Cross-sectional Study of Target Admission General Practitioners' Participation in Combating COVID-19 Pandemic

ABSTRACT

Background: Primary healthcare workers have played an important role in combating the COVID-19 pandemic. Beginning in 2010, China initiated a national policy of implementing the rural-oriented tuition-free medical education(RTME) program, aiming to train general practitioners(GPs) with a medical undergraduate degree to work in rural areas to address the shortage of rural physicians. Since 2015, many graduates with RTME returned to the contracted rural hospital to fulfill a 3-year obliged health services, and their performance in combating COVID-19 epidemic is worth to be concerned about. Objective: To compare the participation and role of target admission GPs and other graduates trained with a five-year undergraduate degree program for clinical medical students in combating COVID-19 pandemic, and to analyze the duties and challenges for target admission GPs during the anti-pandemic period, then based on this, to put forward policy recommendations for incentivizing target admission GPs. Methods The data were sourced from the Target Admission Medical Students Cohort Study Program. We conducted a follow-up survey among 1 631 target admission GPs and 1 009 other clinical medical graduates graduating from 4 medical colleges in central and western China using an online questionnaire in September 2020. Basic demographics, job information and work status during the COVID-19 pandemic were collected. Results Among those who were employed in the study period, target admission GPs had a higher rate of participating in combating COVID-19 pandemic than other clinical medical graduates〔70.18%(1 113/1 586)vs 51.58%(293/568), P<0.05〕. Among target admission GPs, men had a higher rate of being involved in combating COVID-19 pandemic than women(P<0.05);those admitted in 2015 and 2016 had a higher rate of being involved in combating COVID-19 pandemic than those admitted during 2017 to 2019(P<0.05);and those who were married had a higher rate of being involved in combating COVID-19 pandemic than those who were unmarried/divorced/other marital status(P<0.05). The top 3 types of work which most target admission GPs participated were "health promotion and education"〔88.59%(986/1 113)〕, "community epidemic prevention and management"〔85.62%(953/1 113)〕, and "SARS-CoV-2 nucleic acid testing and screening"〔67.30%(749/1 113)〕. The top three challenges most target admission GPs faced in combating COVID-19 pandemic were "lack of personal protective equipment"〔77.72% (865/1 113)〕, "too much workload and/or pressure"〔41.87%(466/1 113)〕, and "worrying about themselves and their family being infected"〔37.56%(418/1 113)〕. The prevalence of target admission GPs who reported that there was an increase in daily clinical work was 57.50%(640/1 113). And that of target admission GPs who reported that there was an increase in daily public health services was 62.26%(693/1 113). Conclusion: Target admission GPs have implemented multiple key services regarding COVID-19 containment, indicating that they have played a role in the national COVID-19 containment that cannot be ignored. However, they faced difficulties such as insufficient personal protective equipment and excessive work pressure. Measures need to be taken to improve the infrastructures in rural areas, and to provide more protection and support for primary healthcare workers. Copyright © 2021 by the Chinese General Practice.