Investigation of Willingness and Influence Factors of Community Residents in Xiamen City to Participate in Family Hearing Care Services / 听力学及言语疾病杂志

Objective To confirm the willingness of community residents in Xiamen to sign up for hearing care family doctors and its influence factors,and to provide reference for the follow-up promotion of the signing up with family doctors of hearing care.Methods From June to July 2022,a multi-stage stratified sampling method was used to conduct a questionnaire survey among 900 residents from 9 communities in Xiamen.The survey contents in-cluded sociodemographic characteristics,ear and hearing health knowledge and attitude,ear and hearing health be-havior.Chi-square test was used for univariate analysis and multivariate Logistic regression analysis were conducted to analyze the factors affecting the willingness to sign up for family service.Results A total of 900 questionnaires were distributed,and 887 were recared,with an effective return rate of 98.6％.A total of 54.9％(n=487)of the community residents were willing to accept the contracted service of family doctors for hearing health care.Multiva-riate Logistic regression analysis showed that knowledge level of ear and hearing health(OR=0.395,P＜0.05),frequent ear cutting(OR=3.026,P＜0.001)and frequency of otolaryngology(OR=0.399,0.024,P＜0.001)was the influencing factor of community residents'willingness to sign a contract with family doctors for hearing health care.Conclusion Community residents in Xiamen have a high willingness to sign up for family doctor service for hearing health care.Residents with more ear and hearing health knowledge,good ear behavior and medical habits are more willing to sign up for family doctor services for hearing health care.

Consideration of countermeasures to promote family doctor contracting rate and first-return-visit rate in primary care institutions / 中华全科医师杂志

Based on the analysis of the existing problems and implementation dilemmas in family doctor contracting and first-return-visits faced by primary medical institutions in China, the authors propose countermeasures to provide reference for managers of primary health care institutions.

El desempeño profesional del médico de familia en la prevención preconcepcional de defectos congénitos

Introducción: La prevención de enfermedades y daños en los individuos, la familia y la comunidad es una de las funciones del médico y la enfermera de la familia. Un factor a tener en cuenta en la prevalencia de los defectos congénitos resulta su inadecuada prevención. En el nivel primario o preconcepcional, esto se lograría con un desempeño profesional adecuado. Objetivo: Sistematizar los referentes teóricos-metodológicos que sustentan el desempeño profesional del médico de familia en la prevención preconcepcional de defectos congénitos. Métodos: Se realizó una revisión bibliográfica sobre el desempeño profesional del médico de familia y la prevención preconcepcional de defectos congénitos, en la Biblioteca Virtual de Salud de Infomed, en las bases de datos Scopus, SciELO, Redalyc, Latindex y Dialnet, en español e inglés, así como en cinco libros. Para la búsqueda se utilizaron los descriptores: desempeño profesional, médico de familia, defectos congénitos y prevención. Luego de aplicar criterios de inclusión/exclusión se seleccionaron 26 bibliografías por su actualidad y calidad científica. Resultados: Diferentes investigadores abordan el proceso de desempeño profesional desde diferentes áreas de las ciencias pedagógicas y la educación médica. Los autores adoptan posiciones teóricas relacionadas con el desempeño profesional del médico de familia en prevención preconcepcional de defectos congénitos, y la necesidad de la preparación permanente y continuada para el mejoramiento del desempeño profesional de estos profesionales. Conclusiones: La sistematización realizada sobre desempeño profesional del médico de familia en prevención preconcepcional de defectos congénitos permitió establecer un acercamiento a los referentes teóricos que sustentan el tema.

Introduction: The prevention of disease and harm in individuals, the family and the community is one of the roles of the family doctor and nurse. A factor to be taken into account in the prevalence of congenital defects is their inadequate prevention. At the primary or preconceptional level, this would be achieved with adequate professional performance. Objective: To systematize the theoretical-methodological referents that support the professional performance of the family doctor in the preconceptional prevention of congenital defects. Methods: A bibliographic review on the professional performance of the family doctor and the preconceptional prevention of congenital defects was carried out in the Virtual Health Library of Infomed, in the Scopus, SciELO, Redalyc, Latindex and Dialnet databases, in Spanish and English, as well as in five books. The following descriptors were used for the search: desempeño profesional [professional performance], médico de la familia [family doctor], defectos congénitos [congenital defects] and prevención [prevention]. After applying inclusion/exclusion criteria, 26 bibliographies were selected for their scientific quality and topicality. Results: Different researchers approach the professional performance process from different areas of pedagogical sciences and medical education. The authors take on theoretical positions related to the professional performance of the family doctor in preconceptional prevention of congenital defects, as well as the need for permanent and continuous preparation to improve their professional performance. Conclusions: The systematization carried out on professional performance of the family doctor in preconceptional prevention of congenital defects allowed establishing an approach to the theoretical referents that support the subject.

¿Medicina General Integral o Medicina Familiar?, una reflexión a tres lustros de esta publicación / Comprehensive General Medicine or Family Medicine? A Reflection Three Decades After This Publication

Introducción: Más de 15 años han transcurrido desde que se publicó, como experiencia médica, el artículo ¿Medicina General Integral o Medicina Familiar? y hace aproximadamente diez años, el tema de reflexión: La Medicina General Integral una especialidad clínica con un verdadero enfoque biopsicosocial de la salud de la población. En el primero de los artículos se tomaba partido con relación al nombre que debía mantener la especialidad de referencia, que debía ser el de Medicina General Integral. En el segundo se resaltaba el carácter general e integral de esta. La Medicina General Integral, según plantean algunos, la Medicina Familiar cubana, definitivamente está a punto de asumir esa última denominación de manera oficial. No creo que la nueva denominación resulte adecuada. Objetivo: Fundamentar por qué no debe modificarse el nombre de la especialidad teniendo en cuenta específicamente su carácter general e integral. Métodos: Se realizó una revisión exhaustiva de los artículos publicados, todos vinculados al trabajo dentro del modelo de Medicina Familiar. Conclusiones: La especialidad en la que se forman y desarrollan los médicos que se desempeñan, fundamentalmente, en consultorios de la comunidad del primer nivel de atención en Cuba debería seguir denominándose Medicina General Integral(AU)

Introduction: It has been more than 15 years since the article Comprehensive General Medicine or Family Medicine? was published as a medical experience. It has been about ten years since this thought was disseminated: Comprehensive General Medicine, a clinical specialty with a true biopsychosocial approach to the population health. The first article supported the position of naming this specialty as Comprehensive General Medicine. The second article remarked the general and comprehensive character of this specialty. Comprehensive General Medicine, according to some authors, is definitely about to be accepted as the official name of this specialty. I do not think that Cuban Family Medicine would be appropriate as a name. Objective: To justify why the name of this specialty should not be modified, specifically taking into account its general and comprehensive nature. Methods: A thorough review of published articles was carried out, all linked to work within the Family Medicine model. Conclusions: The specialty in which doctors are trained and developed, mainly in community offices at the first level of care in Cuba, should maintain the name of Comprehensive General Medicine(AU)

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.

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.

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.

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.

The 1+N+N team model with family physicians as the core for rehabilitation of community-dwelling stroke patients / 中华全科医师杂志

Objective:To explore the effectiveness of 1+N+N team model with family physician as the core for rehabilitation of community-dwelling stroke patients.Methods:Convalescent stroke patients in Fenglin Community of Shanghai Xuhui District, who were followed up and registered from January 2019 to October 2021, were continuously enrolled in this intervention study. The 1+N+N care team consisted of a family doctor as the core (“1”) with the professional and technical team of the community health service center (“N”) and specialists in second or third hospitals (“N”). Patients were randomly divided into 1+N+N intervention group and control group. The control group was treated with traditional stroke management scheme, while the intervention group was treated by the 1+N+N team model. The activities of daily living (ADL), motor function and psychological status scores were evaluated at baseline and 12 months after intervention. Multivariate linear regression model was used to analyze the association of intervention methods with the improvement of ADL score, motor function score and psychological status score of patients.Results:A total of 120 patients were enrolled (60 in each group), including 59 males and 61 females with a mean age of (71.5±6.8) years. Compared with the control group, the age of patients in the intervention group was younger ( P=0.013), and the proportion of patients with coronary heart disease was lower ( P=0.003). There was no significant differences in other variables between the two groups ( P>0.05). After 12 months of intervention, the scores of ADL, motor function and psychological status were significantly improved compared with those before intervention in both groups ( P<0.01). There was no significant difference in motor function scores between the intervention group and the control group before intervention ( P>0.05), but the scores of ADL and psychological status in the intervention group were higher than those in the control group ( P<0.001). After intervention, the above scores in the intervention group were higher than those in the control group ( P<0.01). After adjusting for confounding factors, multivariate linear regression showed that the 1+N+N team model had no significant correlation with ADL score ( t=0.27, P=0.799), but had a positive correlation with motor function score ( t=15.64, P<0.01) and psychological status score ( t=13.70, P<0.01). Conclusion:The 1+N+N team model can effectively improve the daily living ability, motor function and psychological status of stroke patients in the convalescent period, and the intervention effect on the latter two is better than that of the traditional rehabilitation mode.

Survey on role cognition and job burnout among family doctor team members in Futian district of Shenzhen city / 中华全科医师杂志

Objective:To survey on the status quo of the role cognition and job burnout among family doctor team members in Shenzhen Futian district.Methods:A survey on the role cognition and job burnout of family doctor members was conducted in October 2022. One family doctor team was randomly selected from each of the 92 community health service centers in Futian district of Shenzhen city, and all members of the selected family doctor teams were included in the survey. The Chinese version of the Maslach Burnout Inventory-Human Services Survey was used in the study, and the influencing factors of role cognition and job burnout, as well as the impact of role cognition on job burnout were analyzed.Results:A total of 361 family doctor team members were included in the survey, The scores of the Role Ambiguity and Role Conflict Scale were (35.25±5.21) and (27.03±13.73), respectively. In the Occupational Burnout Scale, the scores of Emotional Exhaustion, Dehumanization, and Personal Achievement Scale were (17.89±6.82), (6.51±2.54), and (30.95±5.70), respectively. There were significant differences in role ambiguity and job burnout among family doctor team members with different ages, professions, and years of work ( P<0.05). Team members aged≤30, general practitioners, and working time ≤5 years had higher scores for role ambiguity, emotional exhaustion, dehumanization, and lower personal achievement ( P<0.05). The score of role ambiguity was negatively correlated with the degree of emotional exhaustion and dehumanization ( r=-0.544, -0.352), and positively correlated with personal achievement ( r=0.473). The score of role conflict was positively correlated with the degree of emotional exhaustion and dehumanization ( r=0.352, 0.376), and negatively correlated with personal achievement ( r=-0.440). Regression analysis showed that the role cognition was significantly associated with the emotional exhaustion, dehumanization, and personal achievement ( F=10.28-85.12, P<0.01). Conclusion:Active and effective measures should be taken to improve the role cognition and reduce job burnout of family doctor team members in primary health care institutions.

Analysis of the incentive level and its influencing factors of family doctors in Beijing / 中华医院管理杂志

Objective:To analysis the incentive level of family doctors in primary medical and health institutions in Beijing, and to explore its influencing factors, so as to provide references for promoting family doctors′ contract service.Methods:From October to December 2021, 40 family doctors were randomly selected from 135 urban community health service centers in 8 districts of Beijing, and a survey was conducted on basic demographic information, institutional organizational capacity evaluation, and family doctor incentive level evaluation (including four dimensions of work value, organizational environment, personal development, and reward compensation), and the influencing factors of family doctor incentive level was analyzed. Chi-square test and Pearson correlation analysis were used for univariate analysis, and multiple linear regression analysis was used for multivariate analysis.Results:A total of 4 568 family doctors were included, and the score of family doctors′ incentive level was 3.75±0.81, among which the work value score was the highest(3.89±0.77), followed by the organizational environment score(3.69±0.92) and personal development score(3.75±0.90), and the lowest score was reward(3.75±0.90). Age, education, professional title, working years and average total working hours per week negatively affected the incentive level( P<0.05), while the average monthly income, the frequency of attending training and further study, and the organizational ability of the organization positively affected the incentive level( P<0.05). Conclusions:The overall incentive level of family doctors in primary medical and health institutions in Beijing needed improvement, and there were many factors that affect the incentive level of family doctors. It was recommended to appropriately increase the salary and benefits of family doctors, reasonably arrange the workload of family doctors, strengthen the training mechanism of family doctors, and strengthen the organizational capacity building of primary medical and health institutions.

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 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.

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.

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.

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.

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.

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.

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.

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.