Study on the Construction of Harmonious Doctor-patient Relationship under the Family Doctor Contract Service System / 中国医学伦理学

【Objective:】 To understand the current status and problems of the doctor-patient relationship under the family doctor contract service system through the investigation on residents contracted by community family doctors, and to provide reference for constructing harmonious doctor-patient relationship and promoting the healthy operation of the family doctor contract service system. 【Methods:】 A questionnaire survey was conducted on 1 655 residents of a certain university community in Xi’an from January to February 2023 who completed family doctor contract services in 2022. Through the general situation of signed residents, the willingness of signed family doctors, and the satisfaction and opinions with signed family doctors’ services, this paper investigated the current status of the doctor-patient relationship and proposed corresponding improvement strategies. 【Results:】 A total of 856 residents(52.68%) were willing to sign the contract, 322 residents(19.82%) were unwilling to sign the contract, 397 residents(24.43%) expressed indifference, and 50 residents(3.07%) abstained from signing the contract. There was no statistical difference in service satisfaction between residents of different genders(P=0.292). The satisfaction of working staff aged 40-60(72.33%) was higher than that of retirees aged over 60(61.05%, P<0.001). The satisfaction of those with bachelor’s degree or above(58.23%) was higher than that of those with bachelor’s degree below(51.77%, P=0.008). The satisfaction of individuals living alone(70.21%) was significantly higher than that of non-solitary individuals(54.35%, P<0.001). The overall satisfaction score of contracted residents with contracted services was(4.48±0.14) points, including 4.31 points for satisfaction with service methods, 4.47 points for satisfaction with service attitudes, 4.52 points for satisfaction with service content, and 4.60 points for satisfaction with service effectiveness. 【Conclusion:】 Most community residents have a positive attitude towards family doctor contract services. Improving service satisfaction and strengthening doctor-patient communication are feasible ways to improve grassroots doctor-patient relationships and promote the operation of the family doctor contract service system.

Construction of basic rehabilitation training course for family doctor teams serving for people with disabilities based on WHO rehabilitation competency framework / 中国康复理论与实践

ObjectiveTo develop basic training courses for family doctor teams for people with disabilities. MethodsUtilizing the methods and theories of the World Health Organization (WHO) rehabilitation competency framework (RCF), and referring to the WHO universal health coverage global competency framework, the rehabilitation competency characteristics of family doctor teams for people with disabilities in community settings were analyzed, and a basic training course system for these teams based on the RCF was developed. Results and ConclusionBased on RCF, a competency framework for family doctor teams serving people with disabilities has been constructed. The objectives, content and training course system for basic rehabilitation training has been established.

Study on the social support level of family doctor team members of primary medical and health care institutions in Tai′an city / 中华医院管理杂志

Objective:To compare the social support levels as understood by family doctor team members in township hospitals/community health centers, and village clinics/community clinics, and their influencing factors, in order to provide reference for improving the work status of family doctor team members and enhancing the quality of family doctors′ contracted services.Methods:A multi-stage random cluster sampling method was used to sample medical workers from contracted family doctor teams in township hospitals/community health centers and their subordinate village clinics/community clinics in 6 counties (cities, districts) of Tai′an city, Shandong province. In August 2020, a questionnaire survey was conducted on the perceived level of social support among family doctor team members using the perceived social support scale. Descriptive analysis was conducted on the data, and independent sample t-tests and one-way ANOVA were used to conduct univariate analysis on the influencing factors of perceived social support scores of family doctor team members at different levels, while multiple linear regression analysis was used to conduct multivariate analysis. Results:A total of 765 valid questionnaires were collected, with 203 and 562 from township hospitals/community health centers and village clinics/community clinics, respectively. The total perceived social support scores of family doctor team members in township hospitals/community health centers and village clinics/community clinics were (65.56±10.29) and (67.31±10.14), respectively, featuring statistically significant differences ( t=-2.11, P<0.05). In-mirage marital status ( β=0.18, P=0.008), good/very good self-rated health status ( β= 0.25, P=0.048), participation of work-related training within one year ( β=0.17, P=0.010), relatively satisfied/very satisfied for job promotion ( β= 0.17, P=0.046), as well as above/far above average self-rated economic status as ( β=-0.15, P=0.027), were the influencing factor on the perceived social support scores of family doctor team members in township hospitals/community health centers. In-marriage marital status ( β= 0.12, P=0.002), good/very good self-rated health status ( β=0.14, P=0.026), junior or intermediate level or above professional title ( β=-0.11, P=0.003; β=-0.10, P=0.006), participation of work-related training within one year ( β= 0.14, P<0.001), and relatively satisfied/very satisfied for job promotion ( β= 0.16, P<0.001) were the influencing factors on the perceived social support scores of family doctor team members in village clinics/community clinics. Conclusions:Members of the family doctor teams in primary medical institutions in Tai′an city had a higher level of understanding of social support. There were differences in the social support levels of family doctor team members between the two levels of primary medical and health care institutions, and the influencing factors were not completely consistent. Targeted measures should be taken based on specific circumstances to enable them to better receive and perceive support from family and friends, and to improve the quality of family doctors′ contracted services.

Demands for contracted family doctor service among un-contracted young and middle-aged residents in Shanghai Baoshan District / 中华全科医师杂志

Objective:To analyze the demands of contracted family doctor service among uncontracted young and middle-aged people in Shanghai Baoshan.Methods:An online questionnaire survey on demands of contracted family doctor service was conducted in June 2021 among 702 uncontracted residents aged 18-60 years from Shanghai Baoshan district selected by stratified random sampling method. The demands of contracted family doctor service, including digital health file, routine laboratory tests and imaging investigation;health promotion;service convenience; home service were surveyed, and the factors related the demands were analyzed with regression analysis.Results:The survey showed that the demands of service convenience (3.8(3.0, 5.0)) and home service (4.0(3.0, 5.0)) were higher, while those of digital health file (3.0(2.0, 5.0)) and health promotion (3.0(2.0, 5.0)) were relatively lower. There were significant differences in the demands of all five contracted services among residents with different gender, age, education level, household register and family income (all P<0.05); while for young residents with different types of medical insurance there was significant difference in demands of all contracted services except digital health file (all P<0.05). Logistic regression analysis indicated that female( OR=1.83, P<0.001), high educational level( OR=4.81, P=0.019), household registered in Shanghai( OR=1.80, P=0.004)had higher demand for service convenience; female gender( OR=1.68, P=0.001), high educational level( OR=4.56, P=0.023)had higher demand for home service demands. Conclusion:The demands for contracted family doctor services are different among the uncontracted young and middle-aged people in Baoshan district, while the service convenience is generally most demanded. The study indicates that the contracted family doctor service should be provided accordingly.

Relevant factors of clinic attendance for contracted residents in a community health service center in Shanghai / 中华全科医师杂志

Objective:To analyze factors related to clinic attendance for contracted residents in a community health service center in Shanghai.Methods:It was a cross-sectional study. Through the 'Cloud Management of the Community' APP and the 'Service Fee of Contracted Residents' APP, the basic information, contracted time, hospital visits, number of visits, and medical insurance expenses of the contracted residents in Shanggang Community Health Service Center in 2021 were collected, the visiting rate to the contracted community health center and the contracted medical combination hospitals were analyzed.Results:In 2021, the contracting rate of all residents in the community was 49.96% (51 478/103 033). The contracting rate of the key population was 84.59% (43 545/51 478),among whom 66.28% (34 118/51 478) were over 60 years, 49.93% (25 702/51 478) had been contracted for more than 3 years, and 37.43% (19 270/51 478) had hypertension and/or diabetes. The number of contracted general practitioners was 4.89 times of contracted TCM doctors (1 345.17/274.81). Among all contracted residents 78.75% (40 540/51 478) had at least one visit annually, and 65.00% (33 463/51 478) had at least one visit to community health service center and the average number of visits was 17.63(5.00, 24.00)annually. The rate of visit to contracted the community health service center was (46.97±38.37) %, and 41.78% (16 937/40 540) had≥60% visit to contracted community center; the average visiting rate to the combination hospitals was (70.59±34.57) %, and 55.75% (22 602/40 540) had consultation rate≥80%. These residents were older in age, had longer contract time, higher proportion of hypertension and diabetes, and higher medical expenses, compared to those with less visits to contracted community health center and combination hospitals ( P<0.01). Meanwhile, 11 736 residents (35.07%) only visited to the contracted community health service center. Conclusion:The contracted residents are mainly the elderly and the sick ones in the community, but the use of contracted service is inadequate. Improving the visiting rate to community health center is a challenge for make a full use of the contracted health facilities.

An interview survey on the development of family doctor work mode in Shanghai Xuhui district / 中华全科医师杂志

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.

Analysis of the awareness rate and the influencing factors of extended prescription policy of contracted residents in the outer suburbs of Shanghai / 中华医院管理杂志

Objective:To investigate the awareness rate of " 1+ 1+ 1" contracted residents in the outer suburbs of Shanghai on the extended prescription policy of the family doctor contract service, and to analyze the influencing factors.Methods:From March to May, 2021, the cluster random sampling method was used to select one community health service center in Fengxian district, Shanghai, and a smart voice telephone assistant survey was conducted among the contracted residents aged 18 and above in the area, to understand their awareness of the extended prescription policy. χ2 Test was used for single factor analysis on the influence of different factors on the policy awareness of the contracted residents, while a multivariate analysis was performed by binary logistic regression, presenting P<0.05 as statistically significant. Results:A total of 13 495 " 1+ 1+ 1" contracted residents were surveyed via phone calls. Their awareness rate of extended prescription policy was 67.5% (9 115/13 495), while those with higher awareness rates were patients with ≥2 chronic diseases (92.3%), patients with 1 chronic disease (88.5%) and those aged 81 and above (88.4%). Logistic regression analysis showed that age, marital status, the number of chronic diseases and signing duration were all independent factors influencing the awareness of extended prescription policy (all P<0.05), while whether the residents were key population groups presented no significant influence on the awareness of extended prescription policy ( P=0.431). Conclusions:The awareness rate of " 1+ 1+ 1" contracted residents in the outer suburbs of Shanghai to the extended prescription policy needs to be further improved and publicity should also be strengthened to extend the policy benefit coverage.

Effect of family doctor-specialist double-contract service on management of type 2 diabetic patients in community / 中华全科医师杂志

Objective:To explore the effect of family doctor-specialist dual-contract service model on the management of type 2 diabetic patients in the community.Methods:Two hundred patients with type 2 diabetes mellitus (T2DM)who were treated in Changfeng Community Health Service Center between February 2019 and January 2021 were selected as the study objects by cluster sampling method. Patients were randomly divided into study group and control group with 100 cases in each group. The control group was managed with the conventional family doctor contract service, and the study group was managed with the family doctor-specialist double contract service. After one year of management, the fasting blood glucose, 2 h-postprandial blood glucose, glycosylated hemoglobin, diet control, blood glucose monitoring, medication compliance, exercise and other health behaviors, quality of life and satisfaction of patients were compared between two groups.Results:After intervention, fasting blood glucose, 2 h-postprandial blood glucose and glycosylated hemoglobin in the study group were significantly lower than those in the control group ( t=10.29, 8.49, 7.99, all P<0.05); the health related behaviors such as diet control, exercise behavior, blood glucose monitoring, and medication compliance in the study group were significantly better than those in the control group ( t=9.78, 6.72, 39.81, 7.88, all P<0.05); the quality of life in patients of study group was higher than that of the control group ( P<0.05); the satisfaction rate in study group was higher than that of control group (90.0% vs. 69.0%, χ 2=6.39, P=0.031). Conclusion:Compared with conventional family contract service model, the double contract service improves patient self-management, helps to reduce the blood glucose level and gains high patients′ satisfaction, which is worth promoting and applying in the management of type 2 diabetic patients in the community.

Influencing factors of visits of residents to contracted family doctors in a Beijing community / 中华全科医师杂志

Objective:To analyze the influencing factors related to visiting rate of residents to contracted family doctors in a community health service center in Beijing.Methods:One thousand patients with contracted family doctor services who visited our center from January 2019 to December 2019 were selected for retrospective analysis. According to the corresponding visiting rate of contracted family doctors,patients were divided into low corresponding visiting rate, medium corresponding visiting rate and high corresponding visiting rate, and the influencing factors were analyzed.Results:Among the 1 000 patients, 481 (48.1%) were in the high corresponding visiting rate group, 342 (34.2%) in the middle corresponding visiting rate group, and 177 (17.7%) in the low corresponding visiting rate group. Univariate analysis showed that the corresponding visit rate was significantly associated with the age, marital status and educational level of patients, history of hypertension, the number of family doctor visits, the total visiting time and the consultation time per year (χ 2=12.55, 12.42, 7.69, 21.69, 253.97, 49.54, 9.07, all P<0.05). Multivariate logistic regression analysis showed that compared with the high corresponding visiting rate group, fewer of family doctor visits ( OR=0.68, 95 %CI: 0.58-0.78), lower education level( OR=0.65, 95 %CI: 0.46-0.92), history of hypertension ( OR=0.09, 95 %CI: 0.02-0.49), and 18-65 years old( OR=1.80, 95 %CI: 1.27-2.55) were the influencing factors for the low corresponding family doctor visiting rate(all P<0.05); while fewer of family doctor visits( OR=0.91, 95 %CI: 0.83-0.99),lower education level ( OR=0.74, 95 %CI: 0.55-0.98)and history of hypertension( OR=0.09, 95 %CI: 0.02-0.44)were the related factors of the medium corresponding visiting rate(all P<0.05). Conclusions:The visiting rate of patients to the contracted family doctor needs to be improved. The number of consultations of the contracted family doctor, educational background, history of hypertension, and age are the influencing factors of the corresponding visiting rate.

Efficacy of personalized family doctor contract services on the risk factors of atherosclerotic cardiovascular disease in high-risk people / 中华全科医师杂志

Objective:To investigate the efficacy of personalized family doctor contract services on risk factors of atherosclerotic cardiovascular disease (ASCVD) in high-risk population.Methods:Ten matched-community health centers of Shenzhen Luohu district were divided into intervention group and control group by cluster randomiztion. Subjects with high risks of ASCVD were screened out as intervention group from contracted residents who visited these centers and had complete data of the China-PAR model from August 2018 to April 2019. The control group received conventional general family doctor contract services. The individualized management were given to the intervention group after fully understanding patients′ ideas, concerns, and expectations (ICE). After 2-year intervention, score changes of ASCVD risk factors within and between groups were compared.Results:A total of 571 patients were enrolled, including 288 in the intervention group and 283 in the control group. After 2 years of intervention, 7 and 18 were lost to follow-up in two groups, respectively. Finally, 281 in the intervention group and 265 in the control group were included in the study. At baseline, there was no significant difference in ASCVD scores between the intervention group and the control group [(13.33±3.54) vs. (13.09±3.54) points; t=0.84, P=0.403], and the scores in both groups decreased significantly after the intervention [(10.89±4.01), (11.62±4.11) points], while the intervention group decreased more significantly (both P<0.05). Among the risk factors at baseline, HDL-C and diastolic blood pressure in the intervention group were lower than those in the control group, and there were no significant differences in other factors between the two groups. After the intervention, the levels of total cholesterol, systolic blood pressure and diastolic blood pressure in the two groups decreased significantly, and the number of people taking antihypertensive drugs increased significantly ( P<0.001 and P<0.05); HDL-C decreased in the control group ( P=0.023). After the intervention, compared to control group the intervention group had a higher proportion of patients taking antihypertensive drugs, with lower systolic and diastolic blood pressure ( P<0.05). After the intervention, the increase rate of HDL-C in the intervention group was more than that in the control group, and the decrease rate was less than that in the control group (χ 2=6.65, P=0.036). Conclusion:Family doctor contract services can reduce the risk factors of ASCVD, and personalized family doctor contract services can further improve the effects in the prevention and control of ASCVD. However, the effects might be insignificant and inconsistent for the ASCVD risk factors with deeper management requirements or no specific management measures, which highlights the complexity and diversity of ASCVD prevention and control, calling for multi-level and multi-faceted thinking and exploration.

Analysis of occupational identity among family doctor teams and its influencing factors in Chengdu / 环境与职业医学

Background The contracted family doctor services are the embodiment of the implementation of the new medical reform policy, and the transformation of the grass-roots health service mode. Studies have proved that the occupational stress in medical staff was at a high level. The enhancement of professional identity will contribute to strengthen team building，alleviate job burnout, and reduce turnover intention of family doctors. Objective To investigate the current situation of occupational identity among family doctor teams in Chengdu, to examine potential influencing factors of occupational identity, and to provide a reference for promoting career development and team building of family doctor teams. Methods Multi-stage random cluster sampling was adopted to enroll study participants form 46 primary healthcare centers where family doctor contract services were implemented among 23 districts and counties in Chengdu between March 4 and 26, 2021. A total of 2 681 family doctors participated in this survey. A self-reported survey was conducted to collect participants' demographic and occupational data. The Effort-Reward Imbalance (ERI）questionnaire was implemented to assess occupational stress. The Professional Identity Scale was used to appraise occupational identity. Results A total of 2 327 valid questionnaires were collected, with a valid recovery rate of 86.80%, involving 1 715 females (73.7%) and 612 males (26.3%), with dominant age groups of 26−35 years (43.3%) and 36−45 years (30.4%), a high proportion of being married (82.8%), having college (36.0%) and undergraduate (47.3%) education, a high proportion of primary titles (66.0%) and informal work contract (66.1%). About 88.7% of family doctor team workers reported occupational stress. The average score of occupational identity was (3.68±0.62) points. There were significant differences in occupational identity scores among different professional title, work contract, working years in medical institutions, income, and effort/reward ratio (EER) groups (P < 0.05). ERR was negatively correlated with occupational identity (rs=−0.495, P<0.05）. The multiple regression model showed that occupational identity score in the non-staffed participants was lower than the score in the staffed ones (OR=0.429, 95%CI: 0.299−0.825). The occupational identity score in the participants having associate senior title or above was higher than in without professional title (OR=1.424, 95%CI: 1.194−2.328). The longer the working years, the higher the occupational identity score among the participants. The score of the more than 20 working years group was 1.820 times that of the less than 5 working years group (95%CI: 1.342−2.543). The higher the income, the higher the occupational identity score. The score of the 9001−12000 yuan per month group was 1.977 times that of the 1000−3000 yuan per month group (95%CI: 0.811−9.696) , and the score of the more than 12000 yuan per month group was 2.283 times that of the 1000−3000 yuan per month group (95%CI: 1.199−10.267）. Conclusion The family doctor team workers generally report occupational stress, and their occupational identity is at a medium level in Chengdu. Relevant managers should implement intervention measures against the main influencing factors to reduce their work tension and improve their occupational identity.

Study on the current situation of comprehensive medical and health medical services at primary medical institutions of a city / 中华医院管理杂志

Objective:To evaluate the current situation of comprehensive medical and health services of primary medical institutions in a city under the policy of family doctor contracted service, and explore the influencing factors and put forward improvement strategies, for the reference to improve the medical and health service level of primary medical institutions.Methods:In January 2021, 18 primary medical institutions in 3 counties(cities, districts) of a city in Shandong province were selected by stratified sampling method, and 60-70 contracted residents were selected from each institution for questionnaire survey. The questionnaire covered two dimensions: service provision(19 items) and metion frequency of health problems(12 items). According to the principle of information saturation, qualitative interviews were conducted with 20 family doctors and 15 contracted residents to identify the current service needs and existing problems. Descriptive analysis was used for all data, and single factor analysis of variance and multiple linear regression analysis were used for influencing factors of comprehensive service scores of primary medical institutions.Results:1 098 contracted residents were included in this study, and the comprehensive service score was 3.15±0.42. The vaccination, maternal health care and health education scored higher with 3.80±0.54, 3.70±0.64, 3.78±0.57 respectively; The dermatology, mental health counseling and family sickbed scored lower, with 2.27±1.20, 2.97±1.01 and 1.92±1.18 respectively. Contracted institution, gender, age and marital status were the influencing factors of comprehensive service scores( P<0.05). Residents′ needs for family sickbeds, psychological counseling and fall prevention had not been met. Conclusions:The primary medical institutions of the city had provided better basic public health services, while unmet needs were demand for home sickbeds, psychological counseling and fall prevention. We should take effective measures to increase the service supply based on the needs of residents, and provide more comprehensive medical and health services for residents at primary medical institutions.

Study on the content of family doctor health service packages in functional communities / 上海预防医学

ObjectiveBased on a demand survey， to put forward the idea of family doctor service health service packages for people in functional communities， and provide suggestions for the implementation of family doctor health service in such communities. MethodsThrough the stratified cluster sampling survey of a science and innovation bearing functional community， combined with literature research， current situation survey， case analysis and interviews， this paper proposes the service content of the service packages. ResultsOn the basis of demand survey， the mode of "specified action + optional action" should be adopted. Community health service center should first provide basic service， and then expand their services in diagnosis， treatment， and health management in line with local demand， and provide optional multi-level health service packages for scientific and innovative functional community residents， which should be divided into basic health service， value-added health service and high-end health service. ConclusionSorting out the content of health service packages of family doctor service in functional communities can provide the basis for further improving the allocation of medical service resources， further optimizing the design of the financing and compensation mechanism， and further standardizing the contract service of family doctors.

Utilización de servicios de salud por la población de cuatro consultorios del médico de la familia / Use of health services by the population of four family doctor's offices

Introducción: La utilización de los servicios de salud es un proceso social, dinámico y complejo. Objetivo: Describir la utilización de los servicios de salud por la población de cuatro consultorios del médico y la enfermera de la familia. Métodos: Estudio descriptivo de corte transversal entre los meses de enero de 2019 a enero de 2020. Se aplicó una encuesta a 775 personas de 18 años y más. Los datos se procesaron con el paquete estadístico SPSS versión 20.0 para Windows. Se utilizaron estadísticas descriptivas, expresando los resultados en tablas de distribución de frecuencias. Resultados: El rango de edades de mayor representatividad fue el de 70-74. El sexo femenino representó el 10,2 por ciento (46) y el masculino el 12,7 por ciento (41). En relación con la iniciativa para solicitar actividades de promoción y prevención, las más solicitadas fueron toma de tensión arterial, chequeo médico y peso corporal. La solicitud habitual de receta médica (706; 87,3 por ciento) se realiza al médico del consultorio. El lugar a donde se dirige el paciente, fundamentalmente, en caso de necesitar atención médica no urgente es al consultorio médico de la familia (650; 83,9 por ciento). Los lugares a donde se dirige, esencialmente, en caso de necesitar atención médica urgente son al cuerpo de guardia del hospital (520; 67,5 por ciento) y al cuerpo de guardia del policlínico (208; 27,0 por ciento). Conclusiones: La población de los cuatro consultorios estudiados utiliza los servicios en los diferentes niveles según el problema de salud que necesita resolver. Sería importante poder identificar en otras investigaciones por qué las actividades menos solicitadas son el tacto rectal, el antígeno prostático y el examen físico de mama, en aras de trazar estrategias que permitan incrementar el empoderamiento para la salud individual(AU)

Introduction: The use of health services is a social, dynamic and complex process. Objective: Describe the use of health services by the population of four family doctor and nurse's offices. Methods: Descriptive cross-sectional study carried out from January 2019 to January 2020. A survey was applied to 775 people of 18 years and older. The data was processed using the SPSS statistical package version 20.0 for Windows. Descriptive statistics were used, expressing the results in frequency distribution tables. Results: The age range of greatest representativeness was 70-74. The female sex represented 10.2percent (46) and the male sex was 12.7percent (41). In relation to the initiative to request promotion and prevention activities, the most requested were blood pressure testing, medical check-up and body weight. The usual request of prescriptions (706; 87.3percent) is made to the doctor in the office. The place where the patient goes, fundamentally, in case of needing non-urgent medical attention is to the family doctor's office (650; 83.9percent). The places where the patient goes, essentially, in case of needing urgent medical attention are the emergeny service in the hospital (520; 67.5percent) and the emergency service of the polyclinic (208; 27.0percent). Conclusions: The population of the four family doctor's office studied uses the services at different levels according to the health problem they need to solve. It would be important to be able to identify in other research why the least requested activities are digital rectal examination, prostate antigen and breast physical examination, in order to draw strategies that allow increasing empowerment for individual health(AU)

A new formula for managing family doctors' patient list in Portugal / Uma nova fórmula para a gestão das listas de utentes dos médicos de família em Portugal

Abstract In Portugal, family doctors work with a well-defined list of patients to whom they provide healthcare throughout their lives. Several studies showed that larger list sizes are associa- ted with poorer health outcomes and compromise the quality of care. A significant increase in the average list size has been observed in recent years due to the Portuguese unfavorable socioeconomic context and the lack of family doctors. In 2017, the Portuguese Association of General and Fa- mily Medicine (APMGF) developed technical and scientific research that ultimately typified a set of different clinical practice contexts. It considers the geographic and socioeconomic characteristics and a set of population-based indicators, adjusting the list size according to the population's specific needs. Such adjustments ensure health care services with better quality, safety, efficacy, and personalized to their features. In this paper, a brief review is made on this topic, focusing on the work developed by APMGF and its main results.

Resumo Em Portugal, os médicos de família trabalham com uma lista bem definida de utentes, aos quais prestam cuidados de saúde ao longo da vida. Vários estudos mostraram que as dimensões maiores das listas estão associadas a piores resultados de saúde comprometedoras da qualidade do atendimento prestado. Devido ao contexto socioeconómico português desfavorável e à falta de médicos de família, tem-se verificado um aumento significativo da dimensão média das listas de utentes atribuídas aos médicos de família nos últimos anos. A Associação Portuguesa de Medicina Geral e Familiar (APMGF) desenvolveu, em 2017, uma investigação técnico-científica que acabou por tipificar diferentes contextos do exercício clínico. Este trabalho considerou as características geográficas e socioeconómicas, bem como um conjunto de indicadores demográficos, visando ajustar a dimensão das listas de acordo com as necessidades específicas da população. Com os ajustamentos propostos na gestão da dimensão das listas de utentes, será possível prestar serviços de saúde com mais qualidade, segurança, eficácia e obter ganhos decorrentes da maior personalização na prestação de cuidados. Neste artigo uma breve revisão é feita sobre este tópico, direcionando o enfoque para os resultados do trabalho desenvolvido pela APMGF.

Study on patient experiences of residents contracted with family doctor services in a city / 中华医院管理杂志

Objective:To evaluate and analyze the patient experience of residents contracted with primary medical institutions, for providing a basis for improving quality of contracted family doctor services.Methods:Using the Chinese version of the primary care assessment tools(PCAT), a household survey was conducted on 1 400 contracted residents in 9 community health service centers and 9 township health centers in a city from May to June 2020, and their medical experience in primary medical institutions was statistically analyzed. At the same time, interviews were conducted with institutional managers and family doctors. Descriptive statistics and one-way ANOVA were used for data analysis.Results:1 333 valid questionnaires were collected, and the effective recovery rate was 95.2%.The total PCAT scoring was 25.17. Seven dimensions of first contact, continuous, coordination, comprehensiveness, patient and family centered, community-oriented and cultural competence scored in average 3.57, 3.68, 3.54, 3.40, 3.72, 3.67 and 3.59 respectively.372 people(47.1%) had not been referred by the contracted institution before going to the superior hospital or specialized hospital. There were significant differences in the scores of four core dimensions in different types of institutions, age, education level, occupation and income( P<0.001). Conclusions:Given the initial progress of contracted family doctor services in the city, there is still room for improvement. It is suggested to further improve the comprehensiveness, coordinationand accessibility of services, and promote the high-quality development of contracted family doctor services.

Status of comorbidity among hypertensive patients with contracted family doctor service / 中华全科医师杂志

Objective:To investigate the coexistence status of common chronic diseases among hypertensive patients with contracted family doctor service in the community.Methods:Clinical data of 7 910 hypertensive patients with contracted family doctor service in Yuetan Community Health Service Center and its affiliated service stations were collected. The status of comorbidities and related factors were analyzed.Results:Among 7 910 hypertensive patients, there were 2 959 cases(37.4%) with 2 chronic diseases, 1 747 cases (22.1%) with 3 chronic diseases and 2 289 cases(28.9%) with simple hypertension. There was significant difference in comorbidity status among hypertensive patients in different age groups (χ 2=25.269, P<0.05). The top 3 comorbid chronic diseases were type 2 diabetes (2 979 cases, 37.7%), dyslipidemia (2 227 cases, 28.2%), and coronary heart disease (1 945 cases, 24.6%). Univariate analysis showed that the comorbidity of hypertensive patients was significantly related to age, smoking, marital status,employ status and education level (χ 2=9.697, 19.539, 33.343, 8.986, 7.923; P<0.05). Conclusion:There is a phenomenon of coexistence of multiple diseases in hypertensive patients with contracted family doctor service in Yuetan community.

The quality of life and influencing factors in diabetic patients managed by “ 1+1+1” contracted family physician services in the community / 中华全科医师杂志

Objective:To investigate the quality of life of diabetes patients managed by the“1+1+1”contracted family physician services and to analyze the influencing factors.Methods:A survey on quality of life of diabetic patients in the community was conducted in Shanghai Huacao township from July 2018 to September 2018. A total of 413 residents managed by the contracted family physician services in 3 villages of Huacao township were selected by stratified cluster random sampling as study subjects, including 203 diabetes patients and the 210 healthy subjects (control group). The self-prepared questionnaire was applied for survey of general information and the quality of life was evaluated with the MOS 36-item short form health survey (SF-36) in two groups. The linear stepwise regression model was deployed to analyze the factors related to the quality of life of diabetes patients.Results:The total scores of SF-36 were (711.36±103.40) and (736.72±85.42) in diabetic group and control group, respectively. The total score and the scores of reported health transition, physical function, general health, physiological contents in diabetic group were significantly lower than those of control group ( t=-2.712, -2.326, -4.872, -5.509, -3.504, P<0.05); however, there were no significant differences in role-physical, bodily pain, role-emotional, mental health, vitality, social function, and psychological contents between the two groups ( P>0.05). The univariate regression analysis indicates that age, educational degree, score on the quality of sleep, stressful life event, usual mental state, and the years of contracted family doctor service were associated with the quality of life of diabetes patients ( t/ F=3.373, 3.216, 5.716, 58.146, 28.325, 14.450, P<0.05). Stepwise multiple linear regression analysis showed that stressful life event, usual mental state, and the years of contracted family doctor service were the independent factors related to the quality of life in diabetes patients ( t=7.157, 4.741, -2.779, 2.129, P<0.05). Conclusion:Under the“1+1+1”contracted family doctor service mode, the quality of life of diabetes patients in the community is very close to that of the healthy population in several dimensions. The study has also revealed that the duration of contracted family physician service and other factors can influence the quality of life of diabetic patients.

Analysis of cognition, attitude and barriers to community pharmaceutical care among family doctor team members in Shanghai suburb / 药学实践杂志

Objective To evaluate the cognition, attitude, and barriers of family doctor team members in chongming district of Shanghai to pharmacists joining the team and providing community pharmaceutical care. To provide the reference resources for the establishment of community pharmaceutical care management mode with appropriate suburban characteristics. Methods In a cross-section study conducted in 2020, an online questionnaire was provided to family doctor teams in 18 townships in Chongming District through group WeChat. Descriptive statistical data were used to analyze the cognition, attitude and barrier of family physician team members to community pharmaceutical care. Results Among the 555 participants in the study, 351 (63.24%) were female, 187 general practitioners (33.69%), 226 nurses (40.72%), and 142 public health physicians (25.59%). There were statistically significant differences in CPC cognition among the three classes of family doctor team members (P<0.05). 126 nurses (51.22%) and 84 public health physicians (68.85%) claimed never heard of CPC. 11.48% public health physicians and 23.58% nurses were familiar with the work content and responsibilities of community clinical pharmacists. General practitioners showed relatively high proportion of 34.76%. 34.22% of general practitioners held a "disagree attitude" against that "community pharmaceutical care can improve the medication efficacy for patients". "Insufficient investment in the health sector" and "insufficient community pharmacists" were the main obstacles to the development of community pharmaceutical care. Conclusion The attitude of family doctors in Chongming area to community pharmaceutical care was conservative. Public healthcare persons and nurses had a low awareness to community pharmaceutical care. The development of community pharmaceutical care was limited by the lack of financial investment and manpower.

Study on the content and structure of the contracted residents′ psychological contracts by family doctors / 中华医院管理杂志

Objective:To describe the content and analyze the constitutive dimensions of the psychological contracts with residents contracted for family physician services.Methods:Based on a collection of policy documents on family doctor contracting services issued by central government ministries and relevant departments in Shandong province as well as 27 signed family doctor agreements in nine counties (cities, districts) of Shandong province, semi-structured interviews were made to 48 residents in both September 2019-January 2020 period and May-June 2020 period, regarding the verbal promises of family doctors and the needs of these contracted residents. Then the documented and non-documented commitments of the family doctors were extracted in the content analysis method, and a credibility test was made using the Myers reliability test formula.Results:A total of 639 written commitments of family doctors were obtained, covering 5 types of responsibilities and 20 commitments, and the credibility coefficient was 0.88. 322 codes of non-documented commitments were obtained, 4 commitments were added on the basis of documented commitments, and the credibility coefficient was 0.90. The psychological contracts were sorted out in such five areas as technical quality responsibility, cost control responsibility, convenient access responsibility, communication responsibility, and empathic responsibility, by matching the residents′ medical service needs obtained from the interviews, while the first three categories and the last two categories were classified as transactional and relational psychological contracts, respectively, with 10 items of technical quality responsibility accounting for the highest percentage (41.67%).Conclusions:The documented and non-documented commitments of family doctors differed in content and structure. The psychological contract signed by residents was mainly transactional, and residents had higher expectations for family doctors to provide high-quality, convenient and economical services.