Abstract
BackgroundFollow-up care is crucial but challenging for disease management particularly in rural areas with limited healthcare resources and clinical capacity, yet few studies have been conducted from the perspective of rural primary care physicians (PCPs). We assessed the frequency of follow-up care delivered by rural PCPs for hypertension and type 2 diabetes – the two most common long-term conditions.MethodsWe conducted a multi-centre, self-administered survey study built upon existing general practice course programmes for rural PCPs in four provinces. Information on follow-up care delivery were collected from rural PCPs attending centralised in-class teaching sessions using a set of close-ended, multiple choice questions. Binary logistic regression analysis was performed to examine physician-level factors associated with non-attainment of the target frequency of follow-up care for hypertension and type 2 diabetes, respectively. The final sample consisted of rural PCPs from 52 township-level regions. The Complex Samples module was used in the statistical analysis to account for the multistage sample design.ResultsThe overall response rate was 91.4%. Around one fifth of PCPs in rural practices did not achieve the target frequency of follow-up care delivery (18.7% for hypertension; 21.6% for type 2 diabetes). Higher education level of physicians, increased volume of daily patients seen, and no provision of home visits were risk factors for non-attainment of the target frequency of follow-up care for both conditions. Moreover, village physicians with less working experiences tended to have less frequent follow-up care delivery in type 2 diabetes management.ConclusionsEfforts that are solely devoted to enhancing rural physicians’ education may not directly translate into strong motivation and active commitment to service provision given the possible existence of clinical inertia and workload-related factors. Risk factors identified for target non-attainment in the follow-up care delivery may provide areas for capacity building programmes in rural primary care practice.
Highlights
As the major preventable risk factors for cardiovascular disease (CVD) and premature death, hypertension and type 2 diabetes present long-lasting challenges to globalWang et al BMC Family Practice (2021) 22:224 public health as reflected by the enormous burden of morbidity and disability [1,2,3]
The health management of hypertension and type 2 diabetes are free-of-charge items included as part of the basic public health (BPH) service package to enhance the capacity building for community-based disease prevention and health promotion that are responsive to community healthcare needs
Characteristics of survey participants A total of 602 rural primary care physicians (PCPs) responded to the survey, with an overall response rate of 91.4%
Summary
As the major preventable risk factors for cardiovascular disease (CVD) and premature death, hypertension and type 2 diabetes present long-lasting challenges to globalWang et al BMC Family Practice (2021) 22:224 public health as reflected by the enormous burden of morbidity and disability [1,2,3]. A highlight of national efforts to address healthcare gaps in China is the delivery of basic public health (BPH) service in primary care settings underpinned by government investment at both national and local levels to strengthen preventive health care [10, 11]. In rural regions, those who have completed nationally-accredited medical study curriculum at secondary education level or above are eligible for working as village physicians. We assessed the frequency of follow-up care delivered by rural PCPs for hypertension and type 2 diabetes – the two most common long-term conditions
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