation and promotion of primary medical service mode with various application scenarios.The systematic and professional TLC theory and the foundation of the transition atmosphere are the basis for the successful implementation of service mode transformation based on TLC theory.


Intention of Using Internet-based Chronic Disease Management among Community Physicians and Nurses：an Analysis Using the Hierarchical Linear Model　

HUANG Zhijie，ZHANG Xuejiao，CHEN Baoxin，ZHOU Ya，WU Maofu，SUN Zhihui2，YU Xiaocen，XIAO Qian，ZHENG Xiaofen，WANG Jiaji，CHEN Wenru，ZHOU Zhiheng

2019, 22(28):  3432-3437.  DOI: 10.12114/j.issn.1007-9572.2019.00.442

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Background　With the development of Internet-based medical care，Internet-based chronic disease management models have come into being，showing their unique advantages.Related studies have sprung up，among which the intention of using the models in physicians and nurses is rarely involved.Community physicians and nurses are chronic disease managers，understanding their intention of using the chronic disease management model，and associated factors is of great significance for developing the Internet-based chronic disease management model.Objective　To explore the intention and associated factors of using Internet-based chronic disease management in community physicians and nurses.Methods　This survey was carried out between February and March 2018 with a self-developed questionnaire based on unified theory of acceptance and use of technology （UTAUT）．Participants were 261 physicians and nurses selected by stratified random sampling from 45 community health centers，Shenzhen's Futian District.The hierarchical linear model was used to analyze the factors associated with the intention of using the Internet-based chronic disease management.Results　The average total evaluation score for the intention of using the Internet-based chronic disease management was （4.03±0.88） points.The scores of difference in perceived effectiveness （C6，C7） and the usage intention（C25） among medical staffs of different ages were statistically significant （P<0.05）.The scores of perceived usefulness （C3，C5） and the usage intention （C25） among of medical staffs in different academic qualifications were statistically significant （P<0.05）.The scores of differences in perceived effectiveness （C7），personal factors （C23），and the usage intention （C25，C26） among medical staffs in different professional titles were statistically significant （P<0.05）.The scores of perceived risk （C15） and personal factors （C22） among medical staffs in different positions were statistically significant （P<0.05）.The scores of perceived risk （C15，C16） and task technology matching （C20，C21） among medical staffs in different job categories were statistically significant （P<0.05）.There was a statistically significant difference in the perceived risk （C17） scores among the health care professionals in different professional communities （P<0.05）.The scores of perceived risk （C17） among medical staffs in different professions were statistically significant （P<0.05）.Multi-level linear model analysis showed that the positive factors，the traditional method of identity （B3）〔β=0.110，95%CI（-0.041，0.258）〕，perceived usefulness （C3）〔β=0.110，95%CI（0.026，1.930））〕，social influence （C11，C13）〔β=0.165，95%CI（0.065，0.265）；β=0.235，95%CI（0.094，0.403）〕，task-technology fit （C21）〔β=0.182，95%CI（0.084，0.277）〕 and personal factors （C22）〔β=0.454，95%CI（0.258，0.507）〕，affect the usage intention of medical staffs to use the Internet-based chronic disease（P<0.05）.Conclusion　Community physicians and nurses universally prefer to use the Internet-based chronic management model.Their intention of use grows with the increase of individual creativity，social impact，level of task-technology fit，perceived usefulness of the Internet-based chronic management model，and self-identification of the traditional management model.


Practice and Thinking of Health Management Services Provided by General Practitioners in the Functional Community in Changning District of Shanghai　

JIANG Ping，ZHENG Xing，BI Fangfang，WU Qiong

2019, 22(28):  3438-3440.  DOI: 10.12114/j.issn.1007-9572.2019.00.490

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The goal of the Healthy China is to provide people with comprehensive and lifetime health services in a fair and accessible way.In order to improve the basic medical and health services for young and middle-aged population，Changning District has firstly developed well-rounded，continuous and lifetime health management services for the occupational population in functional communities such as commercial buildings in Shanghai for the general practitioners in community health service centers could practice medical services in different sites.Our aim is to provide the convenient and accessible primary medical and health services for the occupational people to improve their health self-management abilities.In addition，we want to encourage enterprises and institutions to pay more attention to the health of their employees and to increase their input in health care.At last，general practitioners should improve their professional skills in providing medical services in order to obtain extra performance-based remuneration while realizing their professional value.



Service Quality Evaluation of Community-based TCM Health Management Delivered by the Family Doctor-led Team Using the SERVQUAL Scale　

HOU Jin，CAI Liqiang，KANG Jianzhong，TANG Hongwei

2019, 22(28):  3441-3445.  DOI: 10.12114/j.issn.1007-9572.2019.00.384

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Background　Traditional Chinese medicine（TCM） health management has comprehensive and remarkable effects in the delivery of prevention services，medical and health services，health maintaining and rehabilitation services.TCM treatment should be given full play to their advantages and characteristics，such as simple and convenient to use，verifiable and effective，and TCM health management can be used in delivering family doctor services in practice in an exploratory way.To promote the continuous improvement of service quality，we used the revised SERVQUAL scale to identify community-dwelling residents' needs of TCM health management，and to find the gap between residents' expected services and self-perceived services.Objective　To comprehensively assess the quality of self-reported medical services in patients，and community-based health management in residents using the classic SERVQUAL scale，providing support for improving the quality of community-based health management.Methods　Participants were selected from the community-dwelling residents receiving TCM health management from Datuan Community Health Center in February 2016.Demographic characteristics，and expected quality，importance assessment，and perceived quality of community-based TCM health management were obtained by a survey using a self-developed questionnaire consisting of demographic part and SERVQUAL scale revised by our research team.Results　A total of 350 cases participated in the survey，and all of them（100.0%） gave effective responses to the survey.All the interventions covered in the community-based TCM health management program were numerically rated below 0，and tended to 0，and the corresponding satisfaction percentages were all above 90.The overall quality numerical score and corresponding satisfaction percentage score of the community-based TCM health management program were -0.148 7，96.28，respectively.In terms of domain numerical score of the revised scale，tangibles achieved highest residents' satisfaction，was rated -0.075 0 on average，and the corresponding satisfaction percentage score was 98.12.Cost acceptability achieved lowest residents' satisfaction，was rated -0.199 2 on average，and the corresponding satisfaction percentage score was 95.02.According to the analysis results of quadrant diagram，interventions distributed most in the first quadrant （13 in all） and distributed least in the fourth quadrant （2 in all）． Conclusion　The revised SERVQUAL scale provides scientific and objective support for examining the quality of community-based TCM health management.Investigated patients show high satisfaction on the overall service quality of community-based TCM health management offered by the family doctor-led team，especially on the capability for providing committed services in a standardized way，and medical environment.The waiting links for services and cost issues need high-priority actions to improve and optimize.


Effectiveness of Interventions Co-delivered by General Practitioners and Specialists in Populations at High Risk of Ischemic Stroke in the Rural Community　

ZHU Lifang，ZHUANG Junpeng，ZHAO Shuhua，LI Yuanzhao，ZHENG Shuping

2019, 22(28):  3446-3450.  DOI: 10.12114/j.issn.1007-9572.2019.00.402

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Background　Stroke interventions are very important for the reducing of stroke incidence in populations at high risk of stroke.Our research team implemented a delivery model of stroke interventions in populations at high risk of stroke in the rural community in a pilot way，namely，interventions co-delivered by general practitioners（GPs） and specialists，in order to improve the diagnostic and therapeutic level of community physicians and the life quality of rural residents.Objective　To explore the effectiveness of stroke interventions co-delivered by GPs and specialists in populations at high risk of stoke in the rural community.Methods　According to the inclusion criteria，459 residents at high risk of ischemic stroke were randomly selected from Lixin Village（intervention group，n=237） and Pengzhao Village（control group，n=222），Malu Town，Jiading District，Shanghai between March and April，2015.During June 2015 to June 2016，the intervention group received targeted interventions，tracking and follow-up services co-delivered by GPs and specialists based on their own conditions，while the control group received management delivered by GPs in accordance with the diagnostic and therapeutic guidelines.Physical examination and reexamination were conducted in a follow-up in July 2016.Pre- and post-intervention mean total cholesterol（TC），low-density lipoprotein cholesterol（LDL-C），systolic blood pressure（SBP），diastolic blood pressure（DBP） and carotid Doppler ultrasonography results were compared between the groups.For residents who were found with atherosclerotic plaque in two carotid Doppler ultrasonography examinations，pre- and post-intervention atherosclerotic plaque status was compared.Results　After intervention，mean TC，LDL-C，SBP and DBP levels of the intervention group were significantly lower than those of the control group（P<0.05）．The differences of carotid Doppler ultrasonography results between the two groups did not meet statistic significance（P>0.05）．58 in the intervention group and 72 in the control group were found with atherosclerotic plaque in pre- and post-intervention carotid Doppler ultrasonography examinations，but the differences in pre- and post-intervention atherosclerotic plaque overall status between the groups were not significant（P>0.05）．The rates of conversion of atherosclerotic plaque from unstable to stable in the intervention group（36.2%） and control group（20.8%） were not significantly different（χ2=3.792，P=0.052）．The rate of conversion of atherosclerotic plaque from stable to unstable in the intervention group （6.9%） was much lower than that of the control group（13.9%）（χ2=4.565，P=0.033）．Conclusion　Stroke interventions supervised and managed by GPs and specialists for in populations at high risk of stoke in the rural community，could effective control and reverse the high-risk factors of ischemic stroke，by which the incidence of stroke may be reduced.This delivery model is worth promoting in primary care.


"General Practitioner-Specialist" Model in Mastering Inhalation Skills for Patients with Asthma　

ZHAO Jiayi，ZHANG Rong，LI Xia，HAN Yiping

2019, 22(28):  3451-3454.  DOI: 10.12114/j.issn.1007-9572.2019.00.388

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Background　Asthma is a key component of community chronic disease management.The Global Initiative for Asthma（GINA） noted that inhaled corticosteroids are currently one of the most effective treatments for asthma.However，most patients with asthma can not receive good therapeutic effect due to poor inhalation skills.Objective　To explore the application value of "General practitioner-specialist" model in mastering inhalation skills for patients with asthma.Methods　A total of 180 patients with asthma who were admitted to the department of respiratory in Shanghai Changhai Hospital were included in the study from January to December 2018.They were randomly divided into control group and test group，each with 90 cases.All patients were treated with inhaler of budesonide formoterol inhalation powder.The control group was given conventional guidance methods to guide how to master inhalation skills and the test group used "General practitioner-specialist" mode.The error in using the inhaled drug（inhalation method error and device operation error） and the correct inhalation skills（correct device operation，inhalation method as inhalation skills） would be recorded after each guidance.Results　After the second，third instruction，the error rate of inhalation method in the test group was lower than that in the control group（P<0.05）．The operation error rate of patients in the test group after the second and third instructions was lower than that in the control group（P<0.05）．In the control group，the correct rate of inhalation skills after the second instruction was higher than that after the first instruction（P=0.010）；the correct rate of inhalation skills after the third instruction in the control group was higher than that after the second instruction（P=0.003）．The correct rate of inhalation skills after the second instruction in the test group was higher than that after the first instruction（χ2=27.388，P<0.001）；the correct rate of inhalation skills after the third instruction in the test group was higher than that after the second instruction（χ2=11.262，P=0.001）．The correct rate of inhalation skills in the test group was higher than that in the control group after the second，third，forth instructions（χ2=9.454，P=0.003；χ2=11.262，P=0.001；χ2=5.178，P=0.039）．Conclusion　“General practitioner-specialist” model not only has good effect and high efficiency，but also can effectively improve the mastery of inhalation skills.


Interventional Effect of the Closed-loop Management by Family Physicians Team on Patients with Coronary Heart Disease　

XU Weigang，PENG Derong，CHEN Chen，SUN Chaojun，BO Haiyan，FANG Yabei

2019, 22(28):  3455-3460.  DOI: 10.12114/j.issn.1007-9572.2019.00.493

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Background　In the context of hierarchical diagnosis and treatment，the prevention and treatment of coronary heart disease（CHD） as a typical chronic non-communicable disease，requires advanced intervention from specialist departments，and the continuous and standardized management at the community level indispensably.This study preliminarily explored the impact of a new closed-loop management mode collaborated by specialists and family doctors.Objective　To construct the closed-loop management team for patients with CHD and to evaluate its intervention effect.Methods　From January 2017 to January 2019，a total of 236 patients with CHD were randomly selected through simple random sampling method according to the electronic health records which were signed in the Pengpu New Estate Community Health Service Center of Shanghai.The patients were divided into the control group（n=122） and the study group（n=114） by random number table method.Patients in the control group received routine diagnosis，treatment and managemengt，patients in the study group were managed through the closed-loop management by family physicians team.All the patients were followed up for two years.The scores of Health-promoting Lifestyle ProfileⅡ（HPLPⅡ），CHD Knowledge and Cognition Questionnaire，Self-efficacy for Managing Chronic Disease 6-item Scale（SECD6） before and after 2-year interventionand，and the incidence of major adverse cardiac events（MACEs） during the following up were compared.Results　There were no significant differences in the scores of HPLPⅡ，CHD knowledge and cognition questionnaire，and SECD6 between the two groups before intervention（P>0.05）.After the 2-year intervention，the scores of HPLPⅡ，CHD knowledge and cognition questionnaire，and SECD6 were higher in study group than in control group（P<0.05）.Within 2-year follow-up，the incidence of MACEs in the study group was lower than that in the control group〔（1.8%，2/114） vs （8.2%，10/122），P<0.05〕，and the risk of MACEs in control group was about five times higher than that in study group〔95%CI（1.071，23.337）〕.Conclusion　The closed-loop management mode by family physicians team could effectively improve the self-management ability，self-efficacy and knowledge level of patients with CHD and it could improve the prognosis of patients.


Community-based Fall Prevention Strategies Evaluation for Primary Osteoporosis in Elderly People　

YUAN Yuan，LI Bin

2019, 22(28):  3461-3464.  DOI: 10.12114/j.issn.1007-9572.2019.00.488

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Background　Evidence shows that more than 62% of low-violence fractures are caused by falls.Patients with osteoporosis（OP） have a higher risk of falls，so strengthening the prevention of falls in them is of great significance.However，there are many studies on in-hospital falls prevention，but few studies on out-of-hospital falls prevention.Objective　To evaluate the effectiveness of community-based fall prevention strategies in elderly patients with primary OP.Methods　100 elderly patients with primary OP were selected from Lujiazui Community Health Center from June to December 2016.By use of a random number table，they were evenly divided into the control group and intervention group，receiving 1-year routine outpatient follow-up visits，1-year routine outpatient follow-up visits and comprehensive interventions with community-based fall prevention strategies，respectively.Before and after the intervention，perceptions of OP were assessed by the Osteoporosis Knowledge Test（OKT），balance function was measured by the Berg Balance Scale（BBS），and lower extremity muscle strength was measured by the Motricity Index（MI-L），respectively.The incidence rate of falls during the intervention was counted and compared.Results　Compared with the baseline levels，mean OKT score，BBS score and MI-L score increased significantly in both groups after intervention（P<0.05）．Mean OKT score，BBS score and MI-L score were similar in both groups at baseline（P>0.05），but they increased more significantly in the intervention group after intervention（P<0.05）．There were no significant differences in the incidence rates of falls between the two groups during 1-3 months，4-6 months，and 7-9 months of intervention（P>0.05）．During the 10-12 months of intervention，the incidence rate of falls in the intervention group was lower than that of the control group（P<0.05）．Conclusion　Comprehensive interventions with community-based fall prevention strategies may improve their understanding level of OP，enhance the balance function and lower limb muscle strength，and effectively reduce the incidence of falls in elderly people with primary OP.So the interventions are worth promoting.


Community-based Application of Clinical Assessment Scales in China　

YING Meike，LI Shuai，REN Wen，REN Jingjing

2019, 22(28):  3465-3467.  DOI: 10.12114/j.issn.1007-9572.2019.00.385

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With the great support of the government for community health care，realizing homogeneous community healthcare services has become one of the key research contents of general practice.This paper analyzes the current situation of development，application and classification of clinical assessment scales in domestic community healthcare facilities，discusses the limitations and improvement ways of the scales，in order to provide some clues and help for achieving homogeneous community healthcare services.


The Ability and Role of General Practitioners in Rare Diseases　

ZHANG Shimin，WANG Junxia

2019, 22(28):  3468-3470.  DOI: 10.12114/j.issn.1007-9572.2019.00.368

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This paper explores the role of general practitioners（GPs） in the management of rare diseases through the analysis of the problems faced by patients in the course of the diagnosis and treatment of a rare disease case.According to the core competence and characteristics of GPs proposed by WONCA，this paper puts forward that GPs can play an important role not only in the field of the diagnosis and treatment of common and frequently-occurring diseases，but also in the management of all diseases throughout the whole life cycle of human beings.


Survey on the Expectation of General Practice：Community Perspective　

WU Hengjing，WU Jing，ZHAO Xinxin，CHEN Lin，LIU Hui，WU Juanli，LI Jue

2019, 22(28):  3471-3475.  DOI: 10.12114/j.issn.1007-9572.2019.00.399

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Background　The ever increasing health demand in the 21st century have brought significant new challenges to the development of primary health care.Therefore，there is a urgent need for the development and training of high-level general practitioners in order to improve the level of community-based general practice.Objective　To understand the current status and expectations of general practice in community health service centers，and to explore strategies for the construction of community-based general practice.Methods　A total of 51 general administrators from 10 community health service centers（Dinghai Community Health Service Center，Sanlin Community Health Service Center，Shiquan Community Health Service Center，Anting Community Health Service Center，Daqiao Community Health Service Center，Gonghexin Community Health Service Center，Lujiazui Community Health Service Center，Zhenru Community Health Service Center，Nanxiang Community Health Service Center，Pengpu Community Health Service Center） were surveyed from July to August 2018.Self-designed questionnaires were sent out via e-mail to conduct the survey.The questionnaire mainly included the investment and development expectation of community general practice（clinical medicine，scientific research，teaching staff，international exchange），training and exchange expectation of community-based general practitioners，and expectation of its support platform.Results　A total of 51 valid questionnaires were received，with a 100.0% response rate.，Among 51 administrators，37 were administrative leaders and 14 general managers.Investment in scientific research management，international exchange plan，international exchange and the establishment of international exchange platform were all lower than 50% in the actual investment of community-based general practice，whereas the investment in other sectors exceeded 80%.The development expectations of other fields exceeded 80.0% except that the development expectations of international exchanges were about 60%.In terms of clinical training，a total of eight community health service centers have already set up clinical skills training centers or similar centers for general practitioners.In terms of the expectations of clinical training，45（88.2%） managers believed that at least two clinical training sessions should be organized every quarter，and 34（66.7%） managers believed that each training session should be conducted within 1-2 hours.In terms of scientific research management，a total of nine community health service centers have already set up incubation mechanism or platforms for scientific research in order to assist general practitioners in carrying out community based scientific research.In terms of teaching staff and international exchange，a total of nine community health service centers have acquired the management capability of training teachers，but only two have created international exchange programs.According to the survey on the expected exchange channels and time，a total of 21（41.2%） administrators expected the teachers' international exchange channels to be sent by universities，and 31（60.8%） administrators expected international exchange time period to be limited to 2-4 weeks.In terms of the supporting platform for general practice，a total of 35（68.6%） managers hoped that community health service centers can become affiliated to universities or medical colleges.Conclusion　Managers in community health service centers generally believed that the actual investment and development of community-based general practice has not reached their expectations，while international exchange programs need to be strengthened.In addition，most managers believed that community health service centers should become affiliated to universities or medical colleges in order to significantly improve the medical level of community health care.Therefore，by combining health needs with development characteristics of community medical care，we should give full play to the advantages of colleges and universities，improve the continuation of medical mechanisms，strengthen the management of scientific research and training，so as to cultivate more high-level talents in general practice.


Practice and Experience of Integrating National Public Health Related Medical Projects into General Practice Training　

LI Liqi，FENG Mei，WANG Xiaoxu，MA Ke，LI Xiaojing，QIAO Aichun，WANG Jianhua，JIANG Li，ZHANG Xiaoyang

2019, 22(28):  3476-3478.  DOI: 10.12114/j.issn.1007-9572.2019.00.336

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Based on the research background of how to improve the post competence and speed up the training of grassroots general practitioners（GPs），this paper expounds the concrete methods of integrating related medical projects in the National Basic Public Health Service Standards（standards） into the training of GPs and GPs teaching statf and the experience are also discussed.The training was conducted for GPs,GPs teaching staff,transferred general practitioners and assistant rural general practitioners.After training,GPs and transferred doctors can master the medical knowledge in the Standards skillfully,and GPs teaching staff understand the needs of general practitioners.The authors believe that a sustainable development pattern for the training of GPs is available in Shanxi Province when related medical projects in Standards blend with general practice training，which will accelerate the speed of training qualified GPs to grassroots medical hospitals and effectively regulate the medical practice of GPs in Shanxi Province.It will be conducive to the standardized team construction of GPs and promote the development of general practice in Shanxi Province.


Practice and Exploration of Integrating Palliative Care into General Medical Education and Training　

LI Xiaojing，QIAO Aichun，LI Liqi，ZHAI Yanping，FENG Mei

2019, 22(28):  3479-3481.  DOI: 10.12114/j.issn.1007-9572.2019.00.382

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Palliative care is an integral part of general medicine and one of the main things that general practitioners（GPs） need to master.Now，with the increasing population aging in China，the numbers of chronic disease patients and end-stage disease patients are growing，so the importance of palliative care is further highlighted.However，at present，palliative care education is relatively lagging behind in China，and the content of palliative care has not yet been included in The Standardized Training Outline for General Residents（Trial Edition）．We elaborated the specific actions training results taken by Shanxi to integrate palliative care into the training of GPs and general practice teachers，discussed the experiences，and summarized that the integration of palliative care theories into general medical education is a pattern facilitating the sustainable development of GPs training.Moreover，it supplements palliative care knowledge for GPs，further improves the teaching ability and general practice occupational literacy of general practice teachers，enhances the position competencies in GPs，and accelerates the pace of training qualified GPs with comprehensive capabilities using standardized training programs for primary care institutions.We hope that our practice and exploration can offer reference for further palliative care education for GPs in China.


Competence-oriented Evaluation System for Standardized General Medicine Residency Training　

JIANG Jingjin，CHEN Shaohua

2019, 22(28):  3482-3485.  DOI: 10.12114/j.issn.1007-9572.2019.00.325

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General medicine residency training is developing rapidly，but there is no unified mode and indices for the evaluation of the effectiveness of the training.According to the training objectives，requirements and rules of the general medicine residency training，we reviewed the methods，purpose，advantages and disadvantages of general medicine residency training evaluation systems commonly used at home and abroad.In view of domestic general practice development status，on the basis of reviewing the ACGME general medicine resident training program，we suggest that a national unified evaluation system for standardized general medicine residency trainings should be developed to all-roundly assess the post-training residents' core competences as GPs from six aspects （professional literacy，professional knowledge and skills，patient care，communication and cooperation，teaching ability，lifelong learning）．By this way，the quality of such trainings can be improved，which in turn contributes to the cultivation of qualified and competent GPs.


Effect Evaluation of "Internet +" in the Examiner Training of General Practice Skills Assessment　

JIANG Jun，MIN Han，XIANG Yuanyue，HUANG Min

2019, 22(28):  3486-3489.  DOI: 10.12114/j.issn.1007-9572.2019.00.387

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Background　In recent years，with the introduction of documents related to the training and incentive mechanism for general practitioners，the training of general practitioners is becoming more and more important.However，there is still a big gap between the construction level of general practitioner team and the need to deepen medical reform and build a healthy China.Therefore，a number of teachers and assessment teams with strong professional literacy and high level of ability should be trained.It is of great significance to train general practitioners with strong service skills.Objective　To explore the feasible mode to effectively improve training by adopting the multimedia teaching mode of "internet +"，and put forward suitable suggestions for standardized training of general medicine courses and teaching staff （including examiners） in Jiangsu province.Methods　A total of 226 trainees were selected to participate in the training of examiners for general practice skills assessment in Jiangsu Province from March to April 2018.They were trained by attending "internet + class，internet + score，internet + performance evaluation".Before and after the training，trainees evaluated the training effect （assessment process，assessment items and contents，assessment scoring standards，examiner's responsibilities and tasks，etc.） by themselves.Results　After training，the trainees' understanding of assessment process，assessment items and contents，assessment scoring standards，examiner's duties and tasks was higher than those before training （P<0.05）．Among the respondents，55 had previously served as general practice examiner and 158 had no such experience.After training，the trainees who had served as general practitioner before and who had not served as general practitioner before scored higher in understanding of assessment process，assessment items and contents，assessment scoring standards，examiner's duties and tasks （P<0.05）；before training，the trainees who had served as general practice examiners before scored higher on assessment process，assessment items and contents，assessment scoring standards，examiner's duties and tasks than those who had no experience.There was no significant difference in the scores of assessment process，assessment items and contents，assessment scoring standards，examiner's responsibilities and tasks between those who had served as examiners before and those who had not served as general practice examiners after training （P>0.05）．Conclusion　 The multimedia teaching mode of "internet +" has achieved the desired training effect during the training of examiners of general practice skills assessment.


Recent Advances in Attractiveness of a Career as a General Practitioner　

GAN Yong，YANG Tingting，YANG Yudi，LIU Jianxin，LU Zuxun

2019, 22(28):  3490-3494.  DOI: 10.12114/j.issn.1007-9572.2019.00.333

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As the practitioners of general medicine theory and providers of general health services，the quantity and professional quality of general practitioners（GPs）can directly affect the overall service quality of primary healthcare system.So understanding recent advances in the attractiveness of GP career，and identifying its major associated factors are vital for the stabilization of GP workforce building，and for the strengthening of service capacities of primary healthcare institutions.We analyzed the factors in four domains（job satisfaction，job burnout，turnover intention and intention of being a GP）that can produce negative effects on the attractiveness of GP career，hoping to provide evidence for relevant government departments to develop top-level improvement strategies for the attractiveness of this career.


Exploratory Analysis of Competency Indicators for General Practitioners　

LU Zhimin，LU Ping

2019, 22(28):  3495-3500.  DOI: 10.12114/j.issn.1007-9572.2019.00.389

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Background　General practitioners have diverse posts in community health service centers，but the existing training and evaluation system does not meet the competency requirements of community posts.And the existing research on post competency is difficult to play a practical role in selecting talents for specific posts in the organization because of insufficient subdivision of posts for general practitioners.Objective　To explore and analyze the competency indicators of general practitioners in communities，and to provide reference for the selection and training of general practitioners in institutions.Methods　From July to October 2018，the government websites such as the National Health Commission and the Shanghai Health Commission were searched from 2010 to 2018，in order to understand the responsibilities and requirements of general practitioners at the policy level.In 5 September 2008 and 29 October 2018，nine representatives of management，general practitioners and general practitioners in other posts from Malu Community Health Center were invited to participate in the group meeting to summarize the specific duties，responsibilities and the actual situation of general practitioners at the policy level by literature review.From July to October 2018，PubMed，Medline （Ovid），CNKI，Wanfang Data Knowledge Service Platform，and Chinese Biomedical Literature Database were searched for documents related to the comprehensive ability and competency of general practitioners.The retrieval time ranged from 2008 to 2018.In November 2018，five general practitioners in Jiading District of Shanghai were invited to participate in one-to-one in-depth interviews.The main contents of the interviews were as follows：What abilities，qualities or personalqualities should a general practitioner possess in order to do the work within the scope of his/her duties? Through analysis and induction，the competency indicators of family doctor posts were formed.Results　At present，the duties of family doctor posts in communities were mainly divided into two categories：business category and security category，among which business category could be subdivided into basic medical category，public health category and other category.The post competency of general practitioners was embodied in six aspects：basic medical service ability，public health service ability，humanistic professional ability，interpersonal communication ability，educational learning ability and comprehensive management ability.It specifically involved 14 competency evaluation indicators，including clinical theoretical knowledge，clinical diagnosis and treatment skills，comprehensive medical service ability，preventive service ability，information application ability，health supervision and cooperation，medical humanistic care，professional attitude and quality，communication ability，team cooperation ability，self learning ability，teaching and scientific research ability，resource utilization ability，and team management ability.Conclusion　The difference between post responsibility of general practitioners and the policy requirement lies mainly in the security responsibilities in practice，which is due to the need of the institution operation.Fourteen competency indicators of general practitioners' posts in six aspects indicate that community health service institutions need to select and train general practitioners from clinical，communication，management and other aspects.


Research on Motivate Mechanism of Family Doctors Based on Two-factor Theory　

LIAN Lu，ZOU Murong，HU Dan，CHEN Jiaying

2019, 22(28):  3501-3504.  DOI: 10.12114/j.issn.1007-9572.2019.00.371

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Background　The key to improving the team building of family doctors is to improve their work enthusiasm and the scientific and reasonable motivate mechanism is the key to improving their work enthusiasm.Objective　To analyze the influencing factors of family doctor team members' work enthusiasm in contracted service's and make recommendations for improving the motivate mechanism for family doctors.Methods　From July to September in 2017，287 family doctor team members of 11 community health service centers in Pukou District of Nanjing were surveyed by questionnaire，and eight leaders of community health service centers eight leaders of family doctor team，and four government health administrators were surveyed by structured interview.Guided by the two-factor theory，this paper analyzed the influencing factors of family doctor team members' work enthusiasm from two aspects of hygiene and motivation.Results　276 valid questionnaires were collected，the effective recovery was 96.2%.Main drive factors affecting the enthusiasm of family doctor team members were the policy and institutional design and remuneration levels in terms of hygiene，along with sense of achievement and personal development in terms of motivation.Conclusion　A sound and standardized management system and salary system should be established to increase the sense of achievement for family doctor team members.It is necessary to establish a career development platform and improve the incentive mechanism，so as to enhance the work enthusiasm of family doctors.


Barriers for General Practitioner Trainees Becoming Registered General Practitioners：a Survey　

WANG Ronghua，LI Yuntao，JI Guozhong，YUAN Qinbo，LU Xuemei，AN Jinhui

2019, 22(28):  3505-3509.  DOI: 10.12114/j.issn.1007-9572.2019.00.386

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Background　In countries with a relatively sound healthcare system，general practitioners（GPs） account for more than 30% of the total number of doctors，but in China，the percent of GPs is only 7.5%.By the end of 2017，China has trained 253 000 GPs，but only 98 000 （38%） of them become registered GPs.So it is necessary to investigate the relevant reasons to develop facilitation strategies.Objective　To investigate the barriers for GP trainees becoming registered GPs，and to make corresponding recommendations for government decision-making of improvement strategies.Methods　Participants were GP trainees who received general practice theoretical training in The Second Affiliated Hospital of Nanjing Medical University in October 2018.Individual interviews on the topic of "negative factors associated with choosing general practice as a career" were conducted in trainees selected by dynamic sampling until data saturation was reached.Results　A total of 25 GP trainees participated in the survey.Five main barriers for becoming registered GPs were summarized as follows：health policy level：lack of innovation in the implementation of the related policies，and inadequate supporting policies；GP trainees level：unsatisfactory health literacy and low level of trust in trainers；GP career level：unsatisfactory attractiveness；GPs training system level：lack of effective training mode；professional cognition level：unsatisfactory professional self-identity.Conclusion　GP trainees thought that lack of qualitative development in general practice in the short term is the fundamental reason that impedes their registration as a GP.It is recommended to increase the professional cognition and professional self-identity in GP trainees，and build a good working platform to increase their willingness to be registered GPs.


Current Situation and Influencing Factors Toward Death Anxiety in Community Residents　

SONG Zimin，WANG Yuanyuan，LIU Weiwei

2019, 22(28):  3510-3515.  DOI: 10.12114/j.issn.1007-9572.2019.00.477

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Background　China's Quality of Death Index score is much lower than the world average level.One of the reasons is that under the cultural tradition of life-and-death taboo，the public rarely think about death or end-of-life related issues，which lead to the emergence of many social issues before death.Misconceptions，fears，or anxiety are hidden within the public neglect for the end-of-life process.Objective　To analyze the status quo and influencing factors of death anxiety in community residents，and to guide general practitioners in their understanding and familiarization with the state of death anxiety in individuals and groups.Methods　Convenience sampling of 1 100 cases，using survey questionnaires，were conducted in 15 community health clinics in the city of Beijing between May and August 2017.Survey questionnaires were a combination of standard survey and Multidimensional Fear of Death Scale in Chinese language （C-MFODS）.The standard survey contained the following information：clinical agency，age，sex，education level，religion，individual monthly income，marital status，whether suffering from chronic illnesses，number of visits to the same health clinic，satisfaction level with the relevant health clinic，life-threatening events （serious illnesses，accidents，etc.），number of life-threatening events，bereavement experience，grief counseling related to death，death education，and knowledge of death.The Chinese version of the Multidimensional Fear of Death Scale （C-MFODS） was conducted on site，containing the following information：fear for the body after death （dimension 1），fear of the unknown （dimension 2），fear of the dying process （dimension 3），fear for significant others （dimension 4），fear of premature death （dimension 5），fear of the dead （dimension 6） and fear of being destroyed （dimension 7）.Multivariate linear regression analysis was used to analyze the influencing factors of C-MFODS total score.Results　Of 1 100 questionnaires distributed，1 031 valid questionnaires were received.The response rate was 93.73%.The total score of C-MFODS for the 1 031 respondents was 2.30±0.53.The scores of sub-dimensions 1，2，3，4，5，6，and 7 were （2.72±0.77），（2.64± 0.75），（1.95±0.66），（1.88±0.55），（2.08±0.71），（2.18±0.70），（2.73±0.93），respectively.Multivariate linear regression analysis （stepwise method） results indicated that the clinical agency，marital status，number of visits to the same health clinic，and the number of life-threatening events were significantly associated with the total scores of C-MFODS （P<0.001）.Conclusion　Death anxiety is composed mainly of fears for the dying process，bereavement，and premature death.The main influencing factors for death anxiety are clinical agency，marital status，number of visits to the same health clinic，and the number of life-threatening events.This suggests that community health clinics，as a social and family support agency，play an important role in alleviating death anxiety.


Current Status of Self-management among Patients with Coronary Heart Disease and Its Influencing Factors in a Community　

XU Weigang，PENG Derong，CHEN Chen，SUN Chaojun，DU Xiaoben

2019, 22(28):  3516-3522.  DOI: 10.12114/j.issn.1007-9572.2019.00.353

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Background　Good self-management is the best way to improve the clinical outcome and therapeutic effect of patients，and it is of great significance for secondary prevention of coronary heart disease（CHD）．The self- management level of CHD in community is not optimistic at present in China，and there are few studies on its current situation and influencing factors.Objective　To investigate the current status of self-management among CHD patients in community and explore its related influencing factors.Methods　From April to June 2016，248 patients with CHD were selected from the electronic health records by simple random sampling method and interviewed in Pengpu New Estate Community Health Service Center in Shanghai.Questionnaire included the General Situation Questionnaire，Health-promoting Lifestyle ProfileⅡ（HPLP Ⅱ），CHD Awareness and Knowledge Questionnaire，Self-efficacy for Managing Chronic Disease 6-item Scale（SECD6）．Self-management behaviors of patients were evaluated by the HPLP Ⅱ scores and multiple linear stepwise regression was used to analyze the influencing factors of HPLPⅡ scores.Results　A total of 248 questionnaires were distributed and 236 valid questionnaires were recovered with the effective recovery rate of 95.2%.The mean score of HPLP Ⅱ was（110.9±19.0）．There were 21（8.9%） cases with poor self-management behaviors，172（72.9%）cases with general behaviors，and 43（18.2%）cases with good behaviors.The mean scores of CHD Awareness and Knowledge Questionnaire and SECD6 were（14.0±3.2） and （6.0±1.3），respectively.Multiple linear stepwise regression analysis indicated that marital status，history of myocardial infarction（MI），number of coronary angiography（CAG），score of CHD Awareness and Knowledge Questionnaire，and score of SECD6 were the influencing factors of patients' HPLP Ⅱ scores（P<0.05）．Conclusion　The self-management status of CHD patients in community is at a low level.Patients who were married，with no history of MI，fewer numbers of CAG，and higher level of knowledge about CHD and higher self-efficacy have higher level of self-management.


Chronic Bronchitis Health Literacy and Influencing Factors among Primary Health Care Workers　

CHEN Yuhu，WU Yun，BUZUKELA?Abuduaini，YALIKUN?Sailai

2019, 22(28):  3523-3526.  DOI: 10.12114/j.issn.1007-9572.2019.00.390

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Background　Medical personnel are the main popularizers and instructors of health education and health promotion，and their health literacy level is of great significance to the health of the population.The results of the universal health examination in Xinjiang in 2016 showed that bronchitis ranked the top five.Therefore，it is very important to accurately evaluate the health literacy of chronic bronchitis and its influencing factors among primary health care workers.Objective　To investigate the chronic bronchitis health literacy and influencing factors in primary health care workers in Hetian Area.Methods　From September to November 2018，170 primary health care workers in county and sub-county health service centers in Hetian were selected by multi-stage sampling.A self-designed questionnaire was used to investigate the cognitive status of chronic bronchitis among the medical staff.163 valid questionnaires were collected，and the response rate of the questionnaire survey was 95.9%.Results　Among the 163 respondents，121（74.2%） had adequate level of chronic bronchitis health literacy，and 42（25.8%） had not.There were significant differences in age，working time，length of service，department，title of medical staff，qualification certificate，registration，prescribing right and work unit level between those with adequate level of chronic bronchitis and those without（P<0.05）．Multivariate logistic regression analysis showed that the title，registration and prescribing right were the influencing factors of chronic bronchitis health literacy of the respondents（P<0.05）.Conclusion　The chronic bronchitis health literacy level of primary health care workers in county- and sub-county level health service centers in Hetian Area is generally high.In the future，medical staff can be further urged to learn theoretical knowledge and improve operational skills，so as to optimize the title level of medical staff as a whole and improve the registration rate of qualification certificates.