Reasons for encounter and health problems managed by general practitioners in the rural areas of Beijing, China: A cross-sectional study.

Yanli Liu,Chao Chen,Lifen Chen,Yali Zhao,Juan Du,Guanghui Jin,Xiaoqin Lu,Chris Van Weel

doi:10.1371/journal.pone.0190036

Abstract

ObjectiveThe purpose of this study was to describe the patients’ reasons for encounter (RFE) and health problems managed by general practitioners (GPs) in the rural areas of Beijing to provide evidences for health services planning and GPs training.MethodsThis study was conducted at 14 community health service centers (CHSCs) in 6 suburban districts of Beijing, using a multistage sampling method. A total of 100 GPs was selected from the study sites. A self-designed data collection form was developed on the basis of Subjective-Objective-Assessment-Plan (SOAP), including patient characteristics, RFEs, health problems, interventions, and consultation length. Each GP recorded and coded their 100 consecutive patients’ RFEs and health problems with the International Classification of Primary Care, 2nd version (ICPC-2). Descriptive statistics were employed to describe the distribution of RFE and health problems. Student t-test and analysis of variance were used to compare the differences of mean number of RFE or health problems per encounter by patient characteristics.ResultsA total of 10,000 patient encounters with 13,705 RFEs and 15,460 health problems were recorded. The RFEs and health problems were mainly distributed in respiratory, circulatory, musculoskeletal, endocrine, metabolic and nutritional, and digestive systems. Cough and hypertension were the most common RFE and health problem, respectively. With increased ages, the mean number of RFEs decreased and the mean number of health problems increased. Patients with Beijing medical insurance had less RFEs and more health problems than those in other cities (p<0.001). Patients who had visited the CHSC previously and signed contracts with the GP team had more health problems than those who had not (p<0.001).ConclusionsThese findings present a view of patients’ demands and work contents of GPs in Beijing rural areas and can provide reference for health services planning and GPs training.

Highlights

A good primary care infrastructure is positively associated with health outcomes and negatively associated with costs on health care [1]
The reasons for encounter (RFE) and health problems were mainly distributed in respiratory, circulatory, musculoskeletal, endocrine, metabolic and nutritional, and digestive systems
Reasons for encounter and health problems in rural areas of Beijing. These findings present a view of patients’ demands and work contents of general practitioners (GPs) in Beijing rural areas and can provide reference for health services planning and GPs training

Summary

Introduction

A good primary care infrastructure is positively associated with health outcomes and negatively associated with costs on health care [1]. There can’t be a good primary care system without general practice. General practice was introduced into China in 1980s. To speed up the development of general practice and improve the quality of primary care services, a series of policies including finance support, personnel training, pharmaceutical system, and health insurance were established by the Chinese government in the past 2 decades [2,3,4,5,6]. In the CHSC, the GP provides services in a team approach with nurses, and preventive medicine professionals. Patients are encouraged to sign a contract with one of the GP teams in CHSC. The team is responsible for providing continuous care and additional services for patients who have signed contracts [9]

Methods

Results

Conclusion