Table of Content

05 October 2021, Volume 24 Issue 28

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Monographic Research

The Development of Practice-based Research Networks in North America in Early Stage：a Literature Review from Historical Perspective　

WANG Yang, XU Zhijie, LI Li, KUANG Li, XU Yanli, HAN Jianjun

2021, 24(28):  3525-3542.  DOI: 10.12114/j.issn.1007-9572.2021.00.291

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Background　Developing primary care research is essential to the development of discipline. In history，building practice-based research networks（PBRNs） made key contribution for developing primary care research in Europe and the North America. Objective　Summarize historical information on the scale，structure，aims，research questions and designs，data collection approach，funding sources，and other experiences of PBRNs in North America from 1977 to 1994. Methods　This study is a literature review from historical perspective. Researchers conducted a four-stage search on 6 databases：PBRNs Literature database，PubMed Central，Embase，Web of Science，Cochrane Library，and Google Scholar. Included papers need to be published in peer-reviewed journals or by reputable institution（grey literature），and have full text or abstract with key information. Non-original researches need to provide empirical information about PBRNs development. Original researches need to be conducted by PBRNs based on multi-clinic cooperation. Results　27 editorial papers and 2 grey literatures introducing the development experience of PBRNs，and 74 original articles published by PBRNs were included. The result show that most PBRNs were supported by family medicine or related academies and institutions. Most of the networks have 50-300 organizers，researchers，liaisons，and physician members. Their aims are developing primary care knowledge，supporting academic family physicians and improving primary care practice. Their research work focuses on exploring primary care services，patients，and physicians by cross-sectional design and stably or temporarily collected data from multi-clinics. Its main funding source are：government，private foundations，companies，academies，academic institutions，and family physicians. Their core experience includes：obtaining sufficient initial funding，rigorous co-design by principle investigators and general practitioners，developing the culture of equality，unity and communication，and reducing the burden of clinicians in conducting research. Conclusion　The successful elements of building early PBRNs in the primary care system include：seeking support from academies and scientific research institutions，building an organizational structure that can unite organizers，researchers，practitioners，establishing a common goal for the development of primary care disciplines，research and practice. develop primary care institution-centered research question and object，conduct rigorous co-design of research，create trustful data collection approach with low workload of clinicians，and obtain sufficient initial funding.


Development of the General Practice School（Department） in Medical Colleges & Universities：Roles and Strategies　

ZHOU Ningtian，QIAN Dongfu，QIAO Xuebin，ZHOU Yafu

2021, 24(28):  3543-3547.  DOI: 10.12114/j.issn.1007-9572.2021.00.271

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The Opinions of the General Office of the State Council on Reforming and Improving the Incentive Systems for Training and Employing General Practitioners（No. 3〔2018〕 of the State Council）, and Guiding Opinions of the General Office of the State Council on Accelerating the Innovative Development of Medical Education（No. 34〔2020〕 of the State Council）, proposed that medical colleges & universities should attach importance to general practice discipline development, and systematically plan the general practice teaching system. In response to these requirements, medical colleges & universities have listed the establishment of general practice school（department） on the important agenda, and marked defining the roles and development of the school（department） appropriately as important tasks. We discussed the roles and functions of general practice school（department） defined according to the necessity and significance of establishing it, involving providing support for the development of medical colleges & universities based on the new concept of innovative, coordinated, green, open and shared development, promoting the development of new training modes of general practitioners, and contributing to the development of new medical disciplines, and general practice teaching, research and continuing education system. Moreover, we put forward strategies for developing the general practice school（department）, which encompass formulating practical missions and goals, facilitating the coordinated development of theoretical and practice teaching and research, and strengthening the development of general practice discipline and teaching workforce. We expect to see our analysis benefiting further development of general practice school（department） and medical colleges & universities.


Osteoporosis Prevention and Treatment Pathway in the Community Based on Primary Osteoporosis Management Guidelines：Exploration and Development　

SONG Huijiang，LIU Huailei，ZHUANG Kanglu

2021, 24(28):  3548-3554.  DOI: 10.12114/j.issn.1007-9572.2021.00.175

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Background　In Shanghai，the construction of community-based prevention and treatment of osteoporosis has entered the second round，during which many new relevant guides have been issued，such as osteoporosis guidelines for primary care，guiding principles for osteoporosis management，and standardized management options for osteoporosis，providing rich evidence for primary care practice. However，successful application of guides in primary practice can not be achieved overnight，which should be done according to the real conditions of the community，such as human，financial and material resources，size and roles of the community. Objective　To develop a pathway for the second round construction of community-based prevention and treatment of osteoporosis based on our experience summarized from the first round of construction，and the latest osteoporosis guidelines，offering a reference for appropriate use of guidelines in community-based practice. Methods　The entire development process of the pathway to community-based osteoporosis prevention and treatment includes pre-development preparation phase，development phase，information realization phase，and acceptance phase before the offline use. The first two phases were completed from May 2018 to December 2019. In the pre-development preparation phase，we formulated project management options for developing the pathway by reviewing the latest evidence-based studies regarding osteoporosis prevention and treatment and two rounds of group discussions. In the development phase，we developed a standardized process of osteoporosis prevention and treatment used as a reference guide to primary care by analyzing and modifying the first version of osteoporosis prevention and treatment pathway in the community based on the literature review results of in the pre-development preparation phase，three rounds of expert consultation and two rounds of group discussions. Results　The document library formed in the pre-development preparation phase has updated 7 domestic guidelines and 5 foreign guidelines. The osteoporosis prevention and treatment pathway in the community was developed by general medical management and executive representatives from the community health center，orthopedics specialists from the general hospital，in collaboration with the information company，with the help of a third-party healthcare and medical and health consulting firm for data collection，analysis and translation. The final osteoporosis prevention and treatment pathway in the community demonstrates logic in terms of community-based osteoporosis screening and diagnosis，transferring to the general hospital，and osteoporosis follow-up for monitoring treatment. Conclusion　The successful application of osteoporosis guidelines in primary care practice requires multilateral cooperation（the general hospital，community health center，information company，translator as well as third-party communication and coordination）. Our exploratory process may be used as a reference for colleagues to carry out new explorations，and our pathway may be considered as a logical basis for community-based prevention and treatment of osteoporosis using the guidelines appropriately.


Status and Improvement Recommendations for Bi-directional Referrals for Community Osteoporosis Patients　

YANG Lan，ZHOU Peng，DU Jie，XUE Bin，WEI Yangyang，LIU Haijiao，GU Wenqin

2021, 24(28):  3555-3559.  DOI: 10.12114/j.issn.1007-9572.2021.00.097

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Background　Bi-directional referrals are essential in the promotion of community-based prevention and treatment of single diseases，but there is a lack of practical guidance scheme for clinical referrals. We aimed to explore the bi-directional referrals for osteoporosis between primary care and secondary or tertiary care involving primary care physicians，orthopedic specialists and other medical workers. Objective　To summarize the facilitators and barriers to successful bi-directional referrals for community osteoporosis patients based the reviewing of such studies，providing a reference for the improvement of bi-directional referrals for such patients. Methods　Databases of CNKI，Wanfang Data，Web of Science and Science Direct were searched in June 2019 for studies about bi-directional referrals for community osteoporosis patients included during January 1，1999 to June 15，2019. Meta-analysis was conducted on the practices and explorations of bi-directional referrals for community osteoporosis patients with a focus on the expected goal，types of referrals，development methods for new referral patterns，effects and problems during the implementation of referrals，and based on the results，improvement recommendations were proposed. Results　Finally, 14 Chinese documents and 5 English documents were included. The management modes and standards for transferring community osteoporosis patients were different in China and foreign countries during the period. Domestic residents did not attach much weight to osteoporosis，and showed poor adherence to treatment. Moreover，there were no osteoporosis department and sophisticated equipments for detecting osteoporosis as well as a sound system for communicating with higher level hospitals in domestic community hospitals. The types of referrals for such patients in foreign countries were mainly about the referrals for post-osteoporotic fracture patients. Conclusion　To promote community-based prevention and control of osteoporosis，bi-directional referrals for community osteoporosis patients should be implemented effectively，and to do this，priority should be given to：the determination of coverage of long-term preventive and control services of osteoporosis，enriching general practitioners' osteoporosis-related knowledge，improving the resources needed by community-based prevention and treatment of osteoporosis，and the development of a procedure for bi-directional referrals for osteoporosis including four factors such as division of labor，referral indicators and other details.


Development of a Standardized Process of Community-based Osteoarthritis Prevention and Treatment with Integrated Traditional Chinese and Western Medicine by Zhuanqiao Community Health Center　

XU Chengyan，CHEN Guorong，LI Yan，CHEN Junxiang，WANG Jiaoming，LI Liqiu

2021, 24(28):  3560-3570.  DOI: 10.12114/j.issn.1007-9572.2021.00.278

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Background　Osteoarthritis is the third leading chronic disease in older people. There are quite a lot of osteoarthritis sufferers，and a large number of people at high risk for osteoarthritis. However，due to lack of research on standardized community-based diagnosis and treatment of osteoarthritis，and a complete，scientific process regarding standardized community-based management of osteoarthritis，long-term management of osteoarthritis is still not accessible in the community. Objective　To develop a complete，practical standardized process for community-based osteoarthritis prevention and treatment with integrated traditional Chinese and western medicine（hereinafter referred to as "osteoarthritis prevention and treatment process"） with a detailed analysis of the major technical points and difficulties. Methods　The osteoarthritis prevention and treatment process was developed from March to December 2020，which consists of preparatory，development and informatization stages. In the preparatory stage，literature review，investigation approach，and group discussion were used to develop a literature database including guidelines/standards on osteoarthritis prevention and treatment，and the aspects and services involved in the prevention and treatment process were determined. In the development stage，the standard operating procedure（SOP） for osteoarthritis prevention and treatment was updated from version 1.0 to version 4.0 in accordance with a two-round group discussion and focus group discussion，as well as the results of the pilot implementation of the osteoarthritis prevention and treatment process. In the informatization stage，based on the literature database formed in the preparatory stage，and SOP 4.0，a database of indicators involved in the osteoarthritis prevention and treatment process was developed，and used for further informatizing the process. Results　In the preparatory stage，10 eligible guidelines/standards were included. The determined osteoarthritis prevention and control process consists of five aspects〔community mobilization，evaluation（screening），diagnosis，intervention and follow-up〕，with a focus on community mobilization，evaluation（screening），and follow-up. In the development stage，the developed SOP 4.0 for osteoarthritis prevention and treatment includes 10 items: service population，service time，settings，must-have service tools，providers，must-have professional skills of providers，service profile（list），service spending（cost），the generated data list，and evidence-based basis for operation. And the complete prevention and control process was formed. In the informatization stage，a table of the structure of the above-mentioned five aspects was presented. Conclusion　Our osteoarthritis prevention and treatment process could guide community healthcare workers to deliver osteoarthritis prevention and treatment services using available community resources to all the people in the local community. Our development process may be used as a reference for other community health institutions to develop the prevention and treatment pathway of osteoarthritis or other single diseases according to their own conditions.


Capability of Community Health Centers in Cities to Provide Childcare Services　

WANG Xi，YIN Tao，YANG Huimin，ZHENG Xiaoguo，LI Ruili，WANG Lihong，YIN Delu

2021, 24(28):  3571-3577.  DOI: 10.12114/j.issn.1007-9572.2021.00.250

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Background　The implementation of universal two-child policy has brought a significant increase in the number of children in China. The needs of childcare services are increasing rapidly，but the capability of community health centers（CHCs） to provide such services is still unclear. Objective　To investigate the capability of CHCs in some cities of China to provide childcare services. Methods　In April 2020，by use of multi-stage stratified sampling，we selected 35 CHCs in 14 cities of China，and conducted two online surveys using self-developed questionnaires，one with administrators of the CHCs for investigating the general status，personnel，equipment and facilities allocation，and implementation regarding childcare services，and one with childcare staff of the CHCs for investigating their knowledge regarding childcare services and job satisfaction. Results　The survey included 35 community health service centers in 14 cities across the country，and the total number of health technicians in the sample center was 8 009. Among the health technicians，191（2.38%） were pediatricians（including licensed physicians and assistant physicians with pediatrics included in their scope of practice），154 of them（80.63%） had a bachelor degree or above，and 112（58.64%） had intermediate or above professional title；488（6.09%） were general practitioners（received post-shift training with pediatrics before being a childcare provider），293 of them（65.37%） had a bachelor degree or above，and 355（79.30%） had intermediate or above professional title；320（4.00%） were pediatric preventive healthcare physicians，and more than 80.00% of them had the national physician license and pediatric training certificate. A total of 999 people accepted the survey of satisfaction and knowledge level. The job satisfaction level of the childcare providers and the accuracy of the pediatric knowledge test performed by them was（61.38±9.11）%，and （50.40±21.93）% on average，respectively. The pediatric consulting room accounted for less than 1% of the total consulting rooms of the CHCs on average. More than 90% of the CHCs were equipped with 8 kinds of common equipment and facilities for providing childcare services. More than 50% of the CHCs were equipped with less than 7 kinds of common pediatric diagnostic and therapeutic equipment and facilities. Only 10 of the 23 common pediatric medicines could be accessible in more than 50% of the CHCs. In 2019，the number of visits of children to the CHCs accounted for 2.91% of the total visits. And the number of admissions of children to the CHCs accounted for 1.48% of the total admissions. Over 85 percent of the national essential public health projects have been carried out. Simple obese children accounted for the highest number of children receiving management while those with congenital dislocation of the hip accounted for the lowest. Conclusion　Overall，the number of childcare providers in the CHCs was insufficient，with relatively high education level and professional title，but unsatisfactory level of pediatric knowledge，and low job satisfaction. The CHCs were equipped with insufficient equipment and facilities as well as pediatric drugs. The spatial distribution of children's health service level was not balanced. To improve the capability of CHCs to provide childcare services，it is suggested to strengthen guidance and training to improve the ability level of primary childcare providers，establish an effective performance assessment mechanism to improve their job satisfaction，increase types and quantity of pediatric drugs，and reasonably allocate pediatric diagnostic and therapeutic equipment and facilities.


Infectious Disease Prevention and Control Capacity of Community Health Institutions in Beijing：Current Status and Recommendations for Problems　

SU Ning，XU Xiaomin，ZHU Rui，ZHANG Xiangdong，YU Jianping

2021, 24(28):  3578-3583.  DOI: 10.12114/j.issn.1007-9572.2021.00.275

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Background　During the fight against the COVID-19 pandemic，Beijing's community health institutions showed some weaknesses in infectious disease prevention and control. To improve their capabilities in this aspect to fully play their role as a sentinel for monitoring infectious diseases，it is urgent to investigate and analyze their current status to find problems，then put forward recommendations. Objective　To investigate the infectious disease prevention and control level in Beijing's community health institutions，and identify and analyze the problems，with suggestions put forward. Methods　From May to July 2020，a questionnaire survey was conducted in all community health centers（CHCs） in Beijing. Information was collected，including the basic situation，departments，staff structure，infrastructure situation，the provision of public health services，and emergency response capacity for infectious diseases and public health emergencies of the CHC，and was analyzed using descriptive analysis. The above-mentioned data were checked and supplemented if necessary in accordance with the information in the China's National COVID-19 Surveillance Network and Beijing Community Health Statistics 2019. Results　Of the 342 CHCs in total in Beijing as of 2019，90（26.32%） had a fever clinic，102（29.82%） had a gastrointestinal clinic，and 54（15.79%） had both a fever clinic and a gastrointestinal clinic. Among the incumbent workers in the CHCs（n=28 809），2 887（10.02%） held a position in public health，and 178（6.17%） had a senior professional title. HIV testing was carried out in 159 CHCs（46.49%）. SARS-CoV-2 nucleic acid testing was accessible in 11 CHCs（3.22%）. For 29 kinds of common infectious diseases，140（40.94%） CHCs had no diagnosis and treatment capabilities，135（39.47%） had capabilities managing 1-5 kinds，only 29（8.48%） were able to diagnose and treat >10 kinds. Conclusion　The CHCs in Beijing may have a series of problems in the infectious disease prevention and control system and mechanism，sentinel fever clinic，infectious disease diagnosis and treatment capacity，public health workforce development and other aspects. Therefore，the infectious disease prevention and control plan of the CHCs should be developed more appropriately from an overall point of view，to address the problems and improve the current status as soon as possible.


Public Health Informatization in Primary Care in Sichuan Province: an Investigation　

LIU Runyou，YANG Changhong，LI Ling，PENG Yanqiu，LYU Qiang

2021, 24(28):  3584-3589.  DOI: 10.12114/j.issn.1007-9572.2021.00.259

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Background　The informatization of public health is a key measure to improve the accessibility of public health services，and the development of essential public health services provided by primary care，the gatekeeper of residents' health. Objective　To investigate the informatization of public health in primary care in Sichuan，and analyze the existing problems，providing evidence for promoting public health informatization in primary care. Methods　From November to December 2019，an online questionnaire survey was conducted with the deans responsible for healthcare of 1 022 primary medical institutions randomly selected from each district and county at the same ratio in Sichuan Province to collect information mainly about the use of public health information system，including funds，infrastructure，and human resources regarding the use of system，the system coverage，and obstacles to the use of the system. Results　A total of 1 133 cases attended the survey，994 of them responded effectively，achieving a response rate of 87.7%. Among the surveyed institutions，each used nine public health systems on average；48.6%（483/994）had special funds for the informatization development of public health，91.0%（905/994） had sufficient hardware equipment to meet the work needs，45.0%（447/994）had at least five workers to fill in and report health information. The difference in the prevalence of using the PCMIS between community health centers and township health centers 〔82.9%（68/82）vs 96.3%（878/912）〕 was statistical significant（P<0.05）. Among the workers responsible for filling in and reporting health information in the survey institutions，37.7%（n=357） majored in clinical medicine，30.4% majored in nursing（n=288），and only 2.2% majored in information technology（n=21）. The PCMIS was thought to be enough to support the in-hospital needs in 63.2%（43/82） of community health centers and 74.7%（656/912） of township health centers，with statistical difference（P<0.05）. Repeated filling in the public health module of the PCMIS for reporting the information was found in each institution. For the obstacles to the use of public health module，"the insufficiency of the software"〔36.8%（25/68）〕 was chosen as the primary one in the community health centers，but for the township health centers，"the lack of professionals"〔31.4%（276/879）〕 was chosen. Conclusion　Many problems have been found in the public health informatization in primary care in Sichuan Province，such as insufficient basic support，inefficiency of system development，lopsided development between different areas and different types of health institutions，and the insufficiency of the software，which need to be improved urgently.


Status and Influencing Factors of Work Stress among Chinese General Practitioners　

HE Wu，PING Wenjun，ZHANG Xinyu，WANG Hongwei，BAO Xingshuo，FENG Jing，GAN Yong

2021, 24(28):  3590-3596.  DOI: 10.12114/j.issn.1007-9572.2021.00.238

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Background　Chinese general practitioners（GPs） are facing challenges to improve residents' quality of life via satisfying their healthcare needs rising with the social and economic development，and to learn and use new medical technologies as well as continuously developed highly informationized and intelligent healthcare delivery patterns，and their work stress is ever-increasing. Studying the work stress and its influencing factors among GPs in China could help to identify effective methods to relieve the work stress of GPs，benefiting the stabilization of GPs workforce. Objective　To investigate the status，sources and associated factors of work stress in Chinese GPs. Methods　The study was carried out between October 2017 and February 2018. By use of multistage stratified random sampling，3 244 GPs were selected from eastern，central and western China to attend a WeChat-based survey using a self-complied questionnaire named Attractiveness of Occupation as a General Practitioner. The chi-square test was used to compare the difference in prevalence and sources of work stress among GPs with different characteristics. Ordinal multinomial Logistic regression analysis was used to explore the major determinants associated with work stress. Results　Altogether，99.75% of the GPs（3 236/3 244） who returned responsive questionnaires were finally included. The results showed that 58.56% of the GPs（1 895/3 236） had relatively high work stress. The top three sources of work stress were economic factors（low income or inability to buy an apartment）〔76.17%（2 465/3 236）〕，difficulty in achieving performance goals〔42.37%（1 371/3 236）〕 and lack of professional identity〔41.84%（1 354/3 236）〕. Logistic regression analysis indicated that male，working in eastern China，aged between 30-50 years old，longer average daily working hours and high frequency of working overtime were main factors associated with work stress among GPs（P<0.05）. Conclusion　In general，the prevalence of work stress among Chinese GPs is high，which is associated with multiple factors，and the most important are economic factors（low income or inability to buy an apartment） . To reduce GPs' work stress，it is suggested to improve the salary and reduce the workload of GPs appropriately，modify the workload allocation and welfare benefits system for GPs，and pay more attention to improve the mental health of GPs.


Job Satisfaction and Influencing Factors among Essential Public Health Practitioners in Primary Care　

CHEN Xinyue，YOU Lili，WANG Huanqian，LIAN Jun，YANG Li，LIU Meicen，LIAO Zirui，ZHAO Jinhong，YANG Linghe，FAN Zixuan，YANG Siqi，LIU Yuanli

2021, 24(28):  3597-3601.  DOI: 10.12114/j.issn.1007-9572.2021.00.285

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Background　Some public health achievements have been made in China since the nationwide implementation of essential public health services more than 10 years ago. Public health workers in primary care are the direct providers of essential public health services，so studying their job satisfaction and associated factors is conducive to improve the quality and efficiency of public health services. Objective　To understand the overall job satisfaction and associated factors among essential public health practitioners in primary care，then put forward corresponding suggestions. Methods　From November to December 2019，purposive sampling was used to select six urban districts of three regions（Zhejiang，Shanxi and Chongqing） of China（two districts were extracted from each region）. Secondly，convenient sampling was carried out according to the list of community health service centers/township health centers in each district. A total of 53 grass-roots medical and health institutions were selected，and at least 10 employees of basic public health services were randomly investigated in each institution. A survey was used to collect demographics，scores of overall job satisfaction and satisfaction with 10 job-related factors of these medical workers using a questionnaire developed by our research team. Results　The survey achieved a response rate of 100%. The score of overall job satisfaction rated by participants was （3.66±0.77） on average. The participants who were satisfied or very satisfied with their job accounted for 60.5%（334/553）. Among the satisfaction with job-related factors，the doctor-patient relationship was rated highest（3.84±0.68），and satisfaction with work intensity was rated lowest（2.86±0.81）. Multivariate Logistic regression analysis demonstrated that social recognition，performance appraisal，work ability and work intensity were significantly associated with the overall job satisfaction（P<0.05）. Conclusion　The overall job satisfaction of these public health workers in primary care was fair. Recommendations to improve their job satisfaction are as follows：increasing social recognition of public health workers，optimizing the performance appraisal system，and reducing the workload appropriately.


Regional Differences in Satisfaction with Opportunities for Career Development among Primary Care Workers in Jiangsu Province　

WANG Shanshan，SHAO Haiya

2021, 24(28):  3602-3608.  DOI: 10.12114/j.issn.1007-9572.2021.00.241

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Background　Against the backdrop of socio-economic growth，primary care providers are increasingly more concerned about not only their current salary，but also career prospect and opportunities for career development. Objective　To explore the regional differences in the satisfaction with opportunities for career development and associated factors among primary care workers in Jiangsu Province，providing a theoretical basis for the implementation of policies improving the attractiveness of primary care as a career. Methods　In December 2019，a self-administered survey was conducted in a stratified multistage cluster sample of 698 primary care workers using a questionnaire consisting of demographic information，job satisfaction and job satisfaction root cause scale compiled by our research group with ERG theory as guidance. The satisfaction with opportunities for career development was assessed by region and associated factors were analyzed in terms of existence，relatedness and growth. Results　The satisfaction scores of job achievement，job value and opportunities for career development of the primary care workers in Jiangsu Province were（4.36±0.75）（4.44±0.66） and （4.20±0.86） respectively. The satisfaction scores of opportunities for career development of primary care workers in Southern Jiangsu，Central Jiangsu and Northern Jiangsu were（4.07±0.99）（4.38±0.79） and（4.25±0.78） respectively. And the difference was statistically significant（F=6.995，P<0.001）. As for existence，urban attractiveness was associated with the satisfaction with opportunities for career development of primary care workers from central Jiangsu（P<0.05）. Urban attractiveness and salary were associated with the satisfaction with opportunities for career development of primary care workers from southern Jiangsu（P<0.05）. The construction of healthcare workforce was associated with the satisfaction with opportunities for career development of primary care workers from northern Jiangsu（P<0.05）. As for relatedness，working atmosphere and equity-minded leadership were associated with the satisfaction with opportunities for career development of primary care workers from southern Jiangsu（P<0.05）. And working atmosphere and responsible leadership were associated with the satisfaction with opportunities for career development of primary care workers from northern Jiangsu（P<0.05）. Conclusion　Regional differences may exist in satisfaction with opportunities for career development in primary care workers of Jiangsu Province. To attract and retain talents in primary care to promote the development of healthcare and pharmacological industries，actions should be taken according to the associated factors of opportunities for career development and local conditions.


Effect of Mobile Terminal-based Management in Patients with Stable Chronic Obstructive Pulmonary Disease　

ZHAO Xinying，WU Hao，GAO Wenjuan，GE Caiying，LI Zhili，KONG Min，CHEN Ying，ZHU Xiayuan

2021, 24(28):  3609-3614.  DOI: 10.12114/j.issn.1007-9572.2021.00.279

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Background　Chronic obstructive pulmonary disease（COPD） requires long-term and effective health management. Mobile APP has many merits in facilitating chronic disease management as an emerging method，but its effect in comprehensive management of stable COPD patients has been insufficiently studied. Objective　To examine the effect of mobile terminal-based comprehensive management in stable COPD patients. Methods　Eighty stable COPD patients treated in Fangzhuang Community Health Service Center of Fengtai District，Beijing from January to December 2019 were randomly divided into control group and observation group. The control group received routine outpatient treatment and health education，and the observational group received routine outpatient treatment and health education with mobile terminal-based management. Comparisons were made between two groups in terms of the grasp of COPD knowledge and breathing skills，mental state，treatment adherence，lung function indices，clinical assessment of symptoms，and status of acute exacerbation at baseline and 12 months after intervention. Results　After the intervention，the proportion of patients with increased knowledge of the etiology，main symptoms and preventive measures of COPD in the observation group was higher than those in the control group（P<0.05）. The patients in the observation group had better mastery of lip contraction breathing and abdominal breathing than those in the control group after the intervention（P<0.05）. After the intervention，the scores of depression and anxiety，the treatment compliance scores of correct medication，diet control and respiratory function exercise and the scores of CAT and mMRC in the observation group were lower than those before the intervention and lower than those in the control group after the intervention（P<0.05）. There was no significant difference in FEV1% and FEV1/FVC between the control group after intervention and before intervention（P>0.05）. After the intervention，FEV1% and FEV1/FVC in the observation group were higher than those before the intervention，and higher than those in the control group after the intervention（P<0.05）. There was no significant difference in the number of emergency and hospitalization in the control group after intervention（P>0.05）. After the intervention, the times of emergency and hospitalization in the observation group were less than those before the intervention，and the times of emergency were less than those in the control group after the intervention（P<0.05）. Conclusion　Mobile terminal-based management may contribute to the grasp of COPD knowledge and breathing skills，alleviation of negative mood，improvement of treatment adherence，lung function indicators，and clinical symptoms，as well as the reduction of possibility of acute exacerbation in stable COPD patients.


Impact of Aerobic Exercise on Serum Inflammatory Factors and Cardiopulmonary Function in Patients with Stable Chronic Obstructive Pulmonary Disease　

HUANG Xin，QIAN Jun，CHEN Fayu，HAO Jian，YAO Yanmei，ZHU Shifei，WANG Jinghua

2021, 24(28):  3615-3619.  DOI: 10.12114/j.issn.1007-9572.2021.00.217

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Background　Chronic obstructive pulmonary disease（COPD） is a common chronic airway disease that can occur repeatedly throughout the year，seriously endangering the quality of life and health of patients. It is quite necessary to explore the effect of aerobic exercise on enhancing cardiopulmonary reserve and quality of life. Objective　To comparatively analyze the levels of serum IL-10，IL-17，matrix metalloproteinase-9（MMP-9） and cardiopulmonary function in stable COPD patients before and after aerobic exercise，to explore the mechanism of aerobic exercise in improving body function and promoting rehabilitation. Methods　Sixty admitted inpatients with stable COPD were randomly and equally divided into control group and experimental group. Both groups received oxygen therapy，bronchodilator therapy and other usual care for 12 weeks，the experimental group（except one dropout due to acute exacerbation） also received a 12-week regular cycling with the intensity of the individual anaerobic threshold. Pre- and post-treatment expression levels of IL-10，IL-17 and MMP-9 in peripheral serum and cardiopulmonary functions were compared between the groups. Results　Compared to baseline，the mean levels of IL-17，MMP-9，and ratio of ventilation to carbon dioxide production at anaerobic threshold（VE/VCO2 at AT） deceased，while mean levels of IL-10，6-minute walk distance，peak oxygen uptake（Peak VO2） and maximal exercise ventilation（VEmax） as well as mean score of St. George's Respiratory Questionnaire（SGRQ） increased in the experimental group after treatment（P<0.05）. The experimental group showed lower mean post-treatment levels of IL-17 and MMP-9，and VE/VCO2 at AT，and higher mean post-treatment levels of IL-10，6-minute walk distance，peak VO2 and VEmax as well as higher mean post-treatment mean score of SGRQ than the control group（P<0.05）. Conclusion　Early initiating aerobic exercise and maintaining aerobic exercise adherence could significantly improve the health status，reduce inflammatory reaction，enhance cardiopulmonary reserve，quality of life and the prognosis of stable COPD patients.


Hospital-community-home Three-stage Rehabilitation Strategy for Elderly Patients after Total Hip Arthroplasty　

ZHANG Junhong，SHEN Gufeng，CUI Ting，MAO Yuanwen，WANG Lingling，YU Lei，ZHU Yueyue，LIU Jianlin

2021, 24(28):  3620-3628.  DOI: 10.12114/j.issn.1007-9572.2021.00.257

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Background　It is difficult for the orthopedic department in general hospitals to manage increased workload associated with out-of-hospital rehabilitation for increasing elderly patients after total hip replacement（THR）. As out-of-hospital rehabilitation may directly affect the surgical effect and functional rehabilitation outcome，it still needs to be studied to develop a feasible long-term management plan involving hospital-community-home collaboration with efforts ensuring its implementation，to improve patients' functional recovery and reduce medical expenses in the long term. Objective　To develop a hospital-community-home three-stage rehabilitation scheme for elderly patients after THR by representative members from the community general practice team and representative family members of the patients led by the orthopedic team from general hospitals. Methods　The development of hospital-community-home rehabilitation strategy was divided into 3 stages：1. theoretical stage：During August to October 2018，the initial scheme was developed using focus group discussion by 10 members of our research team. 2. clinical trial stage：a randomized controlled trial（RCT） involving totally 60 patients admitted to Shanghai Fourth People's Hospital，Tongji University from January to August 2019 and their family members or carers was conducted to compare video-feedback interventions and regular health interventions in two equal groups of patients randomly divided in terms of efficacy evaluated by Harris Hip Score and Barthel Index at discharge，1 and 3 months after discharge. 3. improving stage：During June to August 2020，our research group determined the contents and predicted the cost of community interventions using literature review，and then formulated the final version of hospital-community-home rehabilitation process for elderly patients after THR using focus group discussion. Results　1. Among the hospital-community-home rehabilitation process，the hospital acts as the "source of technologies and information"，and shoulders the responsibility of efficiently providing professional skills and information for community- and home-based postoperative rehabilitation. The community acts as the "family doctor station"，and shoulders the responsibility of providing post-discharge rehabilitation services including outpatient and inpatient care，home-based visits，in-home medical care，and management of other chronic diseases via integrating various community resources by the family doctor team. In terms of home-based rehabilitation，pre-discharge rehabilitation services could be provided by the orthopedic department of a general hospital or workers engaging in pre-discharge nursing and patient transferring，and other challenging and time-consuming services such as looking for rehabilitation resources and disease management could be provided by the family doctor team. 2. The RCT showed that patients receiving video-feedback interventions had statistically higher Harris Hip Score and Barthel Index at discharge，1 and 3 months after discharge（P<0.05），indicating that the video-feedback interventions were feasible and effective. 3. After once again clarifying the prerequisites for ensuring the sustainable participation of all parties in the collaboration process，specific calculations indicated that the hospital-community-home three-stage out-of-hospital rehabilitation strategy for elderly patients after THR could be implemented via organically integrating the resources of hospitals，communities，and families to satisfy the patients' needs. Among the services，important management services delivered by family doctors should be paid reasonably，such as pooling sources，coordination，consultation and follow-up，and the estimated cost during the rehabilitation period would not exceed 25.3 yuan per day. Conclusion　This rehabilitation strategy has proved to be applicable in terms of both technology and process，and the preliminary exploration is expected to be implemented. Services delivered by family doctors are important and core component of the rehabilitation services，which should to be paid appropriately. As these services are not included in the current medical payment system，a proper payment system reducing the overall long-term cost should be established.


Design of the Intelligent Knowledge-based Service System for Rare Diseases　

HU Hongpu，DAI Guolin，CHEN Qingkun，WAN Yanli

2021, 24(28):  3629-3633.  DOI: 10.12114/j.issn.1007-9572.2021.00.288

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We discussed the design of the Intelligent Knowledge Service System for Rare Diseases，aiming at：making it more convenient for patients，their family members and medical workers to obtain accurate information regarding rare diseases，such as clinical characteristics，specialists，distribution of pharmacological resources，and so on，providing support for tackling difficulties in rare disease diagnosis and treatment，promoting doctor-patient communication and raising public awareness of rare diseases. The design ideas are as follows：firstly，developing a pattern of service delivery according to the features of audience. Secondly，widely collecting authoritative information regarding rare diseases via reviewing data about guidelines on rare disease diagnosis and treatment，analysis of typical cases，rare disease studies and books as well as clinical diagnostic criteria，then revising the information according to specialists' suggestions based on a review，and using it to develop an information system，nine knowledge databases and two model databases，and eventually developing an intelligent platform for rare diseases using artificial intelligence，data mining，big data processing and software engineering techniques. By means of the infomation platform，this system supports the provision of 10 intelligent services（including remote healthcare，internet-based healthcare） for patients and their families，medical workers and healthcare administrators using a convenient and efficient approach，the raising of levels of rare disease identification，screening and diagnosis，rare disease registration and mapping，and rare disease prevention and treatment.


Design of the Knowledge Database and Model Database for Rare Diseases　

LEI Xingyun，DAI Guolin，CHEN Quan，HU Hongpu

2021, 24(28):  3634-3637.  DOI: 10.12114/j.issn.1007-9572.2021.00.289

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Based on a review of rare disease studies，insights derived from the ideas of developing the clinical resource database for diseases and intelligent information systems，we determined the process of developing nine types of rare disease knowledge databases and two types of rare disease model databases，and described the association of knowledge and model databases，to complete the design of rare disease knowledge and model databases. Our rare disease knowledge databases involve knowledge demonstration and storage，thematic database construction and query，analysis and prediction，updating and management. With the help of the knowledge databases，high-quality prevention，diagnosis and treatment services related to rare diseases will be made accessible to patients and their families，medical workers and researchers，the construction of intelligent knowledge service platforms will be supported effectively，and the intelligent knowledge-based service system for rare diseases will be developed based on a good basis. The application of these rare disease knowledge databases and model databases will contribute to the development of solutions to difficulties in  access to rare disease knowledge，and the addressing of diagnostic difficulties，missed diagnosis and misdiagnosis regarding rare diseases.


Design of a Rare Disease Knowledge Network-based Platform 　

HU Hongpu，YIN Tianlu，QIN Panpan，WANG Yan，GAO Xing

2021, 24(28):  3638-3642.  DOI: 10.12114/j.issn.1007-9572.2021.00.290

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The development of information technology and the increasing convenience of information dissemination make it possible to raise patients and their family members' familiarity with rare diseases，primary physicians and specialists' levels of understanding，identification and diagnosis of rare diseases via using a rare disease knowledge network-based platform. In accordance with the analyses of the demand for a rare disease knowledge network-based platform of rare disease patients and their families，clinical healthcare workers，and medical and pharmacological researchers，we designed the technical framework of the rare disease knowledge network-based platform，which showcases the major contents of five layers（data integration，knowledge，function，presentation and users），and clearly indicates seven main functions（comprehensive information，knowledge map，information query，intelligent service，auxiliary registration，communication and interaction，health management）of the knowledge system，with corresponding functional modules developed. This platform will effectively satisfy the diversified needs of users，raise public awareness of rare diseases，facilitate the development of the smart service system for rare diseases，reduce isolated islands or blind spots in rare disease data，and promote the overall and scale effects of rare disease informationization as a good basis.


Development of the Rare Disease Map　

DAI Guolin，LIU Xinyao，CHEN Quan，HU Hongpu

2021, 24(28):  3643-3647.  DOI: 10.12114/j.issn.1007-9572.2021.00.292

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In China，rare diseases have become an important public health issue and a social issue that cannot be neglected. To provide supports for rare disease patients and healthcare decision-making using rare disease big data，we developed the rare disease map using the ArcGIS technology：Firstly，systematically describing the functionality and drawing process of the rare disease map in accordance with the design objectives and the design process. Secondly，developing application modes of the rare disease map to visually demonstrate the paths and methods used for rare disease surveillance，risk assessment and analysis as well as information management. Our study provides ideas and technical routes for the development of a rare disease map，and our rare disease map may be used as a new tool aiding effective prevention and treatment，scientific management and in-depth research regarding rare diseases.


Community General Practitioner's Strategies for Managing Illness Anxiety Disorder　

YU Yushan，XU Zhijie

2021, 24(28):  3648-3652.  DOI: 10.12114/j.issn.1007-9572.2021.00.273

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Illness anxiety disorder（IAD）is a common mental disease encountered by community general practitioners （GPs），which often requires long-term treatment and follow-up. Although community health services are good applicable for treating IAD owing to its continuity and comprehensiveness，community-based management strategies for IAD are very limited，and the research on community GPs' perspectives regarding coping strategies for IAD is very rare. Based on a literature view of IAD，we performed an in-depth analysis of three essentials that community GPs should master for managing IAD：differentiating IAD from other illnesses，exploring potential factors associated with symptoms，evaluating available useful medical and information resources. Furthermore，we put forward IAD managing strategies for community GPs in accordance with features and ideas of community health services，including a thorough evaluation of symptoms and psychological states，implementing shared decision-making，and delivering continuous patient health education. Our study will help to enhance community GPs' management level of IAD.