Community Health Service Institutions Research Articles

Constructing a Competency Training Index System in Public Health Emergencies for Community Nurses.

A competency training index system was designed in public health emergencies for community nurses. The purpose of this approach is to provide community nurses with guidelines for standardized training programs on how to respond to public health emergencies. Through semi-structured interviews, a literature review, and team discussion, the first draft of competency training index system in public health emergencies for community nurses was formed. The Delphi method was used for two rounds of expert consultation to screen, modify and determine indicators. Finally, the analytic hierarchy process was utilized to calculate the weights of indicators at all levels. A total of 15 expert consultants were included. The effective recovery rate of the two rounds of expert consultation questionnaire was 100%, the expert authority coefficient was 0.880, 0.887, and the Kendall coordination coefficient was 0.172 and 0.171 (p < 0.001). Expert opinions have determined that the final revised competency index system in public health emergencies for community nurses training consists of 2 primary indicators, 10 secondary indicators, and 46 tertiary indicators. The study has developed a competency training index system in public health emergencies for community nurses. This system can serve as a foundation for standardized training in community health service institutions. It is characterized by its high demand, scientific approach, reliability, and rationality.

Analysis of blood glucose control and influencing factors in 18-64 year-old community people with type 2 diabetes in Shenzhen

Objective: To describe the current situation of blood glucose control in 18-64 year-old people with type 2 diabetes in the Shenzhen community and analyze the influencing factors to provide a reference for enhancing the management effect of type 2 diabetes in community health service institutions. Methods: The data were from the Shenzhen Community Health Service Information System. A cross-sectional survey design was adopted to include 18-64 year-old patients with type 2 diabetes in Shenzhen community health service institutions in 2022. The blood glucose control rate was calculated through the physical examination data recorded by the information system in 2022, and the influencing factors of blood glucose control in this group of patients were analyzed using a multivariate logistic regression model. Results: A total of 120 174 patients were included in the study. The blood glucose control rate was 53.04%. The results of multivariate logistic regression analysis showed that women (OR=1.07, 95%CI: 1.04-1.10), ages 45-54 (OR=1.10, 95%CI: 1.01-1.19), 55-64 (OR=1.24, 95%CI: 1.14-1.35), middle school (OR=1.09, 95%CI: 1.05-1.13), high school and technical secondary school (OR=1.26, 95%CI: 1.21-1.31), junior college or above (OR=1.75, 95%CI: 1.67-1.83), basic medical insurance for urban employees (OR=1.05, 95%CI: 1.01-1.08), weekly exercise (OR=1.26, 95%CI: 1.22-1.31), daily exercise (OR=1.31, 95%CI: 1.28-1.35) and combined hypertension (OR=1.21, 95%CI: 1.18-1.24) were more likely to reach the standard of blood glucose control; while unmarried (OR=0.85, 95%CI: 0.77-0.95), divorced (OR=0.84, 95%CI: 0.73-0.97), insurance status was fully self-funded (OR=0.95, 95%CI: 0.91-0.99), disease duration was 5- years (OR=0.65, 95%CI: 0.63-0.66), ≥10 years (OR=0.41, 95%CI: 0.39-0.42), the treatment method was diabetes drug therapy (OR=0.74, 95%CI: 0.71-0.76), low weight (OR=0.89, 95%CI: 0.80-1.00), obese group (OR=0.85, 95%CI: 0.82-0.88), combined with central obesity (OR=0.83, 95%CI: 0.81-0.86), combined with dyslipidemia (OR=0.69, 95%CI: 0.68-0.71), current smoking (OR=0.74, 95%CI: 0.72-0.77), and current drinking (OR=0.97, 95%CI: 0.93-1.00) were less likely to reach the standard of blood glucose control. Conclusions: The blood glucose control rate of 18-64 year-old people with type 2 diabetes in Shenzhen still has room for improvement. More attention should be paid to 18-64 year-old patients with type 2 diabetes, especially for patients with dyslipidemia, central obesity, and diabetes with a long course, and supervision and guidance should be strengthened for patients with bad habits such as smoking, drinking alcohol, and lack of exercise.

A community proactive health management model for family doctors in Shandong, China.

Background Chronic disease management is an essential part of public health management and a fundamental means of slowing down the progression of major diseases. Unlike traditional medical care, proactive health management focuses on the combination of prevention and treatment. Proactive health management can reduce the re-admission rate of patients with chronic diseases, improve long-term prognosis, and effectively reduce the disability and mortality rates of major health events. This study aimed to establish a proactive health management model based on a grid-based medical service team arrangement, and to explore the effect of this model on managing chronic diseases in community health service institutions. Methods A grid-based medical service team was established in Binzhou, Shandong, China, consisting of general practitioners, nurses, public health doctors, health promoters and community grid liaison staff. Each team was responsible for several areas to monitor critical populations within the grid and compile statistics on the health management of these key populations in 2022-2023. Results A total of 2050 patients with coronary artery disease, 4973 patients with hypertension, and 1621 patients with type 2 diabetes were followed up in 2022. Compared with 155,612 resident health records in 2022, the number of records increased by 140.50% in 2023. The number of patients with hypertension under health management in 2023 increased by 50.92%; patients with type 2 diabetes increased by 74.65%; and the number of coronary artery disease increased by 42.00%. After the implementation of grid management, the hospitalisation rate for patients with type 2 diabetes significantly decreased in 2023 (P P >0.05). Conclusion The grid-based community proactive health management model makes full use of the advantages of community resources and improves the pertinence and coverage of community health services. Moreover, it reduces hospitalisation for patients with type 2 diabetes.

Analysis on the relationship between professional identity and turnover intention among general practitioners: The mediating role of job burnout

ObjectiveWe aimed to understand the current situation and contributory factors associated with professional identity, turnover intention and job burnout among general practitioners (GPs) in eastern, central and western China. MethodsA total of 3244 GPs from community health service institutions in 12 provinces of China were recruited, from October 2017 to February 2018. Demographic information such as sex, region and mode of employment was sought, and issues regarding job burnout, professional identity and turnover intention of GPs were measured with the corresponding scale, and softwares such as SPSS and AMOS were used. T-test, analysis of variance, and covariance matrix were used for analysis. ResultsThe average total scores of job burnout, turnover intention and professional identity of GPs in China were 44.12, 15.07 and 51.23, respectively. The results of intermediary effect analysis showed that in the GPs group, there were differences in the distribution of the three indicators. Professional identity had a significant negative effect on job burnout (β = −0.373), while job burnout had a significant positive effect on turnover intention (β = 0.528), and job burnout had an indirect effect in the relationship between professional identity and turnover intention. Job burnout played an intermediary role in professional identity and turnover intention. ConclusionsThe turnover intention of GPs in China has improved, but it is still at a high level. Job burnout plays an intermediary role between professional identity and turnover intention.

Influence Factors for Family Physician Contract Services’ Motivation in China: An Empirical Analysis From Jiangsu Province

Since the medical reform implemented by the Chinese government in 2016, more attention has been paid to family doctors and the key role they play in safeguarding citizens’ health. Therefore, it is necessary to explore the factors that affect the motivation of family doctors to provide contracted services. In this study, factors influencing the motivation of family doctors to provide contract services are divided into intrinsic motivation and extrinsic motivation. Intrinsic motivation includes family doctors’ sense of professional belonging, occupational motivation, and occupational efficacy, while extrinsic motivation includes the attraction, support, and promotion of contract services, as well as pressure from government and community health service institutions. And the environment in which family doctors operate during their contracted services. The questionnaire was designed with a sample size of 536 family doctors in Jiangsu Province using logical reasoning method. Stata16 software is used for empirical analysis using linear regression method. The empirical analysis is conducted using the linear regression method. A family physician’s motivation is categorized into two perspectives: intrinsic and extrinsic motivation. Significant findings unveiled that; (i) Family physicians’ sense of professional belonging ( β = .026, p &lt; .01), professional motivation ( β = .076, p &lt; .05), and professional efficacy ( β = .148, p &lt; .01) had a significant positive on their contract services, (ii) Promotion ( β = .085, p &lt; .01), the attractiveness of family physicians’ contract services ( β = .092, p &lt; .01) and contract service support ( β = .137, p &lt; .01) showed a positive effect, whereas (iii) intense pressure ( β = −.079, p &lt; .01) experienced by family physicians could negatively affect their contract services. Among the intrinsic and external factors, only intense pressure negatively affects family physician contracted services. This finding indicates that decision-makers should adopt feedback mechanisms at the various health levels to encourage workers to measure motivational levels and output themselves.

Impact of smart health systems on the behavior of older adults under community healthcare.

With the trend of world population aging, a good community health care system will determine whether the elderly can get good medical conditions. How to improve the community health care system can study how the behavior of the elderly affects it. This paper is based on the analysis of the current situation of population aging at home and abroad. On the premise of analyzing the demand and behavior of elderly people seeking medical treatment and the function of community health service institutions. Literature research was conducted to analyze the influencing factors of community health care needs and elderly people's medical seeking behavior at home and abroad. Then the elderly in Tianjin were investigated by issuing questionnaires, and the law of medical treatment behavior of the elderly in Tianjin was calculated. Combined with the results of relevant investigations abroad, the common phenomenon is summarized. Finally, the analysis method of intelligent medical system is proposed, and the design process of system acquisition module and user usage mode are given. The smart medical system can bring great convenience to the elderly and community healthcare. It emphasizes the powerful functions of smart health systems and their future importance for the health care of the elderly.

Factors influencing self-care behaviours of patients with type 2 diabetes in China based on the health belief model: a cross-sectional study

ObjectivesThe study aimed to explore the status and predictors of self-care behaviours in patients with type 2 diabetes in China based on the health belief model.DesignThe cross-sectional study included 1140...

Work Content of General Practitioners in Beijing, China: A Multi-method Study.

BackgroundDespite the dramatic growth of primary care in China, little evidence showed what general practitioner (GP) do and how GP provided medical service in Beijing.ObjectiveThis study aimed to explore the work content of GPs in primary care in Beijing.MethodsA multi-method study was conducted in five community health service institutions using non-participant observation and critical incident technique interview. Eleven GPs was recruited by purpose sampling, with each GP recording details of 100 patient encounters. Health problems of patients and activities of GPs were observed in consultations. Then, critical incident technique interviews were conducted focusing on GPs' works out of clinics and challenge.ResultsA total of 1, 100 patients encounters and 1,897 reasons for encounter (RFEs) were recorded from 11 GPs. There were 1897 RFEs (1.72 per encounter) and 2,762 health problems (2.51 per encounter) from 1,100 encounters during our observation. GPs' work related to consultation was focus on disease diagnoses and treatment. Physical examination and investigations were performed in only 15.5 and 17.1% consultations, respectively. Procedures for chronic disease management were infrequently provided to patients (0.4–26.6%). Time spent in each work process in consultations ranged from 0.68 ± 0.27 min for reservation to 4.00 ± 2.45 min for surgical treatment. In addition to clinical work, there were tasks about health files, contracted family doctor services, health education, teaching students, and scientific research.ConclusionThis study illustrated the complexity of GPs' work and heavy workload in Beijing, China. More attention and effort are needed to develop GPs performance and release GPs' work workload in primary care.

Challenges faced by Chinese community nurses when providing home-based hospice and palliative care: a descriptive qualitative study

BackgroundHospital facilities in China are experiencing increased strain on existing systems and medical resources, necessitating the use of home-based hospice and palliative care (HBHPC). HBHPC primarily relies on community nurses and related medical personnel. Understanding the challenges that community nurses face when providing this form of care is urgently needed to optimize the design and delivery of HBHPC. Our study aimed to gain insight into community nurses’ challenges when providing HBHPC for patients.MethodsWe performed a descriptive qualitative study using a phenomenology approach. Purposive sampling was used to recruit 13 nurses from two community health service centers in Jinan, Shandong Province, China. A thematic analysis was applied to identify themes from the transcribed data.ResultsThree major themes emerged: 1) Community nurses’ inadequate self-preparation for providing HBHPC; 2) Patients and their families’ non-collaboration in HBHPC; 3) Community health service career disadvantages. Many negative experiences can be attributed to institutional barriers.ConclusionCommunity nurses faced multifaceted challenges in home care settings. This study could provide a framework for guiding the improvement of interventional variables in the provision of HBHPC. Future research should involve developing effective methods of improving community nurses’ job motivation and community health service institutions’ incentive systems, as well as increasing advocacy around HBHPC.

Physical examination performed by general practitioners in 5 community health service institutions in Beijing: an observational study

BackgroundPhysical examination is a core component of consultation. Little is known about the status quo of physical examinations performed by general practitioners in community health service institutions in China. The aim of this study was to investigate general practitioners’ performance of physical examinations in consultations.MethodsAn observational study was conducted in 5 community health service institutions in Beijing between November 2019 and January 2020. Eleven general practitioners were observed for one workday. Information of consecutive consultations was recorded including patient characteristics, reasons for encounter, physical examinations performed by general practitioners, length of consultation time and time spent on specific activities in consultations.ResultsA total of 682 consultations of 11 general practitioners were recorded. Physical examinations were performed in 126 consultations (15.8%). Physical examination was more likely to be performed in patients visiting with symptoms (P < 0.001). Majority of the 126 physical examinations were distributed in “Head, face, and neck examination” (n = 54, 42.9%) and “Cardiovascular examination” (n = 55, 43.7%). No physical examination was performed on skin, male genitalia, female breasts and genitalia, and neurological systems. Total 2823 min of activities were observed and recorded. General practitioners only spent 3.1% of the recorded time on physical examination, which was less than the time spent on taking history (18.2%), test (4.9%), diagnosis (22.7%), therapy (38.4%), and health education (8.6%). The average time spent on physical examinations was 0.8±0.4 min per consultation.ConclusionPhysical examination was insufficiently performed by general practitioners in community health service institutions in Beijing. More time and commitment should be advocated for improving the quality of physical examinations in primary care.

Does Internet Use Affect Medical Decisions among Older Adults in China? Evidence from CHARLS.

Background: The rapid growth of the elderly population poses a huge challenge for people to access medical services. The key to get rid of the dilemma is for patients to go firstly to primary medical institutions. Existing studies have identified numerous factors that can affect patients’ health institution choice. However, we currently know little about the role of Internet use in the patients’ medical decisions. The objective of this study is to explore health-seeking behavior and institution choice under the background of the Internet era from the perspective of older adults, and to analyze whether the Internet could guide patients to the appropriate medical institution so as to accomplish hierarchical treatment. Methods: The dataset comprises 9416 people aged 45 or above from the China Health and Retirement Longitudinal Survey (CHARLS), which, through multistage cluster sampling, was conducted in 2011, 2013, and 2015. Logistic regression, PSM, and FE model are used to estimate the influence of Internet use on the health care decision-making behavior. Results: Internet use has a significant positive impact on the self-treatment of common diseases (β = 0.05, p < 0.05). In terms of medical institution choices, those who use Internet are more inclined to choose top-level hospitals than community health service institutions to treat common diseases (β = 0.06, p < 0.01). Conclusions: The Internet has lowered the obstacles to learning about common ailments, resulting in a substitution impact of self-treatment for hospital care. However, Internet use may aggravate older adults’ perception of the risk of disease, which exacerbates the tendency of going to higher-level medical institutions for medical treatment. The finding of the study is useful for further rational planning and utilization of the Internet in order to guide patients to appropriate medical institution, which helps to improve the efficiency of the overall medical and health services.

Do Migration Characteristics Influence the Utilization of Basic Public Health Services in Internal Elderly Migrants in China?

Background: The literature shows that migration characteristics are a potential pathway through which migration can influence basic healthcare service utilization. The goal of the study was to explore the effect of migration characteristics on the utilization of basic public health services for internal elderly migrants in China and to identify the pathways that might promote their utilization of basic public health services.Methods: We studied 1,544 internal elderly migrants. The utilization of basic public health services was determined through participation in free health checkups organized by community health service institutions in the past year. Migration characteristics were represented by years of residence and reasons for migration. Other variables included demographic characteristics and social factors, e.g., the number of local friends and exercise time per day were measured to represent social contacts. Multivariate binary logistic regression was employed to explore the association of the variables with the likelihood of using community health services.Results: A total of 55.6% of respondents were men, and the mean age was 66.34 years (SD 5.94). A low level of education was observed. A total of 59.9% of migrants had been residents for over 10 years, and the main reason for migrating was related to family. Of these migrants, 12.9% had no local friends. Furthermore, 5.2% did not exercise every day. Social contacts were complete mediators of the impact of migration characteristics on the utilization of primary healthcare.Conclusion: Our study highlighted the mediating role of social factors in the relationship between migration characteristics and the utilization of basic public health services among Chinese internal elderly migrants. The findings supported the need to increase the opportunities for social contacts between local elderly individuals and internal elderly migrants.

Comparison of the caregivers\u2019 and community health professionals\u2019 views on home health care services for disabled older adults: a cross-sectional study in Beijing, China

BackgroundIn an era of an increasingly ageing society, part of healthcare for older adults can be provided in patients’ homes, and the need for home health care services (HHCSs) is increasing. This study sought to determine whether a gap exists between the views of community health professionals and the caregivers of disabled older adults towards HHCSs in Beijing, China.MethodsA cross-sectional study with two comparative questionnaire surveys was conducted in Beijing, China. One survey was administered to the caregivers of disabled older adults, and the other was administered to health professionals in community health service institutions (CHSIs). T-tests and Wilcoxon signed-rank tests were used to explore potential differences between the views of caregivers and community health professionals towards HHCSs.ResultsWe received 370 valid questionnaires from caregivers and 224 questionnaires from health professionals. Of the 370 caregivers, 314 (84.9%) were willing to apply for HHCSs for the older adults, but only 20.5% (N = 76) received HHCSs. Over 80% of the caregivers accepted out-of-pocket costs less than 100 yuan per visit. Caregivers’ demands on home nursing services were significantly higher than those of health guidance services (Z = − 7.725, P < 0.001). Most of the 224 health professionals chose “health professionals’ personal safety cannot be guaranteed” as a problem limiting the provision of HHCSs (N = 151, 40.8%). The health professionals’ attitudes towards home nursing services were significantly less positive than those towards health guidance services (Z = − 10.081, P < 0.001). For home nursing services, health professionals’ attitude scores were lower than the caregivers’ demand scores (Z = − 4.960, P < 0.001), while for health guidance services, health professionals’ attitude scores were higher than the caregivers’ demand scores (Z = − 8.373, P < 0.001).ConclusionsGaps exist between the views of caregivers and health professionals on HHCSs. Compared to health professionals with a higher willingness to provide health guidance services, caregivers need home nursing services. Feasible policies should be implemented to safeguard the rights and interests of health professionals, and qualified health professionals should be trained for HHCSs.

Situation of Integrated Eldercare Services with Medical Care in China

There are clinics around nursing homes in foreign countries or family doctors for every elderly. When a disease occurs, doctors can provide door to door service to help patients. Since the epidemic of coronavirus disease 2019, the elderly have been a high risk group of people infected with coronavirus disease 2019. In both the United States and Canada, the first recorded coronavirus disease 2019 deaths and outbreaks occurred in nursing homes with case fatality rates in these settings reported to be as high as 33.7 %. Due to the lack of adequate medical facilities and adequate medical staff to provide services, the elderly are more likely to be infected with the virus as a result of social interaction. All these show that foreign models can no longer meet the medical needs of the elderly. Therefore, we should take a different perspective and combine pension services with medical care. At present, China is exploring the mode of combination of medical and nursing services. In this study, we investigated the current situation of integrated medical and nursing services in China, exploring the transformation of primary medical institutions into medical and nursing service providers. The integrated eldercare services with medical care is that we make use of the existing medical resources to provide care services, which can meet the health needs of the elderly and reduce the infection rate of the elderly. Using a self-administered or interview questionnaire survey, we conducted t-test and one-way analysis of variance. It was found that the elderly are most satisfied with the geographical location (90.84 %) and medical services (90.82 %), and the most dissatisfied with consultation (87.66 %) and institutional fees (87.23 %). The elderly with the older age, the higher the monthly income of more than 3000 yuan, marriage and chronic diseases, are highly satisfied with their community health service institutions (p<0.05). Through one-way analysis of variance, there were significant differences in medical and health service demand among the groups with different monthly income (f=5.289 and 5.312, p<0.05), different occupation (f=5.574 and 2.325, p<0.05), and different ideal mode of providing for the aged (f=5.237, p=0.002<0.05). By independent sample t test, it was found that there were significant differences in basic medical service demand and health guidance service demand between people with chronic diseases and those without chronic diseases (p<0.05), and those who were willing and unwilling to use information technology for disease management (p<0.05). Through regression analysis, we can see that age (t=4.411, p<0.05) and income (t=2.061, p<0.05) have significant influence on basic medical service among the three variables of age, education and monthly income, and the coefficient is positive. Age (t=2.508, p<0.05) and income (t=3.143, p<0.05) had significant influence on rehabilitation guidance service, and the coefficient was positive. In summary, age, income, occupation, whether suffering from chronic diseases, whether they are willing to use information technology to detect and manage diseases and other factors, all affect the demand of the elderly for basic medical services and rehabilitation guidance services in medical service institutions. Through the research on the current situation of the integrated medical and nursing services in China, this study enriches the relevant evidence of the integrated medical and nursing services, and has a certain reference value for the relevant management departments to formulate policiesis.

Analysis on Space accessibility of Medical Service Facilities in Central Wuhan Based on Improvement of 2SFCA

Aiming at the current imperfect hierarchical diagnosis and treatment system and the unreasonable spatial distribution of medical facilities. This article introduces 2SFCA model improved by the Gaussian distance decay function and multiple stage radius to evaluate the accessibility of medical facilities in Wuhan. The results indicate that: firstly, compared with the traditional 2SFCA model, the improved 2SFCA model is more sensitive to the identification of spatial accessibility, and the transition effect of the identification results is more obvious, which can accurately reflect the spatial distribution characteristics of the accessibility of medical facilities in Wuhan. Secondly, the distribution of medical facilities in Wuhan is obvious and the main factors that affect the accessibility value in different urban areas are quite different. Thirdly, the high value areas of medical facilities in the main urban area of Wuhan are mainly concentrated within the second ring line, the transition effect between the second and third ring lines is obvious, and the low value areas are mainly concentrated outside the third ring line. In the end, the main reasons for the low accessibility of the area outside the Third Ring Road are the low service quantity and low service ability of the community health service institutions and the high traffic resistance. The research results can provide a reference for the layout and planning of medical institutions in the main urban area of Wuhan.

Analysis on professional identity and related factors among Chinese general practitioners: a National Cross-sectional Study

BackgroundStudies on professional identity and related factors among Chinese general practitioners (GPs) are unavailable. The objective of this study was to investigate the professional identity level of GPs in China and explore factors associated with GPs’ perceptions of their professional identity.MethodsA multistage stratified random sampling method was used to collect data with a structured self-administered questionnaire from 3236 GPs working in community health service institutions (CHIs) in China between October, 2017 and February, 2018. Professional identity was measured by the 13 items scale. Descriptive statistics were calculated and groups’ differences were estimated using nonparametric tests. Multiple linear stepwise regression analysis was used to analyze factors associated with professional identity among GPs.ResultsBased on a total score of 65 on the professional identity scale, the average score for GPs’ professional identity was 51.23 (SD = 6.56). Multiple linear stepwise regression analysis showed that GPs who practiced in Central China, with an administrative responsibility, at a moderate or higher income level, who frequently worked overtime, had more occupational development opportunities, with a higher level of job satisfaction and older GPs had higher levels of professional identity.ConclusionsProfessional identity level among GPs in China is high. Region, administrative responsibility, income level, working overtime, occupational development opportunities, age, and job satisfaction were significant predictors of professional identity.

Application of Four in One model for diabetes management in hospital consortium

In 2017, the Diabetes Management Center was founded in Shandong Third Provincial Hospital. On the basis of the center, a network was established which integrated the tertiary hospital, district hospitals, community health service institutions and family of patients forming the Four in One model of diabetes management. This article introduces the background, application, and preliminary accomplishments in individualized and standardized diabetic management of this internet plus model. The challenges and suggestions for future development of theFour in One model are also discussed. Key words: Disease management; Diabetes; Computer communication networks; Progressive patient care; Hospital shared services

Efficiency and coordination of medical service in community health service centers of Shanghai Pudong New Area

Data were collected from national health statistics reports and grassroots health comprehensive reform monitoring reports to survey the workload, service efficiency and regional medical coordination in community health service centers in Shanghai Pudong New Area.The efficiency of basic medical services and basic public health services in Pudong New Area increased yearly from 2010 to 2016. The improved capacity of community health service institutions included: mutual recognition of investigation with superior hospitals, the sharing of test results and test equipment in the region, and achieving remote consultation with superior hospitals. With the continuous improvement, more medical services can be provided in community health centers in Shanghai Pudong New Area, resulting in the increased workload of medical staff. The coordination of regional institutions further promotes the implementation of tiered medical service system. Key words: Community health services; Service efficiency; Synergy

The training contents, problems and needs of doctors in urban community health service institutions in China

BackgroundThe Chinese government offered various types of training programs for strengthening the role of doctors working in community health service institutions (CHSIs). The study intended to investigate the current training programs and training needs of doctors nationally in urban CHSIs in China, and to provide propositions for training more qualified doctors in the future.MethodsTotal 3098 doctors in 192 urban CHSIs were chosen from 9 provinces (Hebei, Liaoning, Shandong, Zhejiang, Fujian, Hunan, Guangxi, Guizhou, Ningxia) and one municipality (Beijing) among 31 provinces in eastern, central, and western regions by stratified sampling methods in Mainland China. All doctors in the selected CHSIs were investigated in this study. We discharged 3073 questionnaires, and the response rate was 98.0%. Descriptive statistics were used to describe the characteristics, training contents, problems and needs of doctors. Differences in training contents, problems and needs between eastern, central and western regions were analyzed with chi-square tests.Results49.3% of doctors in CHSIs had Bachelor’s degree and beyond. 12.9% of doctors had senior professional titles. The most frequent training topics for the doctors in eastern, central and western regions were “basic clinical theory knowledge” (52.4%), “community health service competency” (59.6%), “clinical practice skills” (45.9%) respectively. The most serious problem for doctors was “insufficient training time” in eastern (36.8%), central (36.5%) and western (39.6%). The biggest knowledge need for doctors both in eastern (79.8%) and central region (79.1%) was “the updated international medical knowledge”, in western region it was “the updated domestic medical knowledge” (73.2%). The biggest skill-related training need for doctors in eastern region (84.1%) and central region (82.6%) was “communication skills”, and “diagnosis and differential diagnosis” in western region (78.2%).ConclusionGovernment should design proper training contents according to the knowledge and skill needs of different design. Furthermore, a uniform, rigorous training and evaluation system focus on practicability should be established to promote community health service system in Mainland China.

Exploration and practice of " combination of general practice with specialties" model in community health service institutions

Community health service is an important part of the health system reform in the new period in China, the community health service institutions play important roles in promoting the health reform and the development ofthe national medical and health service. Shanghai Fenglin Subdistrict Community Health Service Center has integrated general practice with specialist care for the patients in community health service, this article summarizes the exploration and practice of the combination of general practice with specialties model in the community health service in order to provide reference for relevant medical institutions. Key words: Community health service; General medicine; Medical model