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    05 October 2022, Volume 25 Issue 28
    World General Practice/Family Medicine
    Paying for Quality: Experience from the UK and Inspiration for China's Healthcare Payment System
    Dongfeng TANG, Sioutang HUANG, Xuan ZHOU, Herngchia CHIU
    2022, 25(28):  3459-3465.  DOI: 10.12114/j.issn.1007-9572.2022.0313
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    China is facing both the rapid growth of medical expenses and challenge of quality care. Paying for quality for healthcare providers used by international healthcare systems has proven to be effective in solving the problems. We systematically reviewed the UK Quality and Outcomes Framework (QOF) , a typical case of paying for quality, with a description of its content, effectiveness of implementation and future prospect, which may have implications for China's healthcare payment system. We analyzed the applicable feasibility of paying for quality in China's healthcare payment system using the policy analytical framework in accordance with China's political, technological, economic and administrative conditions, and suggested that paying for quality may have a good application prospect but with limitations for fully implementation. In the future, it could be first used as a payment method for chronic disease outpatient care or Chinese medicine services as a pilot program, and integrated into the multiple composite medical insurance payment system, and applied to other fields exploratorily.

    Design of the UK Quality and Outcomes Framework for 2021—2022 and Its Implications for China
    Xuezhu LI, Li KUANG, Hui ZHANG
    2022, 25(28):  3466-3474.  DOI: 10.12114/j.issn.1007-9572.2022.0223
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    In China, the performance appraisal system measuring the performance in delivering essential public health services and medical services, and the patient payment system for these services in primary health institutions are still imperfect. The UK Quality and Outcomes Framework (QOF) has been modified many times, and the latest version (2021—2022) places more emphasis on chronic disease prevention and control and the quality of disease management. We introduced the UK QOF, involving its management and operation system, modification process of the indicators, and the indicator composition, scoring rules and performance management of its latest version, particularly detailed the design and operation of its latest version, and summarized the following insights: the UK QOF is a result-oriented quality control system and a reward-oriented incentive mechanism, which focuses on the management of major chronic diseases and their risk factors. Through the establishment of a three-level management system for each major disease, with defined scores and corresponding payment for the indicators, the general practices obtain the payment according to their service quality, thereby increasing the efficiency of the healthcare system in the UK as a whole. The design and operation of the UK QOF will contribute to the improvement of China's national essential public health service specifications and performance assessment systems as well as payment methods for chronic disease outpatient management services in primary care, which in turn boosts the appropriate allocation of the fund for essential public health services and the basic medical insurance fund generally.

    Expert Forum
    2022 Annual Meeting of General Practitioners Association of Shanghai Medical Doctor Association (Ⅰ)
    2022, 25(28):  3475-3483.  DOI: 10.12114/j.issn.1007-9572.2022.W0001
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    The content of this article came from "the Second Shanghai General Practitioners (GPs) Forum" hosted by Shanghai Physicians Association, General Practitioners Division of Shanghai Physicians Association, Shanghai, China, on July 22, 2022, and mainly included four sections as follow: the Role of Primary Medical Care in Integrating Medical Treatment, Constructing General Medical Sciences as National Key Clinical Specialty, Trends in the Development of Primary Health in Shanghai, and Embrace Change, Become Better and Stronger. Among them, the Role of Primary Medical Care in Integrating Medical Treatment illustrated the concept and connotation of "integrated medical treatment" from 3 dimensions: the degree of integration, the stratum of integration, and the direction of integration, and gave a detailed introduction to the realization pathway of integrated medical treatment at 5 levels: the system, management, payment, the service model, and the application of technology; based on the analysis of the common characteristics of primary care and integrated medical care, it illustrated the booster role of primary care in integrating medical treatment at the above 5 levels. From the important role of general practice departments in health care reform and meeting the needs of resident health services, Constructing General Medical Sciences as National Key Clinical Specialty illustrated the need to create a general practice department as a state key clinical specialty, and believed that creating a key clinical specialty need to do the following: creating a high-level of general practice department status, advancing the construction and development of talents in general practice, enhancing the regional collaborative capacity of general practice disciplines, and forming the characteristics of the full range of full cycle health care specialists, thereby promoting the scientific research and innovation development of general practice medicine. Trends in the Development of Primary Health in Shanghai affirmed the contributions of primary health to urban health development, and in the context of "big health", further focused efforts were proposed to promote healthy aging and achieve birth population promotion; the development trend of primary health in Shanghai lay in innovation, while innovation in high-quality development efforts of primary health required GPs as both enablers and leaders to create new models of health services. Embrace Change, Become Better and Stronger argued that the current "weakness" of community health services, was not the hardware or staffing deficit at the beginning of development, but was embodied in the construction of general disciplines. Working staff in the field of general practice should take the initiative to face and accept current changes from the national health strategy, in health needs, medical models, and their own development/management, carry out active health, cope with the coexistence of multiple diseases, strengthen the general and special combination, and focus on service evaluation from the perspective of consumers to assist the discipline construction of general practice medicine.

    Chronic Disease Management
    Application and Prospect of Smart Health Technologies for Optimizing the Healthcare-seeking Behaviors in Chronic Disease Patients
    Yun CHEN, Weijie XU, Huaigu TIAN, Wenxin WANG
    2022, 25(28):  3484-3487.  DOI: 10.12114/j.issn.1007-9572.2022.0297
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    Smart health technologies have been increasingly used in chronic disease management, and become an important way foroptimizing the health management behaviors in patients with chronic diseases. Based on a review of studies about healthcare-seeking behaviors in Chinese patients with chronic diseases and the framework of the Andersen's Behavioral Model of Healthcare Utilization, we summarized that healthcare-seeking behaviors in these patients are associated with predisposing, enabling, and need factors, with enabling factors (economic status and education level) being the key determinant. Therefore, it is necessary to utilize the advantages of care delivery modes using smart health technologies to integrate media resources for health knowledge education, strengthen the social support for vulnerable groups and optimize the cooperation between multiple care delivery groups. The implementation of these strategies will contribute to the empowerment of people with chronic diseases, optimizing their healthcare-seeking behaviors, and making effective use of health service resources.

    Nudge Theory in Chronic Disease Self-management: Advances in Application and Recommendations for Promotion
    Xiaoxuan WANG, Zhenxiang ZHANG, Beilei LIN, Yongxia MEI, Wenna WANG
    2022, 25(28):  3488-3492.  DOI: 10.12114/j.issn.1007-9572.2022.0283
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    Nudge theory is an emerging behavioral intervention theory based on behavioral economics and positive psychology, which has been widely used and proven effective in chronic disease self-management abroad. Compared with traditional intervention methods for chronic disease self-management, nudge theory-based intervention program possesses stronger generalization owing to lower requirements for patients' knowledge and attitude regarding chronic disease self-management without interfering with their freedom of choice. We introduced the concept, mechanism of action and classification of nudge theory, and reviewed the advances in its application in chronic disease self-management from four aspects: symptom monitoring, diet control, physical exercise, and medication adherence. On this basis, we put forward the following recommendations to ensure the effectiveness of nudge theory-based interventions: developing nudge theory-based intervention programs targeting the barriers to chronic disease self-management, delivering different types of interventions to different patients using digital technology as a method for classifying the intervention program, having close contact with the community during the intervention, and strengthening the supervision of relevant departments.

    Chronic Disease Management in Primary Care in China: Recent Advances and Hotspot Analysis Using VOSviewer
    Kai YU, Jiachun WANG, Zhaoyuan ZHOU, Xinyue CHEN, Shuang WANG
    2022, 25(28):  3493-3501.  DOI: 10.12114/j.issn.1007-9572.2022.0393
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    Background

    In China, chronic diseases have become a major public health problem threatening residents' health. Highlighted in the national policies, primary care settings should act as the "main battlefield" for fighting chronic diseases.

    Objective

    To understand the topics, hot spots and development trends in chronic disease management in primary care of China, providing evidence for further research.

    Methods

    In September 2021, relevant literature of chronic disease management in primary care in China were searched in databases of SinoMed, CNKI, Wanfang Data, and CQVIP from inception to September 13, 2021. Endnote X9 was used to conduct statistical analysis of the annual number of publications, distribution of journals, and distribution of institutions.VOSviewer 1.6.14 was adopted for high-frequency keywords analysis, network analysis of keyword co-occurrence, timeline view of keyword co-occurrence network, and visualizing the knowledge map.

    Results

    In total, 4 060 articles published since 1977 (as of September 13, 2021) were included. The annual number of published articles demonstrated an upward trend in general. The journal with the highest number of articles was Chinese General Practice〔329 articles (8.10%) 〕. Fudan University was the most prolific institution〔1.75% (71/4 060) 〕. The top 10 high-frequency keywords were chronic diseases〔8.75% (895/10 224) 〕, community〔7.49% (766/10 224) 〕, elderly people〔4.90% (501/10 224) 〕, diabetes〔4.62% (472/10 224) 〕, hypertension〔4.28% (438/10 224) 〕, chronic obstructive pulmonary disease〔4.22% (431/10 224) 〕, prevalence〔4.04% (413/10 224) 〕, influencing factors〔3.29% (336/10 224) 〕, risk factors〔2.60% (266/10 224) 〕 and quality of life〔1.95% (199/10 224) 〕. Four major hot topics were identified by network analysis of keyword co-occurrence: chronic disease management of the elderly in the community, epidemiology of risk factors for chronic diseases, management and community-based comprehensive prevention and treatment regarding chronic diseases (such as hypertension and diabetes) , community-based nursing and rehabilitation of chronic diseases (mainly for chronic obstructive pulmonary disease) . Hierarchical diagnosis and treatment and contracted family doctor services, informationization and Internet-based services, mental or sleep health, multimorbidity, general practitioner and pharmaceutical care were recently emgerged research themes identified by timeline view of keyword co-occurrence network.

    Conclusion

    The number of studies about of chronic disease management in primary care in China demonstrated an overall upward trend, with management of hypertension, diabetes, and chronic obstructive pulmonary disease in primary care as the research hotspots. Studies on hierarchical diagnosis and treatment and contracted family doctor service, informationization and Internet-based services, mental or sleep health, multimorbidity, and general practitioner and pharmaceutical care are in the ascendant.

    Original Research·Focus on Population Health
    Correlation between Disability and Basic Movement Ability in Elderly People
    Xiangtian WEN, Wenyi NIU
    2022, 25(28):  3502-3507.  DOI: 10.12114/j.issn.1007-9572.2022.0230
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    Background

    As the pace of population aging accelerates, the estimated people aged≥65 years will account for more than 20% of the total population in China by 2030, among them those with disability will expand to 77 million, possessing more than 57% of the total disability population. Decline in the basic movement ability can lead to reduced quality of life, and increased burden on society and families.

    Objective

    To explore the correlation of basic movement ability with disability status in the elderly.

    Methods

    The study was carried out in March 2021. Data were collected from the database of China Health and Retirement Longitudinal Study (CHARLS) in 2015, involving 5 276 surveyees aged≥60 years with complete values of assessed basic movement ability and disability and key variables (gender, age, household location, education level) . The grip strength test, five-repetition sit-to-stand (FRSTS) test, standing balance test and gait speed test were used to evaluate the basic movement ability. Disability prevalence was evaluated by the Instrumental Activities of Daily Living (IADL) Scale. The grip strength level, gait speed, and prevalence of completion of standing balance test and FRSTS test were compared by the prevalence of disability. Logistic regression was used to analyze the correlation of basic movement ability and disability status.

    Results

    The average grip strength value for all individuals was 27.92 (9.02) kg. The prevalence of poor, fair and good grip strength was 32.47% (1 713/5 276) , 33.55% (1 770/5 276) , and 33.98% (1 793/5 276) , respectively. 3 930 cases (74.49%) completed the standing balance test. 5 128 cases (97.19%) completed the FRSTS test. The average gait speed was 0.96 (3.12) m/s for all elderly persons. The prevalence of slow, moderate and fast gait speed was 33.17% (1 750/5 276) , 33.34% (1 759/5 276) , and 33.49% (1 767/5 276) , respectively. 1 419 cases (26.90%) were assessed with disabilities. The prevalence of disability varied significantly by grip strength, standing balance and FRSTS test performance, and gait speed (P<0.05) . Logistic regression results showed that, poor grip strength, inability to complete the standing balance test and the FRSTS test, and low gait speed were associated with increased risk of disability in both 60-74 years and ≥75 years age groups (P<0.05) . The inability to complete the FRSTS test was associated with 3.045 times higher risk of disability in the 60-74 age group, and 4.126 times higher risk of disability in the≥75 age group (P<0.05) .

    Conclusion

    The elderly with poor basic movement ability are prone to disability. In view of this, it is recommended to take measures to improve the basic movement ability of the elderly to delay the onset of disability or relieve the level of disability, thereby improving the quality of life and reducing the health care needs of them, and alleviating the caregiving burden of their family caregivers.

    Migrant Population's Experience of Using Essential Medical Services
    Jinglan WU, Ruqing LIU, Ruwei HU
    2022, 25(28):  3508-3514.  DOI: 10.12114/j.issn.1007-9572.2022.0219
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    Background

    The number of migrant population in China remains high, primarily driven by the developments in industrialisation and urbanisation. The health status and healthcare-seeking experience of this group has become a hot social issue, and promoting their access to equitable essential healthcare services is an important part of China's healthcare system reform.

    Objective

    To compare the experience of using essential medical services between migrant and permanent populations in Guangzhou, to provide evidence for improving the level of using essential medical services in migrant population and for promoting the healthcare equity.

    Methods

    From September to November 2019, we used a multistage random sampling method to select 1 568 cases (including migrant and permanent residents) treated by six general practitioner teams from six community health centers in Guangzhou. Their demographics and experiences of using essential medical services were collected by a questionnaire survey using a self-developed General Data Questionnaire and the simplified Primary Care Assessment Tool-Adult Edition (PCAT-AE) . We compared the total score of the PCAT-AE and its domains scores between the two groups. We used the generalized linear model to analyze the association between the residency status and the experience of using essential medical services.

    Results

    Altogether, 1 568 cases who handed in responsive questionnaires were included for final analysis, among whom 186 (11.86%) were migrant residents. The average total score of the PCAT-AE of all participants, permanent and migrant cases was 3.19 (1.22) , 3.24 (1.23) , and 2.93 (0.75) , respectively. Compared with the permanent residents, the migrants showed lower total score and dimension scores of the PCAT-AE (P<0.05) . The results of the generalized linear model demonstrated that compared with the permanent residents, migrants had worse experience in using services〔b (95%CI) =-0.128 (-0.218, -0.037) , P=0.006〕, such as the use of first-contact care〔b (95%CI) =-0.245 (-0.341, -0.148) , P<0.001〕, continuing care〔b (95%CI) =-0.175 (-0.292, -0.059) , P=0.003〕, family-centered care〔b (95%CI) =-0.112 (-0.225, 0.001) , P=0.050〕, community-oriented care〔b (95%CI) =-0.176 (-0.286, -0.066) , P=0.002〕, and culturally competent care〔b (95%CI) =-0.270 (-0.383, -0.156) , P<0.001〕.

    Conclusion

    The migrants had worse experience of using essential medical services than the permanent residents. In view of this, it is recommended for primary healthcare institutions to provide continuous, accessible, and comprehensive life-cycle essential healthcare services for migrants according to their characteristics, so as to promote the quality development of community health services.

    Breast Cancer Prevention and Treatment Behaviors in Community-living Women: Latent Class Analysis and Influencing Factors
    Jiahui MA, Guolian LIU, Lianhua ZHENG, Yaru BAI, Juanjuan MAI, Wenlian YAO
    2022, 25(28):  3515-3522.  DOI: 10.12114/j.issn.1007-9572.2022.0477
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    Background

    The overall incidence of breast cancer in Chinese women is on the rise, seriously threatening their physical and mental health. Breast cancer prevention and treatment behaviors are critical to the outcomes of affected women in the community. However, these behaviors vary across individuals. And measures should be explored to improve the efficacy of such behaviors.

    Objective

    To perform a latent class analysis of breast cancer prevention and treatment behaviors among community-living women, and to explore the associated factors, providing evidence for individualized prevention and management of female breast cancer in the community.

    Methods

    A total of 1 355 community-living women were selected from in 15 towns/subdistricts of 5 counties/districts in Yinchuan and Zhongwei cities of Ningxia, China by use of convenience sampling method from November 2019 to August 2020. They were surveyed using a questionnaire consisting of baseline characteristics, and breast cancer prevention and treatment behaviors (relevant questions used are belonging to the part of breast cancer prevention and treatment in the Knowledge, Attitude and Practice of Breast and Cervical Cancer Prevention and Treatment Among Women in Ningxia) . The latent classes of breast cancer prevention and treatment behaviors were presented, and their influencing factors were identified by multivariable logistic regression analysis.

    Results

    The survey achieved a response rate of 97.93% (1 327/1 355) .By use of latent class analysis, breast cancer prevention and treatment behaviors of the respondents were classified into four latent classes, including positive prevention and treatment (n=522, 39.34%) , high-risk behaviors plus positive treatment (n=449, 33.83%) , high-risk behaviors plus negative treatment (n=229, 17.26%) , and general prevention and treatment (n=127, 9.57%) . The overall median score of breast cancer prevention and treatment behaviors was 9.00 (7.00, 11.00) points for all respondents. The median score of breast cancer prevention and treatment behaviors was 11.00 (11.00, 12.00) points for respondents with positive prevention and treatment behaviors, 9.00 (8.00, 10.00) points for those with high-risk behaviors plus positive treatment behaviors, 6.00 (5.00, 6.00) points for those with high-risk behaviors plus negative treatment behaviors, and 8.00 (6.00, 9.00) points for those with general prevention and treatment behaviors, with significant difference across the groups (H=1 008.493, P<0.001) . Multivariable Logistic regression analysis showed that, compared with general prevention and treatment behaviors, living in Zhongwei and having a history of childbirth were associated with increased possibility of being classified into positive prevention and treatment behaviors, having health insurance〔urban resident basic medical insurance (URBMI) , commercial health insurance, or other types〕, self-pay treatment, and a history of hormone replacement therapy were associated with increased possibility of being classified into general prevention and treatment behaviors (P<0.05) , having a history of childbirth were associated with increased possibility of being classified into high-risk behaviors plus positive treatment behaviors, having health insurance (URBMI or commercial health insurance) , as well as a history of hormone replacement therapy were associated with increased possibility of being classified into general prevention and treatment behaviors (P<0.05) , and primary education or below, household monthly income per person of 1 000-2 999 yuan were associated with increased possibility of being classified into high-risk behaviors plus negative treatment behaviors, and having URBMI were associated with increased possibility of being classified into general prevention and treatment behaviors (P<0.05) .

    Conclusion

    In general, breast cancer prevention and treatment behaviors in this group could be definitely classified, all being performed at a moderate level. To improve the level of breast cancer prevention and treatment behaviors of Ningxia's community-living women, focus should be on those who have high-risk behaviors and negatively seek for treatment. Moreover, the problems in positive breast cancer prevention and treatment behaviors in women with other three classes of behaviors should also be intervened and corrected to improve the outcomes of them.

    Functional Constipation in Children from Urban Communities: Prevalence and Associated Factors
    Mengdian ZHANG, Shuang YU, Yuchun LIU, Jing DING
    2022, 25(28):  3523-3530.  DOI: 10.12114/j.issn.1007-9572.2022.0306
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    Background

    Functional constipation (FC) is highly prevalent with complex associated factors in children, posing great health risk to the affected children. So far, the results of studies on the prevalence of FC and its influencing factors vary widely, and those focusing on FC in urban children in China are relatively few.

    Objective

    The purpose was to investigate the prevalence and influencing factors of FC in children in urban communities, so as to provide data support for establishing a database of FC in children in the community and for carrying out standardized, multidisciplinary and continuous management of FC in children in the community.

    Methods

    Children aged 6 to 48 months who were registered as recipients of health services delivered by Yuetan Community Health Center, Beijing were selected from the Beijing Maternal and Child Healthcare Information System (Phase 2) during the period from April to July 2021. A questionnaire designed by our research group was used to survey the primary guardians of the included children, focusing on questions related to defecation habits prepared according to the RomeⅣ criteria for FC in the Childhood Functional Gastrointestinal Disorders: Neonate/Toddler issued in 2016, and factors possibly influencing FC including history of allergies, family history of constipation, mode of delivery, feeding practices, appetite, eating habits, daily water intake, frequency of physical activity, and family parenting practices. In total, 1 458 guardians attended the survey, and children of the 1 264 (86.69%) guardians who handed in responsive questionnaires were finally included for analysis.

    Results

    The overall prevalence of FC was 9.89% (125/1 264) . Specifically, the prevalence of FC in age groups of 6 to 12, 13 to 36, and 37 to 48 months was 10.39% (16/154) , 8.75% (69/789) , and 12.46% (40/321) , respectively, demonstrating no significant difference in FC prevalence by age group (P>0.05) . The results of multivariate Logistic regression analysis showed that allergy history and feeding practices were influential factors for FC in 6-12-month-old children (P<0.05) , allergy history, feeding practices and parenting style were influential factors for FC in 13-36-month-old children (P<0.05) , and allergy history and parenting style were influential factors for FC in 37-48-month-old children (P<0.05) .

    Conclusion

    The prevalence of FC in 6-48-month-old children in urban communities is high, which is associated with multiple preventable and controllable factors, suggesting that the prevention of FC in this age group of children should be carried out in accordance with individual factors, family relationship, and social environment.

    Status and Influencing Factors of HIV/AIDS Patients Co-infected with Hepatitis C Virus in Guizhou
    Xiucheng YANG, Zhangping HONG, Qing LIU, Yong HU, Jie LI, Xinglin YANG
    2022, 25(28):  3531-3536.  DOI: 10.12114/j.issn.1007-9572.2022.0329
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    Background

    The status of patients with HIV/AIDS co-infected with HCV considerably varies in different parts of China. The co-infection of HIV and HCV accelerates the clinical progress of the disease, thereby reducing the patients' quality of life and exacerbating the occurrence of death. Currently, there are relatively few studies on patients with HIV/AIDS co-infected with HCV in Guizhou.

    Objective

    To analyze the status of patients with HIV/AIDS co-infected with HCV in Guizhou and its influencing factors and consequently provide basis for its early detection, diagnosis, and treatment.

    Methods

    The cases included in this study were a cohort of HIV/AIDS patients who received antiviral therapy (ART) in the public health rescue center of Guangzhou from March 2006 to December 2020. Finally, 3 084 patients who met the study requirements were included. Patients' sex, age, ethnicity, education level, occupation, marital status, route of infection, year of diagnosis, and CD4+ T-lymphocytes before ART and anti HCV levels were collected. Multivariate Logistic regression model were used to identify influencing factors of patients with HIV/AIDS co-infected with HCV.

    Results

    Among the 3 084 patients with HIV/AIDS, 202 were co-infected with HCV, and the co-infection rate was 6.55%. There were significant differences in HCV infection rates among patients with HIV/AIDS of different age groups, education levels, occupations, route of infection (P<0.05) . There were no significant differences in HCV infection rates among patients with HIV/AIDS by gender, ethnicity, and marital status (P>0.05) . The prevalence of HCV infection among HIV/AIDS patients tended to decrease with increasing year of diagnosis and increasing levels of CD4+ T lymphocytes (P<0.05) . Multivariate Logistic regression analysis showed that the risk of HCV infection was higher among HIV/AIDS patients aged 30-39 and 40-49 years than among those ≥50 years〔OR (95%CI) =2.512 (1.374, 4.593) , 2.802 (1.521, 5.163) , respectively〕, and the risk of HCV infection was higher among HIV/AIDS farmers than among those in other occupations〔OR (95%CI) =1.926 (1.201, 3.090) 〕. Route of infection of intravenous drug user was higher for HIV/AIDS patients with HCV infection than for MSM〔OR (95%CI) =39.038 (17.559, 86.790) 〕, and for HIV / AIDS patients diagnosed 2006—2010, 2011—2015, the risk of HCV infection was higher than that for those diagnosed 2016—2020〔OR (95%CI) =10.890 (6.428, 18.447) , 4.613 (2.928, 7.269) , respectively〕. Those with baseline CD4+ T lymphocytes <200, 200-350, 351-499/μl had higher risk of HCV infection among HIV/AIDS patients than those with baseline CD4+ T lymphocytes≥500/μl, respectively〔OR (95%CI) =7.120 (3.731, 13.589) , 3.614 (1.818, 7.184) , 2.795 (1.319, 5.922) 〕.

    Conclusion

    Although the strategy of "exhaustive treatment" for HIV/AIDS has decreased HCV infection rates among patients with HIV/AIDS in Guizhou, the status still need to be carefully monitored. Early HCV screening should be conducted for the HIV/AIDS population, focusing on individuals aged 30-49 years, intravenous drug users, farmers, and those with low CD4+ T-lymphocyte levels.

    Original Research·Focus on General Practice Education
    Mediating Role of Job Satisfaction in the Relationship between Job Satisfaction and Career Development Satisfaction in Healthcare Workers of Township Hospitals
    Junlin LIU, Gong FENG, Zhiqian DU, Na HE
    2022, 25(28):  3537-3543.  DOI: 10.12114/j.issn.1007-9572.2022.0281
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    Background

    Talent team is a key factor that affects the service level and development of township hospitals. The 19th CPC National Congress held in 2017 proposed to strengthen the construction of primary care system and general practitioners team. There are few available studies on primary care physicians' satisfaction with work unit, job and career development in township hospitals.

    Objective

    To examine the relationships among work unit satisfaction, career development satisfaction and job satisfaction in primary care physicians working at township hospitals, providing scientific evidence for the construction of healthcare talent team in township hospitals.

    Methods

    This study was implemented from December 2019 to August 2020. By use of stratified multistage sampling, 1 736 physicians were selected from 193 township hospitals in 9 counties (districts) of Yulin, Baoji and Shangluo, three cities of Shaanxi to attend a questionnaire survey for understanding their basic demographics, work unit satisfaction, career development satisfaction and job satisfaction. SPSS AU and R were used for data analysis. Pearson correlation was used to analyze correlations among work unit satisfaction, job satisfaction and career development satisfaction. Hierarchical regression was used for mediation analysis. The mediating effect of job satisfaction was further tested by bootstrap test for product of coefficients.

    Results

    Among the 1 736 cases, 1 727 (99.48%) who returned responsive questionnaires were included for final analysis. The average score of work unit satisfaction in the respondents was (2.03±0.52) points, and the average scores for its five dimensions (satisfaction with the overall management, the management system, welfare benefits, and development prospect, as well as the sense of identity obtained from the unit) were (1.94±0.93) , (2.55±1.21) , (2.17±0.73) , (1.91±0.80) , and (1.57±0.72) points, respectively. The average score of job satisfaction was (1.98±0.45) , and that of career development satisfaction was (2.42±0.49) . Pearson correlation analysis showed that career development satisfaction was positively correlated with work unit satisfaction and job satisfaction (P<0.05) . Hierarchical regression analysis revealed that job satisfaction played a mediating role in the relationship of satisfaction with welfare benefits, unit development prospect, and sense of identity obtained from the unit with career development satisfaction (P<0.05) . Further examination of mediation effect of job satisfaction showed that job satisfaction partially mediated in the relationship between satisfaction with welfare benefits and career development satisfaction (with an effect size of 0.020) , satisfaction with unit development prospect and career development satisfaction (with an effect size of 0.022) , or satisfaction with the sense of identity obtained from the unit and career development satisfaction (with an effect size of 0.012) (P<0.05) .

    Conclusion

    As job satisfaction plays a mediating role between work unit satisfaction and career development satisfaction in primary care physicians in township hospitals, it is suggested to improve their satisfaction with welfare benefits, unit development prospect and sense of identity obtained from the unit, to enhance their job satisfaction, thereby improving their career development satisfaction.

    Assistant General Practitioner Training Bases in Hebei Province: the Assessment and Recommendations for Improvement
    Min ZHANG, Shibin SONG, Shujun LI, Jinjia ZHANG, Weiguo QIAN, Zhishan ZHOU, Rongying WANG
    2022, 25(28):  3544-3549.  DOI: 10.12114/j.issn.1007-9572.2022.0192
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    Background

    As an important supplement for strengthening the development of general practitioners (GPs) workforce in primary care in China's rural areas, the training for assistant GPs has been carried out in Hebei Province for five consecutive years. Standardizing the construction of the bases for training assistant GPs, and ensuring the quality of the training are key measures to improve the quality of primary care services in Hebei rural areas.

    Objective

    To understand the assessment of Hebei's assistant GP training bases in 2020, and put forward policy suggestions targeting the existing problems.

    Methods

    We conducted this study during July 27 to 31, 2020. We assessed the 23 assistant GP training bases in Hebei using the Assistant General Practitioner Training Base Assessment System developed by the Chinese Medical Doctor Association, involving general condition, training management, faculty team, process management, quality control and supporting measures. We also conducted a questionnaire survey with trainees randomly selected from these bases (two or three trainees chosen from each base) for understanding their socio-demographics, understanding of the training, satisfaction with the training, attitudes on the career prospect of an assistant GP, and level of intention to work in rural areas.

    Results

    The rates of qualified, basically qualified and unqualified bases were 65.2% (15/23) , 34.8% (8/23) , and 0, respectively. Thirteen 13 bases (56.5%) had not yet set up an independent general medicine department; 11 bases (47.8%) had qualified teaching rounds assessed in terms of number and implementation standards; 10 bases (43.5%) carried out small lectures and case discussions appropriately assessed in terms of number and implementation standards. The rate of passing the national Assistant Physician Licensing Examination once was≥85% in 2019 for trainees in 8 bases (34.8%) . The rate of passing the completion examination at the end of the training conducted for the first time in all bases in 2019 was≥85% for trainees in 12 bases (52.2%) . A total of 50 trainees attended the questionnaire survey. The prevalence of being satisfied with the design of the rotation of departments, training contents, clinical training base, primary care practice base, and the teaching team was 90.0% (45/50) , 90.0% (45/50) , 92.0% (46/50) , 86.0% (43/50) , and 94.0% (47/50) , respectively. The career prospect of an assistant GP was thought to be good by 39 trainees (78.0%) . Twenty-six trainees (52.0%) were willing to practice in rural areas. The level of satisfaction with policies related to the training for assistant GPs or primary care practice bases differed significantly by age in trainees regardless of whether the bases were qualified or basically qualified (P<0.05) .

    Conclusion

    In general, Hebei's training bases for assistant GPs were found with a low rate of setting an independent general medicine department, unsatisfactory training quality, and low trainee satisfaction. It is suggested that these training bases should strengthen the establishment of a general medicine department and connotation construction of general practice, improve the construction of primary care practice bases, standardize the process management, thereby improving the training quality.

    Development of the Effectiveness Assessment System of Community-based Clinical Teaching for Medical Undergraduates
    Li SUN, Zhijun LIU, Min GE, Zhen WANG, Min WANG, Xin LIU
    2022, 25(28):  3550-3555.  DOI: 10.12114/j.issn.1007-9572.2022.0227
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    Background

    Community-based clinical teaching is of vital importance in the training of medical undergraduates, but high level of effectiveness of teaching is difficult to be guaranteed at present. So it is essential to establish a scientific and effective system for assessing the effectiveness of community-based clinical teaching for medical undergraduates.

    Objective

    To develop an effectiveness assessment system of community-based clinical teaching for medical undergraduates, providing support for assessing the effectiveness of community-based clinical teaching in these undergraduates.

    Methods

    The item pool for the system used for assessing the effectiveness of community-based clinical teaching in medical undergraduates was developed on the basis of reviewing relevant literature and assessment tools, and was drawn up by group discussions. Then the items were improved according to two rounds of Delphi consultation with a purposive sample of 32 relevant experts from June 2019 to April 2020, and used to develop the Effectiveness Assessment System of Community-based Clinical Teaching for Medical Undergraduates (EASCCTMU) . The Analytic Hierarchy Process was used to calculate the weight of each indicator.

    Results

    The response rate was 100.0% for both rounds of consultation. The authoritative coefficients for the first and second rounds of consultation were 0.87 and 0.88, respectively. The Kendall's coefficient of concordance for the first and second rounds of consultation were 0.65 and 0.61, respectively (P<0.01) . The final system contains 4 first-level indicators (clinical thinking skills, public health preparedness capability, medical humanistic beliefs, and community-based teaching feelings with corresponding weights of 0.456 1, 0.242 5, 0.283 2 and 0.305 1) and 26 second-level indicators.

    Conclusion

    The EASCCTMU is highly scientific and operable, which could be used for comprehensively and objectively assessing the effectiveness of community-based clinical teaching in medical undergraduates. However, it still needs to be improved by empirical research.

    Original Research·Community-based Pharmaceutical Care
    Needs of Pharmaceutical Care in the Community of Shanghai
    Zhenwei LIU, Wenhui WU, Manhua QIAO, Muhan CHEN, Cao WANG, Qi TANG, Jun LYU, Gang CHEN
    2022, 25(28):  3556-3561.  DOI: 10.12114/j.issn.1007-9572.2022.0075
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    Background

    To satisfy the pharmaceutical care needs of a growing number of patients seeking healthcare in primary care, it is increasingly important to integrate family doctor teams as providers of such care services, while the way bringing the strength of the teams into full play needs to be further explored.

    Objective

    To understand the needs of pharmaceutical care services in the community of Shanghai, providing a reference for improving the way of integrating community pharmacists into a family doctor team for delivering such services.

    Methods

    This study was conducted from September to December in 2020. Multistage sampling was used to select 349 elderly patients with chronic diseases in the community and 855 main members of family doctor teams〔general practitioners (n=481) , nurses (n=234) , and public health doctors (n=140) 〕 for questionnaire survey. The questionnaire for the patients mainly includes demographics, chronic condition, use of medications, needs and utilization of community-based pharmaceutical care. And the questionnaire for family doctor team members mainly contains demographics, understanding of community-based pharmaceutical care, and pharmaceutical services preferred to be involved in as a provider.

    Results

    According to the survey results, the prevalence of three or more chronic diseases, and needing to take medications two or more times a day was 35.8% (125/349) , and 87.4% (305/349) , respectively. Among medication management services, "medication re-prescribing and follow-up" was the most needed〔14.9% (52/349) 〕, and "medication follow-up" was the most used〔14.0% (49/349) 〕. Among medication education services, "universal education on medication cautions for chronic conditions" was the most needed〔70.8% (247/349) 〕, and "healthy lifestyle promotion" was the most used〔9.4% (33/349) 〕. Among family doctor team members, 440 (91.5%) general practitioners, 202 (86.3%) nurses and 112 (80.0%) public health doctors expressed that they had an understanding of pharmaceutical care. In terms of the level of trust in pharmacists, the self-reported level of 302 (62.8%) general practitioners, 183 (78.2%) nurses, and 103 (73.6%) public health doctors was high. The number of general practitioners, nurses, and public health doctors wanting to be involved in "assisting physicians in providing medication selection and use services" was 359 (74.6%) , 112 (47.9%) , and 81 (57.8%) , respectively. The number of general practitioners, nurses, and public health doctors wanting to be involved in "providing nurses with guidance on medication use and management" was 190 (39.5%) , 153 (65.4%) and 57 (40.7%) , respectively.

    Conclusion

    Elderly patients with chronic diseases were in urgent need of medication management services, and more medication education services. However, the strength of pharmaceutical professional workforce in the community was weak, and family doctor team members had limited understanding of community-based pharmaceutical services. To efficiently provide residents with such services, it is suggested to train family doctor team members with relevant trainings by pharmaceutical professionals to improve their understanding level and service capability regarding pharmaceutical services at the individual and team levels.

    Community Pharmaceutical Services Implemented in Shanghai
    Manhua QIAO, Wenhui WU, Zhenwei LIU, Muhan CHEN, Cao WANG, Qi TANG, Jun LYU, Gang CHEN
    2022, 25(28):  3562-3568.  DOI: 10.12114/j.issn.1007-9572.2022.0076
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    Background

    Most of the elderly are prone to more than two chronic diseases and polypharmacy. Community health institutions are the key to ensuring rational drug use for in this population. Given many problems existing in the delivery of community pharmaceutical services, how to make better use of existing resources to improve the level of community pharmaceutical services remains to be further explored.

    Objective

    To understand the status of community pharmaceutical services implemented in Shanghai, providing a reference for improving community pharmaceutical services.

    Methods

    We conducted a survey in Shanghai with 235 pharmaceutical professionals selected by use of phased sampling from September to December 2020 with a questionnaire named as "Community Pharmacists Questionnaire" developed by us based on the results of previous literature review and on-site visits. In November 2020, we conducted a focus group interview with 82 stakeholders (including one pharmaceutical professional, one general practitioner and one community administrator selected from each community, two or three administrators selected from the health commission of each district) in Shanghai guided by an outline named as "Rational Drug Use for the Elderly" developed by us based on the results of previous literature review and on-site visits. The allocation of community pharmaceutical care resources, implementation and management of community pharmaceutical care involved in the interview were extracted as supplements to the survey results.

    Results

    Among the 235 community pharmacists surveyed, the prevalence of providing prescription dispensing, prescription review, pharmaceutical drive-thru window services or outpatient consultation and guidance, and prescription comment services was 94.0% (221/235) , 82.6% (194/235) , 64.3% (151/235) , and 51.9% (122/235) , respectively. Among these services, prescription dispensing and prescription review were ranked as the top two in terms of average comprehensive score, indicating that implementing these two services required longer working hours of community pharmacists. In terms of the delivery methods of community pharmaceutical services, community pharmacists mainly used consultation windows〔226 cases (96.2%) 〕, pharmaceutical clinics〔119 cases (50.6%) 〕 and publicity lectures〔109 cases (46.4%) 〕. Only 53 (22.6%) participated in the family doctor team, among whom 22 (41.5%) had the qualification of clinical pharmacist; 47 (88.7%) mainly provided public education on rational drug use, and 45 (84.9%) mainly provided medication guidance and consultation services for patients. In terms of training, 180 cases (76.6%) participated in a training in the past one year, while other 55 (23.4%) cases did not. The number of trainings for most of cases was one or two times〔105 (58.3%) 〕. The way of trainings for most of cases was continuing education〔155 (86.1%) 〕. Both the questionnaire survey and interview results revealed that the main problems existing in the provision of community pharmaceutical services were heavy workload of dispensing/prescription review, lack of clinical knowledge patients' insufficient trust in pharmacists, and lack of performance incentives.

    Conclusion

    To meet the pharmaceutical needs of elderly patients with multiple chronic conditions, actions need to be taken to reduce the heavy workload of delivering traditional services in pharmacists, strengthen the clinical training of in-service pharmacists, and encourage pharmacists to join the family doctor team. Through providing pharmaceutical consultations and trainings for other family doctor team members by pharmacists, the scope of influence of pharmaceutical services will be expanded, which contributes to the ensuring of rational drug use.

    Evidence-based Medicine
    Prevalence of Helicobacter Pylori Infection and Associated Risk Factors among Chinese Children: a Meta-analysis
    Wenhong LI, Ziwei LI, Na WANG, Jiaxiang YIN
    2022, 25(28):  3569-3578.  DOI: 10.12114/j.issn.1007-9572.2022.0028
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    Background

    Helicobacter pylori is difficult to remove naturally in children after being infected with it. Due to differences in sample size and features, design and setting, there is little consistency between studies on epidemiology of Helicobacter pylori infection and its affecting factors in children from China, a country with high prevalence of Helicobacter pylori. Therefore, a comprehensive and objective understanding of the prevalence and risk factors of Helicobacter pylori infection among Chinese children is of great significance for the prevention of Helicobacter pylori infection in this group.

    Objective

    To systematically review the prevalence and risk factors of Helicobacter pylori infection among Chinese children.

    Methods

    In June 2021, We searched for studies on Helicobacter pylori infection and its risk factors among Chinese children in databases of PubMed, EmBase, the Cochrane Library, CNKI, CQVIP and Wanfang Data from inception to June 2021. Two reviewers independently screened the literature, extracted data, and evaluated the quality of included studies. Meta-analysis was performed using R 4.1.0.

    Results

    Thirty-seven articles were included with a total sample size of 40 786 cases, of whom 11 267 were infected with Helicobacter pylori. Meta-analysis showed that the overall prevalence of Helicobacter pylori infection was 30.31%〔95%CI= (25.72%, 35.10%) 〕. Subgroup analysis showed that the prevalence of Helicobacter pylori infection significantly varied by geographical region of participants, the year of the publication of the article, and Helicobacter pylori detection method (P<0.05) . With the city economic decline, the prevalence of Helicobacter pylori infection in children was on the rise (χ2trend=465.955, P<0.001) . Univariate meta-regression results showed that the city economic level had a significant impact on the prevalence of Helicobacter pylori infection in children (P<0.05) . Meta-analysis further indicated that poor living conditions〔OR (95%CI) =1.47 (1.09, 2.00) 〕, history of premastication〔OR (95%CI) =2.88 (1.80, 4.60) 〕, children〔OR (95%CI) =1.56 (1.01, 2.43) 〕or family members〔OR (95%CI) =2.23 (1.68, 2.98) 〕with gastrointestinal symptoms, gnawing fingers or toys〔OR (95%CI) =3.64 (2.10, 6.32) 〕, and use of shared bathroom utensils〔OR (95%CI) =2.54 (2.54, 5.73) 〕 were all risk factors for Helicobacter pylori infection in children. In contrast, living in urban areas〔OR (95%CI) =0.63 (0.56, 0.71) 〕and washing hands frequently〔OR (95%CI) =0.36 (0.18, 0.69) 〕were associated with decreased risk of Helicobacter pylori infection. In addition, the prevalence of Helicobacter pylori infection increased with the age of the children (χ2trend=416.923, P<0.001) .

    Conclusion

    The overall prevalence of Helicobacter pylori infection among Chinese children is high, which may be higher in children living in rural and economically lagging areas, and with poor hygiene habits of individuals or family members. Strengthening Helicobacter pylori screening in children in rural areas and the education of associated risk factors will help to effectively prevent Helicobacter pylori infection in children.

    Health-related Quality of Life Instruments in Infertility Patients: a Systematic Review and Evaluation
    Zhao SHI, Shunping LI, Xiaoyan WU, Jiaqi LIU, Huimin DU
    2022, 25(28):  3579-3586.  DOI: 10.12114/j.issn.1007-9572.2022.0084
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    Background

    Health-related quality of life (HRQoL) is a key indicator that is used for evaluating clinical outcomes. Infertility-specific HRQoL instruments have been widely used, but it is uncertain whether these instruments have good measurement properties in clinical application, and there is a lack of quality evaluation for them.

    Objective

    To perform a systematical review and evaluation of HRQoL instruments in infertility patients, offering a rational reference for the selection of these instruments.

    Methods

    In October 2020, PubMed, Web of Science, the Cochrane Library, EmBase, CNKI, WanFang Data, CQVIP, and SinoMed databases were searched from inception to October 5, 2020 to identify studies on HRQoL instruments designed for or assess HRQoL for patients with infertility. Two reviewers independently implemented literature screening, data extraction, and methodological quality assessment of the included studies in terms of the process of developing infertility-specific HRQoL instruments and measurement properties of the instruments using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Descriptive analysis was used to summarize and analyze the assessment results.

    Results

    We included 229 studies on 19 HRQoL instruments, including 4 infertility-specific HRQoL instruments〔TLMK (Tübinger Lebensqualit?tsfragebogen für M?nner mit Kinderwunsch) , the Fertility Quality of Life (FertiQoL) , Quality of Life in Infertile Couples Questionnaire (QOLICQ) , Quality of Life in People with Infertility Induced by Liver Qi Stagnation Identified by Chinese Medicine Theory〕, 4 cancer-specific or other disease-specific HRQoL instruments and 11 generic HRQoL instruments. The FertiQoL was the most frequently used in existing studies〔39.1% (91/233) 〕. Regarding the development of PROMs, of the 4 infertility-specific HRQoL instruments, except for the FertiQoL instrument, whose overall development quality was considered "doubtful", the overall development quality of the other three instruments was considered "inadequate". In terms of the content validity, the methodological quality of the studies on FertiQoL and QOLICQ development was rated "very good" and "doubtful", respectively, while that of the study on the TLMK or Quality of Life in People with Infertility Induced by Liver Qi Stagnation Identified by Chinese Medicine Theory scale development was rated "adequate". In terms of the construct validity, except for the study on QOLICQ development, which was of "doubtful" methodological quality, the methodological quality of studies on the other three instruments development was considered "adequate". And the construct validity was rated "indeterminate" for all these 4 instruments. In terms of the internal consistency, the methodological quality of studies on the development of the 4 instruments was rated "very good", and the internal consistency of the 4 instruments was rated "sufficient". Regarding the test-retest reliability, the methodological quality of the study on QOLICQ development was considered "doubtful" and the test-retest reliability of the instrument was rated "indeterminate". The methodological quality of studies on the Quality of Life in People with Infertility Induced by Liver Qi Stagnation Identified by Chinese Medicine Theory scale development was rated "very good" in terms of criterion validity, and the criterion validity of the instrument was rated "sufficient". The methodological quality of the study on TLMK instrument development was rated "very good" in terms of criterion validity, and the criterion validity of this instrument was rated "sufficient". As for responsiveness/sensitivity, the methodological quality of the study on FertiQoL development was rated "very good", and the responsiveness/sensitivity of the instrument was rated "sufficient".

    Conclusion

    The methodological quality of the study on the development of FertiQoL and the measurement properties of the instrument were much higher. The number of Chinese infertility-specific HRQoL instruments is insufficient and needs more relevant studies.