Table of Content

05 April 2024, Volume 27 Issue 10

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Special Report

Building Quality Primary Health Care Development in the New Era towards Universal Health Coverage: a Beijing Initiative

REN Minghui, ZHANG Tuohong, XU Jin, QIAO Jie, QIAO Jianrong, ZHAN Siyan, QIN Jiangmei, SONG Daping, FANG Yanru, LIN Yifang, JIANG Xiaopeng, GUO Yan, MENG Qingyue, QIAN Xu, LIU Yunguo, Chan Sophia Siu Chee, ZHAO Feng, Yip Winnie, WANG Hong, WANG Mingming, YIN Hui, LIU Zuokun, LI Na, SONG Xinyi, LIU Fangfang, JIN Yinzi, ZHOU Shuduo, LIU Fangjing, HUANG Yangmu

2024, 27(10):  1149-1152.  DOI: 10.12114/j.issn.1007-9572.2024.A0011

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Training and Utilization Development Report of General Practitioners in China (2022)

WAN Xiaowen, ZENG Cheng, LI Zongyou, LI Jiangbin, WU Ning, SHENG Wenbin, HUANG Rong, CHEN Shuanghui, CHANG Hongfei

2024, 27(10):  1153-1161.  DOI: 10.12114/j.issn.1007-9572.2023.0856

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The report of the 20th CPC National Congress pointed out that it is necessary to "develop and strengthen the medical and health care workforce, focusing efforts on rural areas and communities". General practitioners (GPs) are the "gatekeepers" of residents' health and medical expenses, and play an important role in basic medical and health services. Training applied and complex new-age GPs who can be deployed, retained and utilized is an important step in promoting the construction of a healthy China. On the basis of Training Development Report of GPs (2018), this report systematically reviews the team construction, training and education, reform of utilization and incentive mechanism of GPs in China from 2018 to the present, and puts forward the future outlook of GPs in China in the hope that it can provide information for further research on general practice in China.

Chinese General Practice/Community Health Service

Challenges and Optimization Paths for the Development of Community Health Service in China

WU Yueping, NIU Yadong, ZHANG Liang, ZHANG Xiang, WU Jian, MIAO Yudong

2024, 27(10):  1162-1165.  DOI: 10.12114/j.issn.1007-9572.2023.0760

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In the new era, the health needs of residents are constantly increasing, and how community health services adapt to the needs of the times and achieve comprehensive transformation urgently needs to be answered. Firstly, the article reviewed the development process of community health service (CHS) in China and found that it is functionally defective. Secondly, the article summarized the challenges faced by the optimization of CHS in China and pointed out that the current health needs of the population are undergoing structural changes. Finally, the article proposed the optimization paths of CHS in China in terms of changing the focus of work, improving the sense of value for contracted doctors and the sense of achievement for residents, building a collaborative and complementary CHS network, and establishing a demand-oriented health information platform.

Article

Survey Research on the Development of Urban Community Health Service Centers

LI Yaling, GU Yanfeng, ZHENG Yanling, CAI Xuemin, WANG Wei, YU Haiyan, DU Zhaohui

2024, 27(10):  1166-1172.  DOI: 10.12114/j.ssn.1007-9572.2023.0310

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Background

The urban community health service centers in China have developed for nearly 20 years, but there is a lack of systematic research on their development, progress made, and existing problems.

Objective

To propose suggestions for the high-quality development of urban community health services centers in China by analyzing their development situation.

Methods

In October 2022, 50 community health service centers were selected from 13 provinces in the eastern, central and western regions by convenience sampling method. A self-developed research questionnaire based on the key core indicators for the assessment of urban community health services centers included two parts of basic data and evaluation content. Basic data included jurisdictional area, number of employees, number of outpatient visits, etc; the evaluation content included 4 gradeⅠindicators (institutional configuration, service function, service mode, and service support), 13 GradeⅡindicators and 33 GradeⅢindicators. The data of year 2006 (or the first year of the hospital's establishment and data) and 2021 were compared, and the survey results were reported in through "sojump".

Results

(1) Basic data: the number of community health service centers established before 2006 were 24 (accounting for 48.00%), and 26 after 2006 (accounting for 52.00%) ; comparing the year of 2006 or the first year of establishment, and the year of 2021, the number of employees was 67.00 (40.00, 101.00) and 94.00 (62.00, 162.00) respectively; the number of outpatient visits was 39 324.00 (22 620.00, 118 384.00) and 106 259.00 (44 999.00, 225 851.00) respectively; the total score of the questionnaire was 36.50 (28.13, 46.00) and 69.00 (56.38, 76.00), respectively. (2) The median scores of Grade I indicators institutional configuration, service mode and service function in 2021 were all higher than those in 2006 or the first year of establishment. The relative scoring rate of Grade I indicators in 2021, institutional configuration was 77.27% (25.50/33.00), service mode was 61.84% (23.50/38.00), service function was 76.92% (10.00/13.00), service support was 47.37% (9.00/19.00). The median score of structure area in the institutional configuration indicators was 0; among the service function indicators, the relative scoring rate of the diagnosis and treatment of common and chronic diseases in the community, and the inpatient service content were all 100.00%; the relative scoring rate of inpatient bed utilization rate was 25.00% (1.00/4.00). (3) Score of GradeⅡ、Ⅲ evaluation indicators of service function, service mode, and service support: The median score of public health items in service function increased from 2.00 points in 2006 or the first year of establishment to 9.50 points in 2021. The differences were statistically significant (P<0.05) in different years, with a relative scoring rate of 59.38% (9.50/16.00) in 2021; the relative scoring rate of resource integration in service mode was 100.00% in 2021. Among the service support indicators, the median scoring of general practitioners, public health practitioners and scientific research tasks all were 0; there was statistically significant difference (P<0.05) in the distribution of scores of general practitioners and scientific research tasks in different years.

Conclusion

The sustainable development of urban community health service centers is reflected in the gradual improvement of the relative scoring rate of institutional configuration, service function, service mode and service support. But the area of structure, inpatient service capacity and personnel ratio are seriously insufficient and the growth is very slow, which has become a constraint on the development of community health service centers.

Chinese General Practice/Community Health Service

Report on Methodological Quality Assessment of Primary Care and General Practice Research in China in 2021: Qualitative and Mixed Methods Research Section

Quality Assessment Group for Qualitative and Mixed Methods Research of Chinese General Practice

2024, 27(10):  1173-1178.  DOI: 10.12114/j.issn.1007-9572.2023.0752

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Background

General practice has significant interdisciplinary characteristics, both qualitative research and mixed methods research are applicable to scientific research in this field. In recent years, there has been a steady increase in the number of relevant academic papers published in China, but the overall quality of the literature has not been systematically assessed.

Objective

To explore the methodological quality of qualitative and mixed methods research literature published in the field of primary care and general practice.

Methods

From August 2022 to April 2023, four investigators analyzed and assessed the methodological quality of qualitative and mixed methods research published in the field of primary care and general practice in China in 2021 using the qualitative assessment tools of Critical Appraisal Skills Programme (CASP) and Mixed Methods Appraisal Tool (MMAT), respectively. The researchers were grouped in pairs and independently for information extraction and quality evaluation.

Results

A total of 35 qualitative research and 9 mixed methods research were included. Among the qualitative research, 23 literature (65.71%) did not sufficiently considered ethical issues; recruitment of participants was not discussed in 94.29% (33/35) of the research; the relationship between the researcher and the participants was not adequately considered in 82.86% (29/35) of the research; 42.86% (15/35) of the research had a sample size of <20 participants and data saturation was not discussed in 25.71% (9/35) of the research. Major problems with mixed methods research included the fact that: 8/9 of the research did not explicitly report the type of mixed methods research design and 8/9 of the research failed to effectively integrate the different components of the study to answer the research question.

Conclusion

The methodological quality of such qualitative and mixed methods research in primary care and general practice published in 2021 in China is still partially limited, especially in the ethics, reliability and information saturation among qualitative research, and the integration among mixed methods research, which should be further strengthened by training in research methodology and strict adherence to research design and reporting statements in order to improve the quality of research and even evidence for decision making.

Article

The Utilization of Health Checkup Services among People Aged 45 and above in China: a National Cross-sectional Survey Based on CHARLS 2018

GAO Chuan, LI Qingyin, KE Dandan, ZHOU Yuyu, ZHANG Yuyang, HE Zhong

2024, 27(10):  1179-1185.  DOI: 10.12114/j.issn.1007-9572.2023.0686

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Background

Research on the utilization of outpatient and inpatient health services and its influencing factors has been well established, but there are few studies on the utilization of preventive medical services such as health checkup by residents in China.

Objective

To investigate the utilization of health checkup in Chinese residents aged 45 years and above and analyze its influencing factors.

Methods

Using data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), the population aged≥45 years was selected to calculate the rate of participation in health checkup and the number of health checkup items from 2015 to 2018. Zero-inflation negative binomial regression was used to analyze the influencing factors of the number of health checkup items attended by residents.

Results

A total of 17 203 samples were included in this study, with an average age of (62.4±10.0), and the participation rate of 47.73% (8 21/17 203). The top three in participation rate in health checkup were Xinjiang Uygur Autonomous Region (96.47%), Shanghai (83.67%) and Beijing (82.05%), while the bottom three were Liaoning Province (35.41%), Qinghai Province (36.55%) and Fujian Province (36.94%). Among the 8 211 people who had participated in health checkup, the average age was (64.1±9.9) years old, and the median number of health checkup items per capita was 9 (5, 12). The top three in the number of health checkup items were Beijing Municipality (14 items), Shanghai Municipality (14 items) city and Xinjiang Uygur Autonomous Region (13 items), and the bottom three were Gansu Province (7 items), Anhui Province (7 items) and Liaoning Province (7.5 items). Non-parametric test showed that the number of health checkup items in urban residents was significantly higher than that in rural areas (10 items vs. 8 items), the eastern region was significantly higher than the central (10 items vs. 8 items), western (10 items vs. 8 items) and northeast (10 items vs. 8 items) region, the western region was significantly higher than the central region (9 items vs. 8 items) (P<0.001). The Zinb model showed that economic region (central, western, and northeastern), type of residence (urban area), gender (female), age (60 years and above), education level (junior high school and above), health status (comorbidity), and type of basic health insurance (employee health insurance) were the factors influencing the number of health checkup items attended by residents (P<0.001). Subgroup analysis according to urban and rural areas showed that economic region (central, western, and northeastern), age (60 and above), and education level (junior high school and above) were the common influencing factors on the number of health checkup items attended by urban and rural residents (P<0.05). In addition, for residents of urban areas, being married was an influential factor in the number of health checkup items attended (P<0.001) ; for residents of rural areas, being male, comorbidity, and employee health insurance were the factors influencing the number of health checkup items attended (P<0.001) .

Conclusion

The people aged 45 years and above in China have a low utilization rate of health checkup services, health check-up services are more available in urban and eastern areas. Age and education level are the influencing factors of utilization of health checkup services. Marital status is the influencing factor of utilization of health checkup services in urban, gender, health status and type of basic medical insurance are the influencing factors of the utilization of health checkup services in rural. In the future, the utilization of health checkup services should be further improved, different policies and measures should be formulated according to urban and rural areas, as well as geographical regions.

A Study on the Factors Influencing the Comprehensive Risk of Cardiovascular Disease in Elderly Patients with Chronic Disease in Primary Care

YU Xinyan, SU Peng, YUAN Xiaojing, JIANG Qingru, YANG Jianyun, ZHAO Xudong, WANG Yifan, ZHANG Haicheng

2024, 27(10):  1186-1193.  DOI: 10.12114/j.issn.1007-9572.2023.0604

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Background

Cardiovascular disease is the primary cause of death and Disease burden of Chinese residents, and the situation of prevention and control is grim. Management of risk factors for cardiovascular disease is an important foundation for preventing cardiovascular disease. However, there is currently limited research on the influencing risk factors of cardiovascular disease risk in elderly patients with chronic disease in primary care using single lead wearable electrocardiogram devices both domestically and internationally, and previous studies have not ranked the importance of variables containing different quantities of risk in patients from a holistic perspective.

Objective

The aim of this study is to analyze the influencing factors of the comprehensive risk of cardiovascular disease in elderly patients with chronic disease aged 65 and above in primary care in Ningxia, and to provide objective basis and assistance for the comprehensive prevention and control of cardiovascular disease in primary care.

Methods

From December 2021 to September 2022, totally 3 039 patients over 65 years old with hypertension, diabetes and coronary heart disease, including at least one chronic disease, from 26 primary care health center in Ningxia were selected as the research subjects. According to the analysis of the 72 hour electrocardiogram, there were 632 cases in the normal group and 2 407 cases in the risk group. Analyze the basic information of two groups of patients to determine the best λ Value, draw a model, and use LASSO regression and multivariate Logistic regression to analyze the comprehensive risk factors of cardiovascular disease in elderly patients with chronic diseases; and rank the variables that affect the overall risk of cardiovascular disease and include different numbers of risks among patients.

Results

The differences in age, gender, BMI, education level, occupation, urban-rural distribution, smoking, exercise, coronary heart disease combined with diabetes, hypertension combined with coronary heart disease and diabetes between the two groups of patients were statistically significant (P<0.05) ; optimum λvalue was 0.015 685 31. LASSO regression and multivariate logistic regression model analysis showed that age, BMI, urban-rural distribution, smoking Hypertension combined with coronary heart disease and diabetes is a influencing factor for cardiovascular disease (P<0.05). Auc was 0.650 (95%CI=0.627-0.673, P<0.001) The top five variables that affect comprehensive risk and different types of risk are age, BMI, urban-rural distribution, tea drinking, and exercise; Age, hypertension combined with coronary heart disease, gender, urban-rural distribution, smoking; Age, hypertension combined with coronary heart disease, gender, BMI, urban-rural distribution; Diabetes combined with coronary heart disease, age, hypertension combined with coronary heart disease, hypertension combined with coronary heart disease and diabetes, hypertension combined with diabetes.

Conclusion

Age, BMI, urban and rural distribution, smoking, hypertension with coronary heart disease and diabetes are the influencing factors of cardiovascular disease risk in patients over 65 years old with chronic diseases. In addition to age, BMI and lifestyle habits have a significant impact on the overall risk of cardiovascular disease. As the number of comorbidities increases, the impact of chronic diseases, especially chronic disease comorbidities, increases. Primary care medical teams should regularly conduct comprehensive CVD risk management for elderly patients with multiple chronic diseases using single lead wearable devices. This not only enables efficient and low-cost implementation of primary and secondary prevention and health management of CVD risks, but also accelerates the transformation of primary medical services from inconsistent diagnosis and treatment services to full process health management.

Influencing Factors of Blood Glucose Monitoring in Middle-aged and Elderly Patients with Type-2 Diabetes Mellitus in Rural Areas

DAI Zhenwei, ZHANG Ling, ZHANG Haoran, XIAO Weijun, WANG Hao, HUANG Yiman, JING Shu, CHEN Xu, FU Jiaqi, WU Yijin, GAO Lei, SU Xiaoyou

2024, 27(10):  1194-1200.  DOI: 10.12114/j.issn.1007-9572.2023.0384

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Background

The risk of diabetes mellitus can increase with age, and the prevalence of prediabetes and diabetes mellitus in the middle-aged and elderly adults is 40% and 10%, respectively. Good adherence to blood glucose monitoring improves the rate of glycohemoglobin compliance. However, adherence to blood glucose monitoring is poor in patients with type 2 diabetes mellitus (T2DM) in rural areas.

Objective

To investigate and understand the blood glucose monitoring situation of middle-aged and elderly patients with T2DM aged 45 to 65 years in rural areas of Zhongmou County, Henan Province, explore the psychological and behavioral factors affecting their adherence to blood glucose monitoring and monitoring frequency, so as to provide a reference for targeted interventions to improve the blood glucose monitoring compliance of the middle-aged and elderly patients with T2DM in rural areas.

Methods

Middle-aged and elderly T2DM patients in rural areas of Zhongmou County, Henan Province from November 2 to 12, 2021 were selected to conduct for questionnaire survey by using convenience sampling method. A self-designed general information questionnaire was used to investigate their basic information and blood glucose monitoring. Additionally, the Five-item Mindful Awareness Attention Scale (MAAS-5), Generalized Anxiety Disorder Questionnaire (GAD-7), Patient Health Questionnaire (PHQ-9), and Diabetic Self-management Scale (DSMS) were used to investigate their mindfulness, anxiety, depression, and self-management ability, respectively. Univariate analysis, multivariate Logistic regression and negative binomial regressions were used to explore the influencing factors of situation and frequency of blood glucose monitoring and monitoring frequency in middle-aged and elderly T2DM patients.

Results

A total of 484 questionnaires were collected, and 469 were enrolled in this study, with a recovery rate of 96.9%. Of the 469 patients, 58.8% (276/469) were unable to monitor blood glucose monthly, and the frequency of monthly blood glucose measurements for the 193 patients who monitored blood glucose ranged from 1 to 60 times, with a median of 2 times. Logistic and negative binomial regression analysis showed that depression symptoms (AOR=1.127, P=0.005), high information level (AOR=0.133, P=0.023), and high motivation level (AOR=1.093, P=0.002) were facilitators of blood glucose monitoring; high annual income (AIRR=2.063, P<0.001) and alcohol consumption in the past 1 year (AIRR=1.569, P=0.011) were facilitators of blood glucose monitoring frequency. Smoking in the past 6 months (AOR=0.559, P=0.043) was a barrier of blood glucose monitoring; aged over 60 years (AIRR=0.668, P=0.024) was a barrier of blood glucose monitoring frequency.

Conclusion

The blood glucose monitoring status of middle-aged and elderly T2DM patients in rural areas is relatively poor, therefore, it is recommended that relevant health authorities should strengthen health education such as blood glucose monitoring knowledge and skills, provide medical and financial social support for low-income populations, to improve blood glucose monitoring compliance and achieve effective control, treatment, and rehabilitation of T2DM.

Analysis of Blood Pressure Trajectories and Distribution Characteristics in Community-based Hypertension Management Population Aged 35 Years and Above

LU Chunyuan, LONG Rong, MAO Yongjia, YE Dexin, WANG Junhua, ZHANG Jiangping

2024, 27(10):  1201-1207.  DOI: 10.12114/j.issn.1007-9572.2023.0640

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Background

As the population suffering from hypertension tends to be younger, the National Basic Public Health Service Project focuses on monitoring individuals aged 35 and above. Presently, the number of hypertensive patients in the community is increasing annually, which significantly increasing the burden of community healthcare. However, few longitudinal studies have been conducted in recent years to investigate the changes in blood pressure and distribution of hypertensive patients after community management.

Objective

To explore the trends in blood pressure changes among hypertensive individuals aged 35 and above in community management, unveiling the trajectory and distribution characteristics of hypertension in this population.

Methods

This study relied on a retrospective cohort study established from 2020 to 2022 under the National Basic Public Health Service Project. From January 2020 to December 2022, hypertensive patients meeting the diagnostic criteria in the National Basic Public Health Service Specification (The Third Edition) were selected from community health service centers/stations in a certain district in Guiyang City responsible for basic public health services. Baseline data were collected using personal basic information forms (gender, age, and duration of hypertension). Follow-up data, including height, BMI, blood pressure, waist circumference (WC), follow-up methods, medication adherence, and control satisfaction, were collected using follow-up record forms. BMI, waist-to-height ratio (WHtR) of the research subjects were calculated. Follow-up was conducted every six months for a total of five times. Latent growth curve models (LGCM) and growth mixture models (GMM) were employed to explore the trajectories of blood pressure values during follow-up among hypertensive individuals aged 35 and above, and to identify latent clusters with similar trajectories. Further analysis was conducted to examine the distribution characteristics of different blood pressure trajectory groups.

Results

A total of 15 958 hypertensive patients were included in the study, and both the baseline level and change rate of blood pressure in the hypertensive population were associated with the baseline level and change rate of BMI. Both systolic and diastolic pressures presented three similar trajectories of change. The three trajectories of systolic and diastolic blood pressure were defined and accounted for as 2.1% (332/15 958) /19.1% (3 052/15 958) in the group of low blood pressure increase, 5.7% (905/15 958) /6.1% (975/15 958) in the group of high blood pressure decrease, and 92.2% (14 721/15 958) /74.8% (11 931/15 958) in the group of stable mid-range blood pressure. Differences in disease duration, medication adherence, follow-up methods, control satisfaction, BMI, WHtR, and WC were statistically significant among different systolic pressure trajectory groups (P<0.05). Similarly, differences in gender, age, disease duration, medication adherence, follow-up methods, control satisfaction, BMI, WHtR and WC were statistically significant among different diastolic pressure trajectory groups (P<0.05) .

Conclusion

Blood pressure trajectory changes in the community-based management of hypertensive individuals aged 35 and above were primarily characterized by stable mid-range blood pressure. The trajectory of blood pressure change in people with different characteristics manifested differently, suggesting that tailored management measures should be targeted for community healthcare workers managing hypertensive populations.

Analysis on the Perceptions Toward Mild Cognitive Impairment and Medical Willingness among Population Aged over 55 Years in Shanghai Based on a Proactive Health Perspective

ZHANG Min, LU Yuan, GAO Song, MA Jia, LIU Yalin, ZHAI Jiayi, YU Dehua

2024, 27(10):  1208-1214.  DOI: 10.12114/j.issn.1007-9572.2023.0588

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Background

Proactive health is an important measure to implement the Healthy China strategy. Mild cognitive impairment (MCI) is an important breakthrough point for early detection and intervention of cognitive impairment disorders and it is also a key link in the realization of brain health.

Objective

To activate the initial health intervention among community population and fully realize the construction of a healthy China by understanding the perceptions and medical willingness among community populations aged over 55 years in Shanghai.

Methods

From October to December 2021, one district of Shanghai's urban and suburban areas was randomly selected (Yangpu District for the urban area and Jiading District for the suburban area), and 1-2 community health service centers were randomly selected from each district (Daqiao Community Health Service Center and Dinghai Community Health Service Center for Yangpu District, and Jiading Town Community Health Service Center for Jiading District). An on-site face-to-face questionnaire survey was conducted among the residents waiting for outpatient consultation at the community health service centers in accordance with the inclusion criteria. The content of community populations' perceptions questionnaire included: (1) general demographic characteristics; (2) the level of MCI disease awareness among the community population; (3) the medical willingness of the community population. Logistic regression analysis was used to explore the factors influencing the medical willingness of the community population.

Results

A total of 970 questionnaires were distributed and 951 valid questionnaires were recovered, with a valid recovery rate of 98.04%. (1) The total score of the community populations' perceptions questionnaire for MCI was (14.55±5.24), 51.3% (488/951) of the community populations were aware of "mild cognitive impairment", mainly through the media (61.7%, 301/488) ; 59.9% (570/951) of the populations believede that "mild cognitive impairment occurs in old age"; 14.1% (134/951) of the population had participated in relevant screening activities; 6.2% (59/951) had consulted a doctor for memory impairment or suspected cognitive impairment. (2) Univariate and multivariate analysis showed that family history of cognitive impairment, knowledge and understanding of MCI as well as personal experience were all influencing factors of community populations' medical willingness for MCI.

Conclusion

Community population aged over 55 years have poor MCI disease perceptions and poor medical willingness. The community populations with poor knowledge, biased understanding of MCI and lack of relevant practical experience had poor medical willingness. It is suggested that multi-angle publicity should be carried out to improve the perceptions of MCI disease in the community and provide comprehensive support, to improve the accessibility of proactive health, and explore effective ways to promote proactive health.

The Development of Quality Indicator System for the Home Care Services for the Disabled Elderly in Beijing

ZHU Chenli, ZHANG Tiancheng, LI Hui, FENG Zhengwen, CHEN Xiaolei, SHAO Shuang, DU Juan

2024, 27(10):  1215-1220.  DOI: 10.12114/j.issn.1007-9572.2023.0572

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Background

With the deepening of aging in China, there is an increasing demand for home care services for disabled elderly individuals. The evaluation of service quality provides an assurance for the implementation of high-quality services.

Objective

To develop a quality indicator system for the delivery of home care services to the disabled elderly population in Beijing based on the Delphi method, so as to offer objective criteria for evaluating the quality of home care services provided by community health service institutions.

Methods

Based on literature research and qualitative study, a preliminary pool of indicator system entries for the indicator system was formed, and an expert correspondence form was designed from March to May 2021. A total of 21 community nursing, general practice, and management research personnel experts with rich experience in the field of home medical services and elderly comprehensive assessment in Beijing were selected, and an expert correspondence form was sent to them by email from June to October 2021 to conduct three rounds of Delphi expert correspondence. The experts' personal information and authority were recorded and analyzed, to the establish a quality indicator system for home care services for disabled elderly individuals in Beijing.

Results

All three rounds of expert correspondence form were returned and valid, with a 100.00% positive coefficient of experts from the 21 selected experts who had a mean expert authority score of 0.927 (ranging from 0.700 to 1.000), indicating an acceptable level of expertise. The first, second, and third rounds of expert correspondence yielded importance and feasibility coordination coefficients of 0.170 and 0.140 (P<0.001), 0.147 and 0.175 (P<0.001), 0.231 and 0.208 (P<0.001), respectively, indicating a high level of consensus among the experts and the reliability of the correspondence results. The resulting quality indicator system for home care services for disabled elderly individuals included three primary indicators of service conditions, service processes, and service outcomes, as well as nine secondary indicators and 34 tertiary indicators.

Conclusion

The indicator system constructed in this study is appropriate for evaluating the implementation quality of single visit medical service, and providing a reference for community health service institutions to formulate regulations and work programs.

Influencing Factors of Salt-reduction Behavior among Residents: a Mixed Methods Research Based on the PRECEDE Model

ZHANG Xing, DONG Jing, GUO Yi, XU Jianwei, BAI Yamin, LIU Min, ZHANG Xiaochang, GUO Xiaolei, MA Jixiang, SUN Xinying

2024, 27(10):  1221-1230.  DOI: 10.12114/j.issn.1007-9572.2022.0356

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Background

The prevalence of hypertension among Chinese residents is high while the control rate is low. It has been suggested by numerous epidemiologic studies that reducing salt intake could reduce blood pressure level. Therefore, it is significant for health management of residents and reducing social burden to explore determinants of salt-reduction behavior among residents.

Objective

To explore the predisposing, reinforcing and enabling factors of salt-reduction behavior among Shandong residents based on the PRECEDE model, and provide scientific suggestions for the subsequent salt-reduction campaign.

Methods

This study was a mixed methods research. A total of 114 residents were interviewed in 2016 and 2018 by using purposive sampling method. The interview guide mainly contained attitudes to salt control, difficulties encountered and assistance received during salt control. The quantitative data were obtained from the database of terminal survey of Shandong and Ministry of Health Action on Salt and Hypertension (SMASH), and the sample of eastern as well as central-southern Shandong from the database was selected into this research. The part related to hypertension among this survey was selected from the database, and a total of 6 697 research objects were finally selected.

Results

The results of multinomial Logistic regression showed that gender, occupation and education level have an impact on the compliance of salt reduction behavior controlling for the effect of other variables (P<0.05). Personal taste, salt reduction knowledge and attitude towards low-salt diet have an impact on salt reduction behavior compliance while controlling for the effect of personal general conditions (P<0.05). Physician intervention could reinforce salt-reduction behavior in residents. The health education of medical personnel could not only enhance the salt-reduction behavior and awareness of hypertensive patients, but also strengthen the supervision of family members. Through enhancing family members' salt-reduction behavior and awareness, and finally promoting salt reduction among residents. Supervision by family members in daily life can strengthen salt-reduction behavior of the residents. SMASH had formulated policies involved in the project promoting, catering industry, food industry and health education about salt-reduction, which playing very important role in creating strong salt-reduction environment. The salt-restriction spoon was the most important low-salt product in affecting residents' salt-reduction behavior, while the impact of low-salt food and low-sodium salt in reducing salt intake was weakened because of the poor accessibility. Mass media promotion was the main way for residents to obtain information on salt reduction. Television and promotion in public places were the more visible forms of mass communication currently.

Conclusion

Attitude towards low-salt diet and knowledge are predisposing factors of residents' salt-reduction behavior. Exhortation of doctors and reminding from family members were reinforcing factors, which can help residents to start out reducing salt intake and also reinforcing salt-reduction behavior. The salt-reduction environment was created by policies regarding salt-reduction and mass communication, products regarding salt restriction were essential tools for reducing salt intake, which are enabling factors.

Effectiveness Evaluation of Contracted Residents' First Contact in Primary Care in the Context of Contracted Family Doctor Services

JIANG Xiaoli, PENG Haibo, XU Lingfeng, XU Na, YIN Chengliang, MENG Wenqi, LIU Songyi, YIN Wenqiang, CHEN Zhongming, MA Dongping, YU Qianqian

2024, 27(10):  1231-1237.  DOI: 10.12114/j.issn.1007-9572.2023.0232

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Background

Since the comprehensive implementation of the contracted family doctor service in 2016, the willingness of residents to have their first contact in primary care has gradually increased, but the effectiveness evaluation of contracted residents' first contact in primary care needs to be further explored.

Objective

To understand the current status of contracted residents' first contact evaluation, explore its influencing factors and propose improvement strategies.

Methods

A multi-stage stratified random sampling method was used to select 54 community health service institutions/township health centers in three cities in Shandong Province, with a total of 4 000 contracted residents. The first contact dimension questionnaire of the Chinese version of the Primary Care Quality Assessment Scale (PCAT) was used to conduct the survey, comparing the first contact dimension scores of contracted residents with different characteristics and using multiple linear regression to analyse the factors affecting the first contact evaluation of contracted residents.

Results

A total of 3 859 valid questionnaires were collected, with the effective recovery rate of 96.48%. Among them, 2 086 (54.1%) were residents of township health centers and 1 773 (45.9%) were residents of community health centers; the total score of the first contact dimension in the three regions was 3.49, with the highest score being "Is your contracted institution open on Saturdays and Sundays?" (3.74) ; the item with the lowest score was "During non-business hours, if you were sick at night, would your contracted facility have a doctor or nurse available?" (3.05). The results of the multiple linear regression analysis showed that the contracted facility, personal monthly income, education level, marital status, occupation, physical health and diagnosis of chronic disease were the factors influencing the scores of the first contact dimension of contracted residents (P<0.05) .

Conclusion

The first contact evaluation result of contracted residents is good, but there is still a need to strengthen the promotion of family doctor contracting service policy, guide contracted residents to form the concept of primary care, and promote primary care by clarifying the process of non-working day consultations, improving the service supply capacity of primary care institutions, strengthening the construction of the sharing platform of medical institutions, and leveraging the medical insurance system, so as to improve the first contact evaluation of contracted residents.

Factors Influencing the Demand for Long-term Family Doctor Contract in Community Health Service Centers

XIONG Liufang, ZHOU Xiaozhao, MA Hanying, ZHAO Tiefu

2024, 27(10):  1238-1244.  DOI: 10.12114/j.issn.1007-9572.2023.0546

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Background

The number of patients with chronic diseases in the community of China is increasing annually. Family doctor contract service is an important way to promote people's health in China, and long-term family doctor contract will help to improve the continuity of health management and the treatment outcomes. Analyzing patient demand for long-term family doctor contract is critical to the advancement of family medicine services in China.

Objective

To investigate the demand for long-term family doctor contract among community patients in Beijing Chaoyang Distrct and analyze its influencing factors, so as to provide a theoretical basis for achieving high quality family medicine services.

Methods

Using continuous enrollment, 500 patients who were enrolled in family doctor contract service at Baliqiao community health service center, Taiyanggong community health service center and Jiangtai community health service center in Chaoyang District, Beijing from January 2020 to January 2021 were included as the study subjects and categorized into the agreement group (those willing to sign long-term contracts) and the refusal group (those unwilling to sign long-term contracts). Data on patient demographics, chronic diseases, educational level, income status, medical expenses, health status, distance from home to the community health service center, compliance, living arrangements, and other indicators were collected through online system retrieval of health records and supplemented by questionnaire surveys from January 2020 to January 2021. From January to March 2021, a questionnaire survey was conducted to collect general information, service quality evaluation, and willingness to sign long-term family doctor contracts. The SERVQUAL scale was designed based on literature retrieval, expert consultation, and preliminary open-ended questionnaire survey results to evaluate the quality of family doctor services. Scores were assigned for expected quality, perceived quality, and importance, ranging from 1 to 5. Expectation scores and perception scores were used to calculate the service quality (SQ) score, and the latter was used to correct importance and calculate the corrected SQ (cSQ) score. Multivariate Logistic regression analysis was used to explore the influencing factors of the demand for long-term family doctor contract services.

Results

A total of 500 questionnaires were distributed, and 423 were collected, including WeChat platform (73, 17.2%), offline questionnaire (190, 44.9%) and telephone interview (160, 37.8%), the validity rate was 84.6%. Among the respondents, 283 belonged to the agreement group (66.9%), and 140 belonged to the refusal group (33.1%). The average score for the SERVQUAL scale was -0.54, with perceived and expected average scores of 3.98 and 4.52, respectively. Statistically significant differences were observed in the cSQ scores and average scores for each dimension between the two groups (P<0.05). The results of multivariate Logistic regression analysis showed that distance from home to the community health service center (OR=1.077, 95%CI=1.013-1.145, P=0.018), compliance (OR=0.291, 95%CI=0.137-0.617, P=0.001), living alone (OR=4.132, 95%CI=1.997-8.550, P<0.001), and cSQ (OR=0.983, 95%CI=0.980-0.986, P<0.001) were independent influencing factors for patients' willingness to sign long-term family doctor contracts.

Conclusion

The corrected family doctor service quality, distance from home to community health service center, living arrangements, and compliance are independent factors influencing patients' willingness to sign long-term family doctor contracts. The SERVQUAL scale can effectively evaluate family doctor service quality and aids in developing strategies for improving family doctor services.

Epidemiological Study

A Study on the Prevalence Trend of Overweight and Obesity among Adults Aged 20 and above in Shanxi Province from 2010 to 2018

SONG Weimei, WANG Xuchun, REN Hao, ZHAO Ying, CHEN Liming, QIU Lixia

2024, 27(10):  1245-1251.  DOI: 10.12114/j.issn.1007-9572.2023.0637

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Background

Overweight, obesity, and central obesity have become significant public health issues globally, affecting the well-being of residents. Analyzing the prevalence trends of overweight, obesity, and central obesity among residents in Shanxi Province can provide valuable scientific insights for the prevention and control of related diseases.

Objective

To analyze the prevalence and trends of overweight, obesity, and central obesity among adults aged 20 and above in Shanxi Province between 2010 and 2018.

Methods

The survey data of adults aged 20 and above in Shanxi Province were collected during four rounds of the China Chronic Disease Surveillance project from August 2010 to November 2018 (in 2010, 2013, 2015, and 2018) to calculate the rates of overweight, obesity, and central obesity among adults aged 20 and above in different years, and analyze the prevalence trends of overweight, obesity and central obesity for different characteristics of the study subjects.

Results

From 2010 to 2018, the overall crude rates and age- and gender-standardized rates of overweight among adults aged 20 and above in Shanxi Province ranged from 37.7% to 40.1% and 36.1% to 39.6%, respectively, with no significant upward trend (Z=0.005, 2.413; P=0.942, 0.120). The overall standardized obesity rate, overall crude rate of central obesity and the standardized rate central of obesity increased from 17.2%, 53.8%, and 52.4% in 2010 to 20.0%, 61.6%, and 60.2% in 2018, respectively (Z=8.100, 10.994, 12.218; P<0.05). From 2010 to 2018, there was no significant trends in the comparison of the overall crude overweight rate and the standardized overweight rate among adults aged 20 years and above by age, gender and region (P>0.05) ; the standardized overweight rate for males was higher than that for females (χ²=4.259, P<0.05), while the standardized obesity rate was lower than that for females (χ²=13.724, P<0.001) in 2013; no statistically significant differences between genders were observed at other time points (P>0.05) ; the overall obesity rate, male obesity rate, and both male and female central obesity rates in the age group of 20-39 years old showed an upward trend during the 8-year period (P<0.05). From 2010 to 2018, the standardized rates of overweight, obesity, and central obesity among urban residents were overall higher than those among rural residents (P<0.05). Specifically, significant differences were observed in the standardized overweight rates in 2013 and 2015, the standardized obesity rates in 2010 and 2015, and the standardized central obesity rates in 2015 and 2018 (P<0.05). The results of the Joinpoint regression analysis revealed that, from 2010 to 2018, the age-standardized overweight rate among females in Shanxi Province exhibited a decreasing trend (APC=-0.57, P<0.05), while the age-standardized obesity rate among males showed an increasing trend (APC=2.72, P<0.05). The standardized rates of overweight, obesity, and central obesity among urban and rural residents remained relatively stable over the 8-year period (P>0.05). There was also no significant difference in the trends of these rates between different genders and regions (P>0.05) .

Conclusion

From 2010 to 2018, the overweight rate among residents aged 20 and above in Shanxi Province remained stable, while the overall trends for obesity and central obesity rates showed an increasing trend. The prevention and control of obesity and central obesity should focus on the population aged 20-39 years to slow down the growth rate. For residents aged 40 and above, as well as urban residents, targeted prevention strategies should be implemented, so as to control the prevalence of overweight, obesity, and central obesity.

Epidemiological Survey of Urinary Incontinence and Its Impact on Quality of Life in Women Aged 40-60 Years in Guizhou Province

WU Chunyan, DENG Yinglan, ZHAO Ping, HU Shixiu, WU Xiaoyan, ZHU Yan, LI Xiangyan, XIE Zhengzhou, WANG Rong, GAO Yan, YANG Xiuying, XU Haina, LU Ran, RAN Limei

2024, 27(10):  1252-1260.  DOI: 10.12114/j.issn.1007-9572.2023.0486

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Background

Urinary incontinence often occurs in women aged 40-60 years and contributes to a significant impact on women's physical health and quality of life.

Objective

To explore the prevalence and influencing factors of urinary incontinence and its impact on quality of life in women aged 40-60 years in Guizhou Province.

Methods

From June 2022 to January 2023, women aged 40-60 years who underwent health checkups in 10 hospitals in 7 regions of Guizhou Province were selected as the study subjects. A self-designed general data questionnaire was used to collect the basic data of the study subjects, and International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and Incontinence Quality of Life Measure (I-QoL) were used to determine the severity of urinary incontinence and the level of quality of life of the study subjects, respectively. Different types of incontinence, including stress incontinence, urge incontinence, and mixed incontinence, were determined according to the diagnostic criteria established by the International Continence Society (ICS). Multivariate Logistic regression analysis was used to explore the influencing factors of urinary incontinence, and explore the effects of different types and severity levels of urinary incontinence on patients' quality of life.

Results

A total of 3 000 questionnaires were distributed, and 2 966 valid questionnaires were collected, with a valid recovery rate of 98.9%. The prevalence of urinary incontinence among the 2 966 study subjects was 33.4% (991/2 966), including 20.1% (596/2 966) for stress incontinence, 2.0% (58/2 966) for urge incontinence, and 11.4% (337/2 966) for mixed incontinence. Multivariate Logistic regression analysis showed that physical exercise, menstrual status, parity, history of pelvic organ prolapse, perineal laceration, and lateral episiotomy were the influencing factors of stress incontinence (P<0.05) ; history of pelvic surgery, number of miscarriages, and neonatal weight were the influencing factors of urge incontinence (P<0.05), waist circumference, history of chronic pelvic pain, pelvic organ prolapse, perineal laceration were factors associated with mixed incontinence (P<0.05). The total score of I-QoL, scores of behavioral limitations, psychological impact, and social activities impairment were lower in patients with mixed incontinence than those with stress and urge incontinence (P<0.05) ; the total score of I-QoL, scores of behavioral limitations, psychological impact, and social activity impairment were lower in the severe incontinence patients than those with mild and moderate incontinence (P<0.05) .

Conclusion

Guizhou Province has a higher prevalence of urinary incontinence of 33.41% in women aged 40-60 years, influencing factors differ for different types of urinary incontinence, mixed incontinence and severe urinary incontinence have the greatest impact on patients' quality of life, to provide a reference basis for prevention and health management in this population.

Epidemic Trend Analysis of Colorectal Cancer in Jiading District, Shanghai from 2003 to 2019

CHEN Dan, WANG Yawei, HUANG Fang, XU Yifan, ZHANG Yiying, SHAO Yueqin

2024, 27(10):  1261-1266.  DOI: 10.12114/j.issn.1007-9572.2023.0537

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Background

Colorectal cancer has become the third most prevalent malignant tumor in Jiading district of Shanghai, and its disease burden is still increasing.

Objective

To analyze the epidemic trend of colorectal cancer in Jiading district of Shanghai from 2003 to 2019 and provide scientific basis for the prevention and treatment of colorectal cancer.

Methods

Based on the cancer registration data from 2003 to 2019 in Jiading district of Shanghai, the statistical indicators such as crude incidence rate, crude mortality rate, standardized incidence rate and standardized mortality rate were calculated (the rate was standardized using the Chinese standard population of 2010). Joinpoint Regression Program 4.9.1.0 software was used to analyze the trends of incidence rate and mortality rate.

Results

From 2003 to 2019, there were 5 020 new cases of colorectal cancer in Jiading district of Shanghai, with a crude incidence rate of 52.12/100 000, a standardized incidence rate of 26.27/100 000; there were 2 419 deaths, with a crude mortality rate of 25.12/100 000, and a standardized mortality rate of 11.16/100 000; with males having higher crude incidence and crude mortality rates than females (P<0.05). There was an overall upward trend in the total population standardized incidence rate (APC=2.63%, P<0.05), with an increasing trend in the male standardized incidence rate (APC=3.48%, P<0.05), and no significant trend in the female standardized incidence rate (APC=1.39%, P=0.119), while no turning point was found. There was no significant trend in the total population standardized mortality rate (APC=-0.49%, P=0.250), of which there was no significant trend in the male standardized mortality rate (APC=0.34%, P=0.545), and a decreasing trend in the female standardized mortality rate (APC=-1.94%, P<0.05) .

Conclusion

From 2003 to 2019, the overall incidence rate of colorectal cancer in Jiading district of Shanghai still increased, among which there was an upward trend in males and no significant change in the trend for females. There was no significant trend in the overall mortality rate, among which there was no significant change in males and a downward trend in females. The prevention and control of colorectal cancer should continue to be strengthened, with a focus on the male population.

Digital and Smart Healthcare & Informationization

Transparent Reporting of the Early-stage Clinical Evaluation of Clinical Decision Support Systems Based on Artificial Intelligence

LEI Fang, DU Liang, DONG Min, LIU Xuemei

2024, 27(10):  1267-1270.  DOI: 10.12114/j.issn.1007-9572.2023.0668

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With the wide application of artificial intelligence (AI) in the medical field, more and more AI-based clinical decision support systems have been applied in the clinical diagnosis, screening, and other fields. Early-stage clinical evaluation is important for evaluating the clinical performance, safety, and human factors of AI-based clinical decision support systems, and laying the foundation for large-scale trials. However, the transparency and integrity of the clinical reports need to be improved. The Developmental and Exploratory Clinical Investigations of DEcision Support Systems Driven by Artificial Intelligence (DECIDE-AI) was officially published online in May 2022. Based on this guideline and relative literature, this paper explores the transparent reporting of early-stage clinical evaluation of AI-based clinical decision support systems, in order to help developers and researchers better understand and apply the relevant guidelines, and improve the reporting transparency of early-stage clinical evaluation of AI-based clinical decision support systems.

Design Features and Methodological Quality of Researches about Prediction Models Based on Machine Learning in Primary Care: a Scoping Review

ZHONG Jinjia, LI Wentao, HUANG Yafang, WU Hao

2024, 27(10):  1271-1276.  DOI: 10.12114/j.issn.1007-9572.2023.0561

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Background

Researches about prediction models based on machine learning in primary care developed rapidly in recent years, but there are few researches about the design features and methodological quality.

Objective

To systematacially summarize and analyze the design features and methodological quality of researches about prediction models based on machine learning in primary care.

Methods

Researches about prediction models based on machine learning in primary care was searched in PubMed, Embase, CNKI, Wanfang Data published from base-building to 2023-02-21, descriptive summary and description methods were used to analyze the basic characteristics of the included literature, types of prediction models, sample size, handling method of missing value, types of machine learning algorithms, model performance evaluation index and prediction efficiency, and model verification method.

Results

Totally 30 literature were enrolled, involving 106 prediction models, thereinto 17 literature were published between 2021 and 2023; research topics: respiratory disease in 6 literature, tumour in 4 literature, outpatient appointment in 3 literature; sample size over 1 000 in 26 literature (accounting for 86.67%, 95%CI=68.36%-95.64%) ; using machine learning methods to hand missing value in 7 literature; 65 prediction models used tree-based machine learning algorithm, in which random forest was the most frequently used (accounting for 32.08%, 95%CI=23.53%-41.95%) ; 61 prediction models used AUC of ROC or consistency (C statistic) as the differentiation evaluation index (accounting for 57.55%, 95%CI=47.57%-66.97%), but only 14 prediction models reported prediction models (accounting for 13.21%, 95%CI=7.67%-21.50%) ; the differentiation of most of the 106 prediction models was good, but bias risk assessment results of 92 prediction models were high-risk (accounting for 86.79%, 95%CI=78.50%-92.33%) ; only 7 literature involved prediction models conducted the external validation.

Conclusion

Researches about prediction models based on machine learning in primary care increase gradually in the past three years, in which the topics mainly involve respiratory disease, tumour, outpatient appointment and so on; there are significant difference in sample size and handling method of missing value in the 106 prediction models, most of the 106 prediction models are with good differentiation, but most of them did not conducted the external validation, and the overall risk of bias is relatively high.