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05 December 2022, Volume 25 Issue 34

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Research Productivity in General Practice of China

Research Trends in General Practice and Community Health: the Future is Coming

YU Dehua

2022, 25(34):  4227-4231.  DOI: 10.12114/j.issn.1007-9572.2022.0702

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Scientific research is a key element of scientific development, which determines the height of that science's development. Research papers published in academic journals are the primary examples of current scientific research results, and analysis of academic journals and publications on a subject can reflect the current development state and trend of scientific research in that science. This paper outlines the trajectory of scientific research in general practice and community health in China, proposes the problems that exist, and provides strategies for improving them througha result of YU Dehua team's bibliometric analysis of papers published in 4 Chinese general practice journals from 2001 to 2020, as well as the Journal of Chinese General Practice research group analyzed papers published by scholars in the field of general practice in 2021. In the future, the scientific research on general practice and community health sciences research can be focused on the following directions: functional positioning and working model of primary medical care, construction of general practice disciplines, collaborative development of regional health, chronic disease management, clinical quality management, primary care and community health service capacity, new models of community health functions oriented to active health, physical and mental care for community populations, training and capacity development of general practitioners, and methodology of scientific research in general practice and community health.

Primary Care and General Practice Research Paper Productivity Report in China in 2021

CAO Xingyang, WANG Yang, XU Zhijie, XU Yanli

2022, 25(34):  4232-4240,4258.  DOI: 10.12114/j.issn.1007-9572.2022.0701

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Background

With the deepening of health care reform in China, primary care and general practice researches have developed rapidly in recent years, and the number of papers published has increased rapidly.

Objective

Summarize and analyze the scientific research papers published in the field of primary care and general practice in China in 2021, explore the characteristics in the number of papers published, journals published, regions, institutions, research categories, research methods, and the number of authors.

Methods

Based on the disciplinary definition of the research concepts, themes and methods in this field, combining scoping review methods and bibliometric techniques, scientific research papers published by researchers in Chinese scientific research institutions in 2021 included in the CNKI, Wanfang, PubMed, and Web of Science database were retried, induced and analyzed. In this paper, combined with the scope review method and bibliometric technology, a systematic search and quantitative analysis were carried out on scientific research papers in the fields of primary care and general practice published by researchers in Chinese scientific research institutions in 2021 included in the CNKI, Wanfang, PubMed, and Web of Science databases.

Results

There are 3 122 original research papers published in the fields of primary care and general practice in China in 2021. The number of papers published by primary care institutions accounted for 57.69%, but most of the papers were completed by a single authoramong such institutions. Papers published by the eastern primary care institutions accounted for 80.12%. The research category is dominated by clinical research (58.23%) and health services researches (27.07%) , the co-occurrence analysis of keywords by VOSviewer shows that the research themes focus on "chronic disease management" and "contracted family doctor services", these papers mostly used randomized controlled trials (40.87%) and cross-sectional survey studies (36.71%) in research methods. The vast majority of papers in primary care and general practice field are published in non-core and non-SCI/SSCI journals (76.75%) , and only 6.98% of papers are published in SCI/SSCI journals.

Conclusion

The productivity level of primary care and general practice research in China has now reached the highest level in the world, of which the primary care institutions in the eastern region have made major contributions. The research topics in the primary care and general practice field are close to institutional practice and national health policy. However, there are still a series of problems and challenges in this field, such as the lack of cooperation among researchers in primary care institutions, the large number of studies using randomized controlled trial methods may have problems such as quality concerns and low recognition of research in this field in China by international SCI/SSCI journals.

Research Hotspots and Trends of General Practice and Community Health in China: Based on the Data of Chinese Journals in General Practice from 2001 to 2020

JIN Hua, FU Qiangqiang, YU Dehua

2022, 25(34):  4241-4251.  DOI: 10.12114/j.issn.1007-9572.2022.0703

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Background

To meet the growing healthcare needs of people and requirements of the national healthcare reform, general practice and its service delivery models have been introduced into Chinese mainland, and developed rapidly with the support and promotion of national policies. However, the localization of general practice in China has revealed that the academic discipline development and delivery models of general practice are still immature, and the research content, practice path and research methods regarding general practice need to be further clarified.

Objective

To perform a review of the articles published in Chinese general practice journals to assess the academic discipline development, theoretic research and practice status, and focus areas for development regarding general practice, providing evidence for academic discipline development of general medicine in China.

Methods

In December 2021, the CNKI database was systematically searched for articles published in four representative Chinese general practice journals (Chinese General Practice, Chinese Journal of General Practitioners, Chinese Journal of General Practice, and Chinese Primary Health Care) from 2001 to 2020, and the official websites of the State Council and the National Health Commission of the People's Republic of China were searched for policy documents about general practice and the reform of the pharmaceutical and healthcare system issued from 1997 to 2020. The themes of policy documents in every five years in the period 2001—2020 were analyzed. And keywords of articles published in every five years in the period 2001—2020 were extracted for word frequency analysis and co-occurrence analysis, and for identification of the burst terms. Then the consistency of research hotspots with the themes of policy documents in every five years during 2001—2020 was assessed.

Results

Altogether, 54 726 articles were included, from which 1 398 keywords were extracted and sorted out, and 62 related policy documents were retrieved. The top 10 keywords in terms of frequency of use were "efficacy" (n=2 998) , "community health service" (n=2 235) , "diabetes" (n=2 004) , "influencing factors" (n=1 586) , "elderly people" (n=1 368) , "diagnosis" (n=1 359) , "hypertension" (n=1 313) , "general practitioner" (n=1 303) , "children" (n=1 302) and "nursing" (n=1 107) . By cluster analysis of key words, the major directions of research on general practice and community health during 2001—2020 were classified into three categories: clinical diagnosis and treatment (involving the efficacy assessment of treatment, nursing, and various laboratory examination methods, and diagnosis and treatment of multiple cancers) , disease management (including the management of various common diseases and frequently-occurring diseases, and most of them are chronic diseases, such as diabetes, hypertension, chronic obstructive pulmonary disease, coronary heart disease, depression, pregnancy complications, and cognitive dysfunction) , and community health services (mainly involving health education, community health, rural health, contracted family doctor services, tiered diagnosis and treatment, and bi-directional referral services) . The analysis of burst terms indicated that the focus of research during 2001—2005 was mainly on clinical analysis and clinical observation of diseases, community health services, township health centers, and rural doctors, and that during 2016—2020 was mainly on the analysis of influencing factors of diseases, tiered diagnosis and treatment, contracted family doctor services and quality of life, which were basically consistent with the requirements of the national policies regarding medical and health development.

Conclusion

The research regarding general practice and community health from 2001 to 2020 in China revealed that general medical services have played an important part in satisfying the needs of basic medical and public health, which cover all population throughout the entire lifecycle, and focus on addressing both somatic or mental health issues. Moreover, the related research hotspots were centered on the application of the biopsychosocial model and people-centered model, and basically targeting the requirements of the national reform of the pharmaceutical and healthcare system. It is recommended to paid more attention to general practice education and the innovation of medical models in future research, so as to promote the sustainable development of general practice.

Development Status and Strategy of Research Capability of General Practice and Community Health in China: Based on the Data of Chinese Journals in General Practice from 2001 to 2020

FU Qiangqiang, JIN Hua, YU Dehua

2022, 25(34):  4252-4258.  DOI: 10.12114/j.issn.1007-9572.2022.0705

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Background

Scientific research is an important part of discipline construction and a driving force of discipline development. However, there is a lack of systematic analysis of research capacity and quality in the field of general practice and community health in China.

Objective

To understand the current situation of China's general practice research capabilities, analyze the existing problems and provide a basis for further improving the research capabilities in the field of general practice and community health in China.

Methods

In December 2021, academic papers published from 2001 to 2020 in Chinese General Practice, Journal of General Practitioners, China General Practice, and Primary Health Care in China were retrieved from CNKI platform. The years of 2001—2020 were divided into four time periods, on average of 5 years, and the regional distribution, institution type distribution, investigator cooperation network, and study type distribution of the institutions of the first author of the included articles were bibliometrically analyzed using Vosviewer 1.6.17.

Results

Finally, 54 726 papers were included. From 2001 to 2020, research institutions in East China published the largest number of papers (24 015, 43.88%) , followed by North China (11 288, 20.63%) and South China (5 437, 9.93%) . There was an overall upward trend in the number of publications in community health service centers, which increased from 15 in 2001 (1.31% of the total annual volume) to 203 in 2020 (9.38% of the total annual volume) . A total of 8 collaborative networks emerged from the analysis of co-occurrence among investigators, including the following research teams: Department of General Practice of Zhongshan Hospital, the Journal of Chinese General Practice, and the Capital Medical University. Regarding the types of studies, the percentage of studies in the theoretical class decreased from 28.68% (329/1 147) in 2001 to 17.93% (388/2 164) in 2020; the proportion of intervention type studies gradually increased from 10.11% (116/1 147) in 2001 to 17.28% (374/2 164) in 2020, but its proportion in the overall studies was still low; the percentage of observational studies was the highest, with 64.79% (1 402/2 164) in 2020.

Conclusion

The research in the field of general practice and community health in China has shown a rapid development trend from 2001 to 2020, but there still remain some problems such as unbalanced development of research capabilities, insufficient cooperation and communication of research teams, and insufficient innovation of research methods. It is recommended to further strengthen the construction of domestic scientific research cooperation network and focus on improving the quality of research.

Evidence-based Medicine

Clinical Guidelines Analysis and Quality Assessment of Guidelines for Hypertension in the Elderly

TIAN Xintong, MA Teng, SUN Xuan, YANG Ji, ZHAO Yingqiang

2022, 25(34):  4259-4266,4285.  DOI: 10.12114/j.issn.1007-9572.2022.0323

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Background

Older people are a group susceptible to hypertension, and among whom hypertension prevalence is increasing as population aging aggravates. Early prevention, diagnosis and treatment of hypertension in the elderly are very important, which can be enhanced by an important way, namely developing high-quality clinical practice guidelines.

Objective

To perform an analysis of the guidelines regarding the diagnosis and management of hypertension in the elderly, and to assess their methodological quality.

Methods

In December 2021, we searched for clinical guidelines for hypertension in the elderly in databases of CNKI, CQVIP, WanFang Data, SinoMed, PubMed, EmBase and Medlive, as well as in the official websites of the National Guideline Clearing house, the Guidelines International Network and the National Institute for Health and Care Excellence from inception to December 2021. Two reviewers independently conducted literature screening and data extraction. Four reviewers independently evaluated the methodological quality of included guidelines using the AGREEⅡ. Recommendations from each guideline were retrieved.

Results

A total of 11 guidelines were included: seven are Chinese guidelines, two are US guidelines and the other two are European guidelines. The mean standardized domains scores of the AGREEⅡinstrument in assessing the overall guideline quality were as follows: 50.13% for scope and purpose, 24.24% for stakeholder involvement, 18.51% for rigour of development, 54.03% for clarity of presentation, 11.36% for applicability and 30.30% for editorial independence. The recommendation level was B for five guidelines, and was C for the remaining six guidelines. The main recommendations involve three aspects: pharmacological intervention, non-pharmacological intervention, and continuing health management.

Conclusion

The overall methodological quality of included guidelines is unsatisfactory. To improve the quality of such guidelines developed in the future to better guide clinical practice, it is suggested to give more attention and priority to domains of stakeholder involvement, rigour of development, and applicability.

Risk Prediction Models for Type 2 Diabetes in Asian Adults: a Systematic Review

HE Ting, YUAN Li, YANG Xiaoling, YE Ziwei, LI Rao, GU Yan

2022, 25(34):  4267-4277.  DOI: 10.12114/j.issn.1007-9572.2022.0358

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Background

The prevalence of type 2 diabetes mellitus (T2DM) is increasing throughout the world. Six out of the top 10 countries with the highest number of adults with diabetes in 2021 were in Asia. Reliable type 2 diabetes risk prediction models can identify individuals at risk of developing T2DM, which may provide a basis for decision-making in the prevention and intervention of T2DM.

Objective

To perform a systematic review of risk prediction models for T2DM, providing a reference for the prevention and treatment of T2DM.

Methods

In April 2021, we searched for studies on risk prediction models for T2DM in Asian adults in databases of PubMed, EmBase, and the Cochrane Library from inception to April 1, 2021. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias and applicability of included studies using the Prediction model Risk Of Bias Assessment Tool (PROBAST) . A descriptive analysis was used to summarise the basic characteristics of the models and the risk of bias and applicability of included studies.

Results

A total of 31 studies were included, among which 17 are prospective cohort studies and other 14 are retrospective cohort studies. Logistic regression and Cox regression were widely used to construct the models. The models were externally validated in 5 studies, internally validated in 22 studies, and externally and internally validated in 4 studies. The number of predictors included in the models ranged from 3 to 24, with performance measured by the area under the curve of receiver operating characteristic curve lying between 0.62 and 0.92. There was a high risk of bias in the included studies, which may mainly due to inappropriate treatment of continuous variables and missing data, and ignoring the overfitting of the model.

Conclusion

The included prediction models may have proven to have good predictive performance, which could support medical workers in early identification of the population at high risk of T2DM. Recommendations for future studies developing risk prediction models for T2DM with good performance and low risk of bias are as follows: improving methods for data modeling and statistical analysis, and attaching great importance to external verification and recalibration of the models.

Original Research·Focus on Population Health

Prevalence and Influencing Factors of Motoric Cognitive Risk Syndrome in the Elderly with Subjective Cognitive Decline in the Community

YANG Cunmei, SHU Gangming, HU Yixin, MA Hongying, LI Jiadai, ZHANG Tianyi, MAO Xin, WU Bing, YAN Jin, LI Tianzhi

2022, 25(34):  4278-4285.  DOI: 10.12114/j.issn.1007-9572.2022.0395

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Background

Both motoric cognitive risk (MCR) syndrome and subjective cognitive decline (SCD) are early stages of cognitive decline in the elderly. MCR syndrome is currently considered as a new effective predictor of preclinical dementia. Identifying the risk factors of dementia in older people with SCD by early MCR syndrome screening is of great significance for reducing the incidence of dementia and related adverse health events in this group.

Objective

To investigate the prevalence and influencing factors of MCR syndrome in the elderly with SCD in the community.

Methods

A long-term cohort study conducted from January 2019 to January 2022 in a community in Beijing selected 459 cases of the elderly (≥60 years old) with SCD as the study population. SCD was assessed using the memory-related questions in the Geriatric Depression Scale-15 and the Chinese version of Montreal Cognitive Assessment-Basic. The the 6-metre walking test was used to assess gait status. MCR syndrome was defined as SCD in combination with gait decline. A self-designed questionnaire was used to collect the demographic data, physiological factors, psychological factors, lifestyle indicators, psychological factors, nutritional status, conditions of illness and medication history. Stepwise multinomial Logistic regression was used to explore the influencing factors of MCR syndrome.

Results

The prevalence of MCR syndrome was 27.2% (125/459) . The elderly in the MCR and non-MCR groups were compared for age, basic activities of daily living (BADL) , instrumental activities of daily living (IADL) , weekly exercise hours, anxiety status, nutritional status, conditions of illness〔hypertension, chronic heart failure, arrhythmia, stroke/transient ischaemic attack (TIA) , multiple lacunar infarction, diabetes mellitus, peripheral vascular disease, cancers, osteoarthritis, history of fracture in the last 2 years, oculopathy, oral disease〕, and medication history, and the difference was statistically significant (P<0.05) . Stepwise multinomial Logistic regression analysis showed that older age〔OR (95%CI) =1.083 (1.034, 1.134) 〕, lower ability to perform BADL〔OR (95%CI) =0.952 (0.914, 0.991) 〕, lower ability to perform IADL〔OR (95%CI) =0.623 (0.486, 0.798) 〕, weekly exercise hours〔OR (95%CI) =0.505 (0.295, 0.864) 〕, anxiety status〔OR (95%CI) =2.442 (1.225, 4.866) 〕, conditions of hypertension〔OR (95%CI) =1.948 (1.086, 3.497) 〕, and conditions of stroke/TIA〔OR (95%CI) =3.154 (1.745, 5.699) 〕were associated with MCR syndrome (P<0.05) .

Conclusion

The prevalence of MCR syndrome was high in older adults with SCD in the community. In view of this, during the MCR syndrome screening in this population, attention should be paid to risk factors such as older age, the ability to perform BADL and IADL, weekly exercise hours, anxiety status, conditions of hypertension, and conditions of stroke/TIA, and support should be provided for these people to control chronic disease and develop a healthy lifestyle, thereby improving their cognitive status.

Participation Intention in Fall-prevention Project and Related Influencing Factors in Community-living Elderly Residents at High Risk of Falls

CHENG Meng, WANG Jian, LI Zhipeng, ZHAO Qi, SUN Xiaoming

2022, 25(34):  4286-4291.  DOI: 10.12114/j.issn.1007-9572.2022.0367

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Background

With the aging of the population, it is essential to implement fall prevention programs for the elderly. Although China has carried out fall prevention programs sporadically, among which comprehensive fall prevention programs centered on exercise intervention are rare, and there have been no investigations about the willingness of elderly people at high risk of falls in the community to participate in comprehensive fall prevention programs.

Objective

To examine the intention of community-living elderly residents at high risk of falls to participate in comprehensive fall-prevention programs, and associated factors, providing a theoretical basis for the implementation of such programs.

Methods

By economic level and geographical location, we selected three communities from Shanghai as research settings, namely, Tangqiao Community in Pudong New Area (central urban area) , Zhaoxiang Community in Qingpu District (outer suburb) and Gangyan Community in Chongming County (outer suburb) . Elderly people aged 65 and above who participated in physical examinations in the three communities from 2018 to 2019 were invited to attend a survey using a questionnaire consisting of demographics, FROP-Com Screen, MFROP-Com Tool, self-designed fall risk questionnaire, Patient Health Questionnaire-9 (PHQ-9) , and Generalized Anxiety Disorder scale (GAD-7) . Individuals with the FROP-Com Screen scale score >3 points were identified with risk of falls, among whom those with total score of MFROP-Com Tool≥11.5 points (high risk of falls) were included finally.

Results

In total, 318 cases were detected with high risk of falls, among whom 62 (19.5%) thought falls were unpreventable. Slippery floor〔73 respondents (23.0%) 〕, inattention〔64 respondents (20.1%) 〕and physical discomfort〔64 respondents (20.1%) 〕were reported to be the three leading causes of falls. Two hundred and fourteen (67.3%) were willing to participate in fall prevention programs. The level of intention to participate in fall prevention programs differed significantly in the participants according to living setting, educational level, use of a walker, self-assessed sleep quality, number of chronic diseases, foot disease prevalence, exercise habits, history of falls in the past year, and cognition of whether falls can be prevented (P<0.05) . Binary Logistic regression analysis showed that living in urban area〔OR (95%CI) =7.828 (2.898, 21.149) 〕, having an exercise habit〔OR (95%CI) =3.474 (1.703, 7.087) 〕, previous history of falls〔OR (95%CI) =2.806 (1.364, 5.773) 〕, and having an idea of falls are preventable〔OR (95%CI) =4.124 (1.749, 9.726) 〕 were associated with higher level of intention to participate in an fall prevention program (P<0.05) .

Conclusion

In general, the community-living elderly residents with high risk of falls had limited understanding of fall prevention, but most of them were willing to participate in fall prevention programs. To promote the implementation of comprehensive fall prevention programs, it is necessary to improve their awareness of fall prevention and enhance their willingness to participate.

Traditional Chinese Medicine Health Management for Community-dwelling Individuals with Chronic Neck and Shoulder Pain: Effectiveness Assessed Using Goal Attainment Scaling and Associated Factors

QIU Xiantao, REN Jianping, HE Mengyan, REN Lixian, CAO Qingchun, WANG Jinjing, WANG Wenting

2022, 25(34):  4292-4297.  DOI: 10.12114/j.issn.1007-9572.2022.0398

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Background

Neck and shoulder pain ranks the 21st in terms of global economic burden of diseases, but it could be effectively treated and relieved by timely standardized interventions. The application of goal attainment scaling (GAS) will help to assess the effectiveness of interventions in a more targeted manner.

Objective

To measure the effectiveness of traditional Chinese medicine (TCM) health management delivered by Hangzhou community health centers for community-dwelling individuals with chronic neck and shoulder pain using GAS, and to identify the associated factors.

Methods

Typical sampling was adopted to choose 262 patients with chronic neck and shoulder pain from three community health centers of Hangzhou from August to September 2020. They were randomly divided into control group (n=131) and intervention group (n=131) , received one-month acupuncture treatment, and one-month acupuncture treatment plus TCM management, respectively. The intervention effect survey was carried out in November 2020 using a self-compiled questionnaire for understanding participants' demographics, level of pain assessed using the Changhai Pain Rating Scale, and effectiveness measured using GAS.

Results

All the participants were included for analysis (n=244, 122 in each group) except for nine missing cases in each group. The post-intervention GAS scores for intervention group and control group were (51.20±7.81) and (42.94±7.57) , showing statistically significant difference (P<0.05) . The intervention group and control group also had statistically significant difference in terms of the number reaching or exceeding the expected target after intervention〔92 (75.4%) vs 44 (36.1%) 〕 (P<0.05) . The post-intervention GAS score in cases in the intervention group differed significantly by education level, marital status, employment status, TCM constitution, and self-assessment health status (P<0.05) . In accordance with the results of stepwise multiple linear regression analysis, TCM constitution, self-rated health, and drinking were associated with the GAS score after acupuncture treatment plus TCM management (P<0.05) .

Conclusion

The comprehensive TCM health management have significant effect on patients with chronic neck and shoulder pain. In view of this, the management is suggested to be implemented in primary care.

Prevalence and Associated Factors of Effective Self-monitoring of Blood Glucose Frequency in Community-living People with Glycemic Management

CHEN Junjian, FAN Guanhua

2022, 25(34):  4298-4303.  DOI: 10.12114/j.issn.1007-9572.2022.0404

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Background

The latest epidemiological data show that the prevalence of diabetes (diagnosed by the WHO diagnostic criteria) in Chinese population was 11.2% in 2020. Diabetes may induce many serious complications, and poor glycemic control will greatly impair the quality of life of people with glycemic management, so self-monitoring of blood glucose (SMBG) is particularly important.

Objective

To explore the prevalence and associated factors of effective frequency of SMBG in community-living people with glycemic management.

Methods

Convenience sampling was used to select individuals from Shantou communities who received online or offline glycemic management from primacy hospitals from August 2019 to August 2020 to attend a survey using a questionnaire consisting of three parts, namely demographic information, the Chinese version of the Brief IMB-SMBG Instrument, and the frequency of SMBG. Effective SMBG frequency was defined as measuring fasting blood glucose or 2-hour postprandial blood glucose 2 to 4 times per week, and by which participants were divided into effective and ineffective SMBG groups. Multivariate Logistic regression was used to analyze the influencing factors of effective SMBG frequency.

Results

Two thousand cases attended the survey, and 1 636 (81.80%) of them who handed in responsive questionnaires were finally included for analysis, including 403 (24.63%) with effective SMBG frequency and 1 233 (75.37%) with ineffective SMBG frequency. Effective and SMBG ineffective frequency groups had significant difference in the average total score of 〔 (211.76±38.36) vs (166.33±40.24) 〕 (t=19.901, P<0.01) . Two groups also had significant differences in sex ratio, distribution of education attainment, occupation type, and monthly income, prevalence of glycemic control through pharmaceutical treatment, drinking, complications, awareness of glycosylated hemoglobin and SMBG frequency, having a blood glucose monitor, catching up the blood glucose measurement missed due to forgetting, getting good access to blood glucose test strips, and massaging fingers to promote blood flow (P<0.05) . Multivariate Logistic regression analysis showed that occupation type, glycemic control through pharmaceutical treatment, good access to blood glucose test strips, catching up the blood glucose measurement missed due to forgetting and massaging fingers to promote blood flow were associated with effective SMBG frequency (P<0.05) .

Conclusion

The rate of effective SMBG frequency in community-living people with glycemic management needs to be improved further. To achieve this, it is suggested that education on SMBG skills should be provided for this group.

Effects of a Chinese-style DASH Diet on Nutritional Health in Hypertensive Patients with Type 2 Diabetes

MU Lisha, GONG Tao, XU Huini, CHEN Dan, TANG Jie, CAI Shuwen, MU Lihong

2022, 25(34):  4304-4311.  DOI: 10.12114/j.issn.1007-9572.2022.0295

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Background

High blood pressure can cause damages of target organs such as the heart, brain, kidneys and retina, while diabetes can cause a series of metabolic disorders, resulting in a variety of complications. Both are major risk factors for cardiovascular and cerebrovascular diseases. Eating a healthy diet may significantly contribute to the prevention and control of hypertension and diabetes.

Objective

To investigate the effects of a Chinese-style DASH diet in improving the nutritional status of community-living patients with type 2 diabetes and hypertension.

Methods

Sixty-one hypertensive patients with type 2 diabetes with medical records created in Chongqing Sihai Community Health Center were selected to undergo an eight-week Chinese-style DASH diet intervention, including dietary guidance (at 1 and 2 weeks) , eating the Chinese-style DASH diet provided using a group-based approach (at 3 and 4 weeks) , and home-based medical care (at 5 to 8 weeks) . Food frequency survey and 24-hour dietary recall were used to investigate the dietary structure and nutritional intake at baseline and after intervention. Anthropometric indicators (BMI and waist-to-hip ratio) , blood lipids (triacylglycerol, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol) , glycemic control and hypertension control status at baseline and after intervention were compared.

Results

A total of 59 cases were included in the study. Regarding dietary structure after intervention, the average daily intake of soy, nuts, pickled products, fried foods and salt significantly decreased in subjects, while that of fresh fruit, milk and dairy products increased significantly (P<0.05) . Regarding nutritional status, the daily average intake of fat and sodium was significantly reduced, while that of dietary fiber, calcium, potassium and magnesium was significantly increased (P<0.05) . The number of participants eating a diet with a recommended ratio of fat increased significantly (P<0.05) . Health monitoring showed that total cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure and 2-hour postprandial glucose were partially improved after intervention (P<0.05) . From the 4th week of the intervention, the control rate of 2-hour postprandial glucose at follow-up was significantly higher than the baseline level (P<0.05) , and it reached 69.5% at the end of the intervention. Except for the 2nd week of the intervention, the blood pressure control rate at follow-up was notably higher than the baseline level (P<0.05) , and it reached 67.8% at the end of the intervention.

Conclusion

Eating the Chinese-style DASH diet helps to promote the health in community-living hypertension patients with type 2 diabetes via effectively adjusting the inappropriate diet structure and improving the nutritional status.

Original Research·Focus on Primary Health Services

Contracted Residents' Evaluation for Continuity of Contracted Family Doctor Services and Influencing Factors

LIU Songyi, MENG Wenqi, PENG Haibo, JIANG Xiaoli, LI Zixin, YU Qianqian, YIN Wenqiang, CHEN Zhongming, SUN Kui, GUO Hongwei

2022, 25(34):  4312-4317.  DOI: 10.12114/j.issn.1007-9572.2022.0519

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Background

Since the full implementation of contracted family doctor services in 2016, we have achieved phased results. Further work needs to be paid equal attention to "quality" and "quantity", focusing on improving the residents' sense of service access and satisfaction, however, at present, the residents' evaluation of contracted family doctor services is not clear.

Objective

To investigate the contracted residents' evaluation for the continuity of family doctor contract, explore its influencing factors, and propose improvement strategies.

Methods

This study used a multi-stage stratified random sampling method to select 1 193 contracted residents from 9 community health service institutions and 9 township health centers in Heze City, Shandong Province in January 2021. A household survey was conducted on the included residents by using the continuity dimension of the Chinese version of the Primary Care Assessment Tools (PCAT) , which contains 15 items. We compared the PCAT-continuity dimension scores of contracted residents with different characteristics, and used multiple linear regression to analyze the factors influencing the PCAT-continuity dimension scores of contracted residents.

Results

A total of 1 098 valid questionnaires were collected, with a valid response rate of 92.04%. 541 (49.27%) of them were contracted to community health service institutions and 557 (50.73%) of them were contracted to township health centers. The average score of the PCAT-continuity dimension of the contracted residents was (3.38±0.51) . The item with the highest score was "Does your family doctor listen to you patiently", with a score of (3.64±0.59) . The item with the lowest score was "Would you be willing to change your family doctor if it was easy to do so", with a score of (2.98±0.92) . Multiple linear regression analysis showed that the type of contract organization, age, education, marital status, occupation, and chronic diseases were the factors that influence the PCAT-continuity dimension score of contracted residents (P<0.05) .

Conclusion

The contracted residents had an overall good evaluation on the continuity of contracted family doctor services, and the long and stable doctor-patient relationship had been established. Township health centers are better than community health service institutions. To further improve the contracted residents' evaluation of contracted family doctor services, we need to pay more attention to the type of contracting institution, the age, education level, marital status, occupation of contracted residents and their chronic diseases.

Development of the General Practitioner Management of Age-related Hearing Loss System

GE Jianli, GENG Shasha, CHEN Xin, ZHU Yingqian, SUN Xiaoming, JIANG Hua

2022, 25(34):  4318-4325.  DOI: 10.12114/j.issn.1007-9572.2022.0310

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Background

The prevalence of age-related hearing loss is increasing gradually as population aging advances in China. Untreated hearing loss is strongly associated with many adverse health events. Age-related hearing loss is difficult to be detected due to slow progression of symptoms, and its harmfulness is often underestimated or neglected. General practitioners (GPs) in primary care could play a vital role in early screening, timely referral and health education management regarding age-related hearing loss.

Objective

To formulate an GP management of age-related hearing loss system, promoting secondary prevention and management of this illness in primary health care.

Methods

By use of literature review and semi-structured reviews, we developed the first draft of General Practitioner Management of Age-related Hearing Loss System from April to June 2021. For reviewing the draft, we conducted a two-round e-mail-based consultation with a purposive sample of 15 experts (engaging in the field of otolaryngology, general practice, administrative management or public health management) from August to November 2021. Then we calculated the response coefficient, authority coefficient and Kendall's Wfor the two consultations, assessed the weights of indicators using analytic hierarchy process, checked the logical consistency of indicators, and determined the final draftof age-related hearing loss management system.

Results

The first draft of General Practitioner Management of Age-related Hearing Loss System consisted of 6 primary indicators and 15 secondary indicators. The response coefficient was 100.0% for both consultations. The expert authority coefficient was 0.877 for the first round of consultation, and 0.920 for the second round. Kendall's W coefficients were 0.428 (χ²=89.821, P<0.001) , and 0.307 (χ²=87.387, P<0.001) , respectively for the first and second rounds of consultations. The final system consists of 6 primary indicators (theoretical knowledge of age-related hearing loss, screening skills for age-related hearing loss, referral ability of age-related hearing loss, ability to diagnose and treat ear diseases, ability to manage adverse events of age-related hearing loss, doctor-patient communication ability) , and 20 secondary indicators. The mean value of importance for all indicators was above 8.000, the coefficient of variation of all indicators was above 0.250, and the full score ratio of all indicators was above 30.0%. The weights of the above-mentioned six primary indicatorswere 0.082, 0.082, 0.082, 0.077, 0.077, and 0.077, respectively. The consistency ratio of primary and secondary indicators was 0.063 5, 0.043 2, respectively (<0.100 0) .

Conclusion

The response and authority coefficients, and Kendall's W coefficients of the consultations were high, suggesting that the consultation results were scientific, credible and reliable. This system can be used as a guidance system for secondary prevention and management of this illness by GPs in primary care.

The Safety Support and Willingness of Providing Home Care Services by Medical Staff of Primary Health Care Institutions

GAO Hui, LIU Suzhen, LI Hang

2022, 25(34):  4326-4331.  DOI: 10.12114/j.issn.1007-9572.2022.0513

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Background

With the trend of population aging, disabled or semi-disabled elderly people suffering from various chronic diseases have an urgent demand for home medical care services, but there are greater medical risks and safety hazards for primary health care workers to provide home medical care services, and strengthening the safety management of home medical care services is conducive to increasing the willingness of primary health care workers to provide home medical care services.

Objective

To investigate the safety support of home care services in primary health care institutions and the willingness of medical personnel to provide home care services, so as to provide a reference basis for further promoting the development of home medical care services.

Methods

From August to October 2021, 1 131 cases of medical personnel from 49 primary health care institutions in five economic regions of Sichuan Province were selected by convenience sampling method. A self-designed questionnaire was used to collect data in the form of an electronic questionnaire called "Questionnaire Star". The questionnaire included general information of medical staff (8 items) , experience of providing medical care at home (2 items) , safety support of medical staff by medical institutions (7 items) , and willingness of medical staff to provide home care (1 item) . The willingness of medical personnel to provide home medical care services was compared across different characteristics, and binary Logistic regression was used to analyze the factors influencing medical personnel's willingness to provide home medical care services.

Results

Of the 1 131 primary care medical personnel, 692 (61.18%) reported experiences with home medical care services, 193 (17.06%) reported adverse events or safety events during the services, 531 (46.95%) reported that their medical institutions had not assessed the safety risks of patients receiving home medical care services, 199 (17.60%) reported that their institutions had assessed the safety risks of medical staff visiting the home, 299 (26.44%) reported that the app location system was used in the process of home services, 273 (24.14%) reported that medical staff equipped with devices such as alarms and delay warnings, 807 (71.35%) reported that they did not receive service support from other medical staff within their institutions during home medical care services, 303 (26.79%) and 352 (31.12%) indicated that the institution had organized special seminars on home medical care services and received special training on home medical care services, respectively, 853 cases (75.42%) of medical staff were willing to provide home medical care services. The results of binary Logistic regression analysis showed that the type of primary health care institution with which they worked, the professional and technical titles currently employed, assessing the safety risk of patients receiving home medical care services, using alarm and delayed warning devices during home medical care services, and attending special training on home medical care services had an effect on the medical staff's willingness to provide home medical care services (P<0.05) .

Conclusion

At this stage, the safety support for home health care services is insufficient, and various factors affect the willingness of primary health care workers to provide home health care services. Primary health care institutions should strengthen the assessment of the safety risks of patients receiving home medical care services, equip the medical personnel who provide home medical care services with alarm and delayed warning devices, and actively organize special training related to home medical care services and encourage medical personnel to participate, so as to reduce the risks of medical personnel who provide home medical care services and ensure their personal safety.

Original Research·Focus on General Practice Education

Family Doctor Confidence Index among General Practitioners in Shanghai's Pudong New Area: Trend Analysis during 2014—2020 Using Survey Data

TANG Huiyun, FANG Jialiang, SHA Jingjing, WU Xiaofei

2022, 25(34):  4332-4338.  DOI: 10.12114/j.issn.1007-9572.2022.0183

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Background

Family doctors play a major role in the construction of the family doctor system, one of the five basic projects in Shanghai launched since April 2011, so understanding their confidence level regarding practice is crucial to the promotion of high-quality development of family doctor system in China.

Objective

To investigate the family doctor confidence index (FDCI) in 2020 and its trend from 2014 to 2020 among general practitioners (GPs) in Pudong New Area of Shanghai, and to predict their future 3-year FDCI, providing insights into the promotion of the construction of family doctor system.

Methods

Participants were incumbent GPs who provided family care services in 9 community health centers in Pudong New Area of Shanghai, the settings in which the 2014 FDCI survey in Shanghai's Pudong New Area was conducted. They were invited to attend an online survey through the platform of www.wjx.cn in December 2020 using a questionnaire developed by ourselves based on the implementation of family doctor system in Pudong New Area, the contents of E2-E3 pages of the original China Medical Tribune·General Practice Weekly published on June 22, 2017, and the survey contents of FDCI developed by GU Yuan Family Doctor Studio. FDCI was compared by demographic indices. The future 3-year FDCI was estimated overall, and compared across GPs by demographic indices. The trend of FDCI between 2014 and 2020 was analyzed.

Results

A total of 350 cases attended the survey, and 347 of them (99.1%) who returned were responsive questionnaires were included for analysis. The average FDCI of the participants was (51.96±28.42) in 2020, and that predicted for 2023 was (54.03±26.56) , showing no significant difference (P>0.05) . In 2020, GPs working at rural areas had higher FDCI than those working at urban and peri-urban areas (P<0.05) ; Those who became a GP after training prior to the post shift had higher FDCI than those who became a GP after standardized residency training or passing the professional title examination (P<0.05) ; GPs with junior college education or below had higher FDCI than those with a bachelor/master degree or above (P<0.05) ; GPs who held a concurrent administrative post or handled administrative matters in their hospital had higher FDCI than those did not (P<0.05) . Higher FDCI predicted for 2023 was found in those with working at rural areas instead of those working at urban and peri-urban areas, and in those with junior college education or below instead of those with a bachelor /master degree or above (P<0.05) . Those who were male, aged 23-29, worked at urban area, had an experience of≤1 or>5 years of working as a family doctor, had a bachelor degree or intermediate professional title were predicted to have higher FDCI in 2023 than in 2020 (P<0.05) . The overall FDCI in 2020 was higher than that in 2014〔 (51.96±28.42) vs (24.65±22.75) 〕and 2017〔 (51.96±28.42) vs (48.20±23.10) 〕, with statistical significance (P<0.05) .

Conclusion

The overall FDCI of GPs in Shanghai's Pudong New Area in 2020 and that predicted for 2023 was moderate, and the overall FDCI in 2020 was significantly higher than that in 2014 and 2017. The present and future 3-year FDCI varied among GPs by demographic characteristics. GPs were fully confident in the future development of the industry and their own occupation, and needed continuous policy and social supports.

General Practitioner Transfer in Xinjiang Uygur Autonomous Region from 2012 to 2020

CHEN Hong, SHAMA· Mulati, LI Qifeng, XU Peilan

2022, 25(34):  4339-4343,4349.  DOI: 10.12114/j.issn.1007-9572.2022.0518

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Background

Currently, there is a shortage of general practitioners (GPs) in primary care. Job transfer training is one of the main ways to train GPs and had important contributions to the construction of general practitioners team.

Objective

To analyze the job transfer operation of GPs in Xinjiang Uygur Autonomous Region from 2012 to 2020.

Methods

During December 2021 to March 2022, this study reviewed China Health Statistical Yearbook from 2013 to 2021 to obtain the data about GPs in Xinjiang from 2012 to 2020, reviewed trainees' lists of GPs job transfer training program from 2010 to 2022 organized by the Health Commission of Xinjiang Uygur Autonomous Region to obtain the real number of GPs transferred to training, and obtained the data about GPs distribution from the Science and Technology Education Department of the Health Commission of Xinjiang Uygur Autonomous Region.

Results

There were 5 980 GPs in Xinjiang in 2020, and 1 765 (29.52%) of them were qualified GPs through the job transfer training. The gender and age distribution of job transfer training GPs in each prefectures of Xinjiang were statistically different (P<0.05) . According to the requirements of 3 qualified GPs per 10 000 residents, 6 696 GPs were needed in Xinjiang, and 7 254 GPs were needed in 2020, however, the fact is that the number of GPs in Xinjiang increased from 1 925 (0.86 per 10 000 residents) in 2012 to 5 980 (2.47 per 10 000 residents) in 2020. The proportion of GPs through job transfer training gradually decreased from 35.84% (690/1 925) in 2012 to 1.07% (64/5 980) in 2020. The largest number of assigned GPs through job transfer training is 293 in 2012, and the smallest number is 11 in 2017. From 2012 to 2020, Kashgar area had the most assigned GPs of 248, Karamay city had the least assigned GPs of 4.

Conclusion

Job transfer training made an important contribution to the training of GPs. With the implementation of various policies, we reached the target of every 10 000 people, but the total number of GPs has not yet reached 7 000. Therefore, there is still a shortage of GPs. We should strengthen the implementation of relevant policies and encourage clinicians to participate in the transfer training of GPs.

Paths to Cultivate Practical Sci-tech Innovation Talents in District (County) Hospitals: a Case Study of the Treatment of Clinical Trial Protocol Violations

QI Mengsha, WAN Jing, LIU Shuyun

2022, 25(34):  4344-4349.  DOI: 10.12114/j.issn.1007-9572.2022.0226

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Background

District (county) hospitals are leading institutions delivering primary health services, which are responsible for providing local healthcare services, teaching and training medical talents, and carrying out medical research. However, their high-quality development has been restricted by limited scientific and technological innovation capability.

Objective

To review the studies published in recent 10 years on the treatment of clinical trial protocol violations, providing evidence for exploring paths to solve such violations during the cultivation of practical sci-tech innovation talents in district (county) hospitals.

Methods

In January 2022, studies on clinical trial protocol violations published between January 1, 2010 and December 31, 2021 were searched in databases of CNKI, WanFang Data, CQVIP, Baidu Wenku, PubMed, Medline, the Cochrane Library, Embase, and ClinicalKey using "临床试验" "医学伦理" "违规问题" as search terms in Chinese, and "Clinical Trial" "Ethical Issues" "Clinical Trial" "Ethical Problems" as terms in English. Clinical trial protocol violations were extracted and classified according to the nature of the violations. Systematic clustering algorithm was used to implement cluster analysis of the violations according to inter-cluster connection. Root cause analysis was used to explore the root causes of the violations.

Results

The violations were divided into five classes (covering 27 subclasses) , and the first three were human subject protection (n=42, 33.6%) , clinical trial protocol (n=33, 26.4%) and informed consent (n=31, 24.8%) . Cluster analysis showed that the 125 violations could be grouped into two categories: authenticity (academic fraud) and compliance (violations) . The root causes of academic fraud and violations were as follows: insufficient research capability and low level of ethical knowledge in individuals or institutions; unsatisfactory punishment on individuals or institutions committing academic fraud; inadequate supervision of the sci-tech innovation achievements assessment and the ethical review system.

Conclusion

To solve academic fraud and ethical violations in trials, it is suggested to provide sci-tech innovation talents with practical ideology education on medical ethics that they should abide by in carrying out clinical trials by hospitals and colleges.

Primary Care Reform: Case Study

Practice and Reflection Regarding the Development of Featured Brand Community-based Specialty Care: a Case Study of Chu's Traumatology

GUO Jin, TANG Yuanru, YAN Wei, HUANG Min, ZHANG Yueqi, MA Yimin, TIAN Yuan

2022, 25(34):  4350-4354.  DOI: 10.12114/j.issn.1007-9572.2022.0189

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Public healthcare institutions are facing challenges to upgrade the level of services to satisfy gradually increased healthcare needs of residents as the economy develops. To address such challenges, Shanghai Huangpu District Waitan Community Health Center (HDWCHC) has explored a way for the development of featured brand community-based specialty care services, and developed a standardized operation toolkit that can be reproduced and promoted based on a summary of the practice of building Chu's traumatology, the first brand specialty built by the HDWCHC. We reviewed the process and achievements of building Chu's traumatology, hoping to provide methodological guidance for the development of featured brand community-based specialty care services in other areas of China. The brand building of Chu's traumatology includes four stages covering seven parts: standards formulation (diagnostic standards formulation, intervention standards formulation, referral standards formulation) , internal promotion (determination of the inheritor of Chu's traumatology, service team building) , standardized single disease diagnosis and treatment and building the standardized clinic room (expanding to all accessible sites in primary care) and external promotion (building a standardized, community-based operation toolkit featured by the brand of Chu's traumatology) . The exploratory practice of HDWCHC has enabled the development of featured services delivered by a standardized process mode transformed from individual mode (from single-person mode to multi-person cooperation mode, or from single-institution mode to multi-institution cooperation mode) , enhancing the transferability, promotion and reproducibility of featured services as well as bettering their allocation, facilitating the formation of ideas of integrated development of multiple techniques with Chu's traumatology services as the core, thereby improving the effectiveness of healthcare services.