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    05 January 2025, Volume 28 Issue 01
    Preface
    Technological Innovation Supporting the Development of General Practice
    LIANG Wannian
    2025, 28(01):  0-C2.  DOI: 10.12114/j.issn.1007-9572.2024.A0024
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    Commentary
    The Application of Large Language Models in Primary Healthcare Services and the Challenges
    YAN Wenxin, HU Jian, ZENG Huatang, LIU Min, LIANG Wannian
    2025, 28(01):  1-6.  DOI: 10.12114/j.issn.1007-9572.2024.0277
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    The primary healthcare system is key to achieving a health equity. In China, great obstacles are challenged by imbalanced medical resources, shortage of primary healthcare providers, and the prevention and treatment of chronic diseases. Artificial intelligence large language models have demonstrated strong advantages in the medical system. This article deeply explored the application of large language models in the primary healthcare system and the challenges. The large language models are expected to assist the diagnosis and treatment of common diseases in grassroot medical institutions, promote intelligent health education and chronic disease management, underpin primary health services in the undeveloped and remote areas, stimulate the leapfrog development of general medicine, and accelerate the industrialization of large language models in general diagnosis and treatment and primary health services, thus providing important support for the construction of healthy China.

    Application and Challenges of Intelligent Robots in Grassroots Chronic Disease Management
    ZHANG Xuan, ZHANG Fei, LI Minglin, WANG Jiahe
    2025, 28(01):  7-12.  DOI: 10.12114/j.issn.1007-9572.2023.0811
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    The increasing prevalence of chronic diseases globally poses major challenges to the health of societies and individuals. Managing chronic diseases requires long-term treatment and monitoring, placing demands on patients' lifestyles. With the aging of the population and changes in lifestyle, chronic disease prevention and control are becoming more and more important. In recent years, as scientific and technological innovation in the field of healthcare develops in depth, and the application of artificial intelligence in healthcare has gradually become one of the important strategic directions of the country, the traditional method of chronic disease management relies too much on the offline communication between the doctor and the patient, which leads to the doctor not being able to maintain long-term and effective communication and follow up with the patient, and the patient may not be able to be detected and monitored by the doctor in a timely manner when his or her condition changes. In addition, the traditional chronic disease management approach is usually a generalized approach that fails to adequately consider the individual differences of each patient. Given the limitations of traditional chronic disease management methods, this study aims to provide more convenient and efficient primary care services using intelligent robots. Through personalized health management plans, assisted medical diagnosis, and timed medication reminders, the intelligent robot is committed to improving patients' quality of life, reducing the pressure on healthcare resources, and promoting the development of intelligent healthcare management globally.

    Standard·Strategy·Guidelines
    Expert Consensus on Primary Health Governance 2024
    Public Health Security and Health Professional Committee of the Public Safety Science and Technology Society, General Practitioner Branch of Chinese Medical Doctor Association
    2025, 28(01):  13-19.  DOI: 10.12114/j.issn.1007-9572.2024.0264
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    Primary health governance is a crucial part of the national health governance system and plays a key role in achieving universal health. However, primary health governance currently faces many challenges. The Expert Consensus on Primary Health Governance is led by the Public Health Security and Health Professional Committee of the Public Safety Science and Technology Society, in collaboration with experts from multiple disciplines. The aim of this consensus is to integrate evidence-based scientific evidence, practical wisdom, and experience from multidisciplinary experts in primary health-related fields. This consensus addresses the connotations, significance, objectives, basic principles, system construction elements, capacity building elements, institutional elements, and technical means of primary health governance. It provides scientific, systematic, and operable consensus opinions and suggestions to enhance the level of primary health governance, standardize primary health governance practices, promote the equalization of primary health services, strengthen the cultivation of primary health governance talents, and drive innovation in health governance. This will provide scientific basis and recommendations to support the realization of the "Healthy China 2030".

    Interpretation of Report on Cardiovascular Health and Diseases in China 2023
    LIU Mingbo, HE Xinye, YANG Xiaohong, WANG Zengwu
    2025, 28(01):  20-38.  DOI: 10.12114/j.issn.1007-9572.2024.0293
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    The prevalence of cardiovascular disease (CVD) in China is on the rise. It is estimated that there are 330 million people with CVD, including 13 million cases of stroke, 11.39 million cases of coronary heart disease (CHD), 8.9 million cases of heart failure (HF), 5 million cases of pulmonary heart disease, 4.87 million atrial fibrillation, 2.5 million cases of rheumatic heart disease, 2 million cases of congenital heart disease, 45.3 million cases of peripheral arterial disease (PAD), and 245 million cases of hypertension. In 2021, the total number of discharges of patients with cardiovascular and cerebrovascular diseases in China was 27 649 800, accounting for 15.36% of the total number of discharges (including all inpatient diseases) in the same period, including 14 872 300 CVDs, accounting for 8.26%, and 12 777 500 cerebrovascular diseases, accounting for 7.10%. The economic burden of CVD on residents and society still increases, and the inflection point of CVD prevention and treatment has not yet arrived.

    Original Research
    Research on the Development of a Risk Model for Coronary Heart Disease in Postmenopausal Hypertensive Women Based on the Triglyceride Glucose Index Combined with Vascular Elasticity Indicators
    ZHANG Gaoyu, WANG Zihan, GAO Xuefei, ZHANG Jin, DAI Tiangu, HE Qing, FAN Jiarong, HUANG Li, LI Lin
    2025, 28(01):  39-46.  DOI: 10.12114/j.issn.1007-9572.2023.0657
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    Background

    Postmenopausal women with hypertension are susceptible to coronary heart disease (CHD), and their prevalence and mortality of CHD are significantly higher than those before menopause. Based on the team's previous research, this study further combined with glucose and lipid metabolism, vascular elasticity and other related indicators to diagnose CHD in postmenopausal women with hypertension, in order to provide new ideas for clinical identification of CHD risk in postmenopausal women with hypertension.

    Objective

    To explore the correlation and predictive value of triglyceride glucose (TyG) index, ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), pulse pressure index (PPI) and arteriosclerosis index (AI) in postmenopausal women with hypertension.

    Methods

    From January 2019 to December 2022, this study selected postmenopausal women with hypertension who underwent coronary angiography for the first time in the Department of Integrative Cardiology of China-Japan Friendship Hospital, and divided them into CHD group and non-CHD group according to the results of coronary angiography. The clinical data such as TyG index, ABI, baPWV, PPI, AI were collected at the time of admission. Multivariate Logistic regression analysis was used to construct a CHD risk prediction model for postmenopausal women with hypertension, and a nomogram was drawn. Calibration curve, receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to evaluate the diagnostic efficiency.

    Results

    In this study, 300 postmenopausal women with hypertension who underwent coronary angiography for the first time were included, including 141 cases in non-CHD group and 159 cases in CHD group. Multivariate Logistic regression analysis showed that ABI, baPWV, TyG index, PPI and AI were the influencing factors of CHD in postmenopausal women with hypertension (P<0.05), and a nomogram was drawn according to which. The ROC curve analysis results showed that area under the curve (AUC) for ABI, baPWV, TyG index, PPI, AI and joint predictive model were 0.662, 0.687, 0.659, 0.700, 0.612 and 0.808, the sensitivity and specificity of the predictive model were 0.780 6 and 0.741 0, respectively. The calibration curve showed that the predicted results were in good agreement with the actual results. The decision curve analysis showed that the nomogram has good clinical value.

    Conclusion

    ABI, baPWV, TyG index, PPI and AI are independent influencing factors for the occurrence of CHD in postmenopausal women with hypertension. The newly developed model can better predict the risk of CHD.

    Associations and Sex Differences between Depression and Cognitive Function in the Urban Elderly
    TIAN Yinghan, LIU Lewei, YANG Cheng, LING Chen, YANG Xiaoxue, FAN Haojie, ZHAO Xin, LI Jun, XIA Lei, LIU Huanzhong
    2025, 28(01):  47-52.  DOI: 10.12114/j.issn.1007-9572.2023.0642
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    Background

    The aging of our population is a growing problem, and depression is one of the more common psychiatric disorders in the elderly population, leading to a significantly increased risk of disability and death. The studies found a significant association between depression and cognitive disorders, and that this association may be influenced by sex. Sex differences in the associations between depression with cognitive functions and different cognitive domains are not clear in the elderly population.

    Objective

    Population ageing has become a common global phenomenon, and psychiatric problems associated with ageing are of great concern. This study investigated the status of depression and cognitive function in the urban elderly and examined the associations and sex differences between depression and cognitive function.

    Methods

    From September to October 2022, a stratified sampling method was used to select elderly residents aged 65 years and above in a community within the city of Hefei, Anhui province as the participants. General information was collected and depression and cognitive function status were assessed using the Geriatric Depression Scale (GDS) and the Brief Screening Scale for Dementia (BSSD), respectively. We explored the factors associated with depression in the elderly and analyzed the effects of depression, sex factors and their interactions on cognitive functioning.

    Results

    A total of 328 older adults were included and the overall detection rate for depression was 14.9 %. Regression analyses showed that drinking (OR=0.362, 95%CI=0.155-0.847), and living with children (OR=2.445, 95%CI=1.021-5.853) were independently associated with depression (P<0.05). Factorial design analysis of variance showed that the total score of BSSD and scores of language (command) comprehension, attention and computation, orientation in place, orientation in time, and immediate memory factors were lower in the depressed group of the elderly than in the non-depressed group. Females had a lower total score of BSSD, lower scores of general knowledge and picture and orientation in place, and a higher score of language (command) comprehension than males (P<0.05). Depression and sex had significant interactions in general knowledge and picture, language (command) comprehension, and orientation in place (P<0.05) .

    Conclusion

    The urban elderly are at a higher risk of depression, and those with comorbid depression may have a certain degree of cognitive decline, with sex differences. Increased attention should be paid to psychiatric problems such as depression and dementia among the elderly, especially for the female geriatric population. It is necessary to develop individualised and comprehensive interventions to improve the mental health and quality of life of the elderly.

    The Influence of Family Cognitive Environment on Early Childhood Language Development: a Retrospective Case-control Study in Shanghai
    GUO Zhichao, CUI Dan, BAO Jiajun, SHI Weiqing, WEI Kang, YANG Xingtang, YU Wenya
    2025, 28(01):  53-58.  DOI: 10.12114/j.issn.1007-9572.2024.0041
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    Background

    The incidence of delay language development in early childhood is high, and the early recognition rate is low, which has a significant negative impact on the early childhood development of other dimensions. The family cognitive environment is a key factor affecting early childhood language development.

    Objective

    This study aimed to explore the influence of family cognitive environment on early childhood language development, and provide theoretical basis for promoting early childhood language development from the perspective of community intervention on family cognitive environment.

    Methods

    A retrospective case-control study was conducted on 4 307 children who were admitted to a community child healthcare department in Shanghai from 2018 to 2020. The Shanghai Pediatric Development Screening Scale Ⅱ (DenverⅡ) was used for developmental screening, which was conducted at the child's age of 1, 2, and 3 years old. A total of 172 children with delay language development were selected as the case group, and 516 children with normal language development were included in the control group, which was determined by the matching factor of age, with a ratio of the number of children in the case and control groups being 1∶3. The following information of children in both groups were collected, including children's basic birth characteristics, parental demographic characteristics, maternal pregnancy and childbirth characteristics, and family cognitive environment characteristics. The Logistic regression analysis was used to explore the influencing factors of delay early childhood language development.

    Results

    A total of 172 children with delayed early language development had an incidence rate of 3.99%, among them ,1-year-old, 2-year-old, and 3-year old children accounted for 33.14% (57 cases), 53.49% (92 cases), and 13.37% (23 cases), respectively. The proportions of male children, children with premature birth, and children with maternal education of high school and below were higher in the case group than those in the control group (P<0.05). The overall family cognitive environment, emotional warmth, social adaptation, linguistic environment, and neglectful environment of the children in the case group were less favorable compared to those in the control group (P<0.05). premature birth, low maternal education, and poor family cognitive environment were risk factors of delay early childhood language development (P<0.05) .

    Conclusion

    Interventions for language development before the age of 2 were key to effectively reducing the rate of delay childhood language development. Guiding and optimizing the family caregiving environment, assisting in establishing good parent-child communication and interaction by community child healthcare doctors could be effective strategies for promoting early childhood language development. Community child healthcare doctors should pay special attention to children with young gestational age and low maternal education, and provide more targeted interventions and guidance on parent-child activities and communication.

    The Prevalence and Influencing Factors of Care Need among Community-dwelling Older People in Three Provinces of China
    AN Ran, TANG Xin, QI Shige, WANG Zhihui, CUI Lu, ZHANG Han, GUO Haoyan
    2025, 28(01):  59-64.  DOI: 10.12114/j.issn.1007-9572.2023.0628
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    Background

    With the aging population, research on elderly care has increasingly become a focal point. Previous surveys on the demand rate for elderly care have shown significant variation (8.54% to 53.15%) and lack large-scale study evidence.

    Objective

    To understand the prevalence and influencing factors among community-dwelling older people in three provinces of China.

    Methods

    The study subjects were from the baseline survey of Prevention and Intervention on Neurodegenerative Disease for Elderly in China conducted in 2019. This survey employed a multi-stage stratified cluster random sampling method, selecting a total of 16 199 elderly individuals aged 60 and above from 16 districts and counties across Liaoning, Henan, and Guangdong provinces. The questionnaire covered basic demographic characteristics (gender, age, urban/rural residence, marital status, education level, occupation, weight, living situation), current care needs, chronic disease status, the Patient Health Questionnaire (PHQ-9), the Mini-Mental State Examination (MMSE), the Activities of Daily Living (ADL) scale, self-rated health status, daily exercise habits, and the number of falls. The PHQ-9 was used to assess the psychological health of the elderly, the MMSE was used to evaluate cognitive function, and the ADL scale or self-reported need for care was used to assess elderly care needs, defined as the presence of BADL or IADL disabilities, or a self-reported need for care. Logistic regression analysis was used to explore the influencing factors of elderly care needs.

    Results

    The prevalence of care needs among community-dwelling older people in three provinces was 14.57% (95%CI=14.02%-15.11%), and the prevalence of care needs increased gradually with age, consistently higher among females than males in all age groups. The results of multifactorial analysis showed that the risk of care need increased 7% (OR=1.07, 95%CI=1.06-1.08) for each additional year of age. Compared with illiteracy, the ORs of care need for those with primary school, secondary school, high school and above were 0.33 (95%CI=0.29-0.37), 0.24 (95%CI=0.20-0.28), 0.17 (95%CI=0.12-0.22), respectively. Compared with daily exercise, the OR of care needs for those who did not exercise daily was 1.17 (95%CI=1.05-1.30) .Compared with those who did not suffer from chronic diseases, the ORs of care needs for those who suffered from 1-2 kinds and those 3 or more kinds of chronic diseases were 1.29 (95%CI=1.10-1.51) and 1.57 (95%CI=1.35-1.82). Compared with normal cognitive function, the OR of care need for those with abnormal cognitive function was 2.02 (95%CI=1.79-2.27). Compared with good self-assessed health status, the OR of care need for those with fair health status and those with poor health status were 1.29 (95%CI=1.14-1.46) and 2.68 (95%CI=2.27-3.16). Compared with those did not having fallen, ORs of care needs for those with 1-2 and 3 or more falls were 1.23 (95%CI=1.06-1.43) and 2.00 (95%CI=1.59-2.52). ORs of care needs for those with mild and moderately severe depression compared to those with a good mental status were 1.14 (95%CI=1.21-1.65) and 2.05 (95%CI=1.69-2.48) .

    Conclusion

    The demand for elderly care among community-dwelling older adults of China is notably high. This demand is particularly elevated among individuals who are older, have poorer physical and psychological health, and have experienced a higher frequency of falls.

    Association between the Chinese Multimorbidity-weighted Index and Health Service Utilization among the Elderly in China
    LI Liping, LIAO Jing, GAO Xinyuan, WANG Li, LAI Yingsi
    2025, 28(01):  65-70.  DOI: 10.12114/j.issn.1007-9572.2023.0713
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    Background

    Multimorbidity pose challenges to older adults' health services. It is of great importance to explore its impact on health services utilization in the elderly. The Chinese Multimorbidity-Weighted Index (CMWI) has been developed to measure the burden of multimorbidity in Chinese middle-aged and elderly, but there is a lack of cohort studies on the association between CMWI and health service utilization.

    Objective

    To explore the association between burden of multimorbidity and utilization of health among older adults, which provides scientific evidence for improving the intervention and management of older adults' patients with multimorbidity.

    Methods

    From December 2021 to January 2024, taking Sihui City of Zhaoqing City, Guangdong Province as an example, the electronic health records of residents from 2017 to 2021 were collected from the city's national health information platform to establish a natural population cohort for health examination of the elderly. We used the time of the first health examination in this period as the baseline, the CMWI was used to measure individual's baseline burden of multimorbidity .We use the negative binomial regression to analyze the association between individual's CMWI respectively and the total number of outpatient visits, chronic disease-related outpatient visits, total number of hospitalizations and chronic disease-related hospitalizations during the follow-up period.

    Results

    Among the total 39 989 participants, there were 14 991 (55.18%) cases of multimorbidity, and the CMWI was 1.3 (0, 2.3). During an average 1 268 days follow-up period, 26 141 people (65.37%) had used outpatient services, the number of total outpatient visits and chronic disease-related outpatient visits was 2 (0, 6) and1 (0, 4). In our study 7 332 (18.34%) had used hospitalization services, the number of total hospitalization and chronic disease-related hospitalization was 0 (0, 0) and 0 (0, 0). Age, genders, education levels and CMWI varied significantly by the utilization of health (P<0.05). The residential type varied significantly by the utilization of outpatient services (P<0.05) but no by utilization of inpatient services (P>0.05). After adjusting the covariates of age, gender, residence and education levels, negative binomial regression analysis showed that CMWI was a risk factor on the increase of health service utilization in the elderly (IRR>1). For each unit increase in CMWI, the total number of outpatient visits increased by 1.210 (95%CI=1.196-1.224), the number of chronic disease-related outpatient visits increased by 1.276 (95%CI=1.259-1.292), the total number of hospitalizations increased by 1.277 (95%CI=1.244-1.312), and the number of chronic disease-related hospitalizations increased by 1.286 (95%CI=1.252-1.321) .

    Conclusion

    CMWI is a risk factor for the increase of health service utilization in the elderly, and the number of health service utilization in the elderly increases with the increase of CMWI. More attention should be paid to the burden of multi-chronic diseases in the elderly, so as to provide scientific basis for improving the intervention and management of multi-chronic diseases in the elderly in China.

    Original Research·Focus on General Practice Education
    A Controlled Study of Salon-training Models Based on the Calgary-Cambridge Guidelines for Improving Patient-physician Communication Skills in General Practice
    PENG Tao, ZOU Chuan, ZENG Xin, ZHANG Yan, SHEN Jing
    2025, 28(01):  71-76.  DOI: 10.12114/j.issn.1007-9572.2023.0729
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    Background

    Doctor-patient communication is one of the core abilities of general practitioners. Dophisticated doctor-patient communication skills are the basis for building a harmonious doctor-patient relationship, and help to improve patients' sense of gain and satisfaction in seeking medical treatment. However, the communication ability of general practitioners in China is generally low, it is necessary to explore a training mode of doctor-patient communication that adapts to China's national conditions and meets the communication needs of general practitioners in China to improve the communication ability between doctors and patients.

    Objective

    To explore the application effect of salon training based on the Calgary-Cambridge Guide in the training of doctor-patient communication ability of resident doctors in standardized training of general practitioners, and to provide reference for the construction of doctor-patient communication training system.

    Methods

    Forty cases of general practitioners in Chengdu Fifth People's Hospital Standardized general practice training from 2019 to 2020 were selected as the research object, and randomly divided into salon group and control group, with 20 cases in each group. Salon group used salon training mode based on Calgary-Cambridge guidelines for doctor-patient communication training, while the control group was set as blank control. Before the training and one week after the training, the standardized patient (SP) model was adopted to clinical reception in the two groups, and the doctor-patient communication evaluation scale (SEGUE) was used to evaluate the level of doctor-patient communication, and the training effects of the two groups were compared.

    Results

    Finally, 28 cases were included, including 15 cases in the salon group and 13 cases in the control group. After the training, the score of the SEGUE scale of the training doctors in the salon group increased from (11.80±4.36) to (18.07±4.11), and that of the training doctors in the control group increased from (12.15±4.63) to (14.46±3.71). The score of SEGUE scale in Sharon group after training was significantly different from that before training (t=3.250, P< 0.001). There was no significant difference in the score of SEGUE scale between the control group after training and before training (t=2.582, P=0.624). After training, 25 items in the SEGUE scale were analyzed, and the difference between the salon group and the control group was statistically significant (P<0.05). The results of the following five items in the salon group were better than those in the control group: "Establishing personal trust relationship" (93.3% vs. 7.7%) and "Protecting patients' privacy/respecting patients' right to choose" (53.3% vs. 15.4%) in the preparation stage; Understand the patient's stage of "recognizing the patient's efforts, changes and difficulties" (33.3% vs. 23.1%) and "expressing concern and making the patient feel warm/confident" (100.0% vs. 69.2%) ; At the end of the consultation stage, "Ask the patient if there are any other questions to discuss" (66.7% vs. 23.1%) .

    Conclusion

    Salon training mode based on Calgary-Cambridge guidelines can enhance students' interest and enthusiasm in participating in the training, which has a good training effect on improving the communication ability between doctors and patients, and is worth learning and popularizing.

    Research on the Construction of Clinical Thinking Ability Evaluation System of General Residents Based on Delphi Method
    SONG Yifan, HAN Qingfeng, XIAO Weizhong, YANG Zhenhua
    2025, 28(01):  77-82.  DOI: 10.12114/j.issn.1007-9572.2023.0471
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    Background

    The clinical thinking of general medicine is based on the characteristics of the general medicine profession and has its uniqueness, requiring general practitioners to have "patient-centered" clinical diagnosis and treatment skills. In order to better reflect the clinical thinking ability of clinical residents in general practice, it is necessary to establish a set of effective evaluation criteria that can reflect all aspects of their ability. At present, there is no suitable method to evaluate the clinical thinking ability of residents in general practice.

    Objective

    To construct a post competency oriented clinical thinking ability evaluation system for general practice residents by Delphi method.

    Methods

    From December 2021 to February 2022, based on literature research, we preliminarily constructed the evaluation system framework of clinical thinking ability of general residents. Delphi method was used to conduct two rounds of in-depth communication with 12 experts to give objective evaluation on the importance of the indicators in the framework. Futher, we use analytic hierarchy process to determine the weight of each indicator.

    Results

    Through two rounds of expert consultations, we developed a comprehensive evaluation system consisting of 5 first-level indicators (clinical knowledge learning and extension, data collection and utilization, diagnostic analysis and utilization, treatment decision making ability, communication and collaboration ability) and 30 second-level indicators. The effective response rate of the two rounds of questionnaire was 100.0%, the expert authority coefficient was 0.85, and the expert coordination coefficient of the first and second indexes were 0.299 and 0.189 respectively (P<0.01). And the weight of 5 first-level indicators were 0.198, 0.198, 0.227, 0.227, 0.150 respectively.

    Conclusion

    Delphi method was used in this study to establish a comprehensive evaluation system of clinical thinking ability of residents. Through the analysis of the result data, it can be seen that the evaluation system is highly authoritative and scientific, which can provide reference for training high-quality general residents and improving the teaching quality of general practice in the future.

    Original Research·Focus on County Medical Community
    The Research Hotspots and Frontiers of County-level Medical Community in China
    WANG Shuyun, LIANG Xia, LI Xia, LIN Lin, FENG Qiming, HUANG Zhaoquan
    2025, 28(01):  83-88.  DOI: 10.12114/j.issn.1007-9572.2024.0099
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    Background

    Promoting the construction of county-level medical communities is a crucial measure for establishing a hierarchical medical system. While the domestic academic community has conducted extensive theoretical and empirical research in this field, there is a lack of comprehensive summaries of existing research findings. This study uses bibliometric methods to systematically review the progress of related literature in this field, providing insights and references for the high-quality development of county-level medical communities.

    Objective

    To conduct a visual analysis of the literature on county-level medical communities in China, exploring research hotspots and frontier trends in this field.

    Methods

    Using the China National Knowledge Infrastructure (CNKI) database, literature related to county-level medical communities published between 2016 and 2023 was retrieved on February 25, 2024. CiteSpace software was employed for bibliometric visualization analysis of the literature, focusing on publication years, authors and institutions, keyword co-occurrence, clustering, timeline distribution, and burst detection.

    Results

    A total of 481 articles were included. The publication volume in this field has been increasing, driven by policy factors, with 65 articles (13.51%) published between 2016 and 2019, 167 articles (34.72%) published between 2020 and 2021, and 249 articles (51.77%) published between 2022 and 2023. The top three authors in terms of publication volume were CHEN Yingchun, WANG Fang, and ZHENG Ying, each with 8 articles. The top two keywords in terms of centrality and cluster size are "medical community" and "hierarchical medical system". The timeline distribution indicated that "hierarchical medical system" was the earliest and most sustained research hotspot in this field. Additionally, clusters such as "integration of medical prevention" "performance evaluation" "countermeasures" and "patients" emerged as research hotspots. Burst detection revealed that "medical insurance fund" "chronic disease" "management model" "development strategy" and "rural doctors" were recent research hotspots and future directions in this field.

    Conclusion

    Key research hotspots in the field of county-level medical communities include the construction of hierarchical medical systems, focusing on chronic diseases and the integration of public health services, and exploring performance evaluation pathways. Future research trends indicate a strong focus on deepening policy research, using county-level medical community construction to promote the establishment of hierarchical medical systems, advancing innovation in the integration of medical prevention, enhancing performance evaluation, and optimizing internal management.

    The Knowledge Sharing of Family Doctor Team and Influencing Factors under the County Medical Community
    CONG Yating, DAI Yao, BAO Xinyu, TAO Hongbing
    2025, 28(01):  89-95.  DOI: 10.12114/j.issn.1007-9572.2023.0907
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    Background

    Knowledge sharing of family doctor teams under the county medical community is an important way of interaction between the county and rural institutions, which plays an important role in enhancing the quality of regional medical and health services and improving the health of residents.

    Objective

    To investigate the knowledge sharing among family doctor teams under the county medical community, to explore its influencing factors, and to provide a scientific basis for promoting knowledge management and capacity enhancement within family doctor teams.

    Methods

    From October to December 2022, multistage sampling was used for selecting 381 family doctor teams under two county medical communities were selected as study subjects in Hubei Province using the convenience sampling method, and a self-administered team knowledge-sharing questionnaire was used to investigate the knowledge-sharing level of the included subjects, and multivariate linear stepwise regression analyses were used to explore the influencing factors of the knowledge-sharing of family doctor teams, including two dimensions of explicit knowledge sharing and implicit knowledge sharing.

    Results

    The total knowledge sharing score of family doctor teams under county medical communities was (27.84±3.84), and the mean item level scores of the two dimensions of explicit and implicit knowledge sharing were (5.51±0.79) and (5.61±0.77), respectively; the results of the multivariate linear stepwise regression analysis showed that the heterogeneity of academic qualifications, intensity of team communication, intensity of team activities, motivation of members to learn, the use of platform carriers, and the team leader's role were the influencing factors of knowledge sharing of family doctor teams under the county medical community (P<0.05) .

    Conclusion

    Knowledge sharing within the family doctor team under the county medical community is at a good level, and there is still room for improvement. It is recommended to improve the level of knowledge sharing among family doctor team members by increasing the frequency of family doctor team activities, improving the intensity of team communication, adopting relevant incentives, and expanding knowledge sharing channels.

    The Perceptions and Related Factors of Family Doctor Team Management under the County Medical Community
    CONG Yating, DAI Yao, BAO Xinyu, TAO Hongbing
    2025, 28(01):  96-102.  DOI: 10.12114/j.issn.1007-9572.2024.0013
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    Background

    The effectiveness of family physician teams under the county medical community is low, and the current status of team management is not yet clear, the perceived status of team management for members with different characteristics is not yet clear.

    Objective

    To understand the current situation of family doctor team management under the county medical community, and to provide a basis for further refinement and improvement of family doctor team management.

    Methods

    From October to December 2022, a total of 1 724 key members of 429 family doctor teams under the county medical communities in Hubei Province were surveyed using a self-developed questionnaire, which included the management of team configurations, the management of team interactions and the results of team management. Differences in perceptions of team management between family doctor team members with different characteristics were analysed using chi-squared test and ANOVA, and Pearson correlation was used to analysis the correlation between team interaction management and team management outcome factors.

    Results

    Among 1 724 survey respondents, 62.9% (1 084/1 724) perceived that team assessment and incentive measures were effective, and 88.7% (1 530/1 724) perceived that they had a reasonable allocation of family doctor team personnel. The respondents had a score of (22.3±5.3) for the intensity of internal team interactions and a score of (22.0±5.3) for the perceived intensity of the team's interaction and liaison with the outside. Regarding family doctor team members' perception of team management results, team members' perceived team goal achievement, i.e., team task performance, scored (33.1±7.4), perceived satisfaction with the team scored (22.3±4.9), and perceived team's ability and potential for future development scored (27.9±6.3), while the total scores of the three dimensions were 0-36, 0-24, 0-30. Comparison of team configuration management, team interaction management, and perceptions of team management outcomes between family doctor team members of different positions, titles, and ages showed statistically significant differences (P<0.05). There was a positive correlation between team interaction management factors and team management outcome factors (P<0.05) .

    Conclusion

    Family doctor team members perceive that team configuration management is relatively good, and there is still room for improvement in team assessment and incentives; family doctor team interactions are better managed, and team interactions play an important role in improving team management results; family doctor team members have a better perception of team management results, and perceive task performance to be lower than satisfaction and development ability; there are large differences in the perceptions of team management among family doctor team members of different positions, titles, and age groups.

    Original Research·Focus on Medication Decision-making for Multimorbidity
    Dilemmas and Coping Strategies in Medication Decision-making for Multimorbidity in the Community
    XIA Yu, LUO Yuan, LI Zhengrong, ZHOU Xinmei, TONG Yuling, ZHAO Yang, XU Zhijie
    2025, 28(01):  103-110.  DOI: 10.12114/j.issn.1007-9572.2024.0356
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    Multimorbidity refers to an individual suffering from two or more chronic diseases simultaneously. Patients with multimorbidity refers often require the concurrent use of multiple medications, posing a challenge to community general practitioners in making scientific medication decisions. This paper analyzes the reasons and influencing factors that lead to the dilemmas in medication decision-making for patients with multimorbidity in the community. It also proposes a dynamic and comprehensive decision-making framework known as the Medication Decision-making for Multimorbidity Framework (MDMF). The framework consists of five stages in the process of community general practitioners treating patients with multimorbidity, which include "Health problems review""Comprehensive medication assessment""Shared decision-making""Medication therapy recording", and "Follow-up arrangement". The MDMF facilitates the development of individualized medication therapy for patients with multimorbidity by community general practitioners, but it also places certain demands on their capabilities. Therefore, it is recommended to provide training for community general practitioners centered on the MDMF, offer decision-making support, and implement reasonable incentives and supervision measures. This is expected to promote primary care institutions to provide patient-centered medication therapy, enhance its safety and efficacy, and alleviate the treatment burden on patients.

    Training Needs of Primary Care Physicians in Medication Decision-making for Multimorbidity: a Qualitative Research
    ZHOU Xinmei, HAN Liyan, XIA Yu, LI Haixin, LUO Yuan, QIAN Yi, ZHAO Yang, XU Zhijie
    2025, 28(01):  111-118.  DOI: 10.12114/j.issn.1007-9572.2024.0272
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    Background

    Primary care physicians in community settings face numerous challenges when making medication decisions for patients with multimorbidity. Enhancing their decision-making capabilities through training is an important way to address these challenges. However, there is a dearth of in-depth research on the training needs of primary care physicians in the context of medication decision-making for multimorbidity.

    Objective

    This study aims to explore the challenge physicians encountered in medication decision-making for patients with multimorbidity and their needs for training content and modalities, providing a reference for designing the training courses for the abilities enhancement.

    Methods

    From October 5th to December 21st in 2023, physicians from community health care centers in Hangzhou, Ningbo, Jiaxing, Shenzhen, and Shanghai were recruited for in-depth interviews following the principle of purposive sampling and maximum variation, which focus on the content and formats of training to enhance medication decision-making abilities. Two researchers transcribed and coded the interviews independently, and content analysis was performed on the interview data.

    Results

    A total of 20 Physicians completed the interviews and 15 were females, mean age were (38.5±3.0) years. Based on the challenges faced by primary care physicians in the medication decision-making for multimorbidity, the training should cover four aspects: evaluation of medication therapy, rational selection of medication, doctor-patient communication and shared decision-making, medication education and follow-up. In terms of training form, primary care physicians are willing to accept flexible and multiple teaching approaches, and prefer case-based training that aligns with community health needs.

    Conclusion

    Primary care physicians have clear training needs of medication decision-making for patients with multimorbidity. The results of this study provide a theoretical reference for the development of training courses, which adapt to the working environment and actual requirements of primary care physicians.

    Medication Decision-making for Patients with Multimorbidity——Study on Medical Records in Consultation of General Practice
    LUO Yuan, XU Zhijie, XIA Yu, SHI Jiana, JIANG Zhizhi, ZHOU Xinmei, ZHAO Yang, TONG Yuling
    2025, 28(01):  119-124.  DOI: 10.12114/j.issn.1007-9572.2024.0273
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    Patients with multimorbidity often require the concomitant use of multiple medications, presenting general practitioners (GPs) with the dilemma of assessing the benefits and risks due to complex and potential interactions between diseases and medications. This article takes one case of a multimorbid patient at a community health service center to illustrate and elucidate the process by which GP employs a medication decision-making framework for multimorbidity (MDMF). Furthermore, by examining the multi-stage goals set by Ariadne principle in the process of multimorbidity management, this article analyzes the key points and considerations for GPs in the assessment, communication, and making treatment plans, thereby offering reference to improve the quality of medication decision-making for patients with multimorbidity in the community.

    Inquiries of General Practice
    Discussion on the Definition of "Major, Minor, Acute, Chronic" Diseases and the Positioning of " 4 Virtues" by General Practitioners
    LI Min, WANG Zhong
    2025, 28(01):  125-128.  DOI: 10.12114/j.issn.1007-9572.2024.0069
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    With the deep reform of China's medical system, especially the advancement of the tiered diagnosis and treatment system, the role of general practitioners in the primary healthcare system has become increasingly significant. General practitioners are not only the first line of defense for residents' health, but also key executors of disease prevention, diagnosis, treatment, and health education. This article analyzes the classification of "major, minor, acute, chronic" diseases and the "4 virtues" positioning of general practitioners (namely adept at treating minor illnesses, identifying major illnesses, referring acute illnesses, and managing chronic illnesses), exploring the crucial functions and challenges of general practitioners in the era of new medical reform. The article points out that although the tiered diagnosis and treatment system aims to optimize the allocation of medical resources, it still faces challenges such as the ambiguity of the classification of "major, minor, acute, chronic" diseases and the uneven distribution of primary healthcare resources. General practitioners play a vital role in this system, needing comprehensive clinical diagnostic and treatment capabilities, and to establish clinical judgment standards and treatment protocols in collaboration with specialists. To address these challenges and fully leverage the role of general practitioners in the modern medical system, urgent reforms and optimizations in general medical education and practice are needed, along with strengthening the role of general practitioners, to ensure the improvement of medical service quality and efficiency while achieving a fair and sustainable health security system.