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.

Process quality of type 2 diabetes mellitus care and association with patient perceived attributes of family doctor service in urban general practices, Beijing, China.

BACKGROUND: Family doctor service (FDS) is a scheme oriented to improving the access and continuity of primary care in China. Type 2 diabetes mellitus (T2DM) management is a core component of FDS. However, evidence on the quality of T2DM care is lacking and the potential association between FDS attributes and T2DM care is largely unknown. This study attempted to assess the process quality of T2DM care in general practice and explore the association between patient perceived FDS attributes and process quality of T2DM care. METHODS: Total 400 patients were recruited from 5 community health service centers in two urban districts in Beijing. Questionnaire survey and extraction of data from electronic health record (EHR) were conducted to collect patient characteristics, patient perceived FDS attributes (accessibility, continuity and team-based care) and process quality indicators (monitoring and health counseling indicators). Chi-square test and a two-level generalized linear mixed model (GLMM) were used to explore the association between FDS attributes and process quality. RESULTS: The utilization rate of all the 12 indicators in monitoring, 6 indicators in health counseling and all the 18 process indicators, was 12.8%, 23.8% and 6.0% respectively. Over half of the patients (56.8%) perceived all the 3 FDS attributes. There were statistically significant associations between accessibility of care and lipid (p = 0.008), electrocardiogram (p = 0.016), retinopathy (p = 0.037) and peripheral neuropathy (p = 0.006) monitoring and each of the 6 health counseling indicators (all the p values < 0.05). Regular follow up (p = 0.039), plasma blood glucose (p = 0.020), blood pressure (p = 0.026), body mass index (p = 0.044) and foot (p = 0.005) monitoring as well as each of the 6 health counseling indicators (all the p values < 0.05) were more likely to be received by patients when continuity of care was ensured. Patients who were managed by a GP team had higher utilization rate of glycosylated hemoglobin monitoring (p = 0.026) and each of the 6 health counseling indicators (all the p values < 0.05). When the patients perceived one more FDS attribute, the indicators they received significantly increased by 1.50 (coefficient = 1.50, p < 0.001). Patients between the age of 65 and 74 years received 1.15 more indicators than those under 65 (coefficient = 1.15, p = 0.003). Patients with more than ten years duration of T2DM received 0.74 more indicators (coefficient = 0.74, p = 0.028). Patients taking both insulin and oral medicine received 0.97 more indicators than those taking oral medication only (coefficient = 0.97, p = 0.027). Patients who were managed by GPs with on-job training experience received 1.19 more indicators (coefficient = 1.19, p = 0.040). Among the patients who had completed junior high school or below, having better self-report health status (≥ 60) received 2.40 less indicators (coefficient = -2.40, p = 0.004). CONCLUSIONS: Improvement of key monitoring and health counseling indicators might be needed in T2DM care in general practice in Beijing, China. Policies for improving process quality of T2DM care should be considered.

Incentives Promoting Contracted Family Doctor Service Policy to Improve Continuity and Coordination in Diabetes Patient Management Care in China.

Background: As the first step toward building a gatekeeping system in China, the governments have introduced a contracted family doctor service (CFDS) policy in primary healthcare (PHC) facilities. This study was to examine the association between apply of incentive to improve the implementation of CFDS and the performance on diabetes management care. Methods: We conducted a cross-sectional study in 72 PHC facilities in 6 cities that piloted the CFDS. Multivariate regression models were applied, based on a sample of 827 PHC providers and 420 diabetic patients. Results: PHC providers who reported the performance being linked with increased income were 168.1 and 78.0% more likely to have good continuity and coordination of diabetes patient management care, respectively. Additional one-point percentage of PHC providers whose performance on CFDS was assessed was associated with 7.192 times higher probability of patients with control of blood glucose. Discussion: Inclusion of incentives rewarding better performance on CFDS were associated with better delivery process and outcome performance on diabetes management care. Conclusion: Design and implementation of the incentive should be accompanied with the policy of CFDS, in order to increase the proportion of performance-related income of PHC providers, thereby improving the quality of diabetes management care.

Facilitate Signing with the Family Doctor: A Study of the Practice in Shanghai, China.

BACKGROUND: In the time since primary care was implemented in China in 2009, programs of promoting residents signing with family doctor services have been key. However, there has been a lack of effective evaluation of its implementation. METHODS: We used mixed methods for evaluating existing measures of facilitating signing with family doctors in Shanghai. Based on the Donabedian model, qualitative informant interviews were conducted to obtain experts' evaluations in aspects of team construction (structure) and innovative solutions for promoting and supervising signings (process). Quantitative data were used to analyse the utilization situation (outcome) from "Shanghai Family Doctor Signing Data Platform". RESULTS: Measures of signing with family doctors in Shanghai have functioned well, but there is still a lack of sufficient family doctors and specialists, including paediatricians and gynaecologists. Although proportions of the key population (average=62.59%) and the elderly population (>65 years) (average=78.10%) who had signed with family doctors were relatively high, the proportion of the permanent resident population (average=29.36%) who had signed with family doctors was low from 2017 to 2020 in Shanghai. The proportions of residents seeking medical advice in signed community health centres in outskirts (71.08%) were higher than those in suburbs (63.51%) and urban areas (53.49%), whereas the proportion of those seeking medical advice from recommended multiple medical institutions were similarly low in urban areas, outskirts and suburbs. CONCLUSION: The practice of facilitate signing with family doctors in Shanghai has increased. However, we showed that numbers of family doctors were relatively low, and there remains a need for more experienced gynaecology and paediatrics professionals, compared with Western countries. Additionally, efforts should be made to increase proportions of residents who utilize the program, especially in urban areas, and seek medical services in contracted group hospitals and community health centres.

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.

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.

Status of outpatient service for cancer patients in Beijing Yuetan Community Health Service Center / 中华全科医师杂志

Objective@#To analyze the outpatient service for patients with malignancies in Yuetan Community Health Service Center of Xicheng District in Beijing.@*Methods@#Two hundred and nine patients with malignancies visiting Yuetan Community Health Service Center in Beijing from January 2016 to January 2018 were included for analysis. There were 92 patients who visited fixed physicians (fixed group) and 117 patients who visited non-fixed physician (non-fixed group), and the influencing factors affecting fixed physician visit were analyzed.@*Results@#Of the 209 patients, 65 (31.10%) were males and 144 (68.90%) were females with a mean age of (69.4±10.0) year. There were 114 cases (54.55%) complicated with, hypertension 52 cases (24.88%) complicated with type 2 diabetes and 40 cases (19.24%) complicated with dyslipidemia. The mean number of visit per patients was (23.16±3.86) times; and the time of visits in fixed group was significantly higher than that in non-fixed group [(27.72±2.67) vs. (22.93±2.61), χ2=4.621, P=0.01]. The mean number of visit in 107 patients having contracted family doctor service was (25.64±7.60) times, while the time of visits in fixed group was significantly higher than that of the non-fixed group [(32.10±2.10) vs. (13.56±3.34), χ2=3.938, P<0.01]. Multivariate logistic regression analysis showed that hypertension (OR=0.445, 95%CI:0.213-0.971) and contracted family doctor service (OR=0.212, 95%CI:0.104~0.435) were significantly associated with fixed physician visits.@*Conclusion@#The outpatient visits of patients with malignant tumors in Yuetan Community Health Service Center meet the follow-up requirements for chronic diseases in the National Basic Public Health Service Regulations. The number of visits to fixed physicians is high, and patients with hypertension and contracted family doctor service have higher rate of fixed physician visits.

Status of outpatient service for cancer patients in Beijing Yuetan Community Health Service Center / 中华全科医师杂志

Objective To analyze the outpatient service for patients with malignancies in Yuetan Community Health Service Center of Xicheng District in Beijing. Methods Two hundred and nine patients with malignancies visiting Yuetan Community Health Service Center in Beijing from January 2016 to January 2018 were included for analysis. There were 92 patients who visited fixed physicians (fixed group) and 117 patients who visited non-fixed physician (non-fixed group), and the influencing factors affecting fixed physician visit were analyzed. Results Of the 209 patients, 65 (31.10％) were males and 144 (68.90％) were females with a mean age of (69.4 ± 10.0) year. There were 114 cases (54.55％) complicated with, hypertension 52 cases (24.88％) complicated with type 2 diabetes and 40 cases (19.24％) complicated with dyslipidemia. The mean number of visit per patients was (23.16 ± 3.86) times;and the time of visits in fixed group was significantly higher than that in non-fixed group [(27.72±2.67) vs. (22.93±2.61),χ2=4.621,P=0.01]. The mean number of visit in 107 patients having contracted family doctor service was (25.64 ± 7.60) times, while the time of visits in fixed group was significantly higher than that of the non-fixed group [(32.10± 2.10) vs. (13.56±3.34),χ2=3.938,P<0.01]. Multivariate logistic regression analysis showed that hypertension (OR=0.445, 95％CI:0.213-0.971) and contracted family doctor service (OR=0.212, 95％CI:0.104～0.435) were significantly associated with fixed physician visits. Conclusion The outpatient visits of patients with malignant tumors in Yuetan Community Health Service Center meet the follow-up requirements for chronic diseases in the National Basic Public Health Service Regulations. The number of visits to fixed physicians is high, and patients with hypertension and contracted family doctor service have higher rate of fixed physician visits.

Feasibility Analysis and Mode Discussion of Introducing Medical Social Workers into Family Doctor Service / 中国医学伦理学

The family doctor service is an important measure to transform primary health care mode,makes the community health service institutions to take on the gatekeeper role of residents' health and health care costs,and promotes the achievements of hierarchical diagnosis and treatment.At present,there are some difficulties in the process of family doctor service.For example,the construction of the general practitioner team is lagging behind and the residents don't understand the specific contents of the family doctor service well.Medical social workers have both the social work professional skills and medical literacy,which makes them become the effective strength of community health service.Introducing medical social workers by the purchase of the governments,volunteer training,and job settings mode can meet the needs of the development of family doctor service to some extent,and bring in new ideas to the implementation of the family doctor service.

Utilization and satisfaction of family doctor service among contract-signing residents in Beijing urban area and related influencing factors / 中华全科医师杂志

Objective To investigate the utilization and satisfaction of family doctor service among contract-signing residents in Beijing urban area,and the related influencing factors.Methods Total 740 contract-signing residents visiting community health service centers of two urban districts in Beijing from June to September of 2015 were selected with purposive sampling as study subjects.All participants completed a questionnaire survey on the utilization and satisfaction of the service provided by family doctors.The influencing factors related to satisfaction were analyzed by chi-square test and multivariate Logistic regression.Results The survey showed that 73.9％ (547/740) of the participants would seek service in community health service centers first when their illness was mild;while 56.2％ (416/740) of the participants would seek service in secondary or tertiary hospitals directly.Four out of 8 contracted services were mostly utilized:personalized health counseling (732/740,98.9％),chronic disease management (721/740,97.4％),health promotion guidance (626/740,84.6％),and health education (614/740,83.0％).The satisfaction rates for service attitude of family doctor,the contents of contracted service,the competence of family doctor and the environment of clinical setting were 82.7％ (612/740),75.4％ (558/740),72.8％ (539/740) and 70.4％ (521/740),respectively.The satisfaction rates of service contents were 85.4％ (164/192) for home visit,81.3％ (248/305) for appointment of experts in tertiary hospital,76.8％ (562/732) for personalized health counseling,76.3％ (550/721) for chronic disease management,75.2％ (471/626) for health promotion guidance,74.4％ (457/614) for health education,72.8％ (302/415) for referral service,and 65.7％ (305/464) for appointment of next visit.Logistic regression showed that the quality of family doctor service in the community health service institutions (OR =2.693,P =0.000) and education levels of residents (OR =0.680,P =0.008) were the factors related to the satisfaction of the patients.Conclusion The contract-signing residents in Beijing urban area are willing to go to the community health service institutions,and generally satisfied with the service.But the service contents and service quality need to be further improved.

Survey on awareness and utilization of community family doctors′service on residents in Beij ing and influential factors / 中华医院管理杂志

Objective To investigate the awareness and utilization of community family doctor services of residents in Beijing and analyze its influential factors.Methods Multistage random sampling was adopted to enroll residents in Beijing from eight community health centers in Haidian District, Xicheng District and Daxing District,to investigate the awareness and utilization of community family doctor services.Customized questionnaires were recovered for descriptive statistics and influential factor analysis.Results All the 3 008 effective questionnaires were recovered.The results found that 92.2% of the residents used community family doctor services.Higher utilization rates of community family doctor services was found among those residents of chronic diseases,those with their family′s annual average outpatient expenses in the medium level,those with their first choice of medical visits in the community health centers,and those who are aware of family doctor service.Services of the most frequent use in the recent year were physical examination and follow-up phone call(87.3% and 73.4% respectively);those of lower frequency were door-to-door service,health assessment,preventive health care,physical examination,health education and consulting,and rehabilitation service.Factors of statistical significance on utilization of community health services were health condition,financial condition and awareness of community family doctor service(P<0.05).Conclusions Residents in Beijing have a high awareness and utilization of community family doctor services,yet some items of services are seldom used.Health condition,financial condition and awareness of community family doctor service are major influential factors for utilization of community health services.

Effect assessment of the intervention by medical workers in the family doctor service system in Beijing / 中华医院管理杂志

Objective To learn the awareness,attitude and behavior changes of medical workers to the family doctor service and the influential factors on their utilization of such service since the service is in place.The purpose is to provide theoretical basis to establish the family doctor service model and the incentive mechanism in line with the development of community health service in Beijing.Methods Eight community health centers were sampled randomly from three representative areas of Haidian,Xicheng and Daxing districts,which were grouped randomly as one intervention group and one control group.All the medical workers surveyed were subj ect to the research.The control group was managed as to the existing management mode,and the intervention group was classified and managed according to the new family doctor service model.A questionnaire survey was made to collect data from the baseline and final stages.Comparisons were made among the districts,institutions,and before-after intervention of the institutions themselves to evaluate the effects of the service model and incentive mechanism.Results The survey found a higher awareness by medical workers to such service,higher recognition and satisfaction, and lower rate of services provided by medical workers.The logistic regression analysis found the influential factors for willingness of medical workers to work as family doctors,include group difference, workload changes after signoff as family doctors,residents′acceptance of the community first visit system,recognition or not for whether a family should have a community service team,residents′acceptance,and the general comments on family doctor service (P< 0.05 ).Conclusions Higher incentives of community doctors to embrace family doctor service,calls for the medical workers to change their perception,better incentive mechanism and greater promotion efforts for family doctors′services.

Compliance rate of clinic appointments among residents contracting family doctor service and its influencing factors / 中华全科医师杂志

Objective To investigate compliance rate of clinic appointments among residents contracting family doctor service and its influencing factors.Methods Total 1 442 clinic appointments among residents contracting family doctor service in Yuetan community were investigated by face to face questionnaire.Results Among 1 442 clinic appointments in Yuetan community health service center in June 2015,563 were kept with a compliance rate of 37.2％.There were significant difference in compliance rate among the residents with difference degree of education (OR =1.461,95 ％ CI:1.296-1.646,P =0.000),between those with and without chronic diseases(OR =2.009,95％ CI:1.136-3.550,P =0.016),with and without receiving first contact care at community (OR =1.360,95％ CI:1.036-1.785,P =0.027),with and without satisfying with family doctor service (OR =1.315,95 ％ CI:1.060-1.630,P =0.013),with and without recognizing clinic appointment system (OR =2.765,95％ CI:2.142-3.569,P =0.000).Among the 906 failed appointments,the reasons were forgetting the appointment in 525 (57.9％),missing the date in 124 (13.7％),time conflict in 92 (10.2％),not bring reservation form in 85 (9.4％),being hospitalized or engaging in other medical service in 41 (4.5％) andneglecting appointment system in 39 (4.3％).Conclusion Compliance rate of clinic appointments among residents contracting family doctor service is lower,and necessary measures should be taken to increase the compliance rate.