ABSTRACT
China launched the nationwide resident standardized training (residential training) project since 2013 and has trained a large number of general practitioners. The primary health care institutions and general practitioners have played an important role during the prevention and control of COVID-19 epidemic, which not only presented the remarkable effect of residential training project, but provided new ideas for the further training program of general practitioners. It is proposed in this paper that we should adjust the training and assessment priorities in the following aspects: highlight the characteristics of general practice in the future training, so as to train general practitioners with more comprehensive ability, such as strengthening the ability to deal with public health emergencies, strengthening the consciousness and capability of scientific research, and increasing the proportion of humanistic quality training; At the same time, we should enhance career attractiveness of general practitioners to keep the excellent general residents stay for their career;All mentioned above will further improve the overall quality of general practitioners, and enable them to better deal with public health emergencies.
ABSTRACT
The current status of primary health institutions and personnels in China were analyzed based on the data from China Health and Family Planning Statistics Yearbook 2016 and China Health Statistics Summary 2018. By the end of 2017, there were 253 000 general practitioners in China, accounting for 7.46% of all practicing physicians or assistant physicians in the country(339 000). In 2017, the number of general practice residents was 8 517, accounting for 11.92% of all residents(71 430), which was 1.70% lower than that in 2016 (8 664) . The registered nurses in primary health care institutions were not sufficient, even the proportion of nursing to medical staff did not reach 1 ∶ 1 in primary settings. The distribution of primary health care institutions was not balanced. In the township hospitals and village clinics the number of practicing physicians or assistant physicians was far from meeting the requirement of the service. In view of the current problems, the social resources would be applied to promote the development of primary health care institutions and to improve the primary medical services in multiple ways such as personnel training, hardware construction, network construction and financial support, etc.
ABSTRACT
The current status of primary health institutions and personnels in China were analyzed based on the data from China Health and Family Planning Statistics Yearbook 2016 and China Health Statistics Summary 2018. By the end of 2017, there were 253 000 general practitioners in China, accounting for 7.46% of all practicing physicians or assistant physicians in the country(339 000). In 2017, the number of general practice residents was 8 517, accounting for 11.92% of all residents(71 430), which was 1.70% lower than that in 2016(8 664). The registered nurses in primary health care institutions were not sufficient, even the proportion of nursing to medical staff did not reach 1∶1 in primary settings. The distribution of primary health care institutions was not balanced. In the township hospitals and village clinics the number of practicing physicians or assistant physicians was far from meeting the requirement of the service. In view of the current problems, the social resources would be applied to promote the development of primary health care institutions and to improve the primary medical services in multiple ways such as personnel training, hardware construction, network construction and financial support, etc.
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Objective@#To survey on the home blood pressure measurement and blood pressure control rate among patients with hypertension in Beijing Yuetan community.@*Methods@#A questionnaire survey was conducted among 504 hypertensive patients, who were visiting Beijing Yuetan Community Health Service Center and selected by convenience-sampling method during June 2018 to January 2019. The status of home blood pressure measurement, the awareness of hypertension, the blood pressure control rate and factors related to not regularly measuring were surveyed.@*Results@#Of the 504 patients, 93.7% (472/504) took regular medication, but only 61.5% (310/504) had regular blood pressure measurements; 92.5% (466/504) had sphygmomanometers at home with electronic type mainly; 89.9% (453/504) patients knew the method of blood pressure measurement, but only 11.5% (52/453) had their sphygmomanometer calibrated. Among those who measured blood pressure, 77.4% (240/310) measured per week. The main reason for not measuring blood pressure regularly was that there was no need to measure blood pressure without any discomfort, accounting for 50.0% (97/194). The office blood pressure control rate (with desktop mercury sphygmomanometer) was 62.3% (314/504); the blood pressure control rate both in the morning and at bed time was 61.3% (73/119), that in the morning was 68.1% (81/119) and at bed time was 75.6% (90/119). The control rates of systolic blood pressure and heart rate by home measurement at morning and bedtime were significantly higher than those by office measurement (χ2=5.02, 9.97, 15.51, 13.72; all P<0.05).@*Conclusions@#The home blood pressure monitoring rate and knowledge level of hypertension among patients with hypertension in Yuetan community are relatively low. There are some differences in blood pressure control rate between office measurement and home measurement. Comprehensive evaluation is needed in the management process, and the treatment plan should be adjusted according to the specific condition of patients.
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Objective:To investigate the mental health status and psychological intervention needs in community health service staff during the outbreak of COVID-19.Methods:From February 28 to March 2, 2020, a total of 554 questionnaires on the mental health status and psychological intervention needs were collected from community health service staff in Beijing, Zhejiang, Hebei and Shanghai. The mental health was assessed by physical symptoms and GAD-7. The status and effectiveness of psychological intervention was analyzed.Results:The survey found that 19.7% (109/554) of community health service staff needed psychological support. Most psychological supports were received from colleagues′ encouragement (59.6%, 330/554) and internet mental health knowledge (41.2%, 228/554); in contrast, less from group intervention (5.8%, 32/554) and one-on-one counseling (5.6%, 31/554). Higher proportion of staff with anxiety symptoms and physical symptoms needed psychological support than that without symptoms (χ 2=53.41, 71.47), and a higher proportion of responders thought that the existing psychological intervention was not helpful (χ 2=26.89, 17.79), the difference is statistically significant ( P<0.05). Conclusion:It is necessary to strengthen the mental health assessment of community health service staff and give effective psychological intervention according to their needs during the outbreak of COVID-19.
ABSTRACT
The current status of primary health institutions and personnels in China were analyzed based on the data from China Health and Family Planning Statistics Yearbook 2016 and China Health Statistics Summary 2018. By the end of 2017, there were 253 000 general practitioners in China, accounting for 7.46% of all practicing physicians or assistant physicians in the country(339 000). In 2017, the number of general practice residents was 8 517, accounting for 11.92% of all residents(71 430), which was 1.70% lower than that in 2016(8 664). The registered nurses in primary health care institutions were not sufficient, even the proportion of nursing to medical staff did not reach 1∶1 in primary settings. The distribution of primary health care institutions was not balanced. In the township hospitals and village clinics the number of practicing physicians or assistant physicians was far from meeting the requirement of the service. In view of the current problems, the social resources would be applied to promote the development of primary health care institutions and to improve the primary medical services in multiple ways such as personnel training, hardware construction, network construction and financial support, etc.
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Objective:To survey on the home blood pressure measurement and blood pressure control rate among patients with hypertension in Beijing Yuetan community.Methods:A questionnaire survey was conducted among 504 hypertensive patients, who were visiting Beijing Yuetan Community Health Service Center and selected by convenience-sampling method during June 2018 to January 2019. The status of home blood pressure measurement, the awareness of hypertension, the blood pressure control rate and factors related to not regularly measuring were surveyed.Results:Of the 504 patients, 93.7% (472/504) took regular medication, but only 61.5% (310/504) had regular blood pressure measurements; 92.5% (466/504) had sphygmomanometers at home with electronic type mainly; 89.9% (453/504) patients knew the method of blood pressure measurement, but only 11.5% (52/453) had their sphygmomanometer calibrated. Among those who measured blood pressure, 77.4% (240/310) measured per week. The main reason for not measuring blood pressure regularly was that there was no need to measure blood pressure without any discomfort, accounting for 50.0% (97/194). The office blood pressure control rate (with desktop mercury sphygmomanometer) was 62.3% (314/504); the blood pressure control rate both in the morning and at bed time was 61.3% (73/119), that in the morning was 68.1% (81/119) and at bed time was 75.6% (90/119). The control rates of systolic blood pressure and heart rate by home measurement at morning and bedtime were significantly higher than those by office measurement (χ 2=5.02, 9.97, 15.51, 13.72; all P<0.05). Conclusions:The home blood pressure monitoring rate and knowledge level of hypertension among patients with hypertension in Yuetan community are relatively low. There are some differences in blood pressure control rate between office measurement and home measurement. Comprehensive evaluation is needed in the management process, and the treatment plan should be adjusted according to the specific condition of patients.
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Patients aged ≥65 years with dementia diagnosed by neurological specialists were selected in Yuetan community from March 2016 to December 2016.The basic information of patients was collected from the health and medical records;the needs for community care were obtained through a questionnaire survey.Total 91 elderly patients with dementia was included in the study,among whom 15 (16.5％) were found by community institutions,18 (19.9％) patients got medication from the community health institutions.The survey showed that the numbers of participants who agreed that the community health service could provide treatment,drug prescription,referral service,condition assessment,regular follow-up,professional guidance for caregivers,door-to-door service and counseling services for patients and their relatives were 29 (31.8％),18 (19.9％),33 (36.3％),19 (20.9％),23 (25.3％),24 (26.4％),49 (53.8％) and 29 (31.9％),respectively.Results showed that 53.8％ (49/91) dementia patients or their family members wanted to receive instruction of drug use in community health service,17.6％ (16/91) wanted to know about the professional care skill as caregivers.Currently the services for dementia patients in health service centers and stations of Yuetan community are less sufficient,which cannot meet the needs of dementia patients and their family members.
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Objective To evaluate the effectiveness of standardized management for patients with type 2 diabetes in Beijing Qinan community.Methods Total 484 patients with type 2 diabetes in Qinan community were under standardized management.A cross-sectional study on the effectiveness of diabetes management was conducted in December 2016 based on the health records and clinic medical records.Results The mean age was(71.2 ± 11.2) years,the duration of diabetes was (12.2 ± 7.8) years,the mean BMI was(24.76 ± 3.06) kg/m2 in 484 patients.The TC was(5.08 ± 3.27) mmol/L and LDL-C was(2.72 ±0.78)mmol in 383 patients.The rate of achieving the target level of fasting blood-glucose was 51.96％ (199/383);the rate of achieving glycosylated hemoglobin target was 60.08％ (155/258);and the rate of achieving quick fasting blood-glucose target was 51.49％ (52/101).There were 80.37％ (389/484) patients with clinic blood pressure ＜ 140/90 mmHg(1 mmHg =0.133 kPa),36.57％ patients (177/484) had normal BMI;and 17.83％ patients (46/258) with controlled clinic blood pressure,fasting blood glucose,glycosaylated hemoglobin and LDL-C.There were 53.79％ patients with LDL-C ＜ 2.6 mmol/L and 23.24％ with HDL-C ≥ 1.0 mmol/L.The patients with fasting glucose ＜ 7.8 mmol/L had lower LDL-C than the patients with fasting glucose ≥ 7.8 mmol/L,(F =4.42,P =0.04),The patients with fasting glucose ＜ 7.8mmol/L had higher HDL-C than the patients with fasting glucose ≥ 7.8 mmol/L (Z =-2.30,P =0.02).The rate of achieving glycosylated hemoglobin target was decreased with the increasing of disease duration (x2 =12.57,P =0.01).Conclusion The comprehensive target-reaching rate of type 2 diabetes patients with standardization management in Qinan community is relatively low.It is necessary to strengthen the control of blood lipid,body weight and blood pressure for improving the effectiveness of standardized management of diabetic patients.
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The randomized controlled trials (RCTs) of treating diabetic nephropathy (DN) with alprostadil and valsartan were collected from CNKI,Wan fang date,VIP,PubMed,Embase,and Cochrane Library.The selected data was analyzed with RevMan 5.1 software.The effect of combination of valsartan and alprostadil in treating DN was evaluated.In 19 RCTs,675 cases were co-treated with alprostadil and valsartan and 670 were treated with valsartan.The results indicated that 24 h urine microalbumin excretion [WMD =-53.23,95％ CI (-67.55,-38.91),P＜0.01] and24 h urine protein[WMD=-0.38,95％ CI(-0.69,-0.07),P=0.02] in patients treated with combination of valsartan and alprostadil were reduced more markedly than in those treated with valsartan alone.There was no significant difference in blood urea nitrogen [WMD =-0.791,95 ％ CI (-20.62,4.79),P =0.22] and serum creatinine[WMD=-5.82,95％ CI(-19.22,7.58),P=0.39] between two kinds of treatment.These results suggest that combined treatment with valsartan and alprostadil shows advantageous effect on reducing urinary protein in DN.
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One hundred and thirty general practitioners ( GP ) who received standard training ( training group ) and 189 GPs who did not receive standard training ( non-training group ) were selected with cluster random sampling method from five districts in Beijing.A questionnaire survey was conducted from April to May 2013, including basic information , working condition , professional competency and continuing education of the interviewees.The survey showed that 72.3%(94/130) in training group had physician titles;89.3%(116/130 )had work experience <10 y;97.0%(126/130)of them had bachelor degree or above;82.3%(107/130) expressed their interest in scientific research , but the 95.4% of them had no research projects;and 96% had no teaching appointment.GPs in non-training group were in a favorite position of education level and professional competency over those in training groups ; however , the latter were highly enthusiastic in further training and scientific research , and had strong potential for career development.