Table of Content

05 August 2021, Volume 24 Issue 22

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Monographic Research

Healthcare Procurement of Clinical Commissioning Groups in the UK：Experience and Implications　

ZHANG Xiaojuan，ZHU Kun

2021, 24(22):  2757-2764.  DOI: 10.12114/j.issn.1007-9572.2021.00.203

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Strategic procurement is a key way to improve the utilization efficiency of health insurance fund. The financing of England is not the bismarck model，but Clinical Commissioning Groups（CCGs） still can provide some experience for strategic procurement in China. The promotion of primary healthcare is important to achieve "healthcare for all". General practitioners being involved and responsible for CCGs enable purchasers to have a good understanding of residents' healthcare needs，so that they can communicate with suppliers more effectively，which is the essential premise of implementing strategic procurement. CCGs are formed by general practice clinics spontaneously using a bottom-up approach，which are totally built on the special local situation with differences by scale and governing structure，aiming to help to satisfy residents' healthcare needs，ensure continuous improvement of service quality，reduce healthcare inequality，ensure the right for choosing healthcare and patient participation，promote the provision of integrated health services and reduce the use of inpatient services.


Enhancing the Attractiveness of General Practice as a Career：a SWOT Analysis　

SHEN Xin，FENG Jing，GAN Yong，LU Zuxun

2021, 24(22):  2765-2769.  DOI: 10.12114/j.issn.1007-9572.2021.00.152

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In China，the shortage of general practitioners（GPs） and difficulties in retaining general practice talents have produced great effects on the development of primary healthcare services，and also brought great challenges to the implementation and promotion of the tiered healthcare system. So it is necessary to formulate policies to maintain and improve the attractiveness of general practice as a career. To this end，we performed a SWOT analysis based on an overview of domestic general practice and general practice workforce，and proposed the following ideas：strengths consist of extensive policy support，continuous development of general practice education and developmental significance similar to a goal of building a healthy China；weaknesses include low social identity for GPs，and lack of efficient manage system for GPs；opportunities cover the reform of the pharmaceutical and healthcare system，construction of the medical consortium，and development of health information technologies；threats contain lack of limitations for some medical practice behaviors，training system for GPs and appropriate hardware infrastructure. Then we put forward recommendations as incentive solutions to enhance the attractiveness of general practice as a career and promote the sustainable development of general practice，including increasing the financial support for general practices，strengthening the development of a management system for general practices，broadening the promotion platform for GPs，and optimizing the configuration of the GP team.


New Advances in Turnover Intention of General Practitioners at Home and Abroad　

SHEN Xin，JIANG Heng，FENG Jing，GAN Yong，LU Zuxun

2021, 24(22):  2770-2776.  DOI: 10.12114/j.issn.1007-9572.2021.00.106

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Reducing the turnover intention among general practitioners（GPs） and strengthening the construction of GPs workforce are the key links to improve the development of primary healthcare system and hierarchical medical system to maintain and improve people's health，and achieve the goals of Healthy China. Considering global shortage of primary healthcare and China's increasing emphasis on both general medicine and GPs，we discussed the role of GPs in primary healthcare，and systematically analyzed the significance of reducing GPs turnover intention，and comprehensive summarized the key factors associated with turnover intention among GPs，including demographic characteristics，job satisfaction，organizational identity，salary and work enthusiasm，then put forward some advice on dealing with turnover intention among domestic GPs，which may provide effective evidence for related departments to formulate policies and measures to stabilize GPs team，and to improve the attractiveness of GPs as an occupation.


Degree of Coordination between Primary Care Resource Allocation and Economic Development in Eastern，Central and Western China　

LI Liqing，ZHOU Xu，ZHAO Yulan，LU Zuxun

2021, 24(22):  2777-2784.  DOI: 10.12114/j.issn.1007-9572.2021.00.234

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Background　The equity and rationality of primary care resource allocation and their adaptation to economic development will affect the improvement of regional economic development level. At present，there is little research on the coupling and coordinated development between primary care resource allocation and regional economy. Objective　To measure the degree of coordination between primary care resource allocation and economic development in eastern，central and western China to clarify the coordination development relationship，to provide a reference for achieving balanced development between them via promoting sound interaction. Methods　By consulting China's Health and Family Planning Statistical Yearbook，China's Health Statistics Yearbook and China Statistical Yearbook（2014—2019 volumes），relevant indicators measuring primary care resource allocation and economic level were collected，and the degree of coordination between the two aspects was evaluated empirically using a coordination model constructed using the entropy method and comprehensive evaluation function. Results　On the whole，the degree of coordination between primary care resource allocation and regional economic development was not high，only six regions had achieved coordinated development. In general，the degree of coordination between them seemed to come to a halt with appearance of regression，and the average annual growth rates of coordination degree in eastern，central and western regions were -0.31%，-1.69% and -0.45%，respectively. Geography-based analysis found that the degree of coordination between primary care resource allocation and regional economic development in eastern China was 0.63，which was in the primary coordination stage（0.6，1］. The promotion of the coordination was restricted by the lagging allocation of primary care resources. Central and western China owned a degree of coordination of 0.45 and 0.44，respectively，both were in the barely coordinated stage（0.4，0.6］. The lagging economy restricted the degree of coordination between primary care resource allocation and regional economic development. Conclusion　To achieve a good coordinated development between primary care resource allocation and economy at the national level，it is necessary to reduce regional development differences，and improve the levels and sound interaction of regional primary care resource allocation and economic development.


Prevalence and Healthcare-Seeking for Common Diseases and Associated Factors in Elderly Migrants in China　

HUO Tianqi，YAN Xiao，GUO Jun，GUO Qingfang，XIAO Gexin

2021, 24(22):  2785-2792.  DOI: 10.12114/j.issn.1007-9572.2021.00.240

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Background　As an important task for building a "Healthy China"，the health issues and health-care seeking in an increasing number of elderly migrants，have become a key concern. Objective　To examine the prevalence and healthcare-seeking for common diseases and associated factors in elderly migrants in China. Methods　Data stemmed from the results of 2017 China Migrants Dynamic Survey，involving 6 478 cases aged 60 or over. Four variables including personal and family characteristics，mobility characteristics，utilization of public services and personal health status were collected. The binary Logistic regression model was used to explore factors associated with prevalence and healthcare-seeking behaviors for common diseases in the participants. Results　Among the participants，5 264（81.2%） rated their health status as "healthy" and "basically healthy"，but in reality，the prevalence of hypertension，diabetes，plus hypertension with diabetes in them was 35.0%（2 270/6 478）. 4 112 （63.5%）cases reported that they had experienced symptoms of common diseases，but only 1 624（39.5%） of them had seen a doctor. Logistic regression analysis revealed that the prevalence of a common disease in the participants was associated with education level，number of family members living together，geographical scope of migration，inflow area，status of health education participation，medical insurance coverage，self-rated health and prevalence of chronic diseases（P<0.05）. And health-seeking behavior for a common disease was associated with age，education level，urban or rural hukou，inflow area，status of health education participation and self-rated health（P<0.05）. Conclusion　These elderly migrants overrated their health status to a certain extent，and had a low rate of actively seeking healthcare for a common disease. The prevalence and healthcare-seeking for common diseases in them were found to be associated with multi-dimensional factors. To effectively improve their health status，it is suggested to make more efforts to health education promotion，and optimize the policies for inter-regional on-the-spot settlement of medical bills for this group，with a focus on their needs and utilization of medical services.


Needs of Family Doctor Services and Associated Factors in Functional Communities Bearing Science Innovation　

MEI Lichen，TANG Zhenqing，ZHANG Yue，ZHONG Heng，WANG Lan，XU Weiqi，YU Shuangyan，HE Jiangjiang

2021, 24(22):  2793-2799.  DOI: 10.12114/j.issn.1007-9572.2021.00.236

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Background　For Shanghai，an important bearing area of the National Science and Technology Innovation Center，Shanghai，it is essential to meet the extended needs of various talents in healthcare and other aspects to promote the industry-city integration besides meeting the needs of policy support for innovation and entrepreneurship，entrepreneurial environment，capital investment，etc. The development of functional community health services is a key link to improve functional facilities and promote the industry-city integration. However，the current functional community services are limited and cannot provide support for the integration，and need a breakthrough urgently. Objective　To analyze the diversified health service needs of people in functional communities bearing science innovation，providing suggestions for the expansion of family doctor services in functional communities. Methods　Data were collected through a stratified cluster sampling survey carried out with 1 500 individuals selected from Shanghai's functional communities bearing science innovation from March to November 2019 using a self-developed questionnaire，including general demographic information，lifestyle，mental health status，health service demand and utilization. The health status，health service demand and utilization were analyzed，and factors associated with health service demand were explored. Then the health problems and health service demand in this population were compared to those of populations in other types of functional communities reported in other studies. Results　A total of 1 487 cases（99.13%） who returned responsive questionnaires were finally included. The two-week morbidity〔5.92%（88/1 487）〕 and chronic disease prevalence〔5.98%（89/1 487）〕 were relatively low. The subjective health service needs in functional communities were mainly common disease treatment〔84.13%（1 251/1 487）〕，health management〔57.70%（858/1 487）〕，physical examination〔47.01%（699/1 487）〕，health consultation〔39.41%（586/1 487）〕，psychological consultation〔31.61%（470/1 487）〕. The rates of knowing and intending to contract family doctor services were 57.03%（848/1 487），and 45.73%（680/1 487），respectively. The intention to contract family doctor services differed significantly by gender，age，education level，physical condition，and chronic disease prevalence（P<0.05）. In terms of preferred healthcare institutions，the top three were municipal hospitals〔41.69%（620/1 487）〕，district hospitals〔27.17%（404/1 487）〕，outpatient department（clinic）/community health clinic/ health station〔10.29%（153/1 487）〕. Healthcare quality 〔25.41%（734/1 487）〕，distance between home and the healthcare institution〔25.34%（732/1 487）〕 and reliable doctors working at the healthcare institution〔13.48%（391/1 487）〕 were main factors associated with the choice of healthcare institution. The actual utilization of health services was basically consistent with the healthcare-seeking intention. Conclusion　It is practical and operable to deliver healthcare services to functional communities bearing science innovation. The needs of community health services may differ across different types of functional communities，so service provision should be based on the specific conditions of the community，with experiences of other types of functional communities as a reference. To promote family doctor services in functional communities，it is recommended to determine the coverage population and service scope，enrich the ways of provision，optimize funding sources，and strengthen overall planning and coordination.


Making and Keeping an Appointment in Residents Contracting Services Delivered by Gatekeeper Family Doctors in a Subdistrict of Jing'an District：an Empirical Study　

HUANG Jiaoling，YUAN Minjian，SUN Jin，XU Bin，ZHOU Liang，SHI Jianwei，YU Wenya，LI Songguang，WANG Zhaoxin，CHEN Chen

2021, 24(22):  2800-2804.  DOI: 10.12114/j.issn.1007-9572.2021.00.237

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Background　In response to the phenomenon of blindly pursuing the contract rate，the national and local governments have issued a series of policy documents，the focus of which has shifted from the pursuit contracting rate to making and keeping the contracted services. Objective　To investigate the status of making and keeping an appointment in residents contracting services delivered by family doctors from a subdistrict of Shanghai，to promote the development of such services. Methods　Data mainly about the contracting of family doctor services，healthcare-seeking in contracted and non-contracted residents in a subdistrict of Shanghai's Jing'an District during 2017—2020 were collected from the subdistrict information system，Jing'an District hospital information system，electronic health records of patients created by family doctors，the online platform of contracted family doctor services，annual reports of community health centers，and so on. Results　The number of contracted residents in the subdistrict in 2020 increased compared to that of 2017（24 485 vs 8 554），so did the contracting rate（36.3% vs 13.8%）. Moreover，the contracting rate in older people increased from 38.7% in 2017 to 70.9% in 2020. The number of contracted hypertension patients rose from 3 409 to 7 271，and that of contracted diabetes patients rose from 1 463 to 3 088. In 2018，the visits of contracted residents in hospitals in the subdistrict numbered 162 640，accounting for a larger percentage of the total patients compared to non-contracted residents. In 2019，the visits of contracted residents in hospitals in the subdistrict numbered 232 772，which also accounted for a larger percentage of the total patients compared to non-contracted residents. During 2017 to 2020，the percentage of contracted residents visiting community health centers（healthcare settings） was above 60% in each year，but that for 2020 showed a decrease compared to that for 2017（62.4% vs 66.5%）. But the percentages of contracted residents visiting secondary and tertiary hospitals ranged from 26%-30%，and 6%-9%，respectively，without significant changes. The annual healthcare cost of contracted residents in community health centers in Jing'an District increased steadily during 2018—2020，with 13.9%，and 14.0% year-over-year growth for 2019，and 2020，respectively. The annual healthcare costs （after conversion） of contracted residents in secondary hospitals in Jing'an District in 2018，2019，and 2020 were 21 854 472.1 yuan，24 843 680.2 yuan，and 26 556 426.3 yuan，respectively，with 13.7%，and 6.9% year-over-year growth for 2019，and 2020，respectively. The healthcare cost status of contracted residents in this district was similar to that of contracted residents in Shanghai. Conclusion　The number of contracted residents in the subdistrict of Jing'an District increased during the period，and more than 60% of them sought healthcare in designated healthcare settings. Moreover，the healthcare cost of them in community health centers showed a stable increase. Although the absolute value of healthcare cost of them in secondary and tertiary hospitals also showed an increase，the growth rate was controlled.

Effectiveness of Family Doctor Services and Associated Factors in Dongcheng District，Beijing　

WANG Fang，DENG Hongyue，CAO Guili，SHEN Qiang

2021, 24(22):  2805-2809.  DOI: 10.12114/j.issn.1007-9572.2021.00.227

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Background　Beijing's Dongcheng District has achieved some improvements in the effectiveness of family doctor services via balancing supply and demand and innovating incentive mechanisms for family doctors. It is of great importance to study the effectiveness of family doctor services and associated factors to improve relevant policies and the sense of gain of both contracted residents and family doctor teams. Objective　To analyze the status of family doctor services implemented in Beijing's Dongcheng District from 2018 to 2019，and the effectiveness and problems，providing policy recommendations for improving such services in Beijing and the whole country. Methods　From March to June 2020，we collected the data used for analyzing the contracting rates of general population and priority populations，rates of making and keeping an appointment in contracted residents and so on in Beijing's Dongcheng District during 2018 to 2019 from Beijing Common Data Monitoring Platform，Beijing Healthcare Reform Monitoring Platform and Dongcheng District Community Health Information System，and obtained the information regarding satisfaction levels with family doctor services of both family doctor team members and contracted residents using questionnaire surveys. Results　Dongcheng District owned a higher contracting rate of general population in 2019 compared to 2018（36.26% vs 33.19%）. It also had a higher contracting rate of priority populations in 2019 compared to 2018（94.50% vs 88.08%）. Moreover，the contracting rates of general population（36.26% vs 35.02%） and priority populations（94.50% vs 93.06%） in the district in 2019 were all higher compared with those of Beijing. The rate of keeping an appointment in contracted residents in the district was 17.41% in 2019，with a year-on-year increase of 8.13 percentage points. And it was 5.44 percentage points higher than that of Beijing in 2019. Compared with 2018，the standardized management rate of hypertension and diabetes in the district raised by 2.12 and 3.61 percentage points，respectively，and the control rates of hypertension and diabetes raised by 11.65 and 13.78 percentage points，respectively，in 2019. 83.09%（3 596/4 328） of the contracted residents were satisfied with the services they received. 91.59%（850/928） family doctors were satisfied with the delivery of contracted services，and 89.22%（828/928） of them were willing to continue to provide such services. Qualitative data reflected that residents' misunderstanding of contracted services，heavy workload of service delivery and inadequate health insurance policy support. Conclusion　Both the contracting rates of general population and priority populations in Dongcheng District met the requirements of Beijing. The residents' understanding level，utilization rate and satisfaction level regarding the contracted services were relatively good. To further improve the effectiveness of such services，more efforts should be made to strengthen the relevant publicity appropriately，deliver the services according to the real condition by step not by leap，innovate evaluation and incentive systems，and improve health insurance policies.


Clinical Profile of Patients Treated in the MDT Clinic in a General Hospital　

SHAO Shuangyang，REN Jingjing，WEI Guoqing，LU Liping，LU Minxia，LIU Ying

2021, 24(22):  2810-2813.  DOI: 10.12114/j.issn.1007-9572.2021.00.206

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Background　In contrast to the traditional individual care and experience-based care，multidisciplinary team（MDT） model is a new care delivery model that is actively recommended internationally，which is aimed at providing quality care for patients using based on team collaboration. Objective　To investigate the clinical profile of patients treated in the MDT clinic in a general hospital. Methods　A total of 145 eligible outpatients were recruited from the MDT Clinic，the First Affiliated Hospital，Zhejiang University School of Medicine between July 24th，2018 and January 31st，2019. Data were collected through the electronic MDT platform，including basic demographics（sex，age），diagnosis，reasons for visiting the MDT clinic，departments involved in the consultation and care suggestions，and were analyzed retrospectively. Results　Of the patients，45.5%（66/145） were men，54.5%（79/145） were women；71.7%（104/145） aged over 45 years old；66.9%（97/145） had a suspected tumor，and 33.1%（48/145） had one or more non-tumor illnesses. The major reasons for visiting the MDT clinic were hoping to get a definite diagnosis after further consultation〔68.3%（99/145）〕 and/or to obtain a modified regimen〔85.5%（124/145）〕，and 60.0%（87/145） of the patients visiting the MDT clinic for the above-mentioned two reasons. The recommendations given by the MDT clinic included having a further examination〔53.8%（78/145）〕，regular review 〔31.0%（45/145）〕，pharmacological treatment〔31.0%（45/145）〕，and surgical treatment〔26.9%（39/145）〕.  Conclusion　The majority of patients encountered by the MDT clinic were middle-aged and elderly，and the main reason for treatment was to determine whether there is a tumor，for the MDT clinic has advantages in the diagnosis and treatment of difficult and complicated diseases，such as tumor，and comorbidities. In addition，more than half of the patients were recommended to have a further examination，so the prescriptions of the MDT clinic need to be strictly reviewed.


Essential Medicine Prescribing Behaviors of Urban General Practitioners in Beijing：a Qualitative Study　

CHEN Xiaolei，SHAO Shuang，WU Ying，XU Xiaojingyuan，ZHANG Tiancheng，DU Juan

2021, 24(22):  2814-2818.  DOI: 10.12114/j.issn.1007-9572.2021.00.190

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Background　The role of China's national essential medicine system（NEMS） has been highlighted by its implementation effects on easing patient burden of healthcare costs via reducing the increased medical expenses. The General Office of the State Council of the People's Republic of China，clearly stated that the determined functions of essential medicines shall be strengthened，priority shall be given to the use of essential medicines for drug treatment，and the provision of essential medicines for initial treatment in primary care shall be ensured. Objective　To investigate essential medicine prescribing behaviors in urban general practitioners（GPs） in Beijing，to provide a reference for the implementation and promotion of the NEMS in primary care. Methods　Purposive sampling was used to select 17 GPs from 17 urban community health centers in Beijing from January to March 2020. Individual in-depth interviews were conducted with voice call in WeChat，and each interview was kept under 30 minutes. The interview data were analyzed through content analysis. Results　In all，82.3%（14/17） of the GPs said that essential medicines prescriptions accounted for 50%-60% of the total prescriptions written by them. Six themes were identified：GPs had a low level of understanding of the NEMS；The supply of medicines in primary care was not timely；There was a lack of surveillance and follow-up for effectiveness and safety of essential medicines；The available essential medicines could not fully meet the clinical needs in primary care；The health insurance reimbursement for cost of essential medicines was similar to that for the cost of originally developed medicines，negatively affecting the promotion of the use ofessential medicines；Patients showed a low preference for essential medicines. Conclusion　In Beijing，the proportion of essential medicine prescriptions written by urban GPs was not high，and the implementation of the NEMS needs to be improved. To further improve essential medicine prescribing behaviors of GPs，it is suggested to modify the policies related to the NEMS，and enhance the awareness levels of GPs and residents.


Application of the Chinese Version of the General Practitioner Assessment of Cognition in Screening for Mild Cognitive Impairment in Older Physical Examinees in Primary Care　

LIU Yalin，LU Yuan，XU Shengming，YU Dehua，XUE Yaya，ZHOU Lulu

2021, 24(22):  2819-2825.  DOI: 10.12114/j.issn.1007-9572.2021.00.228

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Background　There are no effective treatments for dementia，a disease with a heavy burden，which is becoming increasingly prevalent among the rapidly growing aging population. As a pre-stage of dementia，mild cognitive impairment（MCI）has attracted wide attention，but the screening for it using scales has not been popularized due to various scale limitations. So it is very important to find a simple tool suitable for screening for MCI in primary care. Objective　To explore the value of the Chinese version of the General Practitioner Assessment of Cognition（GPCOG-C） in screening for MCI in primary care. Methods　By use of simple random sampling and systematic sampling，860 cases were selected from 4 962 physical examinees（≥ 60 years old）in Shanghai to attend a questionnaire survey conducted from May to July 2020 by unified trained college student volunteers using a demographic questionnaire developed by our research group，four MCI assessment scales〔Montreal Cognitive Assessment Basic（MoCA-B），Activities of Daily Living（ADL） Scale，Dementia Rating Scale（CDR）and GPCOG-C〕. MCI was diagnosed using the criteria proposed by Petersen et al. Participants with MCI were matched 1:1 to those with normal cognitive function randomly in terms of age，sex，and years of education using SPSS software to run a comparative analysis. ROC curve of the GPCOG-C in screening for MCI was plotted to examine its cut-off threshold，sensitivity，specificity，positive and negative predictive values. Spearman's rank correlation analysis was used to measure the reliability of the GPCOG-C. The internal consistency of the scale was measured by Cronbach's α. Results　Altogether，812 cases completed the survey，and 192 of them（24.27%） were assessed to have MCI. 187 MCI cases（MCI group） and 187 matched cases of normal cognitive function（control group）were finally included. Compared with the criteria for MCI defined by Petersen et al，the gold standard，the GPCOG-C was found by ROC analysis to have a maximal Youden index of 0.43. When the cut-off threshold was determined as 12 points，the sensitivity，specificity，positive predictive value and negative predictive value of the GPCOG-C were 70.05%，69.52%，69.68% and 69.89%，respectively. The control group had higher mean scores of MoCA-B and GPCOG（P<0.05）. The mean time used for completing the MOCA-B differed significantly between the groups（P<0.05），but that used for completing the GPCOG-C did not（P>0.05）. MCI group had statistically significantly lower mean scores of time orientation，clock drawing，message，memory（first name，last name，city，road，house number），patient part，informed part and total score（P<0.05）. The inter-item correlation analysis of the GPCOG-C showed that the correlation between clock drawing and memory（last name） was negative and the correlation between clock drawing and informant section was negative. Other items were positively correlated to a certain extent，and the correlation coefficient r ranged 0.021 to 0.836. The Cronbach's α of GPCOG-C was 0.78. The mean time used for completing the MoCA-B was longer than that used for completing the GPCOG-C in all participants（P<0.001）. And the mean total GPCOG-C score was positively correlated with the mean MoCA-B score（rs=0.484，P<0.001）. Conclusion　The reliability and validity of the GPCOG-C have proved to be reasonable，suggesting that it may used for the screening for MCI in primary care.


Adherence to WeChat Interventions and Associated Factors among Middle-aged and Elderly People with Prehypertension and Hypertension in the Community　

LUO Yang，LI Xiaowen，LIN Aihua

2021, 24(22):  2826-2831.  DOI: 10.12114/j.issn.1007-9572.2021.00.239

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Background　The development of science and technology and the popularity of smart phones have made WeChat a potential tool for community-based hypertension management. Objective　To study the adherence to WeChat interventions and associated factors in middle-aged and elderly people with prehypertension and hypertension in the community. Methods　From November 2018 to May 2019，we delivered a six-month WeChat-based tiered interventions（first three-month health education，then three-month health behavior promotion） to middle-aged and elderly people with prehypertension and hypertension selected using convenient sampling method from Baiyun Subdistrict，Guangzhou's Yuexiu District. A descriptive analysis of the adherence to the interventions was performed. Logistic regression analysis was used to identify the associated factors of adherence to the interventions. Results　A total of 209 cases were enrolled，and 167（79.9%）of them completed the study，including 81 with good intervention adherence，and 86（51.5%）with poor adherence. Multivariate Logistic regression analysis found that education level，current marital status，comorbidities，and drinking status were influencing factors of adherence to WeChat interventions in middle-aged and elderly people with prehypertension and hypertension in the community（P<0.05）. Conclusion　The adherence to WeChat-based interventions in these people may be associated with multiple factors，and needs to be improved. To do this，priority during the intervention delivery shall be given to individuals having a low level of education，spouse，at least one comorbidity，or drinking.


General Practitioners' Learning Ultrasound Techniques and Future Applicability of Portable Ultrasound Device in Primary Care：Perspectives from General Practitioners and Sonographers　

FU Xiaohong，JIA Zhenxi，ZHAO Feng，HUANG Guoqian，ZHANG Tao

2021, 24(22):  2832-2837.  DOI: 10.12114/j.issn.1007-9572.2021.00.149

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Background　Both ultrasound imaging and general medicine are developing rapidly. But it is still unknown that whether the advancement and popularization of portable ultrasound imaging can be used by general practitioners（GPs） to promote the development of general medicine，and what innovative ideas and methods can be used to accelerate the popularization of ultrasound imaging in primary care and to train ultrasound professionals with humanistic care，early disease screening，high service accessibility，and medical insurance expense control in primary care under consideration. Objective　To explore the perspectives of multiple healthcare providers（community GPs，community sonographers，and general hospital sonographers） on GPs' learning ultrasound techniques and applying portable ultrasound devices，and their suggestions on the implementation goals and specific operation requirements. Methods　The study was implemented from October to December 2019. In-person interviews using a semi-structured format were conducted with GPs and sonographers from Pudong New Area Jinyang Community Health Center，a community hospital that has trained the most GPs in China so far in terms of ultrasound learning and practice（two authors' current affiliation） for investigating their attitude and willingness regarding learning ultrasound techniques and delivering ultrasound services，and their opinions on the required ultrasound knowledge and level of actual performance. And two rounds of consultation using the Delphi technique were carried out with 17 sonographers with an experience of working at least 10 years in the general hospital for investigating their opinions on the specific requirements for community GPs to perform the ultrasound examination，such as collecting，storing and transmitting ultrasound imaging data，and making an ultrasound-based diagnosis. Results　Altogether，six community GPs and three community sonographers attended the interviews. The results showed that community GPs had interests in learning ultrasound techniques，and expressed their concerns about the post-learning application. Community sonographers believed that trained GPs would be capable of performing ultrasound examinations，and they could begin from performing simple scanning of external organs，such as thyroid and carotid. The positive and authoritative coefficients of senior sonographers for the two rounds of consultation were all 100.0%，and greater than 0.7，respectively. The consultation results indicated that eligible community GPs for collecting data of ultrasound examinations should have: a bachelor degree or above，major in clinical medicine，at least three years' clinical practice，GP certification，ultrasound technician certification，and at least two times of attending continuing ultrasound education per year. The required levels of knowledge and skills for GPs to store and transmit ultrasound imaging data，and make an ultrasound-based diagnosis were almost the same for sonographers，including common instrument adjustment，postural guidance，operation techniques，plane choice，probe placement，knowledge of data should be recorded，stored and reported，and knowledge of common requirements for diagnostic classification. Conclusion　Community GPs showed interests in learning ultrasound techniques for increasing their competencies，and they could try to begin from performing scanning of thyroid and carotid. The operational procedures and actual settings appropriate for GPs to perform ultrasound examinations should be determined. The use of portable ultrasound device may be a key to benefiting the ultrasound performance of GPs，which can be used to scan thyroid，carotid and other organs with a clear shape and simple structure，and to screen for chronic diseases as a chronic disease management program vigorously promoted in the community.


Development of the Specifications for Community General Practitioners to Screen for Thyroid and Carotid Diseases Using the Portable Ultrasound Device　

ZHAO Feng，JIA Zhenxi，CHEN Yue，ZHANG Tao

2021, 24(22):  2838-2843.  DOI: 10.12114/j.issn.1007-9572.2021.00.151

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Background　Community general practitioners（GPs） with interests in learning ultrasound techniques need a tool with applicability in settings and academic disciplines to help them learn the techniques quickly，effectively，and efficiently. Objective　To develop a set of simple guide specifications applicable for community GPs to screen for diseases of two external organs of human body（thyroid and carotid） using the portable ultrasound device in a standardized way. Methods　We conducted this study in October 2019. By using in-depth，semi-structured interviews，we formulated the framework of specifications for community GPs to screen for thyroid and carotid diseases using the portable ultrasound device，and used it to develop the draft of the specifications by use of literature review，then revised it according to the review of GPs participating in the development，and revised it again according to the results of expert consultation to produce the final version. Results　Two set of specifications were developed，one for thyroid screening，and the other for carotid screening. The community GPs were anxious about the data collection and assessment required by the specifications. The community sonographers believed that they could perform practices well according to the specifications，but they thought that whether it is a paid service or not would directly affect GPs' enthusiasm in the delivery and long-term delivery of such services. Conclusion　The feedbacks for the development indicated that the first revised version of the specifications met the goals of development，and the final version is applicable. In the opinion of community GPs and sonographers involved in the development，the technical difficulty in delivery such services and performance measurement are closely associated with the application of the specifications. In addition，time consuming and missed diagnosis in the delivery are also issues to be considered. In short，to help GPs develop their interests in learning ultrasound techniques，one key is to select suitable body parts to be screened by GPs with settings，time consuming，technical difficulty，and risk in the implementation taken into account，and there is also a need to consider performance subsidy and ways for integrating the implementation of these services with the family doctor system.


Specifications for Community General Practitioners to Screen for Thyroid and Carotid Diseases Using the Portable Ultrasound Device：Quality Evaluation Using AGREEⅡ and Recommendations　

SONG Ye，ZHAO Feng，CHEN Ming，ZHANG Tao4

2021, 24(22):  2843-2849.  DOI: 10.12114/j.issn.1007-9572.2021.00.150

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Background　To enable community general practitioners（GPs） to screen for thyroid and carotid diseases using the portable ultrasound device high efficiently and effectively at the community level，we developed the Specifications for Community General Practitioners to Screen for Thyroid and Carotid Diseases Using the Portable Ultrasound Device（hereinafter referred to as the Specifications）. Objective　To evaluate the quality of the Specifications using AGREEⅡ precisely，comprehensively and structurally by experts，to make further improvement. Methods　In December 2019，for further improving the specifications via situation adaptation，we invited five experts from community and general hospitals to evaluate the specifications using the modified AGREEⅡ. Results　On the whole，the items of the Specifications were rated high，each was rated higher than four out of seven points，with an average score of higher than five. Compared to the part of thyroid screening，the part of carotid screening was rated lower. And one expert abstained from the assessment for the part of carotid screening. Conclusion　Overall，the experts rated the Specifications high，but specifically，they recommended the use of the part of thyroid screening owing to higher quality，but did not recommend the use of part of carotid screening presently due to lower quality and feasibility. Our study indicates that the AGREEⅡis suitable to be used to evaluate practice guidelines. In terms of evaluating the specific contents of such guidelines to improve the quality，we suggest to use the validity theory to perform a thorough item-by-item expert evaluation.


Status and Influencing Factors of eHealth Literacy in Stroke Patients　

ZHANG Zhenxiang，REN Hui，PING Zhiguang，GUO Yunfei

2021, 24(22):  2850-2854.  DOI: 10.12114/j.issn.1007-9572.2021.00.209

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Background　Thanks to the rapid development of Internet technologies，electronic resources have come to play an increasingly important role in public health. Objective　To investigate the status and influencing factors of eHealth literacy in hospitalized patients with stroke，providing evidence for improving eHealth literacy in this group. Methods　A total of 580 hospitalized stroke patients and their main caregivers in three grade A tertiary hospitals in Henan Province were selected by convenience sampling from July to October 2020. The Chinese version of the eHealth Literacy Scale（eHEALS） was used to investigate their eHealth literacy and associated factors. Results　The survey obtained a response rate of 96.21%（558/580）. The mean total score of the eHEALS in the respondents was 13（13）. The rate of having qualified total eHEALS score was only 5%. The mean total scores of dimensions of network health information and service application ability，evaluation ability，and decision-making ability were 8（7），4（4），and 2（2），respectively. The rate of having qualified total eHEALS score of caregivers was 24.7%（138/558）. Binary Logistic regression analysis showed that age of stroke inpatients and eHealth literacy of their caregivers were associated with the level of eHealth literacy of stroke inpatients（P<0.05）. Conclusion　The level of eHealth literacy of hospitalized patients with stroke was low. Our study suggests that the eHealth literacy in these patients should be concerned about clinically，and interventions developed according to factors associated with eHealth literacy will help improve patients' health better.


Correlation of Mental Health Literacy between Stroke Patients and Their Caregivers　

ZHANG Zhenxiang，LI Hui，PING Zhiguang，LIU Qingxuan，LIU Feng

2021, 24(22):  2855-2859.  DOI: 10.12114/j.issn.1007-9572.2021.00.208

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Background　As a whole，both stroke patients and their caregivers face mental health problems during treatment. Improving mental health literacy is conducive to mental health，but there is a lack of investigations on the status and relationship regarding mental health literacy in stroke patients and their caregivers. Objective　To explore the correlation of mental health literacy between stroke patients and their caregivers，providing a basis for formulating corresponding interventions. Methods　This investigation was conducted between July and October 2020 with 580 stroke patient-caregiver pairs selected using convenience sampling from three hospitals of Henan Province using the Chinese version of the Multicomponent Mental Health Literacy Measure（MMHLM-C）. The correlation of mental health literacy between patients and their caregivers was analyzed. Results　In all，558 patient-caregiver pairs（96.2%） who returned responsive questionnaires were included for final analysis. The total score of the MMHLM-C and subscale scores of knowledge-oriented，beliefs-oriented，and resource-oriented mental health literacy were 8（8），4（4），4（4），0（1），respectively for stroke patients，and were 8（8），4（4），3（3），0（2），respectively，for caregivers. The mental health literacy level of stroke patients was positively correlated with that of caregivers（rs=0.715，P<0.001）. Conclusion　The mental health literacy was low in both stroke patients and their caregivers，and was positively correlated. So nurses should pay attention to give health education to both stroke patients and their caregivers simultaneously to achieve mutual promotion to improve their mental health literacy.


Relationship between Mental Health Literacy and Health Behaviors among Elderly Stroke Patients　

ZHANG Zhenxiang，REN Juanjuan，LIN Beilei，PING Zhiguang，WANG Wenna，GUO Yunfei，LUAN Wenyan

2021, 24(22):  2860-2865.  DOI: 10.12114/j.issn.1007-9572.2021.00.207

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Background　Elderly stroke patients have been found with notable psychological problems and low levels of health behaviors and health literacy. Evidence suggests that mental health factors are closely related to the changes in health behaviors，but there are few studies on the relationship between mental health literacy and behaviors in elderly stroke patients. Objective　To explore the status of mental health literacy and health behaviors and their relationship in elderly stroke patients，providing a basis for improving mental health and health behaviors in this group. Methods　From July to October 2020，265 stroke inpatients aged 60 and above were selected by convenience sampling from a grade A tertiary hospital in Henan Province，and surveyed using the General Conditions Questionnaire，the Chinese version of the Multicomponent Mental Health Literacy Measure（MMHLM-C），and Health Behavior Scale for Stroke Patients（HBS-SP）. Results　Altogether，247 cases（93.2%） who handed in responsive questionnaires were finally included. The survey revealed that the total score of MMHLM-C in the respondents differed significantly according to education level，residence status，and monthly household income per capita（P<0.05）. The total score of HBS-SP varied notably by education level and duration of stroke（P<0.05）. On average，the total MMHLM-C score was（10.27±5.04） and the total HBS-SP score was（62.68±8.58）. Correlation analysis showed a moderate positive correlation between mental health literacy and health behavior（rs=0.525，P<0.01）. Conclusion　In elderly stroke patients，the mental health literacy and health behavior level showed a positive correlation，and both need to be improved. To enhance their health behaviors via mental health，it is suggested to provide targeted care interventions in accordance with the mental health of these people observed with full attention，with mental health education，positive belief cultivation and strengthening，innovative publicity of health resources，and monitoring and management of health behaviors incorporated if possible.


The Building of a Four-force General Medicine Faculty Team　

ZHU Wenhua，FANG Lizheng，DAI Honglei，CHEN Liying，CHAO Guanqun，ZHU Yue

2021, 24(22):  2866-2869.  DOI: 10.12114/j.issn.1007-9572.2021.00.214

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Strengthening the building of a general medicine faculty team is an important part for the development of general practice in China. But the overall building status is unsatisfactory，and teaching levels of the teams across regions are uneven currently. To give full play to the role of diversified faculty in the training of general medical talents，we have developed a combined teaching model by constructing a four-force faculty team，which consists of general practice supervisors，teachers of general medicine，specialty medicine and community medicine. This model fully reflects the characteristics of general practice training，and ensures the quality of general practice personnel training.


Research on the Mode of "College-Hospital-Community Linkage" Assistant General Practitioner Training　

JIANG Lihua，WU Jianping，ZHANG Li，YE Jianli，QIU Mochang

2021, 24(22):  2870-2873.  DOI: 10.12114/j.issn.1007-9572.2021.00.232

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To improve the quality of talent cultivation by strengthening the linkage between in-school phase and hospital-based phase for the "3+2" training program with assistant general practitioners（3-year education on clinical medicine+2-year training as an assistant general practitioner），Jiangxi Medical College，basing itself on the features of talent cultivation in these two phases，consolidates the hospital-college integration，and explores the reform in the "college-hospital-community linkage" training mode for assistant general practitioners. On account of this，the integration of college，the affiliated hospital and community hospital is fully conducive to the hospital affiliation to the medical college and their close cooperation in teaching. The two phases of "3+2" training mode，administered by the college as a whole，alternate theoretical teaching，practical training and professional spirit training，which promotes boosting the talent cultivation quality and provides an approach to optimizing medical talent cultivation system.


Exploration and Effect of Hospice Care by the Hospice Multiple Professional Team in Support of General Practice　

TANG Yuezhong，XU Donghao，CHENG Mingming，ZHOU Dashuang，YU Zhijie，CHEN Wen

2021, 24(22):  2874-2879.  DOI: 10.12114/j.issn.1007-9572.2021.00.017

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Background　In China，hospice care has become an important part of the national healthcare system. Since the year of 2017，the national health authorities have initiated two rounds of implementing hospice care at the national level with 1 municipality，and 76 cities /districts as the pilot areas. However，there is no available practical pattern for delivering hospice care by community healthcare institutions，a major kind of healthcare settings for delivering such services，which needs to be explored urgently. Objective　To establish a hospice multiple professional team（H-MPT） in support of general practice with determined roles of team members for delivering hospice care in community healthcare settings，and to assess the management effect of the team. Methods　A quantitative and qualitative mixed design was used to evaluate the effect of hospice care delivered by a H-MPT in Kangjian Subdistrict Community Health Centre from October 2016 to December 2019. Two self-made questionnaires，the H-MPT Team Member Assessment Form and Patient's Family Members' Assessment of H-MPT Services were used in the quantitative study. Interviews with self-developed outlines were used in the qualitative study. Descriptive statistical analyses of questionnaire assessment results and recorded interview results were performed. Results　The members of the H-MPT had scores ranging from 4.58 to 5.00 in terms of each assessment item. The scores of the effect of hospice care delivered by the H-MPT evaluated by patients' family members ranged from 4.60 to 5.00 in terms of each assessment item. The interviews indicated that hospice care delivered by the H-MPT significantly improved the quality of humanistic care services，efficiency of team cooperation，and doctor-patient relationship as well as the recognition of medical social workers. Conclusion　The H-MPT established for supporting general practice to offer hospice care may significantly improve the quality of hospice care. Moreover，this pattern may provide a referential practical framework for the delivery of community-based hospice care in China.


Implementation Effect of Home Care：a Case Report and Exploratory Home Follow-up Study　

YANG Kaiwen，JIANG Yue，ZHAO Fuying

2021, 24(22):  2880-2884.  DOI: 10.12114/j.issn.1007-9572.2021.00.212

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Home care is one type of essential services included in primary care services. Various family-related factors，interaction between family members and family resource utilization are important for disease incidence，treatment and rehabilitation of a family member. So it is necessary for a general practitioner（GP） to pay attention to the patient's family-related factors besides the health problem when delivering diagnosis and treatment services clinically. To explore the benefits of home care via follow-up investigation as useful evidence，we analyzed the data of home care for a case obtained by home follow-ups. The analysis indicates that by home follow-up assessment of the patient and his family，family resource management and family management，GPs may identify the potential family health risks，effectively address family health problems，and reduce the possibility of the patient having an adverse event. Moreover，long-term continuous home follow-ups and patient's positive feedback of interventions may also facilitate the solving of family health problems，and the building and strengthening of a good patient-physician relationship. Furthermore，home follow-up has been proved applicable for community care as a flexible and efficient consultation way.