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    05 March 2024, Volume 27 Issue 07
    Editorial
    How Many People Can Avoid Hospitalization with Good General Practice Service
    YANG Hui
    2024, 27(07):  0-C3.  DOI: 10.12114/j.issn.1007-9572.2024.A0010
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    Commentary
    A Ten-year Retrospective of General Practitioner Team Construction in China
    ZHU Xuebo, DAI Haojie, LIN Jin
    2024, 27(07):  765-772.  DOI: 10.12114/j.issn.1007-9572.2023.0529
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    Background

    General practitioners (GPs) are an indispensable part of primary health care system in China and the implementation of the "Healthy China" strategy. In the past decade, the number of GPs in China has developed rapidly.

    Objective

    To summarize the experience and achievements of GP team construction from 2012 to 2022 (nearly ten years) , analyze the existing difficulties and deficiencies, and provide reference for the subsequent construction of GP team in China.

    Methods

    With the help of Donabedian model, policy support, capital investment and base construction were selected as the evaluation indicators of structural design process based on the SMART principle, the process quality was focused from two perspectives of standardized training of residents (referred to as standardized training) and job transfer, the construction of GP team in central and western China. The team size, structure, job satisfaction, resignation intention and career development opportunity were considered as the main analysis dimensions. The data were mainly obtained from Chinese government website and CNKI from 2012-01-01 to 2022-12-31, as well as Health Statistical Yearbook 2012-2022.

    Results

    In the past decade, the structural design of the construction of GP team in China has been continuously optimized and improved, and the supporting facilities such as capital investment and base construction have been closely implemented. The policy end of process has responded to the practical needs with dynamic adjustments, the standardization of relevant systems for standardized training and job transfer has steadily improved, and the construction of GP team in the central and western regions has been strengthened year by year. Regional differences in the effectiveness of team building still exist, and some problems need to be solved.

    Conclusion

    Existing human resource statistics on GP cannot accurately measure the human resource supply for GP team in China, and the construction of team stability needs to be further improved. It is recommended to continuously promote the stability construction of the GP team focusing on enhancing career attractiveness, improve the stability of the whole cycle of training, employment and career development, and jointly promote the stability of GP team.

    Report on Methodological Quality Assessment of Primary Care and General Practice Research in China in 2021: Quantitative Research, Systematic Review and Guidelines/Consensus Section
    Quality Assessment Group for Quantitative Research, Systematic Review and Guidelines/Consensus of Chinese General Practice
    2024, 27(07):  773-783.  DOI: 10.12114/j.issn.1007-9572.2023.0751
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    Background

    At a time when healthcare reforms are being implemented in the new era, the scientific research output in the field of general practice and primary care in China has grown rapidly in recent years. However, the methodological quality of the literature is unclear.

    Objective

    To evaluate the methodological quality of representative quantitative studies and systematic reviews/guidelines in the field of general practice and primary care in China in 2021, to reveal the overall methodological quality characteristics of scientific papers in this field.

    Methods

    A sample of 449 papers was selected from a total of 3 122 papers collected in the Primary Care and General Practice Research Paper Productivity Report in China in 2021. A methodological quality assessment group consisting of 22 researchers in the field of public health and general practice from different institutions was organized to evaluate the quality of 320 of these papers (71.3%) using six different quality assessment tools for different study designs (cross-sectional studies, cohort studies, pre- and post-intervention studies, randomized controlled trials, systematic reviews, guidelines and consensus) by working in pairs and under the training and guidance of an expert in evidence-based medical methodology. Descriptive statistics method was used to report the overall quality assessment results of the various types of research papers.

    Results

    Of the 114 cross-sectional research papers, quality issues were prevalent in the areas of "whether the source population was representative of the study's target population" (41.2%) , "whether the reliability and validity of the survey instrument could be conclusively demonstrated" (32.5%) , "whether the survey is clinically meaningful" (26.3%) ; of the 25 cohort study papers, quality issues were more concentrated in the areas of "whether the cohort was adequately followed up" (44.0%) and "whether the co-intervention was similar among groups" (56.0%) ; of the 34 pre- and post-intervention studies, quality issues were mostly found in the areas of "whether the target outcome was measured multiple times before and after the intervention" (97.1%) , "whether the sample size was large enough to generate confidence in the study results" (82.4%) , and "whether the study participants were representative of the eligible population" (61.8%) ; of the 122 randomized controlled trials, quality concerns were mostly in the areas of "blinding of different stakeholders" (25.4%-61.5%) , "adequate concealment of random allocation" (41.8%) , and "other risks of bias" (72.1%) ; of the 19 systematic reviews, quality issues were mostly found in the areas "is the source of funding for the included studies reported" (100.0%) , "were the methods of the review developed before the start of the review" (94.7%) , "was heterogeneity reasonably discussed and explained" (84.2%) , and "was the risk of bias of individual studies considered" (84.2%) . Finally, the quality of all six clinical guidelines/consensus was rated low.

    Conclusion

    The scientific research output of recent years in the field of primary care and general practice in China is still of limited quality in general, which is particularly evident in the categories of cross-sectional studies, pre- and post-intervention studies, randomized controlled trials, guidelines and consensus. This highlights the urgency and importance of strengthening systematic training in basic research in this area of research in China, increasing the importance of research and evidence-based reporting standards, and developing pragmatic methodological specifications for the development of guidelines.

    General Practice Education Research
    Advances in the Construction of Quality Evaluation System for General Practice Faculty
    ZHAO Wenwen, WANG Rongying, ZHANG Jinjia, ZHANG Yali, ZHANG Min
    2024, 27(07):  784-788.  DOI: 10.12114/j.issn.1007-9572.2022.0837
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    Ensuring the quality of general practice faculty is not only an important basis for training qualified general practitioners, but also relates to the relationship between general practice and other professional disciplines, which is an important guarantee for improving the status of general practice and promoting the development of general practice. This article summarizes the roles and functions, admission standards, quality evaluation standards, and certification standards of general practice faculty by reviewing the websites and literature related to the training of general practitioners and general practice teachers at home and abroad, and prospects the quality evaluation and certification indicator system for general practice teachers in our country in the future, suggests that a quality evaluation and certification indicator system for general practice teachers should be constructed and adapted to national conditions in China, an authoritative professional committee for general practice teachers should be established, the standards for the admission, evaluation and assessment of general practice teachers should be formulated, and a systematic and complete management system for the training of general practice teachers should be established. This paper also suggests to select 1 or 2 excellent general practice faculty training bases in each province, to establish a relatively fixed and high-quality team of general practice faculty, which can provide a useful reference for the continuous quality improvement of general practice faculty training in China.

    Teaching of Undergraduate General Practice in China: a Survey Research
    QI Dianjun, JIANG Nan, YU Xiaosong
    2024, 27(07):  789-793.  DOI: 10.12114/j.issn.1007-9572.2023.0046
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    Background

    The education of general practice has developed rapidly in recent years in China, but there is still a lack of comprehensive survey for undergraduate general practice education.

    Objective

    To understand the current situation and development trend of undergraduate general practice teaching in China.

    Methods

    A questionnaire survey was conducted to investigate the offices of academic affairs of all colleges and universities offering clinical medicine programs in China (n=189) in December 2019, the questionnaires included teaching institutions, faculty and curriculum construction of general practice, which were collected in June 2020. The colleges and universities were categorized into four types for analysis, including comprehensive universities, single-subject colleges (medical colleges or pharmaceutical colleges) , Chinese medicine (TCM) colleges and independent colleges to compare differences in the teaching of undergraduate general practice at different types of colleges and universities.

    Results

    A total of 175 valid questionnaires were returned, with a response rate of 92.6%. In 2019, 85.7% (150/175) of colleges and universities had undergraduate general practice teaching institutions, and the total number of general practice faculty members in colleges and universities nationwide reached 3 371, with 59.8% (2 016/3 371) of them working in the department of general practice in affiliated hospitals. Among the 175 colleges and universities that participated in the survey, 142 (81.1%) offered elective or compulsory courses in general practice, 68 (38.9%) offered graduation practice in general practice in community health centers, and 22 (12.6%) offered graduation practice in general practice in general hospitals. Among the four types of colleges and universities, the proportion of general practice departments set up in general hospitals and affiliated hospitals of single-subject colleges was over 90.0%, the proportion of TCM colleges was 70.0% (7/10) , and the proportion of independent colleges was only 63.3% (19/30) ; the proportion of independent colleges offering elective or compulsory courses in general practice was 60.0% (18/30) , while the proportions of other three types of colleges and universities offering elective or compulsory courses were ≥80.0%. The proportion of single-subject colleges carrying out graduation practice in general practice in community health centers was the highest (61.2%, 30/49) , followed by comprehensive universities (36.0%, 31/86) , and the proportions of independent colleges and TCM colleges were≤20.0%; the proportion of comprehensive universities and single-subject colleges carrying out graduation practice in general practice in general hospital was over 10.0%, while the proportion of independent colleges was 6.7% (2/30) .

    Conclusion

    The development of undergraduate general practice education has been relatively rapid in recent years, but there are still many problems, such as general practice undergraduate education is not widely carried out and developed unevenly, non-community faculty members lack practice experience in primary care, teaching and evaluation methods are simple. There is still a need to further improve the universality and balance of development in the future, and to strengthen teacher training, and enrich teaching methods and evaluation tools.

    Effectiveness of Whole-course Management in the Practice of Standardized Training of General Practitioners
    ZHU Yingfei, ZHANG Yuwei, LUO Yingquan, XU Yan
    2024, 27(07):  794-800.  DOI: 10.12114/j.issn.1007-9572.2023.0295
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    Background

    Whole-course management refers to a patient-centered care model over the entire course of patients, aimed at patients' satisfaction with medical care, improving the whole course management of the disease. The whole-course management model has achieved significant success in various medical fields, such as the treatment of mental health disorders. However, its application in the general practitioner training has been rarely studied.

    Objective

    To investigate the practical effectiveness of the whole-course management teaching model in standardized training for general practitioners.

    Methods

    A total of 60 general practitioners of grades 2020, 2021 and 2022 who received national standardized training at Xiangya Second Hospital of Central South University. Additionally, 30 mentors specializing in total disease management were selected, with each mentor supervising two general practitioners, one from the research group and one from the control group, in order to minimize the impact of personal factors of mentors and ensure more objective research results. All levels of general practitioners of grades 2020, 2021 and 2022 were randomly divided into the research and control groups. The research group adopted whole-course management teaching mode while the control group followed the traditional lecture-based learning (LBL) model, with one team leader selected from each grade. After a nine-month training period (July 2022 to March 2023) , participants were evaluated on 6 items of diagnostic capability, treatment effect evaluation, patient management ability, teamwork ability, self-learning capability, and teaching ability. Simultaneously, a self-designed satisfaction questionnaire was also used to investigate patients under the care of these general practitioners. The average score was calculated based on ratings from three patients per general practitioner.

    Results

    Diagnostic capability, patient management ability, self-learning capability, and teaching ability scores of grade 2020 in the research group were high than those of the control group (P<0.05) ; diagnostic capability, teamwork ability, self-learning capability and teaching ability scores of grade 2021 in the research group were high than those of the control group (P<0.05) ; the research group of grade 2022 achieved higher scores than the control group in diagnostic capability, patient management ability, teamwork ability, self-learning capability, and teaching ability, with statistically significant differences (P<0.05) . The research groups of grades 2020 and 2021 received higher patient satisfaction scores than the control group in various aspects, including communication style, privacy protection, formulation of diagnosis and treatment plan/examination of patients informed, explaining and educating before operation or administration, treatment effectiveness and operation skills, addressing patients' inquiries patiently, responsibility/service attitude, integrity in medical practice, medical fairness, and discharge guidance satisfaction, with statistically significant differences (P<0.05) . The research groups of grade 2022 received higher patient satisfaction scores than the control group in communication style, privacy protection, formulation of diagnosis and treatment plan/examination of patients informed, explaining and educating before operation or administration, treatment effectiveness and operation skills, addressing patients' inquiries patiently, responsibility/service attitude, integrity in medical practice, etiquette dress code and discharge guidance, with statistically significant differences (P<0.05) .

    Conclusion

    The whole-course management teaching model demonstrated advantages in enhancing the diagnostic capabilities, patient management ability, teamwork ability, self-learning capability, and teaching ability of general practitioners. Additionally, patients expressed higher satisfaction with general practitioners trained in whole-course management teaching mode in terms of communication style, privacy protection, formulation of diagnosis and treatment plan/examination of patients informed, explaining and educating before operation or administration, treatment effectiveness and operation skills, addressing patients' inquiries patiently, responsibility/service attitude, integrity in medical practice and discharge guidance.

    Evaluation of the Improvement Programme on Ambulatory Training Ability of Community Preceptors in Practice Base of General Practice Based on the CIPP Model
    WU Lingyan, XU Zhijie, TONG Yuling, YU Yingying, MAO Lingna, LI Bohan, SUN Xue, GUO Yi, SONG Zhenya
    2024, 27(07):  801-809.  DOI: 10.12114/j.issn.1007-9572.2022.0666
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    Background

    The training ability of community preceptors is an important factor related to the quality of standardized training for general practitioners (GPs) . In recent years, training programs for community GP preceptors have been conducted in several regions of China, but no research evaluated the implementation of these programs using a comprehensive approach so far.

    Objective

    To explore the current situation and obstacles to the implementation of training program of Graded-Supervised Ambulatory Training by the Second Affiliated Hospital of Zhejiang University School of Medicine, and provide theoretical references and strategic support for the development of problem-oriented countermeasures.

    Methods

    From October 2021 to January 2022, the implementation status of Graded-Supervised Ambulatory Training program by the Second Affiliated Hospital of Zhejiang University School of Medicine was systematically evaluated based on CIPP model from four aspects of context, input, process and product, using multiple research methods such as content analysis, expert panels, in-depth interviews, expert rating, and surveys.

    Results

    The results of policy document analysis and literature review indicated that community preceptor's training is strongly supported by national health policies, and has been widely implemented in China. The training system developed by the Second Affiliated Hospital of Zhejiang University School of Medicine basically covers the content and process of community preceptor training programme, while the assessment and incentive system developed by the community lacks of detailed instructions. From May 2021 to January 2022, ten community preceptors completed 57 times of ambulatory training, each attending four to seven times. The average score of ability of ambulatory training increased from (78.6±5.7) in the first round to (87.8±4.5) in the seventh round. The satisfaction rates of "site and equipment of training" "training forms" "content of training" and "effect of training" were over 90% among community preceptors and GP residents, yet the satisfaction rate of "proper incentives" among community preceptors was only 20%. Participants reported that the main barriers at present were "imperfect incentive system" "difficulties in recruiting appropriate patients" and "inapplicable training content" .

    Conclusion

    In the initial stage, the Graded-Supervised Ambulatory Training programme has achieved desired results in many aspects, but there is still room for improvement. In the next stage of training, countermeasures should be formulated based on the actual situation of the community practice base to continuously improve the quality of training.

    Article
    Correlation between Snoring and 10-year Risk of Atherosclerotic Cardiovascular Disease in Middle-aged and Elderly Population
    LUO Yuanxin, PENG Derong, ZHANG Lin, LIU Haiying, TAN Jun
    2024, 27(07):  810-815.  DOI: 10.12114/j.issn.1007-9572.2023.0343
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    Background

    With the change of lifestyle, atherosclerotic cardiovascular disease (ASCVD) is showing a younger trend as an important component of ASCVD. Snoring as a common health problem related to sleep breathing, which is a characteristic indicator of obstructive sleep apnea-hypopnea syndrome (OSAHS) . However, there are few studies on the correlation between snoring and ASCVD, and it is still necessary to identify this factor to provide scientific basis for early intervention.

    Objective

    To investigate the correlation between snoring frequency and 10-year risk of ASCVD in middle-aged and elderly population.

    Methods

    From 2018 to 2021, a multi-stage stratified cluster sampling method was adopted to investigate the permanent residents aged 35-75 in Jing'an District. General information of the subjects was collected through questionnaire survey, and laboratory tests were used to collect total cholesterol (TC) , triacylglycerol (TG) , low-density lipoprotein cholesterol (LDL-C) , and high-density lipoprotein cholesterol (HDL-C) . Snoring frequency: snoring 1-2 times per week was considered as mild snoring, snoring 3-4 times per week was considered as moderate snoring, and snoring 5-7 times per week was considered as severe snoring; the 10-year risk of ASCVD <5%, 5%-<10%, and≥10% were defined as low-risk group, intermediate-risk group, and high-risk group, respectively. Multilevel ordinal Logistic regression analysis was used to explore the correlation of snoring with the 10-year risk of ASCVD and ASCVD risk factors.

    Results

    A total of 10 898 residents participated in the study, excluding 1 079 who were unclear about their individual snoring status, for a total of 9 819 residents included in the study. The risk assessment results of ASCVD showed 5 930 in the low-risk group, 1 804 in the intermediate-risk group and 2 085 in the high-risk group. In the general population, Model 1 with multilevel ordinal Logistic regression analysis showed that both moderate and severe snoring were risk factors for the 10-year risk of ASCVD compared with no snoring (P<0.05) . Model 2 adjusted for age based on Model 1, and Model 3 adjusted for hypertension, diabetes, overweight or obesity, smoking, alcohol consumption, and educational factors based on Model 2, the results showed that increasing snoring frequency would cause an increase in the 10-year risk level of ASCVD. After further dividing the total population into males and females by gender, severe snoring was associated with a 10-year risk level of ASCVD compared with the no snoring (P<0.05) , and severe snoring in males has a greater risk than in females, but mild and moderate snoring was not associated with ASCVD risk (P>0.05) . Further analysis of the relationship between snoring and ASCVD risk factors showed that severe snoring was a risk factor for hypertriglyceridemia, hypercholesterolemia, hyper-low-density lipoproteinemia and hypo-high-density lipoproteinemia, and moderate snoring was a risk factor for hyper-low-density lipoproteinemia and hypo-high-density lipoproteinemia compared with no snoring (P<0.05) . Mild snoring was not associated with ASCVD risk factors.

    Conclusion

    The frequency of snoring is correlated with the 10-year risk and risk factors of ASCVD, and it is concentrated in moderate and severe snoring population. People with mild and moderate snoring should be regarded as the focus of early intervention to promote the early prevention and treatment of ASCVD.

    Design and Development of Communication Skills Training in Diabetes Care for General Practitioners in China
    YAO Mi, LIN Kai, FAN Jieting, JI Xinxin, WANG Ying, DONG Aimei, HAN Xiaoning, QI Jianguang, CHI Chunhua, Haroon Shamil, Jackson Dawn, Cheng KK, Lehman Richard
    2024, 27(07):  816-821.  DOI: 10.12114/j.issn.1007-9572.2022.0900
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    General practitioners (GPs) play an important role in diabetes care in primary care as the "gatekeepers" of population health. The management of diabetes can slow its progression, reduce complications and improve patient outcomes, which requires effective communication and collaboration between patients and their doctors. GPs with good communication skills can help to build long-term care relationships with diabetes patients and help them develop effective self-management skills. This paper summarizes the design and development of diabetes communication skills training for GPs guided by research team with multiple theoretical frameworks, including evidence-based findings from systematic review, experiences and ideas of diabetes patients communicating with GPs based on qualitative studies, prioritization of training content for patient-doctor communication in GPs captured by mixed-methods research, in order to provide new ideas for high-quality diabetes management in primary care and inform the design of training programmes for GPs based on evidence and medical education frameworks.

    Quality Evaluation on Integrated Elderly Care and Medical Services Based on the Perspective of Differences between Public and Private Nursing Institutions
    ZHANG Yuan, DONG Jingjing, LIAN Nannan, LIU Yun
    2024, 27(07):  822-828.  DOI: 10.12114/j.issn.1007-9572.2023.0153
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    Background

    There are various researches about the mode and influencing factors of the integrated elderly care and medical services in China in recent years, but researches about quality of integrated elderly care and medical services in nursing institutions are limited, especially in the comparison of quality of integrated elderly care and medical services in difference types of institutions.

    Objective

    To evaluate the quality of integrated elderly care and medical services between public and private nursing institutions.

    Methods

    A total of 1 106 older adults from 25 nursing institutions in Baotou, Xi'an, Yichang and Shaoxing were selected by stratified random sampling method from October 2020 to September 2021 to conduct questionnaire survey. The SERVQUAL model was used to construct the Evaluation Index System of Integrated Elderly Care and Medical Services Quality, involving 5 dimensions of reliability, timeliness, supportability, normativity and empathy and 15 secondary indexes, entropy weight method and fuzzy comprehensive evaluation method were used to calculate and compare the service quality scores of integrated elderly care and medical services between public and private nursing institutions.

    Results

    The comprehensive evaluation score of integrated elderly care and medical services quality was 41.66 and 38.82 in public and private nursing institutions, respectively, among which the scores of the 15 secondary indexes were all above 40.00 in public institutions, and the scores of 13 secondary indexes were below 40.00 in private institutions.

    Conclusion

    There is certain difference in the comprehensive evaluation results of satisfaction on the quality of integrated elderly care and medical services between public and private nursing institutions, among which the differences in the scores of normativity and empathy are higher, while the differences in the scores of reliability, timeliness and supportability are lower, providing a reference for identifying the problems in integrated elderly care and medical services and promoting its high-quality development in nursing institutions.

    Analysis of the Shortage of Pediatrician Workforce in Jiangsu from the Integrated Perspective of Supply and Demand
    JI Wenzhou, HUANG Longyi, XU Aijun, ZHAO Xia
    2024, 27(07):  829-833.  DOI: 10.12114/j.issn.1007-9572.2023.0282
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    Background

    Based on the particularity of children and the adjustment of birth policy in recent years, the development of pediatrician team is becoming more and more important. However, most of the current studies on the shortage of pediatricians are qualitative, lacking of quantitative researches.

    Objective

    To establish a multi-perspective demand forecasting model, comprehensively analyze the shortage of pediatricians in Jiangsu, and provide reference for promoting the development of children's health during the "14th Five-Year Plan" period in Jiangsu Province and accelerating the construction of pediatrician team in the new era.

    Methods

    According to the relevant indicators of pediatric medical services in Jiangsu Province in 2018 obtained from "2018 Jiangsu Provincial Health Service Survey and Analysis Report", and the basic data of pediatrics in each city of Jiangsu Province was obtained from "2019 Jiangsu Provincial Statistical Yearbook" and the database of the Jiangsu Provincial Health Statistics Information Center. Using SPSS 24.0 analysis software, a multi-perspective demand forecasting model was developed from the perspectives of supply and demand, and a comprehensive analysis of the number of pediatrician shortage in Jiangsu Province was performed.

    Results

    The proportion of female physicians in the pediatrician team in Jiangsu is relatively high. The young and middle pediatricians occupy a leading position. The academic backgrounds of the pediatricians are mainly undergraduate. The professional title structure is much reasonable. Most of pediatricians have been working for over 20 years. Combined with the basic situation of the pediatrician team in Jiangsu and the perspective of supply and demand, the shortage number of pediatricians in Jiangsu Province was 18 300 and the average shortage number of physicians in 13 cities was 1 500.

    Conclusion

    There is an overdemand of resources for pediatric care and a high workload for physicians with an imbalance in the gender and title structure of the workforce; the special practice environment leads to increased practice risk. It is necessary to strengthen the personnel training and introduction policies, consolidate the professional foundation of personnel, and explore a new management model of "Internet + medical consortium".

    Status and Influencing Factors of Mental Health of Community Medical Personnel during the Normalized Prevention and Control of COVID-19
    YANG Huajie, WANG Haoxiang, CHEN Yuncong, LIANG Xudong, WANG Jiaji, HUANG Xiang
    2024, 27(07):  834-842.  DOI: 10.12114/j.issn.1007-9572.2022.0673
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    Background

    Since the outbreak of COVID-19 infection, community medical personnel on the front lines of prevention and control of COVID-19 face the risk of direct contact with the virus, as well as problems such as high-intensity work, long working hours and high psychological pressure. Therefore, it is of great significance to explore the mental health status of community medical personnel and its internal relationship for the tailored implementation of mental health interventions.

    Objective

    To understand the mental health status of community medical personnel during the normalized prevention and control of COVID-19 and explore its influencing factors.

    Methods

    A total of 296 cases of community medical personnel in Zhongshan City were selected as the study subjects on December 2021 using a multi-stage random sampling method. The general information questionnaire, self-designed questionnaire of working pressure on COVID-19 prevention and control among community medical personnel, Generalized Anxiety Disorder 7 (GAD-7) and Patient Health Questionnaire 9 (PHQ-9) were administered for online investigation, and multivariate Logistic regression analysis was performed to explore the influencing factors of the perceived stress level on COVID-19 prevention and control, the presence of anxiety and depression of community medical personnel.

    Results

    Among the community medical personnel in Zhongshan City, the detection rate of high perceived working pressure on COVID-19 prevention and control was 10.1% (30/296) . The prevalence of anxiety and depression at moderate level was 7.1% (21/296) and 9.5% (28/296) , respectively. Gender, the existence of depression and the level of perceived working pressure on COVID-19 prevention and control were influencing factors of the presence of anxiety among community medical personnel (P<0.05) . Performing daily diagnosis and treatment during the epidemic, engaging in three-member team for door-to-door screening, the presence of anxiety and level of perceived working pressure on COVID-19 prevention and control were factors associated with the presence of depression among community medical personnel (P<0.05) . The presence of anxiety and depression were factors associated with the level of perceived working pressure on COVID-19 prevention and control among community medical personnel (P<0.05) .

    Conclusion

    The perceived working pressure on COVID-19 prevention and control and negative emotions of anxiety and depression are related and interacted with each other, and the relative shortage of epidemic prevention and control tasks and human resources, as well as the imbalance between labor effort and labor income, have exacerbated the synergistic effect of negative emotions among community medical personnel. And health administration department should be dedicated to build up long-term investment and development mechanism for community health service institutions in the new situation and strengthen health administration department according to the development characteristics and problems exposed at community health service institutions during the normalized prevention and control of COVID-19.

    The Relationship between Effort-reward Imbalance and Job Stress among Medical Staff in Beijing
    LI Ang, GUO Moning, TAN Peng, LU Feng, WANG Mei
    2024, 27(07):  843-848.  DOI: 10.12114/j.issn.1007-9572.2023.0179
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    Background

    Medical work is characterized as challenging, tasking and stressful. The effort-reward imbalance (ERI) model suggests that if the organizational environment contributes to ERI, it can negatively affect employees. The investigation of medical staff is an important part of the 6th National Health Services Survey in 2018. The good job satisfaction and work conditions of medical staff are important determinants of service utilization and health improvement for the population. The sense of accomplishment and satisfaction of medical staff is also an important goal of the new healthcare reform.

    Objective

    To explore the relationship between ERI and job stress, and provide a reference for reducing the job stress of medical staff.

    Methods

    The data for this study were obtained from the results of a sample survey of 4 156 healthcare workers in Beijing during the 6th National Health Services Statistics Survey in 2018. A predictive structural equation model of job stress was constructed and based on ERI questionnaire and job stress questionnaire. Relevant parameters were estimated by using the partial least squares to analyze the relationship between ERI and job stress.

    Results

    The valid records for participating in the ERI index calculation were 4 098. According to the ERI index calculation results, 1 333 (32.53%) healthcare workers were in a state of balance between effort and reward, and 2 765 (67.47%) health workers were in a state of imbalance between effort and reward. The results of factor analysis showed that 46.00% of the job stress experienced by medical staff in Beijing can be attributed to ERI model. Extrinsic, intrinsic effort and work reward all had a direct impact on job stress (P<0.001) , the total effect of intrinsic effort was 0.409 (95%CI=0.373 to 0.443) ; the total effect of extrinsic effort was 0.583 (95%CI=0.559 to 0.606) ; the total effect of work reward was -0.199 (95%CI=-0.227 to -0.171) . In addition, the intrinsic effort mediated the impact of extrinsic effort and work rewards on job stress.

    Conclusion

    The results of the study support the hypothesis that ERI is an important source of job stress for medical staff in Beijing. Based on the evidence that the intrinsic effort has the greatest impact on job stress, the relevant management system should be improved by health administration and medical institutions to address ERI and reduce the job stress of medical staff.

    Research on the Efficiency and Equity of Rural Medical and Health Resources Allocation in China Based on DEA-GIS Methodology
    GAO Dian, SHI Lushaobo, LIN Jinhui, WANG Xingmin, WANG Dong
    2024, 27(07):  849-856.  DOI: 10.12114/j.issn.1007-9572.2023.0413
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    Background

    "Strengthening primary health care" is one of the focuses of China's health care reform, and the study of the efficiency and equity of rural medical and health resources allocation in China is of great significance in promoting the orderly development of primary health care services, but at present, there are few relevant literature based on the DEA-GIS methodology with both equity and efficiency.

    Objective

    To analyze the efficiency and equity of rural medical and health resources allocation in 29 provinces in China in 2020, in order to provide a reference for optimizing the allocation of rural medical and health resources and improving the rural medical and health service system in China.

    Methods

    The data for this study were collected from the Statistical Tables of Administrative Divisions of the People's Republic of China, the 2021 China Health Statistical Yearbook. After synthesizing the existing literature research, data availability and soliciting expert advice, the township hospitals and village clinics in 29 provinces in China (excluding Beijing, Shanghai, Hong Kong, Macao and Taiwan) were selected as the study objects, and the number of township hospitals and village clinics (hereinafter referred to as the number of health institutions) , the number of beds in township hospitals (hereinafter referred to as the number of beds) , and the number of health technicians in township hospitals and village clinics (hereinafter referred to as the number of health technicians) were used as input indicators; the number of consultations in township hospitals and village clinics (hereinafter referred to as the number of consultations) , and the number of hospital admissions to township hospitals (hereinafter referred to as the number of admissions) were used as output indicators. The data envelopment analysis (DEA) model was used to assess the efficiency of rural medical and health resources allocation in China, and the health resource agglomeration degree and geographic information system (GIS) technology were used to spatially map the rural medical and health resources allocation to analyze its equity.

    Results

    In 2020, China's rural medical and health resources had 4 provinces with effective DEA, 7 provinces with weakly effective DEA, and 18 provinces with ineffective DEA. Among them, the DEA ineffective regions all had different degrees of excess inputs, and only Shandong Province and Tibet Autonomous Region had insufficient outputs. The results of regional analysis showed that rural medical and health resources were concentrated in the eastern region, followed by the central region, with the lowest degree of concentration in the western region.

    Conclusion

    The government needs to pay attention to improving the technical efficiency of rural medical and health resources allocation, and promote equity and efficiency by applying precise measures to each region based on optimizing the input and output structure, reducing resource redundancy, rationally coordinating the allocation of resources in the eastern, central and western regions.

    Measurement of the Intelligence Level of Elderly Care Institutions: Theory and Demonstration
    TIAN Qinrui, LI Qiaoxing
    2024, 27(07):  857-866.  DOI: 10.12114/j.issn.1007-9572.2023.0014
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    Background

    With the increasing aging of China, the exploring of smart elderly care institutions development has become a research focus in the field of elderly care at home and abroad.

    Objective

    To establish an evaluation model for the intelligence level of elderly care institutions, and provide theoretical reference and basis for research work in related fields.

    Methods

    A smart evaluation index system for the intelligence level of elderly care institutions containing a total of 37 three-level indicators was constructed based on literature analysis and descriptive statistics; hierarchical clustering analysis was performed based on the variable data of each evaluation index to obtain a cluster pedigree; the hierarchical clustering method was proposed, and 43 top-end elderly care institutions in Shanghai were selected for empirical analysis of hierarchical clustering based on the "elbow method".

    Results

    Top-end elderly care institutions in Shanghai can be divided into three categories of smart, semi-smart and non-smart; more than 60% of the elderly care institutions are non-smart; more than 70% of the elderly care institutions do not have comprehensive intelligent equipment or have sound intelligent supervision system unable to provide in-depth psychological services.

    Conclusion

    The intelligent construction of elderly care institutions in Shanghai is still at a low level of development with a large upside. Finally, the endogenous and exogenous meanings of smart elderly care institutions proposed based on the literature review and empirical analysis results can provide reference for research in related fields.

    Qualitative Studies on Care and Support Needs in Elderly People with Physical Disability: a Systematic Review
    ZHANG Jinxin, YAO Nengliang, SUN Xiaojie
    2024, 27(07):  867-876.  DOI: 10.12114/j.issn.1007-9572.2023.0297
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    Background

    In the context of population aging, the care needs of the disabled elderly cannot be ignored. A comprehensive understanding of the care and support needs of the elderly with disabilities can provide basis for government policymakers in the development of rational care strategies.

    Objective

    To systematically review qualitative studies on the care and support needs of the disabled elderly.

    Methods

    In this study, a systematic search of Web of Science, PubMed, Embase, Cochrane Library, CNKI, Wanfang Data, and CBM for relevant qualitative studies was conducted from inception to February 26, 2023. The Joanna Briggs Institute's Critical Appraisal Tool for qualitative studies was performed to evaluate the quality of included qualitative studies. The results of the original qualitative studies were synthesized through a pooled integration approach.

    Results

    A total of 33 qualitative studies were finally included, and 7 themes with 18 categories were distilled, including daily activities-related needs (basic activities of daily living, household activities, and caregiving characteristics) , functional independence-related needs (independence in physical functioning, independence in autonomous decision-making) , health care-related needs (content of health care services, health care service experience, expression of needs for health care services) , contextual support-related needs (objective environmental support, policy support) , positive emotional support-related needs (psychological comfort, spiritual care) , social support-related needs (community support services, social engagement, relationship connection, information linkage) , health technology-related needs (care auxiliary equipment, technical services) .

    Conclusion

    The care and support needs of the disabled elderly are both complex and diverse. To meet the physical, psychological, social, healthy and environmental needs of the disabled elderly, it is essential for the government to integrate resources from family, community and institutions. Furthermore, attention should be given to the equitable of care resources from a group perspective, and additional social welfare should be provided to support the disabled elderly.

    Regional Differences in Disability and Its Influencing Factors among Middle-aged and Elderly People in East, Central and West Major Regions in China
    LIU Ying, JIANG Juncheng, JING Huiquan
    2024, 27(07):  877-885.  DOI: 10.12114/j.issn.1007-9572.2023.0552
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    Background

    The aging of our population and the intensification of major chronic disease problems will inevitably lead to an increase in the number of disabled people, resulting in increased pressure on social care and a heavier burden on the government and families for the elderly. At the same time, the unbalanced allocation of health resources will pose even more serious challenge to the medical treatment and nursing care of the disabled population.

    Objective

    To explore the differences of disability rate, disability degree and influencing factors among middle-aged and elderly people in eastern, central and western regions of China.

    Methods

    Data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were analyzed from 2022-10-05 to 2023-01-13, and 19 170 middle-aged and elderly people aged 45 years and above were selected as the study subjects. Activities of daily living (ADL) and instrumental activities of daily living (IADL) scales were used to determine disability. The situation and degree of disability in middle-aged and elderly people were considered as dependent variables, and independent variables were selected from three aspects of general demographic characteristics, health evaluation and lifestyle according to CHARLS data questionnaire. Binary and multivariate Logistic regression analyses were conducted to analyze the factors affecting the disability and degree of disability of middle-aged and elderly people in eastern, central and western regions of China.

    Results

    Comparison of the rate and degree of disability among middle-aged and elderly people in eastern, central and western regions showed statistically significant differences (χ2=143.014, P<0.001; χ2=136.356, P<0.001) . Mild disability predominated among middle-aged and elderly people in eastern, central and western regions; the difference was statistically significant when comparing the age composition of middle-aged and elderly people with mild and severe disability in eastern, central and western regions (P<0.05) . There were commonalities and characteristics in the influencing factors of disability and disability degree in the three regions. Age, education level and self-rated health status were the common influencing factors of disability in middle-aged and elderly people in eastern, central and western regions (P<0.05) . Gender and physical disability were the independent influencing factors for the development of disability in middle-aged and elderly people in eastern China (P<0.05) . The risk of disability in middle-aged and elderly people in females was 86.0% higher than that in males (OR=1.860, 95%CI=1.036 to 3.338) . Marital status and combining with chronic disease were the independent influencing factors for disability in middle-aged and elderly people (P<0.05) . Residence, brain damage/intellectual impairment were the independent influencing factors for disability among middle-aged and elderly people in western China (P<0.05) .

    Conclusion

    In order to solve and improve the differences of disability status among the middle aged and old people in the eastern, central and western regions of China, individualized prevention and intervention strategies for different regions should be developed according to the differences of influencing factors, regional medical services and rehabilitation guidance should be provided, and a cross-regional allocation mechanism of medical and health resources should be established to promote regional healthy and sustainable development.

    Differential Analysis of Disability in Different Settings in China: Based on a Survey of 23 922 Older Adults
    SUN Ke, SUN Chao, HAO Jinjuan, XU Huazhao, MA Yan, HU Huixiu
    2024, 27(07):  886-892.  DOI: 10.12114/j.issn.1007-9572.2023.0583
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    Background

    With the increasing of older adults with disability, it is urgent to understand the disability status of older adults in different settings and to improve the long-term care service model from professional institutions to communities and families.

    Objective

    To investigate the disability status of older adults in different settings (hospitals, nursing facilities, and communities) , compare and analyze the differences in the disability status of the elderly in different settings.

    Methods

    The multi-stage sampling method was used in this study from January 2022 to January 2023. At the first stage, one or two provinces were conveniently selected in East China, South China, Central China, North China, and Southwest China; at the second stage, 3 tertiary hospitals, 2 secondary hospitals, 2 community health centers, and 1 nursing facility were conveniently selected as the study sites in each province. Older adults in 27 tertiary hospitals, 18 secondary hospitals, 18 community health service centers, and 9 nursing facilities in 9 provinces and cities (Beijing, Hunan, Jiangsu, Guangdong, Fujian, Xinjiang Uygur Autonomous Region, Guizhou, Hainan, and Sichuan) were finally included as study subjects. Barthel Index (BI) was used to evaluate basic activity of daily living (BADL) . Lawton-Brody Instrumental Activity of Daily Living scale was used to evaluate instrumental activity of daily living (IADL) . The Logistic regression analysis was used to explore the association of settings with BADL disability degree, IADL disability degree and functional disability in different aspects for older adults.

    Results

    A total of 27 344 questionnaires were collected and 23 922 were valid, with a valid recovery rate of 87.5%. There were 10 318 cases (43.1%) disabled in BADL, and the top three disabled BADL functions were bed-chair transfers, ascend and descend stairs, mobility on level surfaces. The incidence of BADL disability in various places was 29.0% in communities, 74.9% in elderly care institutions, 54.0% in secondary hospitals, and 44.6% in tertiary hospitals. Besides, 19 200 (80.3%) cases were disabled in IADL and the top three disabled IADL functions were mode of transportation, housekeeping and shopping. The incidence of IADL disability in various places was 74.6% in communities, 96.4% in elderly care institutions, 83.6% in secondary hospitals, and 81.1% in tertiary hospitals. Different settings were the influencing factor for the disability degree and functional disability types (P<0.05) .

    Conclusion

    The status of disability of older adults in nursing institutions is most dismal, which were recommended to develop professional disability care services and improve the service capacity of practitioners.