Table of Content

05 August 2024, Volume 27 Issue 22

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Editorial

Attitude and Practice of General Practitioners toward Research Activity: Enablers and Barriers

YANG Hui

2024, 27(22):  0-D.  DOI: 10.12114/j.issn.1007-9572.2024.A0017

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Background

General practice research should be in the hands of general practitioners (GPs) . GPs' participation in research is an important condition of development of the discipline. Compared with other clinical medicines, the research activities of GPs need to be enhanced.

Objective

Based on the perspectives and actions of GPs worldwide towards research, this study aims to investigate the driving forces and obstacles underlying the development of family medicine.

Methods

Rapid literature review, using PubMed data to understand opinions of international general practice colleagues.

Results

Over 90% GPs thought research was very important, 60% of GPs were interested in research, 30% expressed willingness to participate, 10% were actually involving research, and less than 1% of GPs published research results. In terms of attitude and ability, GPs believe that the lack of relevance between research and actual clinical practice weakens the usefulness of research; some GPs believe that research work is not part of their own duties and out of their abilities; less than half of doctors believe research training should provide to registrars. The barriers for research included heavy clinical workloads, too much paperwork, increasing clinical management requirements, doctors' goals of making more money, and lack of research practice, support and research funds. Facilitating factors for research included access to good research mentors, having the opportunity to join well-known and well-designed general practice research projects, or having access to more information resources through research activities. GPs' factors include experience, diligence and hard work, frequent participation in research training, frequent reading of academic literatures, and running or managing their own general practice.

Conclusion

Research activity in general practice is low and high-quality research results are few. Research methodology training is one of the strategies to promote general medical research. Same important, we should also pay more attention to the intrinsic motivation and intensity of doctors' participation in research, provide doctors with research time and funding resources, and encourage the establishment and maintenance of a core team and network for general practice research, as well to develop the research ideas and culture of critical thinking in general practice area.

Healthy China·Focus on Treatment-prevention Integration

Innovative Integration of Treatment and Prevention to Build a Healthy China Together: Expert Consensus from the Healthy China Research Network in 2023

Expert Group of the Healthy China Research Network

2024, 27(22):  2685-2688.  DOI: 10.12114/j.issn.1007-9572.2024.0136

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The innovative integration of treatment and prevention is pivotal for enhancing the healthcare system and advancing Healthy China. Guided by a focus on preventive health policies, it fosters collaboration between treatment and preventive services, ensuring seamless linkage across health promotion, prevention, treatment, rehabilitation, and end-of-life care. Conceptually, this shift involves transitioning from unidirectional intervention to comprehensive health management, from provider-driven to participatory decision-making, and from transient doctor-patient relationships to sustained accountability relationships. Structurally, it emphasizes coordination between medical and public health systems, collaboration among healthcare institutions, and multi-stakeholder governance. Institutionally, it optimizes evaluation, financing, remuneration, and talent development systems while leveraging intelligent means for integration and promoting interoperability across personnel, resources, and information.

Community-oriented Integration of Medicine and Prevention: an Analysis of Theoretical Basis and Contemporary Implementation Pathways

WANG Yang, JIN Hua, YUAN Beibei, HUAN Hongmei, YANG Hui, YU Dehua, FANG Hai

2024, 27(22):  2689-2699.  DOI: 10.12114/j.issn.1007-9572.2024.0060

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In this commentary, we elucidate two distinctive characteristics of China's primary health care system relative to the global primary health care framework: a more narrowly defined patient population and scope of services, along with a diminished clinical capacity in primary care. Building upon this foundation, we critically examine and juxtapose the two quintessential theoretical-practical models of the 20th century that are intimately linked with the integration of medication and prevention. They are the "Community-Oriented Primary Care" Model and the "Barefoot Doctor" Model. Additionally, leveraging a series of practical cases observed within Shanghai's primary care settings in the fourth quarter of 2023, we deliberate on viable approaches for adapting and applying these models in China's primary care infrastructure. We further delineate the requisite external conditions for such a transformation and offer targeted recommendations for the deployment of these models across diverse locales.

Analysis of Factors Influencing the Implementation of Medical Defense Integration Based on the Horn-mitte Model

LAI Qingling, XU Chuanchuan, FENG Yuanyuan, LIANG Peifeng, LI Yinshan

2024, 27(22):  2700-2705.  DOI: 10.12114/j.issn.1007-9572.2023.0780

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As an important direction of China's medical and health system reform, medical and prevention integration is of great significance to meet the all-round health needs of the people, and how to establish a scientific and effective medical and prevention integration model is a top priority. Using literature analysis and other methods to collect data, the implementation status and dilemma of China's medical and prevention integration policy were reviewed, and the influencing factors of medical and prevention integration policy implementation were analyzed based on the six dimensions of the Horn-mitte model. On this basis, it is proposed to refine policy objectives, clarify policy implementation standards, increase resource supply, enrich policy implementation methods, explore common interests of medical and defense institutions, improve "coordination mechanisms", and actively guide policy implementers to carry out medical and prevention integration services. It aims to provide reference significance for the high-quality improvement of medical and prevention integration services in the future.

Research on Implementation Mechanism of Treatment-prevention Integration Under the Background of Constructing Integrated Service System

HU Meili, ZHANG Qian, SHEN Dou, LI Hongli, LIU Yuehua, YANG Wen, YANG Jinlan, GU Fang

2024, 27(22):  2706-2713.  DOI: 10.12114/j.issn.1007-9572.2023.0722

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Background

The key task in China's medical and health field during the "14th Five-Year Plan" period is to realize treatment-prevention integration and innovate the mechanism of treatment-prevention integration.

Objective

This paper analyzes the implementation mechanism of treatment-prevention integration under the background of integrated service system construction, and provides reference for exploring the path of medical and prevention integration adapting to the strategy of "Healthy China".

Methods

Taking 2018 as the time node, relevant literature was searched on CNKI and Wanfang Data Knowledge Service Platform with keywords of "treatment-prevention integration" "medical and prevention coordination" "combination of prevention and treatment" and literatures on case policies, measures and implementation effects of integrated service systems such as medical alliance. Finally, 18 literatures and 15 cases were selected. Based on the rainbow model, system integration, organizational integration, professional integration, service integration, functional integration and normative integration were determined as condition variables from macro, meso and micro levels and supporting factors, and the effect of treatment-prevention integration was determined as result variable. QCA was adopted to explore the implementation mechanism of medical and preventive integration under the background of integrated service system construction.

Results

There were four configuration paths that could effectively improve the effect of treatment-prevention integration, and the four paths were in line with the multi-layer integrated path and the medium-micro integrated path respectively. The following results were obtained: (1) It was more effective to carry out treatment-prevention integration relying on the integrated service system, and there are multiple paths that can effectively improve the effect of treatment-prevention integration under the integrated service system; (2) Service integration plays a fundamental role in improving the effect of medical and preventive integration; (3) The setting of relevant policy indicators for improving the system integration, professional integration and functional integration of treatment-prevention integration is not perfect.

Conclusion

(1) Relying on the construction of integrated service system to promote the improvement of treatment-prevention integration effect; (2) Give full play to the basic guarantee role of service integration; (3) Make reference to the successful experience of multi-level integration cases, set policy indicators at macro, meso and micro levels in a balanced manner, and improve the integration of system integration, professional integration and supporting elements.

Article

Effects of Intervention Based on Behavioral Change Wheel and Behavioral Change Technologys on the Behavior, Ambulatory Blood Pressure and Quality of Life in Patients with Hypertension

YU Haiyan, WANG Haitang, DU Zhaohui

2024, 27(22):  2714-2723.  DOI: 10.12114/j.issn.1007-9572.2023.0481

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Background

The control rate for patients with hypertension remains suboptimal, with hypertensive patients experiencing a lower quality of life compared to healthy individuals. Enhancing life quality and lowering blood pressure in patients with hypertension through behavioral interventions is currently a critical area of research. Theoretical-based behavioral interventions are shown to be more effective and sustainable in modifying the behaviors of hypertensive patients. The Behavior Change Wheel (BCW) and Behavior Change Techniques (BCTs) are widely utilized in the management of chronic diseases globally to maximize the exploration of modifiable factors. Nevertheless, in the domestic context, studies on the impact of BCW and BCTs-driven behavioral interventions on the ambulatory blood pressure and quality of life of hypertensive patients are relatively limited, indicating a need for more comprehensive research.

Objective

This study aims to develop and evaluate the intervention based on BCW and BCTs, focusing on its impact on behavior, ambulatory blood pressure, and quality of life in hypertensive patients.

Methods

From December 2021 to August 2022, a hundred hypertensive patients who met the inclusion criteria were selected as study participants. They were allocated into an intervention group and a control group using a simple randomization method, with each group comprising fifty participants. Patients in the control group received conventional outpatient medication and health education lifestyle guidance. In contrast, patients in the intervention group was treated with standard medication supplemented by the BCW and BCTs-based intervention guidance.Before and after the intervention, assessments were conducted using the Hypertension Knowledge-Level Scale, the Chinese Version of the 8-item Morisky Medication Adherence Scale, the International Physical Activity Questionnaire-Short, the Patient Health Questionnaire-9, the General Anxiety Disorder-7, ambulatory blood pressure monitoring, and the 12-Item Short-Form Health Survey. The study examined changes in behavioral indicators, results of ambulatory blood pressure monitoring, and quality of life pre- and post-intervention.

Results

The results indicated that after the intervention, the intervention group exhibited significantly higher levels of hypertension knowledge, medication adherence, quality of life scores, proportions of high medication adherence and engagement in moderate physical activity compared to the control group (P<0.05) . Additionally, the intervention group showed lower average daytime systolic and diastolic blood pressures, nighttime systolic and diastolic blood pressures, morning systolic and diastolic blood pressures, 24-hour systolic and diastolic blood pressures, variability coefficients of 24-hour systolic and diastolic blood pressures, BMI, anxiety scores, depression scores, and lower proportions of individuals with anxiety, depression, high sodium intake, and excessive alcohol consumption compared to the control group (P<0.05) .

Conclusion

The BCW and BCTs-based intervention model positively impacts behavioral interventions for hypertensive patients. It effectively improves the behaviors of these patients, lowers their blood pressure levels, and elevates their quality of life. This model is recommended for incorporation into the management of hypertension as a chronic disease.

Impact of an Integrated Hospital-community-patient Chronic Disease Management Pathway on Postoperative Colorectal Cancer Patients

YANG Sen, ZHAO Huaxin, GE Xuhua, MA Le, JIN Hua, XIE Mujin, PU Zhen, BAI Zhaohui, YU Dehua

2024, 27(22):  2724-2730.  DOI: 10.12114/j.issn.1007-9572.2023.0661

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Background

Surgery is one of the main means of treating colorectal cancer. However, patients with colorectal cancer need to face many physical and psychological problems after surgery, which seriously affects patients' treatment outcomes and quality of life, so how to carry out effective postoperative management is extremely important. Objective To investigate the effectiveness of an integrated hospital-community-patient chronic disease management pathway intervention for postoperative colorectal cancer patients. Methods Based on different postoperative interventions, colorectal cancer patients were divided into a control group (n=40) and a co-management group (n=36) , with the control group implementing conventional postoperative interventions and the co-management group following a constructed integrated chronic disease pathway for co-management. Changes in laboratory indices, recurrent metastasis, death, postoperative complications, quality of life, and anxiety were compared between the two groups before and after surgery. Results Retrospectively selected 80 patients with colorectal cancer who were discharged from the Department of General Surgery at Yangpu Hospital, affiliated with Tongji University, between January 2021 and April 2022, as study subjects. At 3 and 6 months postoperatively, patients in the co-management group had lower carcinoembryonic antigen levels than patients in the control group (P<0.001) . The incidence of recurrent metastases was not significantly different from that of the control group at 3 months postoperatively (P>0.05) , while at 6 months postoperatively, the incidence of recurrent metastases was lower in the co-management group than in the control group (5.6% vs. 22.5%, χ²=4.395, P=0.036) ; in addition, the incidence of complications was lower in the co-management group than in the control group at both 3 and 6 months postoperatively (0 vs. 16.2%, χ²=3.981, P=0.046; 5.6% vs. 25.0%, χ²=5.388, P=0.020) . However, the difference in mortality at 6 months postoperatively between the two groups was not significant (2.8% vs. 7.5%, χ²=0.165, P=0.685) . In quality of life scores at 6 months and 1 year postoperatively, the co-management group was higher than control patients (P<0.05) , and the anxiety scores were lower in the co-management group than in the control patients (P<0.05) . Conclusion The integrated hospital-community-patient chronic disease management pathway can reduce postoperative complications, decrease recurrence and metastasis of colorectal cancer, improve quality of life, and improve anxiety symptoms, and is of great value to the prognosis of postoperative colorectal cancer patients.

A Retrospective Cohort Study on the Relationship between Triglyceride-Glucose Index and Its Combination with Obesity Indices and Chronic Kidney Disease in Adults

HOU Qinchuan, ZHANG Rui, LI Binghong, ZHANG Huiwang, ZHANG Beibei, YONG Tao, LIU Yuping, SHUAI Ping

2024, 27(22):  2731-2738.  DOI: 10.12114/j.issn.1007-9572.2023.0456

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Background

Chronic kidney disease (CKD) is the eleventh leading cause of death globally, and the burden of disease and economic impact caused by it is increasing rapidly. Its disability and mortality rates have exhibited the highest increase among all chronic diseases. Insulin resistance (IR) and obesity are closely associated with the onset and progression, and triglyceride-glucose (TyG) index can serve as a substitute indicator for IR. Nevertheless, the exact relationship between the TyG index and the development of CKD remains to be fully elucidated.

Objective

Through a cohort study, we aim to investigate the relationship between triglyceride-glucose (TyG) index and its combination with obesity indices in relation to the occurrence of CKD.

Methods

This retrospective cohort study selected 4 921 adult participants who underwent annual physical examinations at the Sichuan Provincial People's Hospital Health Management & Physical Examination from January 2015 to November 2022, according to specific inclusion and exclusion criteria. The study cohort was categorized into four groups based on quartiles of the baseline triglyceride-glucose (TyG) index: Q1 (5.43-6.66) , Q2 (6.67-7.04) , Q3 (7.05-7.43) , and Q4 (7.43-9.97) , with sample sizes of 1 230, 1 231, 1 230 and 1 230, respeciyvely Obesity-related indices including waist circumference (WC) , BMI, and waist-to-hip ratio (WHR) , were combined with the TyG index to form TyG-WC, TyG-BMI, and TyG-WHR indices. Based on the quartiles of the baseline TyG-WC index, the study subjects were divided into 4 groups, Q1 (204.49-523.14) , Q2 (523.15-593.21) , Q3 (593.22-657.16) , and Q4 (657.17-992.75) , with sample sizes of 1 230, 1 232, 1 229 and 1 230, respectively. Based on the quartiles of the baseline TyG-BMI index, the study subjects were divided into 4 groups, Q1 (92.43-149.16) , Q2 (149.17-168.43) , Q3 (168.49-188.92) , and Q4 (88.93-306.64) , with sample sizes of 1 228, 1 231, 1 232 and 1 230, respectively. Based on the quartiles of the baseline TyG-WHR index, the study subjects were divided into 4 groups, Q1 (2.76-5.66) , Q2 (5.67-6.26) , Q3 (6.27-6.83) , and Q4 (6.84-9.67) , with sample sizes of 1 230, 1 230, 1 231 and 1 230, respectively. The relationship between the TyG index and its combination with obesity indices and the incidence risk of CKD was examined by a Cox proportional hazards model, while a restricted cubic spline regression (RCS) was used to assess dose-response relationships.

Results

At the end of follow-up, there were 139 new cases of CKD in the study cohort, with an incidence rate of 2.8%. After accounting for potential confounding factors, the results showed that compared to the TyG index Q1 group, the TyG index Q4 group exhibited a significantly elevated risk of CKD incidence (HR=1.756, 95%CI=1.010-3.054) . Compared to the TyG-WC index Q1 group, the TyG-WC index Q4 group demonstrated a significantly higher risk of CKD incidence (HR=2.532, 95%CI=1.210-5.296) , with P<0.05. There was a non-linear dose-response relationship between the TyG index and the risk of CKD incidence (P_nonlinearity=0.048) , with higher TyG index values (>6.93) associated with a greater risk of CKD incidence. The TyG-WC index had a linear dose-response relationship with the risk of CKD incidence (P_nonlinearity=0.078) , with an increasing trend of CKD incidence risk with increasing TyG-WC index values.

Conclusion

Both TyG and TyG-WC are risk factors for CKD, controlling for TyG and WC can effectively prevent and manage CKD, this finding holds great importance for the prevention and treatment of CKD.

Construction of a Hospice Service Model for Elderly Care Institutions in China

WANG Huaping, ZHU Huajie, ZHU Chunman, PAN Danhong

2024, 27(22):  2739-2744.  DOI: 10.12114/j.issn.1007-9572.2022.0681

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Background

With the acceleration of the aging process in society, the demand for hospice services is increasing. The development of hospice care in China started relatively late, and relevant institutional construction standards and management norms are still in the trial stage. As one of the important integrated medical and nursing service institutions, elderly care institutions currently lack an effective and homogeneous model and service system for hospice services.

Objective

To establish a scientific, standardized and feasible hospice service model for elderly care institutions.

Methods

From April to May in 2020, Chinese/English databases were systematically searched to obtain the literature related to hospice services. Five experts in the field of hospice care were invited to carry out semi-structured interviews, and the initial index system was constructed based on the results of literature retrieval and semi-structured interviews. In May 2020, a purposive sampling method was used to select fifteen experts in the field of hospice care to conduct two rounds of correspondence, and the indicator system was determined based on the analysis of the research group and expert suggestions. After two rounds of correspondence, an expert group interview was conducted to further optimize and adjust the formed indicator system.

Results

In both rounds of correspondence, the questionnaire response rate was 100.0%, with expert authority coefficients of 0.89 and 0.94, respectively. The Kendall's W coefficients for the first level indicator were 0.54 and 0.59, respectively, and the Kendall's W coefficients for the second level indicator were 0.18 and 0.10, respectively. The final constructed indicator system for the hospice service model of elderly care institutions included three primary indicators of necessary resources and conditions, content and processes, assessment indicators, and 36 secondary indicators. In the second round of inquiry, the average importance score of the indicator was 3.87 to 5.00 points, the coefficient of variation was 0 to 0.25, and the full score rate was 63.0% to 100.0%.

Conclusion

The scientificity and reliability of the model hospice service model for elderly care institutions constructed in this study are good, which can provide reference for elderly care institutions to provide high-quality medical services for elderly patients at the end of their lives.

Palliative Care Service Development Experience in Singapore and Its Implications for China

GAO Xiaoyi, HU Liping, ZHAO Yue, LIU Lanqiu

2024, 27(22):  2745-2751.  DOI: 10.12114/j.issn.1007-9572.2023.0226

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Palliative care is one of the effective means to protect the rights of good death and improve the quality of life in end-stage patients. Palliative care in Singapore is developing rapidly and a comprehensive palliative service system has been gradually established, ranking in the top of Asia in the latest national quality of death ranking. This paper proposes that the social awareness, education and training of palliative care should be strengthened, the power of charities and NGOs should be utilized, the existing palliative care carrying capacity should be improved, palliative care related system and legal protection should be established in China, by sorting out the current situation of hospice care, the practical experience in public education, personnel training, charitable support, related policies and legal protection in Singapore, in order to achieve the hospice needs of end-stage patients.

Article·Focus on General Practice Education

Root Cause Analysis of the Influencing Factors of Professional Identity in Rural Order-oriented Medical Students: a Qualitative Research

QIAO Xue, YIN Yongtian, LUO Wenjun, LI Yinghui, YANG Jinguang, LI Jingwei, CHEN Hongzhi

2024, 27(22):  2752-2758.  DOI: 10.12114/j.issn.1007-9572.2023.0344

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Background

With the continuous development of the training program of rural order-oriented medical students (referred to as publicly-funded medical students) in China, the talent team of general practice is constantly enriched, and the professional identity status and its influencing factors in rural order-oriented medical students have become the focus of current attention.

Objective

To analyze the influencing factors of professional identity in rural order-oriented medical students.

Methods

Purposive sampling method was used to interview the 30 rural order-oriented medical students from 2018 to 2022 grade of Traditional Chinese Medicine (five-year system) Beneficiary Class of Shandong University of Traditional Chinese Medicine by semi-structured interviews from December 2022 to March 2023. The interview data were coded and analyzed by using open coding, axial coding, and selective coding, following the Anselm Strauss and Juliet Corbin programmatic grounded theory approach.

Results

A total of 482 initial concepts and 47 basic categories were extracted by open coding, 9 main categories obtained by axial coding. A typical relationship structure was formed by selective coding, and it showed that the influencing factors of professional identity in rural order-oriented medical students were consisted with six dimensions of career cognition, career behavior, career choice, career will, career emotion, and career belief.

Conclusion

The influencing factors of professional identity in rural order-oriented medical students are composed of six dimensions, including career cognition, career behavior, career choice, career will, career emotion, and career belief, of which career cognition, career behavior, and career choice belong to the exogenous factors, while career will, career belief, and career emotion belong to the implicit factors.

Analysis of Problems and Optimization Strategies of the Free Training Program for Rural Order-oriented Medical Students in Guangxi Based on Social Network Analysis

MENG Shanshan, CHEN Lili, LI Xianjing, HUANG Lingbo, FENG Qiming, QIN Xianjing, LIU Peiyun, LU Decheng

2024, 27(22):  2759-2765.  DOI: 10.12114/j.ssn.1007-9572.2023.0310-1

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Background

In 2010, China began to implement a free training program for rural order-oriented medical students (the "program") , which has played an important role in improving the construction of grass-roots health personnel and upgrading the level of grass-roots medical and health services. As the program has progressed, despite certain successes, there are many problems that remain to be solved, and it is not yet known which are the urgent and important core issues.

Objective

Sorting out the problems with the program to provide lessons learned for moving the program forward.

Methods

In May 2023, Chinese databases were searched using the literature analysis method to sort out the problems of the project documented in the literature; the problems resulting from the sorting out were analyzed using the social network analysis method, and the results calculated based on the social network analysis method were comprehensively evaluated using the TOPSIS method.

Results

The relevant problems in the literature were organized and counted. The top-ranked problems in order of frequency were low salary and treatment at the grassroots level for oriented medical students (14 times) , limited space for career development at the grassroots level for oriented medical students (10 times) , imperfect relevant supporting policies (10 times) , poor working conditions at the grassroots level (7 times) , and lack of motivation and initiative in learning for oriented medical students (7 times) ; and the results of the social network analysis were synthesized and evaluated by the TOPSIS method. The results of the social network analysis method were comprehensively evaluated by the TOPSIS method, and the top four rankings were imperfect relevant supporting policies (C_i=0.867) , limited space for grassroots career development of oriented medical students (C_i=0.800) , low grassroots salary and treatment of oriented medical students (C_i=0.786) , and poor grassroots working conditions (C_i=0.621) in the order of ranking.

Conclusion

Guangxi's free training program for rural order-oriented medical students still has major problems in the process of promoting the program. It is recommended that the program be optimized in the following ways to ensure its high-quality development: improve relevant supporting policies and strengthen supervision and evaluation; smooth career promotion channels and establish a long-term incentive mechanism; improve the remuneration system and raise the level of treatment; and improve the grass-roots working environment to enhance the quality of grass-roots work and increase efficiency.

Association between Burnout, Workplace Violence, and Turnover Intention among Medical Graduates from a National Compulsory Service Programme

SHEN Lijun, LI Hange, WANG Peicheng, ZHU Jiming

2024, 27(22):  2766-2772.  DOI: 10.12114/j.issn.1007-9572.2023.0783

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Background

China's National Compulsory Service Programme (CSP) is an important measure to alleviate its shortage of primary health care (PHC) workforce and improve quality of care in rural areas. Currently, the work status and turnover intention of the CSP medical graduates (the fully-fledged general practitioners in China) have received considerable attention.

Objective

This article will investigate the medical graduates' workplace violence, burnout, and turnover intention, in order to provide policy recommendations to stabilize the general practitioners.

Methods

From December 2021 to February 2022, an online structural questionnaire survey was conducted in nine out of 22 provinces adopting a stratified random sampling method. The electronic questionnaires were distributed to medical graduates with the assistance of the Science and Education Department of the Provincial Health Commission. The burnout of medical graduates was assessed using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) . Workplace violence involved the verbal and physical violence. Turnover intention was measured by "Are you willing to continue serving at the PHC institutions upon the completion of the contract (the compulsory service) ?" Multivariate Logistic regression analysis was used to explore the impact of burnout and workplace violence on turnover intention.

Results

A total of 3 615 questionnaires were effectively collected. 87.77% (3 173/3 615) of medical graduates were unwilling or unsure to continue their employment after finishing the contract. 17.46% (631/3 615) of medical graduates had experienced physical violence, and 60.33% (2 181/3 615) had experienced verbal violence. In addition, the detection rate of burnout was 55.82% (2 018/3615) , of which 60.80% (2 198/3 615) were in moderate or severe emotional exhaustion, while the proportions of depersonalization and personal accomplishment were 67.55% (2 442/3 615) and 83.76% (3 028/3 615) , respectively. Logistic regression analysis showed that after controlling for socio-economic factors such as gender, professional title, and personal monthly income, medical graduates who were experiencing burnout had a 4.92 times[95%CI (3.87-6.25) ] higher risk of leaving, a 1.92[95%CI (1.50-2.46) ]times higher risk of uncertain retention (P<0.05) . Medical graduates who experienced verbal and physical violence were 1.46 times[95%CI (1.12-1.91) ] and 0.38 times[95%CI (0.27-0.52) ] more likely to leave after the contract expires (P<0.05) .

Conclusion

Medical graduates have a high intention to leave, and it is expected that there will be a significant loss of general practitioners after the contract expires. Burnout is a significant and prevalent problem affecting turnover intention. Efforts should be made from multiple perspectives to alleviate medical graduates' negative emotions, and thus stabilize the general practitioners.

Article·Chinese General Practice/Community Health Service Research

Family Doctor Teams' Evaluation for Contracted Family Doctor Services and Influencing Factors

OU Yanchen, XIE Yueying, WANG Zhenbang, ZHAO Yue, ZHANG Xin, ZUO Yanli

2024, 27(22):  2773-2779.  DOI: 10.12114/j.issn.1007-9572.2023.0501

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Background

Contracted family doctor services were implemented as a key action to reform primary care services in China. At present, the coverage of contracting has expanded stably. But the family doctor teams' evaluation of contracted family doctor services is not clear, which also highlights a number of issues that require further improvement in the provision of the services.

Objective

To study the contracted family doctor services for family doctor teams and associated factors.

Methods

In October 2022, a combination of purposive sampling and stratified cluster sampling was used for selecting family doctor team members from southern, central, northern and eastern Guangxi to participate in a questionnaire survey. The survey was conducted on the included subjects by using the provider version of the Primary Care Assessment Tools (PCAT-PS) , which contains 8 dimensions and 43 items. Multivariate Logistic regression analysis was used to research the influencing factors of family doctor teams' perception of PACT-PS of the services.

Results

A total of 775 valid questionnaires were collected, with a valid response rate of 99.36%. The average score of the PCAT-PS of the family doctor team members was (32.55±3.90) . The dimensions with the relatively high score were family-centeredness and comprehensiveness, but the dimensions of first contact-access and ongoing care of the services had a relatively low-level perception. Multiple linear regression analysis showed that the type of organization, age, professional title, division of team responsibilities and working patterns were the factors that influence the PCAT-PS score of family doctor team members (P<0.05) .

Conclusion

The family doctor team members had an overall good evaluation on contracted family doctor services while differences in the quality of the services among primary health care institutions in urban and rural areas. The working mode of family doctor team has a positive effect on the improvement of contracted family doctor services quality. To further improve the family doctor teams' evaluation of contracted family doctor services, we need to accelerate the construction of family doctor teams with equal emphasis on "quality" and "quantity", explore the path of integrated salary and job development, and create a "government-community-family" shared governance and resource sharing network.

Evaluation Study of Childhood Bronchial Asthma Prevention and Treatment Services by Primary Care General Practitioners in Chongqing

YANG Qiao, LIU Yulin, WANG Chongjie, LIU Enmei, FU Zhou, CHEN Fei

2024, 27(22):  2780-2788.  DOI: 10.12114/j.issn.1007-9572.2023.0758

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Background

Bronchial asthma (asthma) is the most common chronic respiratory disease in childhood, with long disease course and repeated attacks, which affecting the development and life quality of children. As the main providers of primary healthcare, general practitioners play important role in the early diagnosis and grading management of childhood asthma. Understanding their level of prevention and treatment services for this disease can provide suggestions for improving the quality of primary care childhood asthma prevention and treatment services.

Objective

To investigate the service level of primary general practitioners in the prevention and treatment of childhood asthma, and the influencing factors on the service level.

Methods

From April to July 2022, 22 districts (counties) were randomly selected from the 38 districts (counties) in Chongqing Municipality, and conducted a questionnaire survey on primary general practitioners in the sampling. The questionnaire was designed by the research team based on relevant guidelines and literatures, and formed through two rounds of expert consultation and pre-investigation, including four dimensions of knowledge, attitude, behavior and self-evaluation. We investigated the knowledge, attitude, behavior and self-evaluation of primary general practitioners regarding the prevention and treatment of childhood asthma and analyzed the influencing factors.

Results

A total of 234 general practitioners participated in the questionnaire survey. The knowledge score of general practitioners on the prevention and treatment of childhood asthma was (6.03±2.04) , with a pass rate of 44.9%; the attitude score was (49.42±4.94) , with a pass rate of 100.0%; the behavior score was (30.55±6.66) , with a pass rate of 87.2%; and the self-evaluation score was (21.57±5.30) , with a pass rate of 85.0%. Regarding the selection of referral indications, 98.7% (231/234) of the general practitioners believed that children with moderate or severe acute asthma attack that was not significantly relieved after emergency treatment needed to be referred, and 94.0% (220/234) of the general practitioners believed that children with asthma that could not be controlled effectively after standardized treatment needed to be referred. For children with poorly controlled symptoms, 33.8% (79/234) of the general practitioners would carefully analyze the cause of poor control, and 17.5% (41/234) of the general practitioners would advise patients to follow the doctor's advice, temporarily observe the condition and make an appointment for next reexamination. 33.8% (79/234) of the general practitioners held an uncertain or opposed attitude towards the diagnosis and treatment of childhood asthma in primary medical institutions. The main influencing factors of this attitude was the lack of disease-related knowledge and learning opportunities for general practitioners, reluctance of parents to visit primary medical institutions, strained pediatric doctor-patient relationship, the small number of children suffering from asthma, and the lack of related facilities and equipment. Multiple linear regression analysis showed that professional title and training experience on childhood asthma were the influencing factors of knowledge score (P<0.05) ; academic qualification and years of service in primary medical institutions were the influencing factors of attitude score (P<0.05) ; and pediatric work experience and training experience on childhood asthma were the influencing factors of behavior and self-evaluation scores (P<0.05) .

Conclusion

The general practitioners in Chongqing have some confidence in the management of children with asthma, but their knowledge of asthma prevention and treatment is poor. Their attitude and behavior were both positive, but there is a gap between the two. It is suggested that while optimizing the allocation of pediatric facilities and equipment in primary medical institutions and improving the trust of patients, knowledge and practical training is important to improve the knowledge, confidence and abilities of general practitioners. Academic education and continuing education training of general practitioners should be strengthened to effectively improve their learning and self-improvement ability.

Cost Effectiveness Analysis of the Prevention and Treatment of Osteoporosis among the Entire Population in Fenglin Community, Shanghai Based on Markov Chain

SU Jin, SHOU Juan, GU Wenqin, YI Chuntao, XU Liping, CHENG Lili, DING Hongjuan, ZHOU Peng, WU Yinghua, QIN Jie, XUE Bin, WEI Baichuan, WANG Qian, PENG Yan, CHENG Yimin, YANG Lan, WEI Yangyang, WANG Lei, QI Jinlin, SHAO Ying, CAI Liming

2024, 27(22):  2789-2796.  DOI: 10.12114/j.issn.1007-9572.2023.0420

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Background

With the gradual deepening of the comprehensive reform of community health services, the prevention and control of single diseases for the entire population in the community is also constantly being optimized, However, there is still a lack of appropriate evaluation methods in the community to reflect its prevention and control effectiveness evaluation.

Objective

By analyzing and exploring the cost effect of the existing whole-population prevention and control measures of osteoporosis in Fenglin community, from 2016 to 2022, this paper answers the initial results and possible problems of the whole-population prevention and control of single disease in the community.

Methods

This study conducted a cost-effectiveness analysis on 4 293 community residents who received osteoporosis prevention and treatment in Fenglin community from 2016 to 2022. Divide the research object into three states based on bone density values: healthy, low bone mass, and osteoporosis, and construct a Markov model to analyze the influencing factors of different state transitions. And based on the predicted values of the Markov model combined with quality adjusted life years (QALY) , the increment of quality adjusted life years (QALY) is calculated. All costs invested in prevention and control work from 2016 to 2022 are counted, and the effectiveness of prevention and control is evaluated by the cost/quality adjusted life year increment ratio. Quality adjusted life years (QALY) are obtained by calculating the health utility value and expected life determined through literature search.

Results

The total cost of osteoporosis prevention and treatment in Fenglin community was 33 814 102.15 yuan. The total quality-adjusted life years of 4 293 community osteoporosis prevention and treatment population were 77 098.288 9 at the first diagnosis, the average per capita was 17.959, and the standard deviation was 9.34. At the second diagnosis, the total quality-adjusted life years were 79 616.936 1, the mean per capita was 18.546, the standard deviation was 9.342, and the difference between the two diagnoses was 2 518.647 2. The incremental cost-effectiveness ratio (ICER) is 2 132.907 0 yuan /QALY, and the incremental cost-effectiveness ratio (ICER) is less than 1 times (66 965.10 yuan) per capita GDP, indicating that the intervention scheme is fully cost-effective.

Conclusion

This study combined Markov model and quality-adjusted life years (QALY) to make a preliminary evaluation of the prevention and treatment effect of osteoporosis in Fenglin community. The results showed that the intervention program of osteoporosis prevention and treatment in Fenglin community was worth investing, and provided a certain basis for the accurate prevention and treatment decision of osteoporosis in the future.

Methodology Research

The Design and Application of In-depth Interview in Primary Care Research

XU Zhijie, WANG Yang, QIAN Yi

2024, 27(22):  2797-2806.  DOI: 10.12114/j.issn.1007-9572.2022.0597

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In-depth interview is to understand the life experience and lifestyle of a certain social group through in-depth conversation with the respondents, explore the formation process of specific phenomena, and propose ideas and recommendations to solve problems. In-depth interview has been widely used in the study of primary care research. Thus, understanding its basic concept and mastering the design and application process are essential to master this method. This paper comprehensively describes the research process of in-depth interview research according to the 3 stages at before, during and after the research. Before formally conducting in-depth interview research, researchers need to understand its basic concepts, characteristics and limitations related to the research purpose and process, and identify which studies are applicable. In the design and implementation of in-depth interview research, researchers should focus on the main steps of the research in four stages: recruitment of interviewees, design and modification of interview guide, collection of interview data, and analysis of interview data. After completing the data analysis of the in-depth interview, researchers need to write a research paper referring to the report specification of qualitative research to increase the credibility of research results and the transparency of the research process. In addition, this paper recommends five fields suitable for in-depth interviews in primary care research, and introduces learning resources for researchers to master in-depth interview methods. Through the introduction of in-depth interview research method, this paper aims to help researchers in the field of general practice/primary care to master a method suitable for scientific research, and provide methodology reference for improving the quality of qualitative research in this field in China.

Digital and Smant Healhcare & Informationization

Research on Countermeasures for the Construction of Modernized Urban Healthcare System Based on Digital Healthcare: Taking Tianjin City of China as an Example

GAO Yajie, WU Shuang, CHEN Gang, YANG Licheng

2024, 27(22):  2807-2812.  DOI: 10.12114/j.issn.1007-9572.2023.0662

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The impact of the COVID-19 on the whole society exposed the inadequacy of the modernization of the urban public health system and governance capacity, which has brought new challenges to the development of health care in China.Promoting digital medicine and building a modern urban medical system is an important starting point for implementing the healthy China strategy and promoting the development of China's modern medical cause, an important embodiment of the country's comprehensive strength, an important symbol of economic and social development and progress, an important way to improve the people's healthy life quality, it is of great significance to realize resource integration, optimize medical treatment process, reduce operating costs, improve service quality, improve work efficiency and management level. Starting from the analysis of the current situation of informationization construction in second and third level medical institutions in a certain municipality directly under the central government in China, this article focuses on how to adapt to the needs of the times, build intelligent digital hospitals, seek scientific solutions, plan future development positioning, provide a basis for policy and normative formulation in the field of digital healthcare, and better serve health administrative departments and public hospital managers, providing new ideas for medical reform for government decision-making departments.