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The contents of general practice discipline construction comprise of orientation, team development, personnel training, scientific research, teaching base establishment and management of the discipline, etc. At present, the weakness in above aspects of general practice discipline construction is still the major challenges in most of the primary healthcare institutions. Our experiences in last 10 years shows that the application of Leicester Assessment Package can effectively promote the general practice discipline development for primary care institutions.
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Objective:To evaluate the effectiveness of mentorship-Leichester assessment package (LAP) model in general practice teaching.Methods:Sixty five-year Traditional Chinese Medicine (TCM) students undergoing general medicine internship from July 2020 to December 2020 were divided into study group and control group with 30 students in each group. Students in study group undertook general practice internship in Fangzhuang Community Health Service Center with the mentorship-LAP model, including group-based teaching, weekly LAP case discussion and mentor-intern individualized LAP clinical practice teaching; students in control group undertook general practice internship in other community teaching bases with the traditional clinical practice training methods. After one month, students were evaluated with LAP score sheet and the evaluation results were compared between two groups.Results:After one month of training, the scores of medical history collection, physical examination, problem solving, patient management, doctor-patient relationship, expected care and medical records in both groups increased compared with pre-training (the control group: t=4.23, 5.06, 8.94, 4.85, 3.99, 1.04, 5.13, study group: t=1.86, 2.85, 12.42, 13.61, 6.29, 4.83, 5.63, all P<0.05). The scores of medical history collection, physical examination, problem solving, patient management, doctor-patient relationship, and expected care after training in the study group were higher than those in the control group ( t=5.66, 2.83, 5.67, 8.13, 2.76, 2.52, all P<0.05). After the training, in the medical history collection items, the scores of patient-centered communication, RICE recognition, and physical-psychological-social factors in study group were higher than those in the control group ( t=5.66, 7.35 and 2.66, all P<0.05); in the problem-solving items, the scores of clinical data application, comprehensive analysis ability and personal ability limitation in study group were higher than those in the control group ( t=4.32, 3.38 and 2.26, all P<0.05); in the patient management items, the scores of overall management plans, doctor-patient collaboration, dispelling doubts, subsequent visits/follow-up, and the degree of patient understanding the management plan in the study group were higher than those in the control group ( t=3.03, 2.07, 2.43, 3.15 and 2.17, all P<0.05). Conclusion:The mentorship-LAP teaching model is helpful to improve the effectiveness of general practice internship for medicine students.
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Objective:To investigate the current status of prevention and treatment of esophagogastric variceal bleeding (EVB) in cirrhotic portal hypertension patients in Ningxia region.Methods:The retrospective and descriptive study was conducted. The clinical data of 820 cirrhotic portal hypertension patients who were admitted to 21 medical centers in Niangxia region from January 2018 to December 2020 were collected, including 85 cases in Ningxia Hui Autonomous Region People′s Hospital, 73 cases in the Fifth People′s Hospital of Ningxia Hui Autonomous Region, 59 cases in the Wuzhong People′s Hospital, 52 cases in the Qingtongxia People′s Hospital, 50 cases in the Guyuan People′s Hospital, 47 cases in the Yuanzhou District People′s Hospital of Guyuan City, 47 cases in the Yinchuan Second People′s Hospital, 40 cases in the General Hospital of Ningxia Medical University, 40 cases in the Tongxin People′s Hospital, 35 cases in the Yinchuan First People′s Hospital, 34 cases in the Third People′s Hospital of Ningxia Hui Autonomous Region, 32 cases in the Zhongwei People′s Hospital, 30 cases in the Lingwu People′s Hospital, 30 cases in the Wuzhong New District Hospital, 30 cases in the Yanchi People′s Hospital, 29 cases in the Ningxia Hui Autonomous Region Academy of Traditional Chinese Medicine, 28 cases in the Shizuishan Second People′s Hospital, 25 cases in the Shizuishan First People′s Hospital, 21 cases in the Haiyuan People′s Hospital, 20 cases in the Pengyang People′s Hospital, 13 cases in the Longde People′s Hospital. There were 538 males and 282 females, aged (56±13)years. Observation indicators: (1) clinical charac-teristics of cirrhotic portal hypertension patients; (2) overall prevention and treatment of EVB in cirrhotic portal hypertension patients; (3) prevention and treatment of EVB in cirrhotic portal hypertension patients from different grade hospitals. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Results:(1) Clinical characteristics of cirrhotic portal hypertension patients: of 820 cirrhotic portal hypertension patients, 271 cases were in compensated stage and 549 cases were in decompensated stage. Of the 271 cases in compensated stage, there were 183 maels and 88 females, aged (53±12)years. There were 185 Han people, 85 Hui people and 1 case of other ethic group. The etiological data of liver cirrhosis showed 211 cases of viral hepatitis B, 4 cases of alcoholic liver disease, 8 cases of viral hepatitis C, and 48 cases of other etiology. There were 235 cases of Child-Pugh grade A and 36 cases lack of data. Of the 549 cases in decompensated stage, there were 355 males and 194 females, aged (57±14) years. There were 373 Han people, 174 Hui people and 2 cases of other ethic group. The etiological data of liver cirrhosis showed 392 cases of viral hepatitis B, 33 cases of alcoholic liver disease, 10 cases of viral hepatitis C, and 114 cases of other etiology. There were 80 cases of Child-Pugh grade A, 289 cases of grade B, 170 cases of grade C and 10 cases lack of data. (2) Overall prevention and treatment of EVB in cirrhotic portal hypertension patients: of 271 patients in compensated stage, 38 cases received non-selective β-blocker (NSBB) therapy, 16 cases received endoscopic treatment, 6 cases received interventional therapy. Of 549 patients in decompensated stage, 68 cases received NSBB therapy, 46 cases received endoscopic treatment, 28 cases received interventional therapy. (3) Prevention and treatment of EVB in cirrhotic portal hypertension patients from different grade hospitals: of 271 patients in compensated stage, 181 cases came from tertiary hospitals, of which 28 cases received NSBB therapy, 15 cases received endoscopic treatment, 6 cases received interventional therapy. Ninety cases came from secondary hospitals, of which 10 cases received NSBB therapy, 1 cases received endoscopic treatment. There was no significant difference in NSBB for prevention of EVB between tertiary and secondary hospitals ( χ2=0.947, P>0.05), while there was a significant difference in endoscopic treatment for prevention of EVB between tertiary and secondary hospitals ( χ2=5.572, P<0.05). Of 549 patients in decompensated stage, 309 cases came from tertiary hospitals, of which 22 cases received NSBB therapy, 29 cases received endoscopic treatment, 22 cases received interventional therapy. Two hundreds and fourty cases came from secondary hospitals, of which 46 cases received NSBB therapy, 17 cases received endoscopic treatment, 6 cases received interven-tional therapy. There were significant differences in NSBB and interventional therapy for prevention of EVB between tertiary and secondary hospitals ( χ2=18.065, 5.956, P<0.05). Conclusions:The proportion of receiving EUB prevention in cirrhotic portal hypertension in Ningxia is relatively low. For patients with compensated liver cirrhosis, the proportion of NSBB therapy and endoscopic treatment in the secondary hospitals was lower than that in tertiary hospitals. For patients with decompensated liver cirrhosis, the proportion of interventional treatment in secondary hospitals is lower than that of tertiary hospitals, but the proportion of NSBB in secondary hospitals taking is higher than that of tertiary hospitals.
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Objective:To evaluate an intelligent voice call system in popularizing knowledge of prevention and control of Coronavirus Disease 2019 (COVID-19) for chronic disease patients in the community.Methods:An intelligent voice call system for popularization of scientific knowledge of COVID-19 and protective measures was developed in Fangzhuang Community Health Service Center of Beijing Fengtai district, in which 12 popular education modules ware designed and 3-6 core points were extracted from each module. During January 23 to January 29, 2020, the system was applied to send voice calls and text messages to all contracted chronic disease patients in Fangzhuang community with popular science education in different time points. Using equidistant sampling method, 400 participants were selected from the patients of successful voice outbound calls. The intelligent voice outbound system was used to investigate the participants′ COVID-19 knowledge levels, the main sources of knowledge and satisfaction with education. The outbound results of the above indicators were queried from the database of the intelligent voice outbound system.Results:A total of 98 487 voice outbound calls were effectively connected, the average call duration per person was 2.24 minutes, and the total call duration was equivalent to 488.5 workdays. A total of 141 201 messages were sent, with a read rate of 97.8% (141 201/144 405) . After the voice outbound education, the participants′ scores in answering the questionnaire on 12 popular science knowledge modules ware all significantly increased compared to those before the education ( t=22.4, 27.5, 24.3, 31.2, 25.6, 18.9, 22.5, 27.3, 28.1, 26.4, 15.2, 22.6, all P<0.01) ; 94.8% (235/248) of participants′ knowledge of COVID-19 mainly came from voice call. In addition, the patient′s overall satisfaction with the application of the intelligent voice call system for popularizing science education was 90.8% (225/248). Conclusions:The knowledge levels of COVID-19 and its prevention and control measures effectively have been improved among the community chronic disease patients with the application of an intelligent voice outbound system. Moreover, this mode is highly acceptable to patients, which would be introduced to other urban communities in China.
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Objective To investigate the health-seeking behavior and related factors among hypertensive and diabetic patients contracting medical service in Beijing Fangzhuang Community Health Service Center.Methods By using stratified random sampling method, 830 contracted hypertensive and diabetic patients were selected in the study.A face to face questionnaire survey was conducted in Fangzhuang Community Health Service Center from November 2016 to January 2017.Total 800 questionnaires were completed, and the medical behavior and influencing factors of patients were analyzed.Results The first-contact rate of community for hypertensive and diabetic patients was 73.0%(584/800).The reasons for choosing community service were: near home(86.3%,690/800), shorter waiting time(71.4%, 571/800)and trust in doctors(50.3%, 402/800); while the reasons for not choosing community service were less drug varieties(76.1%, 609/800), poor facilities(32.1%,257/800)and lower technical level(11.4%, 91/800).Its influencing factors were: frequent need of accompanying for visit(χ2=5.719, P=0.012),family income(χ2=4.540,P=0.021),awareness of service scopes(χ2=64.668,P=0.000),purpose of service(χ2=19.234,P=0.000),frequency of doctor contact(χ2=9.367, P=0.001), the awareness of referral(χ2=5.736,P =0.011).Conclusion The community health service centers should take the advantage of easy access, short waiting time and patients′trust,at the same time should improve the service conditions and quality,so as to increase the first-contact rate for patients contracting medical service.
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To implement the effective docking and optimization of a new community comprehensive management information system and cardiocerebrovascular disease-related auxiliary system for a communitybased information platform for intelligent chronic disease management.The cooperation of community team and a distinct division of labors were enforced according to standard operating procedures.This mode of patient-centered medical home (PCMH) could offer scientific and effective management,promote the rational classification of medical and two-way referral systems and improve service efficiency and management capabilities for the goals of achieving a reasonable allocation of medical resources and saving medical costs.