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Objective:To survey the status quo of family doctor work mode in Shanghai Xuhui district.Methods:Semi-structured and structured in-depth interviews were conducted in Shanghai Xuhui district from April to June 2021, 11 directors, 12 deputy directors in charge and 30 family doctors from 12 community health service centers participated in the survey and completed two stages and four sessions of interviews on the development of the integrated and high-quality family doctor work mode and the ways to realize and the challenges to face. The records of interviews were transcribed, sorted and analyzed using the Colaizzi 7-step analysis method.Results:The survey showed that the family doctor contracting was carried out in a large team mode in the whole district, mainly for the elderly, and most of contracted residents were not included in health management and follow-up services. The team was composed of family doctors and assistants, and the routine outpatient service was the main work pattern, and the regular services also included the chronic disease follow-up and health check-up for elderly. On the issue of how to output high-quality integrated services, the majority of doctors (12/13) believed that the contracted individual should be taken as the unit of fine service, carrying out overall health assessment, optimizing medication plan, lifestyle guidance, one-stop service in hospital, etc.; only one doctor suggested that the family should be the management unit. For upgrading the working mode and service quality, insufficient time and energy were the main obstacle. Public health work occupied a lot of working time, but it seemed not be transformed into favorable resources and conveniences in health management and services. The professional assistants should carry out some responsibility to save family doctor′s time. The survey suggests that informatization, service space, and sufficient drug supply are the keys for ensuring high-quality and high-efficiency integrated services.Conclusion:The organizational structure of the family doctor team in Shanghai Xuhui district is relatively mature, but the integrated and high-quality service output has not yet reached. It is necessary to make regional overall planning and increase efforts to achieve the integration of medical treatment and prevention, so as to gain time for family doctors to carry out high-quality services. At the same time, it is also necessary to cultivate effective family doctor assistants, provide an information work platform that matches the work attributes and goals of family doctors, open up an integrated health management service space, and ensure the full range supply of drugs.
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Objective:To understand the utilization situation of community health service institutions, the awareness of basic public health items and the degree of satisfaction of residents in Guangzhou City, so as to provide direction and reference for improving the quality of community health service in Guangzhou City.Methods:In December 2020, 1 050 residents in a district of Guangzhou City were selected by multi-stage random sampling method to fill out the questionnaire. Single factor analysis was used for Pearson chi-square test, and binary logistic regression analysis was used for multiple-factor analysis.Results:A total of 1 092 questionnaires were sent out and 1 050 were valid, with an effective rate of 96.2%. The average times of seeing a doctor or receiving other health services in community health service center in the past year were (4.60±4.10). The total awareness rate of basic public health services was 91.6%(962/1 050), and the total awareness rate of free public health services was 89.5% (940/1 050). The total scores of residents' satisfaction with community health service institutions were (4.61±0.75) points, among which the basic medical service scored the highest, and the institution facilities, system and basic information scored the lowest. Single factor analysis showed that 10 factors, such as type of medical insurance, preferred medical institution, walking time to community center and medical service time, were the influencing factors of residents' overall satisfaction. Multiple-factor analysis found that institutions and facilities, systems and basic conditions, basic medical services, medical expenses, the type of first-visited hospital were the four influencing factors of residents' overall satisfaction ( OR=21.294, 109.013, 18.203 and 20.989, respectively). Conclusion:The residents have a good utilization of community health services, and they have good awareness of public health service projects, but the residents' satisfaction with community health services still needs to be improved, especially in the aspects of facilities, equipment and service efficiency of medical staff.
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OBJECTIVE:To systematically evaluate therapeutic efficacy and safety of pitavastatin comparison of atorvastatin in the treatment of primary hypedipemia in Chinese adults,and to provide evidence-based reference for clinic.METHODS:Retrieved from The Cochrane Library,PubMed,Chinese Journal Full-text Database,Wanfang database,and manually search Google Scholar,Baidu academic search engine,randomized controlled trials (RCTs) about pitavastatin (trial group) vs.atorvastatin (control group) in the treatment of primary hyperlipemia in Chinese adults were collected.After literature screening,data extraction,quality evaluation of included studies with modified Jadad scale,Meta-analysis of the levels of total cholesterol (TC),low density lipoprotein cholesterol (LDL-C),triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C),response rate and the incidence of ADR was conducted by using Rev Man 5.3 statistical software.RESULTS:A total of 5 RCTs were included,involving 456 patients.Results of Meta-analysis showed that the decrease of TC level [MD=0.09,95％CI(0.01,0.16),P=0.03] in trial group was more better than control group,while the increase of HDL-C level [MD=0.08,95％ CI (0.01,0.14),P=0.03] and the decrease of the TG level [MD=-0.13,95％ CI (-0.20,-0.06),P=0.000 4] in trial group were worse than control group,with statistical significance.There was no statistical difference in the decrease of LDL-C[MD=-0.01,95％ CI (-0.13,0.10),P=0.84],response rate [OR=0.75,95％CI (0.15,3.66),P=0.72] or the incidence of ADR [OR=0.68,95 ％ CI (0.44,1.05),P=0.08] between 2 groups.CONCLUSIONS:Pitavastatin has better therapeutic efficacy in decreasing TC,but its therapeutic efficacy in decreasing LDL-C is similar to that of atorvastatin;its therapeutic efficacy in decreasing TG and increasing HDL-C is worse than that of atorvastatin.The safety of them is equivalent.
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Objective To discuss the accuracy and objectivity of student standardized patients (SSP) in objective structured clinical examination(OSCE). Methods On March 30 and 31, 2013, 168 seven-year program medical students of class 2006 and 2007 took part in OSCE. Differences in as-sessment results between SPP and those given by professional doctors at 3 SP sites(angina pectoris SSP station, acute cholecystitis SSP station, depression SSP station) were analyzed. Each site had 4 items for assessment, with a total score of 100. Scores were given in strict accordance with a set of unified scoring rules. Counting data were presented as x±s. Data were verified using t test. P<0.05 was considered statis-tically considerable. Results At angina pectoris station, respective scores of SSP and professional physi-cians were 85.2±7.1 and 85.5±6.6, P=0.688. At acute cholecystitis station, respective score of SSP and professional physicians were 89.1±5.2 and 88.2±6.2, P=0.150. At depression station, respec-tive score of SSP and professional physicians were 79.8±7.5 and 78.2±7.0, P=0.078. Conclusion There is no statistical difference between scores given by SSP and those given by the physicians in OSCE. This proves that SSP who received standardized training delivers fair and accurate results in OSCE , and therefore is recommended for future application.