Loading...

Table of Content

    05 November 2024, Volume 27 Issue 31
    Academician Forum
    Holistic Integrative Medicine Declaration
    China Institute for Development Strategy of Holistic Integrative Medicine
    2024, 27(31):  0-C3.  DOI: 10.12114/j.issn.1007-9572.2024.A0021
    Asbtract ( )   HTML ( )   PDF (1119KB) ( )  
    References | Related Articles | Metrics

    Holistic integrative medicine, abbreviated as HIM, has been officially proposed since 2012. Its theoretical system has been continuously improved, and its practical methods have become increasingly diverse, becoming an inevitable choice and path for the medical development in the new era. This article demonstrates ten major propositions for HIM, elaborating on the connotation and extension of HIM from the perspectives of epistemology and methodology, in order to achieve the transformation and adaptive evolution of modern medicine.

    Guidelines·Consensus
    Chinese Consensus on Application Speifications for Noninvasive Positive Pressure Ventilation of Elderly Patients with Obstructive Sleep Apnea
    Chinese Association of Geriatric Sleep Medicine, Chinese Geriatrics Society
    2024, 27(31):  3841-3849.  DOI: 10.12114/j.issn.1007-9572.2023.0931
    Asbtract ( )   HTML ( )   PDF (1333KB) ( )  
    Figures and Tables | References | Related Articles | Metrics

    Obstructive sleep apnea (OSA) is prevalent in the elderly population due to the weakened neuromuscular function of the upper airway and unstable respiratory regulation in the elderly. OSA is a risk factor for a variety of common chronic diseases, and affects cognitive function and multi-system organ function in the elderly. Therefore, it is essential to provide effective therapeutic interventions for OSA in the elderly. The Sleep Medicine Branch of the Chinese Geriatrics Society, as the initiator, organized domestic experts in related fields to repeatedly discuss the operation process, requirements, specific ways and methods of noninvasive positive pressure ventilation (NPPV) treatment for elderly OSA patients with reference to domestic and international clinical studies, and finally made this expert consensus, which is aimed at standardizing the treatment of NPPV in elderly OSA patients in China to provide a reference.

    Development Status, Challenges, and Strategies of Clinical Practice Guidelines in Traditional Chinese Medicine Orthopedics
    FENG Tianxiao, SUN Kai, QIN Xiaokuan, WANG Xu, BU Hanmei, ZHU Liguo, WEI Xu
    2024, 27(31):  3850-3856.  DOI: 10.12114/j.issn.1007-9572.2024.0155
    Asbtract ( )   HTML ( )   PDF (1300KB) ( )  
    References | Related Articles | Metrics

    Clinical practice guidelines can standardize medical behaviors, improve the quality of medical services, rationalize resource allocation, and safeguard the rights of patients. However, all of these are achieved based on the rigorous design, scientific formulation, and standardized reporting of guidelines. With the nation's high attention to the standardization of traditional Chinese medicine, many clinical practice guidelines for traditional Chinese medicine or integrated traditional Chinese and Western medicine have been published. Traditional Chinese medicine orthopedics, as a discipline with obvious advantages in specialization in the field of traditional Chinese medicine, is witnessing a rapid increase in the number of clinical practice guidelines, prompting the discipline to gradually move towards standardization, modernization, and internationalization. However, many issues are increasingly emerging in this context, attracting widespread attention from researchers. This article systematically reviews and summarizes the current status and challenges of the development of clinical practice guidelines in orthopedics of traditional Chinese medicine, and proposes targeted strategies. Currently, the development of clinical practice guidelines in orthopedics of traditional Chinese medicine faces many challenges, including inaccurate positioning of clinical problems, a lack of high-quality clinical evidence, insufficient standardization in guideline formulation, a shortage of multidisciplinary talent development, and various issues regarding guideline updating and implementation. In future research, professional societies/associations should strengthen guidance on guideline formulation. Researchers should focus on improving the quality of original research, enhance learning and research in guideline methodology, prioritize guideline updating and adaptation, and promote the dissemination and implementation of guidelines, aiming to develop high-quality guidelines and promote the standardization of orthopedics of traditional Chinese medicine.

    Methodological Quality Evaluation and Comprehensive Analysis of Clinical Practice Guidelines and Expert Consensus for Lumbar Disc Herniation
    QIN Xiaokuan, SUN Kai, FENG Tianxiao, XIAO Xiangyu, WANG Guochen, SU Xiangfei, WEI Xu, ZHU Liguo
    2024, 27(31):  3857-3864.  DOI: 10.12114/j.issn.1007-9572.2024.0051
    Asbtract ( )   HTML ( )   PDF (1461KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    Lumbar disc herniation is one of the most common causes of low back pain, and the number of cases has been increasing year by year in recent years. High-quality guidelines can standardize clinical diagnosis and treatment behaviors and improve medical quality, and screening and formulating high-quality guidelines are of great significance for standardizing the clinical practice of lumbar intervertebral disc herniation.

    Objective

    To systematically evaluate the methodological quality of clinical practice guidelines and expert consensus for lumbar intervertebral disc herniation, and to analyze the high-quality guidelines and consensus recommendations, in order to provide reference for the prevention and treatment of lumbar intervertebral disc herniation.

    Methods

    Clinical practice guidelines and expert consensus on lumbar intervertebral disc herniation were searched from the establishment of each database to October 31, 2023. At the same time, Dangdang.com and others were manually searched to obtain the guidelines for lumbar intervertebral disc herniation published in the form of monographs. After the consistency evaluation was passed by two researchers, the methodological quality of the included guidelines and consensus was evaluated using the AGREE Ⅱ tool, and the high-quality guidelines and consensus recommendations were analyzed.

    Results

    A total of 15 guidelines and consensus were included, and the final recommendation level of 9 guidelines was B (can be recommended after modification), and 6 guidelines and consensus were C (not recommended for the time being). Recommendations mainly include bed rest, medication, surgical treatment, etc.

    Conclusion

    The methodological quality of the clinical practice guidelines and expert consensus for lumbar intervertebral disc herniation needs to be further improved, and some treatment methods are controversial, and the recommendations of the guidelines need to be further improved and unified to optimize clinical practice.

    Methodology
    Mixed Methods Research Reporting Standards and Case Analysis
    ZHANG Le, JING Chengyang, CHU Hongling, LIAO Xing
    2024, 27(31):  3865-3869.  DOI: 10.12114/j.issn.1007-9572.2023.0249
    Asbtract ( )   HTML ( )   PDF (1353KB) ( )  
    References | Related Articles | Metrics

    Mixed methods research is a third research paradigm that integrates qualitative and quantitative research. By combining the advantages of qualitative and quantitative research and analyzing specific problems more widely and deeply, it can increase the universality of research results and is applicable to study complex problems. At present, the application of mixed method in domestic medical research is still in the early stage, and there is no unified standard in the reporting specifications. The Mixed Methods Article Reporting Standard (MMARS) is one of the Journal Article Reporting Standards (JARS). This paper comprehensively introduces MMARS and interpret MMARS through example applications, in order to provide reference for improving the quality of reporting.

    How Does a Rigorous Case Study of Primary Healthcare Service Management Produced?
    SUN Zhenyu, CHEN Jianping, SUN Wei, QIAN Dongfu, LAN Qing
    2024, 27(31):  3870-3876.  DOI: 10.12114/j.issn.1007-9572.2022.0817
    Asbtract ( )   HTML ( )   PDF (1421KB) ( )  
    Figures and Tables | References | Related Articles | Metrics

    This article aims to help beginners in general practice and primary healthcare research clarify the standard operating procedures and understand that the "rigor" of case study is based on strict adherence to standard implementation procedures. The paper began with a literature review to sort out the development of case studies, overview the connotation, historical background, and applicable issues of case study. Then, the standard operational procedures of case study were introduced step by step, with specific examples to illustrate the application of case studies in general practice and primary healthcare. Step 1: plan initiation to determine whether to conduct a case study. Step 2: plan design to select appropriate cases and types of case study. Step 3: work preparation, researchers training and pilot study. Step 4: data collection to obtain data from multiple sources. Step 5: data analysis to obtain conclusions based on evidence. Step 6: report writing and communication with readers. Case study is suitable for addressing the "what" "how" and "why" questions in general practice and primary healthcare, with a broad application prospect.

    Article
    Responsiveness Assessment and Its Influencing Factors of Community Health Services among Residents of Different Ages
    SHI Yinan, ZHOU Chi
    2024, 27(31):  3877-3883.  DOI: 10.12114/j.issn.1007-9572.2023.0714
    Asbtract ( )   HTML ( )   PDF (1534KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    Responsiveness is a key goal in evaluating the performance of the health system, and is also an essential basis for improving the capacity of primary health services. Currently, many studies confuse the concepts of responsiveness and satisfaction, and the evaluation of responsiveness is not comprehensive enough, focusing on the level of responsiveness but ignoring its distribution.

    Objective

    To understand the responsiveness evaluations of community health services among residents of different ages in Zhejiang province and to analyze its influencing factors.

    Methods

    Utilizing the method of purposive sampling and convenience sampling, six community health service centers in Hangzhou and Taizhou, Zhejiang province, were selected as the investigation sites from July to August 2022 to assess the responsiveness scale of outpatient residents. The weights of the eight components of responsiveness recommended by the WHO were used to calculate the overall level and distribution of responsiveness. Univariate analysis and multiple linear regression were used to explore the influencing factors on the responsiveness level among residents of different ages.

    Results

    The score of responsiveness for community health services in Zhejiang was (8.31±1.04) points, and the responsiveness distribution index was 0.13; residents of different age groups expressed their higher satisfaction with the dimensions of dignity and social support, with scores of (8.60±1.24) points and (8.63±1.20) points, respectively. In contrast, the dimensions of selectivity and autonomy received lower ratings, with scores of (7.96±1.56) points and (8.04±1.34) points, respectively. Household registration was an influencing factor for responsiveness evaluation of community health services among young people, while education level and monthly income were influencing factors for responsiveness evaluation among middle-aged individuals (P<0.05) .

    Conclusion

    The overall level of community health service responsiveness in Zhejiang province is good, and the distribution is more balanced. More attention should be paid to the demand and responsiveness of community health services among young people with urban household registration and middle-aged people with a college/bachelor's degree or above. Primary care community health service centers still need to improve in providing patients with access to information about health service plans and the freedom to choose community doctors/nurses, thereby better satisfying the reasonable healthcare service demands of residents.

    The Application of AI in Primary Care General Practitioners' Practice: a Perspective on Skin Disease Diagnosis and Disease Course Management
    LIU Huan, ZHU Shifei, CHEN Fayu, WANG Jinghua
    2024, 27(31):  3884-3889.  DOI: 10.12114/j.issn.1007-9572.2024.0121
    Asbtract ( )   HTML ( )   PDF (1456KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    Primary care general practitioners encounter significant challenges in diagnosing and managing skin diseases, highlighting the urgent need for artificial intelligence (AI) assisted systems. Although AI has the potential to improve diagnostic and treatment efficiency, research on its application in primary care settings remains limited.

    Objective

    To investigate the effectiveness and impact of an AI-assisted system in supporting primary care general practitioners with the diagnosis and management of skin diseases.

    Methods

    From December 2022 to March 2024, 19 general practitioners from community health centers in Hangzhou were voluntarily recruited for this study. They were randomly divided into two groups: an AI group with 10 physicians and a control group with 9 physicians. During this period, these physicians treated a total of 90 patients with skin diseases: 50 in the AI group and 40 in the control group. Physicians in the AI group utilized the Ruifu AI-assisted system for diagnosing and managing dermatological diseases, whereas those in the control group followed standard treatment protocols without AI assistance. Both groups compiled patients' medical records, auxiliary examination reports, and photographs of skin lesions during consultations. Two skin disease experts were invited to conduct remote consultations to evaluate the diagnostic accuracy of the two groups. On the first day (1 d) and the fourteenth day (14 d) of treatment, patients underwent assessments using the Dermatology Life Quality Index (DLQI), and satisfaction surveys were conducted separately for patients in the AI and control groups. A questionnaire survey was administered to doctors in the AI group to assess their experience with the Ruifu AI-assisted system.

    Results

    No significant differences were observed in gender, age, or education level among patients in the AI and control groups (P>0.05), nor among physicians in terms of gender, age, education, and professional titles (P>0.05). The AI group's general practitioners achieved higher diagnostic accuracy for skin diseases than those in the control group (64.0% vs 37.5%, P=0.012). Fourteen days post-treatment, improvements in the DLQI scores were observed in both the AI and control groups, with significant differences (P<0.05), and the improvement in the AI group was more significant (P<0.05). The satisfaction level of the AI group was higher than that of the control group (P=0.024), and there was a positive correlation between the 14 d DLQI score and patient satisfaction in the AI group (rs=0.471, 95%CI=0.186-0.683, P=0.002), the correlation between the improvement in DLQI score and patient satisfaction was even more significant (rs=0.816, 95%CI=0.676-0.899, P<0.001). The results of the questionnaire survey revealed that a majority of physicians demonstrated a positive attitude towards their use of the AI-assisted system, acknowledging its practical value in several areas: diagnosis selection (70.0%), auxiliary diagnosis (80.0%), treatment recommendations (60.0%), and the provision of professional knowledge (90.0%). Remarkably, 90.0% of the physicians indicated their intention to continue utilizing the AI-assisted system.

    Conclusion

    In the primary care setting, the application of AI-assisted systems has enhanced the diagnostic accuracy of general practitioners in identifying skin diseases, improves the quality of life for patients, and increases patient satisfaction. The majority of general practitioners report positive experiences with the use of AI-assisted systems.

    Analysis of Overweight and Obesity Trends and BMI Variation among Children and Adolescents Aged 6-15 Years: Based on the Centralized Distribution of Food Material System
    XIONG Chang, LI Zhijuan, WANG Jinming, YU Yun, YU Yingqing, QIAN Hongdan
    2024, 27(31):  3890-3895.  DOI: 10.12114/j.issn.1007-9572.2023.0787
    Asbtract ( )   HTML ( )   PDF (1644KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    The prevalence of overweight and obesity among children and adolescents is continuously rising. As countries have developed several school-based nutrition policies to control overweight and obesity, it is important to examine the effectiveness of nutrition policies.

    Objective

    To evaluate the effect of the centralized distribution of food material system on overweight and obesity rates among children and adolescents aged 6-15 years.

    Methods

    In April 2023, a total of 104 749 BMI data from sixteen schools aged 6 to 15 years (8 schools were included in the unified food distribution system and recorded as the unified distribution group, and 8 schools were not included in the unified food distribution and supply system and recorded as the non-unified distribution group) in Wuxi were retrospectively collected between 2017 and 2021. The data of physical examination was collected from Student Health Monitoring System in Jiangsu Province. The overweight and obesity epidemiologic trends among children and adolescents were analyzed from 2017 to 2021 in Wuxi, and the changes in BMI-Z scores and trends in overweight and obesity rates among children and adolescents were compared before and after the implementation of the centralized distribution of food material system by the Joinpoint regression and grey GM (1, 1) model.

    Results

    The prevalence of overweight and obesity among in children and adolescents aged 6-15 years was increasing from 2017 to 2021. The results of the Joinpoint regression analysis indicated that the prevalence of overweight (APC 1.8% vs 4.6%) and obesity (APC 6.9% vs 13.3%) among students included in the system exhibited a slower rate of increase than among those not included. The disparity in the increase of BMI-Z scores among students included in the system and those not included changed from -0.055 (95%CI=-0.108--0.002) to -0.195 (95%CI=-0.246--0.145) before and after the implementation of the system. The results of grey GM (1, 1) model showed that the incidence rate of overweight among children and adolescents in Wuxi in 2022, 2023 and 2024 was 22.02%, 22.39% and 22.77% respectively, with the incidence rate of overweight being 17.02%, 18.50% and 20.12% respectively.

    Conclusion

    The increasing trend in the prevalence of overweight and obesity, as well as the increase in BMI-Z scores among children and adolescents, has slowed down after the implementation of the centralized distribution of food material system. The system may be an effective method of improving the nutritional status of children and adolescents. Therefore, it is recommended that the centralized distribution of food material system still needs to be implemented and the monitoring area needs to be expanded.

    Research Status of Patient-reported Outcome Measurements for Acute Exacerbation of Chronic Obstructive Pulmonary Disease
    LI Chunyang, WANG Jiajia, WEI Mengyu, LI Jiansheng
    2024, 27(31):  3896-3904.  DOI: 10.12114/j.issn.1007-9572.2023.0617
    Asbtract ( )   HTML ( )   PDF (1729KB) ( )  
    Figures and Tables | References | Related Articles | Metrics

    Chronic obstructive pulmonary disease (COPD) is one of the common respiratory diseases, and the acute exacerbation of COPD is an acute event that severely reduces the quality of life in patients with COPD. We searched PubMed, CNKI, Wanfang Data Knowledge Service Platform, Vip.com and Chinese Biomedical Literature, sifted out 69 representative literatures according to the inclusion and exclusion criteria, and found that there were 23 patient-reported outcome (PRO) assessment tools used in patients with acute exacerbation of COPD. Except for the EXACT-PRO, all of them directly use PRO assessment tools of stable patients. These assessment tools are divided into general, disease-specific and symptom-specific assessment tools, mainly involving symptoms, physiological field, social field, psychological emotion, daily activities and other fields. The number of items is from one to 100, and the response scale is mostly in the form of Likert, and its development and assessment are based on classical test theory. It is suggested that future studies on quality of life of patients with acute exacerbation of COPD should focus on the following points: strengthening the research on specific assessment tools; attaching importance to the combined application of classical test theory, item response theory and generalizability theory; paying attention to the study of the minimal clinically important difference of assessment tools; selecting assessment tools appropriately.

    Effects of the Integration of Urban and Rural Residents Basic Medical Insurance on the Self-evaluation of Health Status and Life Satisfaction of the Chinese Elderly
    GONG Zhizhong, WU Xi'ai, HUANG Sioutang, CHIU Herngchia
    2024, 27(31):  3905-3910.  DOI: 10.12114/j.issn.1007-9572.2023.0485
    Asbtract ( )   HTML ( )   PDF (1646KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    Empirical research and evidence on the relationship among the medical insurance system reform, health status and life satisfaction of the elderly are scant.

    Objective

    To analyze the effects of the integration of the urban and rural residents basic medical insurance (URRBMI) on the self-evaluation of health status and life satisfaction of the Chinese elderly.

    Methods

    Based on the follow-up data of China Health and Retirement Longitudinal Study (CHARLS) from 2015 to 2018, elderly people over 60 years old with complete information were included as the research subjects. The demographic information, health status and function, medical care and insurance were extracted from the CHARLS questionnaire. According to the integration of URRBMI or not, subjects were assigned into URRBMI integration group and non-integration group. Logistic regression model was used to analyze the effects of the integration of URRBMI on the self-evaluation of health status and life satisfaction of the elderly. In addition, a structural equation model was constructed to analyze the mediating effect with the URRBMI integration as an independent variable, self-evaluation of health status as a mediating variable, and life satisfaction as a dependent variable.

    Results

    A total of 4 364 subjects were analyzed in this study, including 694 (15.90%) in the URRBMI integration group and 3 670 (84.10%) in the non-integration group. The self-evaluation of health status in the URRBMI integration group was significantly better than that of the non-integration group (20.74% vs 17.41%, P=0.038). The self-evaluation of health status in the URRBMI integration group was significantly superior (OR=1.281, 95%CI=1.038-1.581, P=0.021). The life satisfaction of the URRBMI integration group was significantly higher than that of the non-integration group (94.80% vs 91.87%, P=0.009). The life satisfaction was better in the URRBMI integration group (OR=1.378, 95%CI=1.037-1.831, P=0.027). There was a partial mediating effect of the self-evaluation of health status on the impact of URRBMI integration on the life satisfaction, with the mediating effect value of 0.050 (P=0.043), and the proportion of mediating effect in the total effect accounted for 46.66%.

    Conclusion

    The URRBMI integration is beneficial to improve the self-evaluation of the health status and life satisfaction of the elderly, which has a positive practical significance. In the future, further efforts should be made on strengthening the publicity of the URRBMI, constantly improving the medical insurance treatment level for urban and rural residents, establishing a more reasonable financing mechanism, promoting the quality of medical services in rural areas, and finally improving the health level of the elderly population.

    The Characteristics of the Distribution of Healthcare Resources in Primary Healthcare Institutions between Provinces in China
    QIU Linping, SONG Guoqiang, LIU Meng, JIANG Chenglei, SUN Xianhong
    2024, 27(31):  3911-3918.  DOI: 10.12114/i.issn.1007-9572.2024.0089
    Asbtract ( )   HTML ( )   PDF (1956KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    Health care workers are vital service providers in primary healthcare, playing a crucial role in safeguarding public health, disease prevention, and chronic disease management. At present, research on healthcare resources mainly focuses on the quantity and structure, and there are few studies on the spatial distribution characteristics of healthcare resources.

    Objectives

    To analyze the spatial development trend of healthcare human resources in primary healthcare institutions nationwide, and to provide reference for optimizing the spatial allocation of healthcare resources and upgrading the level of primary healthcare services.

    Methods

    The data for this study were obtained during 2013-2017 China Health and Family Planning Statistical Yearbook, the 2018-2022 China Health and Wellness Statistical Yearbook, and the annual data of the National Bureau of Statistics (NBS) by province and the Ministry of Civil Affairs of China. From February to June 2023, the health density index (HRDI) was used to comprehensively reflect the demographic and geographic distribution of primary health care in China from 2012 to 2021, spatial autocorrelation analysis was applied to calculate the global Moran's I index to characterize the spatial distribution of primary health care resources in China from 2012 to 2021 analysis, and calculate the local Getis's G index to analyze the hotspots of primary care resource allocation in China from 2012 to 2021.

    Results

    The number of practicing physicians and nurses per 1 000 population at the grassroots level has increased in all regions of China, and the ratio of healthcare to nursing is still low. The high HRDI values for the number of practicing (assistant) physicians and nurses were in the eastern region, while the western region had lower HRDI values. The global Moran's I index for the number of practicing (assistant) physicians turned from negative to positive in 2016. The Moran's I index for nurses was always negative, but the overall trend was gradually approaching 0. Western regions such as Xinjiang and Xizang have low health density indices and are cold spots for resource distribution.

    Conclusion

    The allocation of medical and nursing resources to primary health care organizations has been increasing year by year, but there are obvious differences in allocation between provinces. The spatial correlation between physicians has gradually increased, and nurses have become more dispersed in their spatial distribution. It is recommended that the reserve of primary care physicians and nurses be strengthened, and that the ratio and collaboration between physicians and nurses be improved; that the planning of health care resources take into account both demographic and geographic configurations, and that Internet-based health care be promoted to improve the accessibility of health care services; and that the investment of resources in central and western China be increased, and that the construction of health care organizations be pushed forward in order to enhance the capacity of grass-roots-level services.

    The Current Situation of the Building of Human Resources for Public Health in Beijing in the Context of Public Health Emergencies
    GU Mei, ZHAO Ning, LI Jin, YANG Jia
    2024, 27(31):  3919-3925.  DOI: 10.12114/j.issn.1007-9572.2023.0405
    Asbtract ( )   HTML ( )   PDF (1777KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    The personnel building of public health is the key to improving the public health system and enhancing the emergency response capability of public health emergencies.

    Objective

    The study aims to analyse the status, advantages and deficiencies of human resources for public health in Beijing after public health emergencies. Then, the study put forward suggestions to optimise the construction of human resources for public health in Beijing.

    Methods

    The data on the sum of public health workforce, disaggregated by age, academic qualifications and job title, was collected from 2016 to 2021 Basic Information Survey on Manpower of Health Institutions in Beijing and the Compendium of Statistics on Community Health Work in Beijing. The data was collated between June and September in 2022 with the aims of analysing the sum, structure and configuration of human resources for professional and grassroots-level public health in Beijing in the context of public health emergencies.

    Results

    From 2019 to 2021, the sum of human resources for public health in Beijing's professional public health institutions increased from 15 157 to 16 048. Additionally, the percentage of those with postgraduate qualifications increased by 0.93 percent, while the percentage of those with senior and intermediate titles increased by 2.29 and 3.87 percent, respectively. The sum of human resources for public health at the grassroots level increased from 3 701 to 4 017. Among these, the percentage of those with bachelor's degree or above increased by 5.36 percent, while the percentage of those with senior and intermediate titles increased by 0.72 and 1.70 percent, respectively. And the ratio of CDC force per 10 000 population decreased from 1.68 to 1.57, the number of health personnel in professional public health institutions per 1 000 population increased from 0.70 to 0.73, the number of grassroots public health personnel per 10 000 population increased from 1.72 to 1.84.

    Conclusion

    After the public health emergency, the sum of human resources for public health has increased in Beijing, yet staffing gaps persist. The echelon of public health institutions has been reinforced, although the quality of human resources for public health in different institutions varies considerably. Furthermore, the structure of titles of human resources for public health is becoming more logical. It is recommended that public health staffing standards be clarified to fill the gap in human resources for public health. Furthermore, it is essential to enhance the training methodology for human resources for public health and elevate the calibre of them. Additionally, there is a need to refine the mechanism for ensuring the advancement of the human resources for public health, with the objective of attracting and retaining talent.

    Construction of an Evaluation Index System for Competency of Healthcare Social Workers in Beijing from an Interdisciplinary Perspective: Taking the Healthcare Social Work Team of T Hospital as an Example
    WANG Hongmei, ZHANG Lei, WANG Kexia
    2024, 27(31):  3926-3932.  DOI: 10.12114/j.issn.1007-9572.2023.0210
    Asbtract ( )   HTML ( )   PDF (2128KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    The rapid development of healthcare social work in policy and practice in Beijing, especially since the COVID-19 epidemic, urgently calls for a competence-based evaluation system.

    Objective

    This study is to develop a competence-based index system for the training and evaluation of professional healthcare social workers at an institutional and regional level from an interdisciplinary perspective.

    Methods

    From August to November 2022, a one-to-one half structured interview was conducted with snowball sampling among 21 members of an interdisciplinary healthcare social work team in T hospital and surrounding communities in Beijing, a focus interview was conducted among the healthcare social workers, and the interview outlines were formulated based on the Spencers' Iceberg Model. Subject analysis method was used to analyze the data, extract the themes of competency for construction of evaluation index system of T hospital. From November to December 2022, a total of 10 experts in healthcare social work practice were invited by using purposive sampling method to imolement the Fuzzy Delphi and form the Beijing competency evaluation system of healthcare social workers.

    Results

    (1) A evaluation index system for competency of healthcare social workers in T hospital was formed through qualitive method, including 4 first-level indexes, 16 second-level indexes and 97 third-level indexes. (2) A total of 2 rounds of Fuzzy Delphi were conducted. The enthusiasm coefficient was 100%. According to S1=8.30 and S2=7.00, a revised index system of T hospital and Beijing were respectively formed.

    Conclusion

    This study has constructed an evaluation index system for competency of healthcare social workers in Beijing, which covers 4 first-level indexes, 14 second-level indexes and 73 third-level indexes, from the perspective of interdisciplinary including social work, medicine, nursing and community governance.

    Article·Focus on General Practice Education
    The Willingness and Influencing Factors of Standardized Training Instructors for General Practitioners to Conduct Teaching Clinics
    YANG Xin, PAN Xuanda, XU Haofeng, YAN Ping, YU Lina, YE Huiling, HU Bingjie
    2024, 27(31):  3933-3940.  DOI: 10.12114/j.issn.1007-9572.2023.0790
    Asbtract ( )   HTML ( )   PDF (1934KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    The implementation of standardized teaching clinic activities by the faculty of standardized training of general practice residents (hereinafter referred to as residency training) is a key link in the cultivation of qualified general practitioners. And in July 2021, the Chinese Physicians' Association organized experts to revise the Specification for General Practice Teaching Clinic for Standardized Training of Residents in the Specialty of General Practice (for Trial Implementation), which is referenced by all the residency training bases of general practice across the country to carry out the teaching clinic. However, at this stage, the implementation of teaching clinic in each residency training base is still in the exploratory stage, and the degree of attention is insufficient, and the phenomenon of low quality and irregularity in the form of teaching clinic prevails.

    Objective

    To understand the current situation and influencing factors on the willingness of general practice residency faculty to conduct teaching clinics, not only to analyze the difficulties and confusions in conducting teaching clinics, but also provide reflections and recommendations.

    Methods

    From October 2021 to November 2023, a survey was conducted among general practitioners who participated in the provincial-level general practice residency training programs for regular and key instructors in Guangdong Province. A self-designed questionnaire was used to collect data from the included instructors, covering their basic information, work situation, and their willingness to teach. The electronic questionnaire was created using the "Questionnaire Star" platform, which also facilitated the online distribution and collection of the survey.

    Results

    The average age of general practice faculty was (40.7±14.1) years, 724 (72.18%) faculty members' institutions had general practice teaching clinics, 792 (78.96%) had a desire to teach, 710 (70.79%) had no experience in teaching, 904 (90.13%) had self-assessed their competence in teaching as a score of 60-89, and 583 (58.13%) had received no general practice teaching clinic faculty training, 462 (46.06%) expected faculty training to be conducted in the form of a combination of multiple types of training, 417 (41.58%) and 309 (30.81%), respectively, believed that the teaching difficulty of general practice teaching clinics was to instruct general practice residents to independently receive patients in the general practice clinic and to teach in a tiered manner, and 377 (37.59%) believed that the most difficult teaching objective to achieve was to instruct general practice residents in general practice clinical thinking and improve their clinical decision-making skills, 216 (21.54%) believed that the most needed training component for general practice residents was consultation skills, and 456 (45.46%) believed that the reason their institution did not/would not conduct a teaching clinic was lack of time. Also, the results of the multifactorial logistic regression analysis showed that the availability of general practice teaching clinics at the institution where they are located, experience in teaching, self-assessment of teaching competence, and acceptance of faculty training in general practice teaching clinics were the factors influencing the willingness to teach in general practice faculty teaching clinics (P<0.05) .

    Conclusion

    Most of the general practice resident training faculty are willing to carry out general practice teaching clinics, but there are difficulties such as insufficient experience in teaching, training in teaching, and ability in teaching. So it is recommended to optimize and standardize general practice teaching clinics, strengthen the training of general practice concepts for general practice teaching clinic faculty, strengthen incentives for teaching, and improve the monitoring and feedback mechanism for resident faculty in order to improve the quality of general practice teaching clinics.

    The Impact of MDT-based CBL Education Mode on Improving Clinical Practice Skills of General Practitioners
    YANG Shifang, JI Lupeng, LI Xiaoming, CHEN Xueying, ZHAO Manzhi, HUANG Guohua, CUI Jinghua, CHEN Lian, LI Jing
    2024, 27(31):  3941-3945.  DOI: 10.12114/j.issn.1007-9572.2023.0796
    Asbtract ( )   HTML ( )   PDF (1747KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    The development of excellent general practitioners is essential to preserving people's health. Unfortunately, the general practitioner training model in place today is insufficient, which leaves them unqualified to provide primary medical services. Consequently, enhancing clinical competency should be the main goal of general practitioners' training.

    Objective

    To investigate how general practitioners' clinical practice abilities are affected by MDT-based CBL education.

    Methods

    From July 2020 to July 2023, 26 trainee general practitioners received training at the department of pulmonary and critical care medicine as part of their residency programme. As research subjects, they were divided three groups and trained with different model: traditional model, CBL model and MDT-based CBL model, respectively. Leicester Assessment Package (LAP) was used to assess their clinical practice skills by the end. Self-designed questionnaire was used for satisfaction survey anonymously. The results were analyzed statistically.

    Results

    The MDT-based CBL teaching group outperformed the traditional teaching group and the CBL teaching group in the theoretical examination (P<0.05). The MDT-based CBL teaching group had a significantly higher total LAP score (P<0.05) in comparison to either the conventional teaching group or CBL teaching group. Further investigation revealed that the MDT-based CBL teaching group performed better (P<0.05) in the part of patient admissions, collecting medical histories, patient management, problem solving, physician behavior, patient relationship, and preventive therapy. The students from the MDT-based CBL model had the best overall satisfaction, with a significant difference comparing the students from the CBL and traditional teaching groups (P<0.05). Additionally, the MDT-based CBL teaching group showed a significant improvement in their capacity to guide healthy lifestyle, deal with commodities, guide patient recovery, and use medications after discharge (P<0.05) .

    Conclusion

    A novel training approach for general practitioner, the MDT-based CBL teaching mode may enhance the clinical practice abilities and competency of general practitioners.

    Construction of Competency Model for Chinese Assistant General Practitioners Based on Delphi and Analytic Hierarchy Process
    ZHANG Xu, GONG Xue, XU Shasha, ZHANG Xinyan, LI Yixuan, YU Xiaosong
    2024, 27(31):  3946-3952.  DOI: 10.12114/j.issn.1007-9572.2023.0205
    Asbtract ( )   HTML ( )   PDF (1893KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    As an important part of the general practice team, assistant general practitioners undertake a lot of grassroots general practice work, but at present, there is no recognized national level assistant general practitioners post competency model to provide scientific basis for training qualified assistant general practitioners.

    Objective

    The competency of assistant general practitioners for China was constructed to provide support for the design of national assistant physician qualification examination, and provide theoretical basis for the training and evaluation of assistant general practitioners.

    Methods

    Based on the research group's previous literature research and behavioral event interviews, from September 2019 to January 2020, the entry pool was established, and 30 experts engaged in general practice were consulted by Delphi method for 2 rounds. The index and weight coefficient of the Chinese assistant general practitioner post competency model were determined by AHP.

    Results

    Six first-level indicators [the basic medical and health services (0.244 8), medical knowledge and life-long learning (0.244 8), and professional quality (0.244 8), interpersonal communication and team work (0.138 9), the basic public health services (0.085 8), the information utilization ability and management capacity (0.041 0) ] and 63 second-level indicators were finalized, and the weight coefficients of each indicator were defined.

    Conclusion

    This study constructs the post competency of assistant general practitioners for China for the first time, which has a high degree of expert representativeness and authority, and a more comprehensive and reasonable index selection, laying a foundation for the empirical study of the index system.

    Article·Healthy China·Focus on Treatment-prevention Integration
    Progress and Challenges in the Integration of Treatment and Prevention of Chronic Non-communicable Diseases
    ZHAO Yuling, GU Zhengping, ZHANG Xueying
    2024, 27(31):  3953-3957.  DOI: 10.12114/j.issn.1007-9572.2023.0417
    Asbtract ( )   HTML ( )   PDF (1634KB) ( )  
    References | Related Articles | Metrics

    With the aging of the global population and the transformation of lifestyle, the incidence of chronic non-communicable diseases continues to rise, thus having brought great challenges to global public health. In this context, medical and health services must adapt to this growing trend, which necessitates carrying out research on the medical prevention integration mode, and gradually strengthening its application in clinical practice. This paper aims to explore the application status quo, and future development trends of the treatment-prevention integration mode, as well as the challenges it faces from the perspective of chronic non-communicable disease management. We first introduce the background of chronic non-communicable disease management, and then describe the integration of treatment and prevention from multiple aspects in chronic disease management, including multidisciplinary collaboration, patient follow-up system, family doctor signing services, and health education on chronic diseases, so as to realize the comprehensive, chronic disease management throughout the life cycle, and improve patients' health level and living quality. Finally, we believe that in the future, it is necessary to strengthen scientific and interdisciplinary research, intensify the training and education of medical staff, and enhance the development of digital medical technology, in order to better meet the growing health needs of the people. Therefore, this paper has significant reference value for exploring the management methods of chronic non-communicable diseases and promoting public health services.

    Demand Analysis of Diabetes Primary Healthcare and Prevention Integration Services in the Context of Digital Health
    WU Xinyi, ZHANG Yongze, YANG Chenghu, WU Xiaoyuan
    2024, 27(31):  3958-3965.  DOI: 10.12114/j.issn.1007-9572.2023.0597
    Asbtract ( )   HTML ( )   PDF (2175KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    With the acceleration of the aging process of the population and the change of the disease spectrum of residents, the prevalence of chronic diseases such as diabetes is increasing year by year. It is urgent to establish a wide coverage and efficient medical prevention integration mode. Most of the existing studies have focused on the demand for health management services and the influencing factors of service adoption, and few have identified and analyzed the demand for chronic disease healthcare and prevention integration services under digital technology.

    Objective

    To explore the demand of residents for medical and preventive integration services for diabetes in the context of digital health, and the impact of different service contents on the acceptance and satisfaction of service objects, so as to provide a theoretical basis for the public to improve the whole process and all-round medical and preventive integration services.

    Methods

    Combined with relevant research and practical work, 20 survey items on demand for diabetes medical and prevention integration services were established. From January to June 2023, convenient sampling method was used to survey diabetes patients and risk groups in Fujian Province, Guangdong Province and Yunnan Province, and 410 respondents' data were obtained. According to five demographic characteristics of gender, age, education level, residence type and medical insurance type, attribute classification analysis was carried out according to Kano model analysis method, to investigate the relationship between service demand of different attributes and residents' satisfaction, and then put forward the supply strategy of diabetes medical and prevention integration services.

    Results

    Residents with different demographic characteristics show common and individual differences in the demand for medical and preventive integration services for diabetes. Among them, the demand for services among people of different ages and educational levels is quite different. The demand for medical prevention integration services of diabetes prevention and treatment groups focuses on screening, prevention and treatment, but the relevant convenient services provided by the Internet and social media have nothing to do with user satisfaction.

    Conclusion

    The level of personalization of diabetes primary health care and prevention services should be improved to fully satisfy the needs of the service population for essential attributes such as "initial screening for diabetes and complications", improve the services for desired attributes such as "establishment of a full-cycle personal electronic health record", and enhance the services for charismatic attributes such as "risk prediction" and "remote health monitoring". It will also improve services with desired attributes such as the establishment of a full-cycle personal electronic health record, and enhance services with attractive attributes such as "risk prediction" and "remote health monitoring".

    The Grid-style Management Mode of Family Doctors Based on the Concept of Treatment and Prevention Integration
    2024, 27(31):  3966-3968.  DOI: 10.12114/j.issn.1007-9572.2023.0685
    Asbtract ( )   HTML ( )   PDF (1527KB) ( )  
    Figures and Tables | References | Related Articles | Metrics