What Does the Chinese Public Care About with Regard to Primary Care Physicians: Trustworthiness or Competence?

Background and Objective: China has launched a series of reforms to enhance primary care. The aims of these reforms are to strengthen the functionality of primary care to encourage patients to use primary care. Patients' trust in physicians is important in clinical medicine; however, little is known about how Chinese patients' preferences relate to their trust in primary care physicians. This study's objectives are to measure the Chinese public's trust in primary care physicians and to characterize reasons of their preferences for health care. Materials and Methods: This quantitative study comprises a face-to-face survey with a convenience sample (n = 273) of people visiting community health centers or stations (CHCSs) in Wuhan, China. We measured the patients' preferences for the different level of hospitals and their trust in physicians, as well as the reasons of the patients' preferences, using a Chinese version of the Wake Forest Physician Trust Scale and other variables (such as demographics, health status, and hospital preference). Results: Approximately two thirds (68.6%) of the participants had experienced a mild or chronic disease in the year before the survey, but only 26.4% preferred to visit CHCSs in such cases. The negative factors related to this lack of preference are the physicians' competence (odds ratio [OR] = 0.250), the medical equipment (OR = 0.301), and the popularity of hospitals (OR = 0.172). The positive factors were ease of access (OR = 2.218) and affordability (OR = 1.900). The participants expressed a moderate trust in physicians in CHCSs (score of 3.02 out of 5). There is no association between the patients' trust and their hospital preference (r = 0.019, p = 0.859). Of the participants, 92 suggested that the physicians in CHCSs should improve in terms of their competence (n = 53), attitude (n = 35), and/or medical ethics (n = 16). Conclusions: This study's results suggest that patients consider improving physicians' competence to be more important and urgent than improving those physicians' trustworthiness in terms of reconstructing Chinese primary care. Improving the physicians' competence would not only reduce the barriers that patients experience regarding CHCSs, but would also increase their trust in the physicians.

Understanding how to improve physicians' paradigms for prescribing antibiotics by using a conceptual design framework: a qualitative study.

BACKGROUND: Antimicrobial resistance (AMR) is a growing public health threat. Primary care physicians are important inducers of the overuse of antimicrobials and inappropriate prescribing. Augmented reality (AR) might provide a potential educational tool in health care. The aim of this study was to identify the need for education and expectations for AR-based education in the context of improving the rational use of antibiotics by primary care physicians in China. METHODS: The study used a qualitative approach based on face-to-face interviews with eleven physicians from three community health service centers and stations in China. We used a hybrid thematic analysis approach to analyze the interview data. A conceptual design framework, mobile augmented reality education (MARE), guided the work. RESULTS: The physicians' personal prescription paradigms included problems regarding the way they diagnosed and chose treatments and prescriptions. Although the physicians mentioned that they should not treat patients with antibiotics without proof of a bacterial infection, in practice, they often did not wait for necessary test results before they prescribed antibiotics. It was also revealed that they often experienced difficulties when trying to convince patients to follow non-antibiotic treatments. Physicians' prescription of antibiotics was based on three different paths: if they thought there was a bacterial infection, if they thought preventing additional possible infections for the patient to be necessary; and if the patients requested antibiotics. The physicians expressed various learning needs for the rational use of antibiotics, and their expectations of an AR-based educational intervention included suggestions for contents, learning assets, learning environments and learning activities. CONCLUSIONS: The results showed that the physicians were not only unfamiliar with national guidelines on the use of antibiotics and local AMR patterns but also had personal paradigm issues related to the physicians' decision making. Moreover, the physicians provided meaningful insights into and expectations for possible AR-based education on AMR. In this article, we demonstrate how to apply the MARE framework to analyze the needs of educational interventions for rational use of antibiotics.

Exploring the needs and possibilities of physicians' continuing professional development - An explorative qualitative study in a Chinese primary care context.

BACKGROUND: One component of the 2009 Chinese health care reform plan is to train general practitioners to improve the delivery of primary care services. This continuing professional development is expected to further improve the physicians' competencies to be general practitioners in primary care. Augmented reality-a combination of virtual information and the real environment-may enhance general practitioners' continuing professional development by allowing their learning experiences to overlap with their workplace practice. OBJECTIVE: To explore the needs, opportunities, and challenges involved in continuing professional development for Chinese physicians becoming competent general practitioners within primary care, with a special focus on the possibilities of applying augmented reality. METHODS: This study used a qualitative approach with semi-structured face-to-face interviews. Two managers and thirteen physicians (from four community health centers and stations) participated. The data were analyzed using a thematic inductive analysis approach. RESULTS: Based on our interviews, most of the physicians were not fully trained as general practitioners but still assumed the duties of that position; they were supposed to eventually become fully trained in line with the reforms of the Chinese primary care system. However, they reported a lack of in-service training opportunities to fulfill this goal. Even those who said that they had such opportunities perceived the efficacy of that training as being poor. The managers and most of the physicians reacted positively to the idea of using augmented reality in continuing professional development, and they suggested antibiotics treatment, surgery, and emergency care as learning areas in which augmented reality could be applied. CONCLUSIONS: Due to the Chinese reforms of the primary care system, both managers and the physicians themselves expect general practitioners to become qualified by engaging in continuing professional development. Both groups also regarded augmented reality as a potentially useful tool.

Design of Mobile Augmented Reality in Health Care Education: A Theory-Driven Framework.

BACKGROUND: Augmented reality (AR) is increasingly used across a range of subject areas in health care education as health care settings partner to bridge the gap between knowledge and practice. As the first contact with patients, general practitioners (GPs) are important in the battle against a global health threat, the spread of antibiotic resistance. AR has potential as a practical tool for GPs to combine learning and practice in the rational use of antibiotics. OBJECTIVE: This paper was driven by learning theory to develop a mobile augmented reality education (MARE) design framework. The primary goal of the framework is to guide the development of AR educational apps. This study focuses on (1) identifying suitable learning theories for guiding the design of AR education apps, (2) integrating learning outcomes and learning theories to support health care education through AR, and (3) applying the design framework in the context of improving GPs' rational use of antibiotics. METHODS: The design framework was first constructed with the conceptual framework analysis method. Data were collected from multidisciplinary publications and reference materials and were analyzed with directed content analysis to identify key concepts and their relationships. Then the design framework was applied to a health care educational challenge. RESULTS: The proposed MARE framework consists of three hierarchical layers: the foundation, function, and outcome layers. Three learning theories-situated, experiential, and transformative learning-provide foundational support based on differing views of the relationships among learning, practice, and the environment. The function layer depends upon the learners' personal paradigms and indicates how health care learning could be achieved with MARE. The outcome layer analyzes different learning abilities, from knowledge to the practice level, to clarify learning objectives and expectations and to avoid teaching pitched at the wrong level. Suggestions for learning activities and the requirements of the learning environment form the foundation for AR to fill the gap between learning outcomes and medical learners' personal paradigms. With the design framework, the expected rational use of antibiotics by GPs is described and is easy to execute and evaluate. The comparison of specific expected abilities with the GP personal paradigm helps solidify the GP practical learning objectives and helps design the learning environment and activities. The learning environment and activities were supported by learning theories. CONCLUSIONS: This paper describes a framework for guiding the design, development, and application of mobile AR for medical education in the health care setting. The framework is theory driven with an understanding of the characteristics of AR and specific medical disciplines toward helping medical education improve professional development from knowledge to practice. Future research will use the framework as a guide for developing AR apps in practice to validate and improve the design framework.

Augmented reality in healthcare education: an integrative review.

Background. The effective development of healthcare competencies poses great educational challenges. A possible approach to provide learning opportunities is the use of augmented reality (AR) where virtual learning experiences can be embedded in a real physical context. The aim of this study was to provide a comprehensive overview of the current state of the art in terms of user acceptance, the AR applications developed and the effect of AR on the development of competencies in healthcare. Methods. We conducted an integrative review. Integrative reviews are the broadest type of research review methods allowing for the inclusion of various research designs to more fully understand a phenomenon of concern. Our review included multi-disciplinary research publications in English reported until 2012. Results. 2529 research papers were found from ERIC, CINAHL, Medline, PubMed, Web of Science and Springer-link. Three qualitative, 20 quantitative and 2 mixed studies were included. Using a thematic analysis, we've described three aspects related to the research, technology and education. This study showed that AR was applied in a wide range of topics in healthcare education. Furthermore acceptance for AR as a learning technology was reported among the learners and its potential for improving different types of competencies. Discussion. AR is still considered as a novelty in the literature. Most of the studies reported early prototypes. Also the designed AR applications lacked an explicit pedagogical theoretical framework. Finally the learning strategies adopted were of the traditional style 'see one, do one and teach one' and do not integrate clinical competencies to ensure patients' safety.