Community Medical Institutions Research Articles

Community medical service construction: identifying factors that influence medical choice for patients with non-communicable chronic diseases in the Southwest China

BackgroundCommunity medical institutions play a vital role in China’s healthcare system. While the number of these institutions has increased in recent years, their construction contents remain insufficient. The potential of community medical institutions in preventing, screening, diagnosing, and treating non-communicable chronic diseases (NCDs) has not been fully utilized. This study aims to assess the status of construction contents in community medical institutions in Southwest China and examine how these contents influence the medical choices of NCD patients.MethodsDescriptive statistics were used to evaluate the construction content of community medical institutions. Multiple-sets of multinomial logistic regression were employed to analyze the associations and marginal impacts between construction content and medical choices. Shapley value analysis was applied to determine the contribution and ranking of these impacts.ResultsDescriptive statistics revealed satisfactory construction contents in community medical institutions. Notably, factors such as service attitude, nursing services, expert consultations, charging standards, medical equipment, medical examinations, privacy protection, and referrals significantly influenced medical choices. Among these, service attitude, charging standards, and privacy protection had the most significant marginal improvement effects on NCD patients’ choices, with improvements of 12.7%, 10.2%, and 5.9%, respectively. The combined contribution of privacy protection, medical examinations, service attitude, charging standards, and nursing services to medical choices exceeded 80%.ConclusionOptimizing the service contents of community institutions can encourage NCD patients to seek medical care at grassroots hospitals. This study addresses crucial gaps in existing literature and offers practical insights for implementing new medical reform policies, particularly in underdeveloped regions of Southwest China focusing on hierarchical diagnosis and treatment.

Using sustained vowels to identify patients with mild Parkinson's disease in a Chinese dataset.

Parkinson's disease (PD) is the second most common neurodegenerative disease and affects millions of people. Accurate diagnosis and subsequent treatment in the early stages can slow down disease progression. However, making an accurate diagnosis of PD at an early stage is challenging. Previous studies have revealed that even for movement disorder specialists, it was difficult to differentiate patients with PD from healthy individuals until the average modified Hoehn-Yahr staging (mH&Y) reached 1.8. Recent researches have shown that dysarthria provides good indicators for computer-assisted diagnosis of patients with PD. However, few studies have focused on diagnosing patients with PD in the early stages, specifically those with mH&Y ≤ 1.5. We used a machine learning algorithm to analyze voice features and developed diagnostic models for differentiating between healthy controls (HCs) and patients with PD, and for differentiating between HCs and patients with mild PD (mH&Y ≤ 1.5). The models were independently validated using separate datasets. Our results demonstrate that, a remarkable diagnostic performance of the model in identifying patients with mild PD (mH&Y ≤ 1.5) and HCs, with area under the ROC curve 0.93 (95% CI: 0.851.00), accuracy 0.85, sensitivity 0.95, and specificity 0.75. The results of our study are helpful for screening PD in the early stages in the community and primary medical institutions where there is a lack of movement disorder specialists and special equipment.

Policy Evaluation of Primary Care Doctor Practice Based on PCMH in Shenzhen

This work is to conduct a comprehensive policy evaluation of the Patient-Centered Medical Home (PCMH) in Shenzhen since the year of 2009. Main stakeholders of the primary care policy are community residents, government, general hospitals, health agencies, community service providers and medical insurance institutions, drug suppliers. Equity is improved through better community service coverage condition, increase of outpatients in community health service centers, decrease in medical expenditure and the implementation of zero price addition policy of drugs. Better performance in terms of public health cost saving upon primary care doctor policy based on PCMH in Shenzhen are reflected in the reduced proportion of government grant by 7.1%. Each community health service center provided medical services are increased from an average of 97.1 to 156.1 person-times per day, and every doctor servicing with an average of 27.1 to 53.2 person-times per day from 2009 to 2013. Every 1 million from government found brings 2.2 million in operational revenue in 2013, with ratio 1:2.2 compared to 1:1.6 in 2008. Based on the findings from this policy evaluations, it appears that the introduction of PCMH model in public health may improve health care equity, efficiency of community service utilization and cost saving in Shenzhen. However, the extent in which PCMH might be useful also depends on the stakeholders’ effort, as well as the validity of the data used in this evaluation report.

The Current Situation and Legal Improvement of Home Care in Community Medical Institutions from a Population Ageing Perspective

The Current Situation and Legal Improvement of Home Care in Community Medical Institutions from a Population Ageing Perspective

A structural equation modelling analysis: interprofessional team collaboration, organizational career management, and post competency of community nurses

BackgroundWith the advent of an ageing society and an increase in the prevalence of chronic diseases, the role of primary health care has become increasingly important and reliant on multidisciplinary collaboration. As members of this interprofessional cooperative team, community nurses play a dominant role. Thus, the post competencies of community nurses study deserve our attention. In addition, organizational career management can affect nurses in some ways. This study aims to examine the current situation and relationship among interprofessional team collaboration, organizational career management and post-competency of community nurses.MethodsA survey was conducted among 530 nurses in 28 community medical institutions from November 2021 to April 2022 in Chengdu, Sichuan Province, China. Descriptive analysis was used for analysis, and a structural equation model was used to hypothesize and verify the model. A total of 88.2% of respondents met the inclusion criteria and did not meet the exclusion criteria. The main reason nurses gave for not participating was that they were too busy.ResultsAmong the competencies on the questionnaire, ensuring quality and helping roles scored the lowest. The teaching-coaching and diagnostic functions played a mediating role. Nurses with greater seniority and those who were transferred to administrative departments had lower scores, and the difference was statistically significant (p < 0.05). In the structural equation model, CFI = 0.992 and RMSEA = 0.049, which shows that the model fit well, suggesting that organizational career management had no statistically significant effect on post competency (β = -0.006, p = 0.932) but that interprofessional team collaboration had a statistically significant effect on post competency (β = 1.146, p < 0.001) and organizational career management had a statistically significant effect on interprofessional team collaboration (β = 0.684, p < 0.001).ConclusionsAttention should be given to the improvement of community nurses' post competency in ensuring quality and performing helping, teaching-coaching, and diagnostic roles. Moreover, researchers should focus on the decline in community nurses' abilities, particularly for those with greater seniority or in administrative roles. The structural equation model shows that interprofessional team collaboration is a complete intermediary between organizational career management and post competency.

Level of knowledge on low-dose CT lung cancer screening in Sichuan province, China: a cross-sectional study

ObjectivesLow-dose CT (LDCT) can help determine the early stage of lung cancer and reduce mortality. However, knowledge of lung cancer and lung cancer screening among community residents and medical workers,...

Dilemma and breakthrough of acupuncture-moxibustion department under the situation of rapid expansion of hospital

Under the situation of the rapid expansion of hospital, the dilemma of acupuncture-moxibustion department, as well as the relevant solutions are explored. The main reasons for the shrinking situation of the service in acupuncture-moxibustion department include: the disease-based department division trends to divert many diseases suitably treated in acupuncture-moxibustion department; the environment pursuing economic benefits restricts the development of acupuncture-moxibustion therapy characterized by "simple and low-cost operation". There are three important approaches for breaking through the dilemma of acupuncture and moxibustion therapy. First, modifying the traditional service mode as waiting for patients in acupuncture-moxibustion department and promoting acupuncture and moxibustion technology to be adopted in other departments rather than limited only in acupuncture-moxibustion department. Second, increasing the charges of acupuncture and moxibustion technology rationally. Third, positioning accurately the role of acupuncture and moxibustion technology in health services based on its own characteristics and advantages and promoting it in community medical institutions. All of these solutions require the guidance of supporting policies.

Influential Pathways of Employees’ Career Growth: Linkage of Psychological and Organizational Factors Based on Qualitative Comparative Analysis

Implementing the “hierarchical diagnosis and treatment” system highlights the important role of general practitioners as “residents’ health gatekeepers.” Still, the low level of career growth always limits the realization of their service value. Inertial thinking uses a single factor to explain the complexity of career growth in previous studies; in fact, it isn’t easy to assess whether the factor is a sufficient and necessary condition for a high level of career growth. Herein, we have used a set theory perspective to analyze the mechanism of influencing high-level career growth by combining psychological and organizational factors. This research aims to analyze causal complexity relationship between these conditions and results is analyzed in detail. We choose fuzzy-set qualitative comparative analysis (fsQCA) with a sample of 407 GPs to test 5 antecedent conditional variables that can affect their career growth. The variables include professional identity, self-efficacy, achievement motivation, training mechanism, and incentive mechanism. To ensure the universality and diversity of data, the samples were selected from community medical institutions in different regions of China. The results show that three pathways can affect the high career growth of GPs, and the optimal pathway A2 is the linkage matching of high incentive mechanism, high professional identity, high achievement motivation, and high self-efficacy. At the same time, we find that professional identity plays an alternative role in the three pathways. When professional identity is at a high level, as long as achievement motivation and self-efficacy are superior, or achievement motivation, self-efficacy, and achievement motivation are superior, a high level of career growth can be achieved. We broke the shackles of previous studies that only focused on the impact of single factors on the career growth of GPs. From the perspective of set theory, we use configurational thinking to construct Influential pathways of high career growth of GPs by integrating antecedents. The results can provide effective support for improving GPs’ service ability and realizing their service value to protect residents’ health.

New Pension Institution under the Background of Moderately Aging Population: Exploring the Model of Community Nursing Home

China's elderly population has been growing rapidly and will enter a moderately aging society in the 14th Five-Year Plan period. The demand for senior care industry will continue to increase in the moderately aging society, but the supply of senior care services in China is obviously insufficient, so we will develop the community nursing home model and create a more suitable service model for senior care by closely focusing on the aging population and senior care. This paper points out the value of community nursing home construction, analyzes the advantages and problems of two traditional aging models: home care and institutional care, and proposes a plan for community nursing home model: optimize the spatial layout of community nursing home, standardize community medical service institutions, adopt "government-enterprise cooperation" operation method, promote the industrialization of community nursing home, and improve the service system of community nursing home.

Analysis and optimization of 15-minute community life circle based on supply and demand matching: A case study of Shanghai.

The 15-minute community life circle (15min-CLC) strategy is one of Shanghai's important methods for building a global city and facing a society with a more diverse population structure in the future. In the existing research, the balance between the construction of the life circle and the needs of the people in the life circle still needs to be further fulfilled. This paper is based on the city's multi-source large data set including 2018 AutoNavi POI (Point of Interests), OSM (OpenStreetMap) road network data and LandScan population data set, and evaluates the current status of Shanghai's 15min-CLC through the fusion of kernel density estimation, service area analysis and other statistical models and proposes relevant optimization suggestions. The results show that there are the following shortcomings: (1) From the perspective of different types of infrastructure service facilities, the spatial construction of Shanghai's overall life service facilities and shopping service facilities needs to be optimized. (2) From the perspective of comprehensive evaluation, the comprehensive service convenience of infrastructure service facilities in the downtown area is relatively high, while the comprehensive service convenience of urban infrastructure service facilities in the suburbs and outer suburbs is relatively low; The diversity of basic service facilities in the 15min-CLC in the downtown area is more consistent with the population distribution; However, in the peripheral areas of the urban area, too many infrastructure service facilities have been constructed. Based on the above shortcomings and the perspective of supply and demand matching, relevant optimization strategies are proposed in different regions and different types of infrastructure service facilities: (1) focus on the construction of basic service facilities in the urban fringe and urban-rural areas, improve the full coverage of the basic service facilities, and appropriately reduce the number of basic service facilities in the downtown area. (2) The development of community business models can be used to promote the development of new life service facilities and shopping service facilities. (3) Improve community medical institutions through facility function conversion, merger and reconstruction, etc. (4) Optimize the hierarchical basic service facility system and improve the population supporting facilities of basic service facilities in the 15min-CLC. This paper incorporates people's needs and concerns on the living environment into the 15min-CLC evaluation model, and uses Shanghai as an example to conduct research, summarizes the existing shortcomings, and proposes corresponding optimization strategies based on the matching of supply and demand. This article attempts to explore a replicable 15min-CLC planning model, so that it can be extended to the Yangtze River Delta urban agglomeration, to provide reference for further research on the 15min-CLC, and to promote urban construction under the concept of sustainable development.

Research on community promotion and application of single acupoint electroacupuncture therapy for lumbar intervertebral disc herniation

To observe the clinical effect of single acupoint [Yaotu (extra)] electroacupuncture (EA) therapy on lumbar intervertebral disc herniation (LIDH) and its promotion and application in community medical institutions. This research adopted a three-level promotion model, and used multi-center collaboration topics as a platform. A total of 240 patients with LIDH were divided into a group A (top three hospital, 80 cases, 3 cases dropped off), a group B (secondary hospital, 80 cases, 8 cases dropped off), and a group C (community health center, 80 cases, 7 cases dropped off). All groups were treated with EA at a single acupoint [Yaotu (extra)] under the guidance of a unified experimental protocol. The EA was given 60 min each time and performed 3 times a week for a total of 2 weeks. The changes of visual analogue scale (VAS) scores of three groups before and after each treatment were compared, and the clinical efficacy was evaluated. Compared with before each treatment, the VAS scores of three groups after each treatment decreased (P<0.05). Except for the second and fifth treatments, the immediate effect in the group A was higher than that in the group B and C (P<0.05). The total effective rate of group A, group B, and group C respectively was 90.9% (70/77), 93.1% (67/72), 86.3% (63/73), and there was no statistically significant difference among the three groups (P>0.05). The single acupoint EA therapy has a significant effect in the treatment of LIDH, can quickly relieve the pain symptoms, and has the characteristics of simple operation and easy control, suitable for promotion and application in primary hospitals.

COVID-19 and the Hospital Neurologist: How should we confront the COVID pandemic?

Ninety-six patients were admitted to our hospital during the first wave of the 2020 COVID pandemic. Our hospital, a core hospital in Kobe, was in confusion at the beginning of the pandemic. The following three factors were considered important for preventing the collapse of hospitals during the pandemic based on our experiences: avoidance of contact, prompt and accurate communication, and role-sharing among community medical institutions. Of the 96 patients, 36 had severe cases with several neurological problems: 18 had consciousness disorders, 19 had generalized weakness, 7 had polyneuropathy, and 2 had severe limb weakness. There are several unsolved pathological problems, and neurologists should play important roles in the treatment of patients with COVID.

Analysis of special ehealth service for corona virus disease 2019 (COVID-19) pneumonia

To analyze how governments, hospitals and information technology(IT) companies use Internet technology to provide online health services during the early stage of corona virus disease 2019 (COVID-19) epidemic in January 2020 in China, and then provide suggestions and coping strategies for the later stage and post-epidemic time. We searched for information on ehealth services related to the outbreak of COVID-19 in China. The sources of information were mainstream search engines such as Baidu and the popular interactive social platforms such as Webchat. The keywords were "Internet+pneumonia", "Internet clinic", "pneumonia online clinic" and so on. The time of information was from January 20 to February 3, 2020. The key information was extracted and encoded by two persons back-to-back. The coding information included: name of organization provider, launching time, location of provider, service items, user, health workers engaging in the service, and so on. The coded information was entered and analyzed with SPSS 24.0 and Excel. There were totally 57 projects launched by local governments, hospitals and IT companies. Most of them were launched from January 24th to 27th, the hospital and government projects services regionally, especially in eastern provinces. In this study, 90.48% of the enterprises and 100.00% of the hospitals had online fever clinic and consultation services for COVID-19, 66.67% of the enterprises and 37.04% of the hospitals serviced derivative health problems. Only a few projects provided tele-medical consultation. There were individual projects that provided online health management for home quarantine people. Physicians were the main force of various projects. In some hospital projects, there were also nurses, pharmacists and professional technicians to provide featured consultation. Ehealth is useful and helpful for the health care system to rapidly cope with health demand during instantaneous and post epidemic time. Regional distribution of ehealth is unbalanced. There are institutional and technical feasibilities for the emergency application of Internet technology. However, community health centers seldom provide ehealth or connect with tertiary hospitals with Internet. Therefore, all kinds of providers within healthcare system should promote emergence ehealth. Tele-medical diagnosis and referral should be developed by local governments during COVID-19. The application of "Internet+medical treatment" in community medical institutions and synergy among various institutions should be promoted.

Quantitative assessment of disease markers using the naked eye: point-of-care testing with gas generation-based biosensor immunochromatographic strips

BackgroundImmunochromatographic strips (ICSs) are a practical tool commonly used in point-of-care testing (POCT) applications. However, ICSs that are currently available have low sensitivity and require expensive equipment for quantitative analysis. These limitations prohibit their extensive use in areas where medical resources are scarce.MethodsWe developed a novel POCT platform by integrating a gas generation biosensor with Au@Pt Core/Shell nanoparticle (Au@PtNPs)-based ICSs (G-ICSs). The resulting G-ICSs enabled the convenient and quantitative assessment of a target protein using the naked eye, without the need for auxiliary equipment or complicated computation. To assess this platform, C-reactive protein (CRP), a biomarker commonly used for the diagnosis of acute, infectious diseases was chosen as a proof-of-concept test.ResultsThe linear detection range (LDR) of the G-ICSs for CRP was 0.05–6.25 μg/L with a limit of detection (LOD) of 0.041 μg/L. The G-ICSs had higher sensitivity and wider LDR when compared with commonly used AuNPs and fluorescent-based ICSs. When compared with results from a chemiluminescent immunoassay, G-ICS concordance rates for CRP detection in serum samples ranged from 93.72 to 110.99%.ConclusionsThese results demonstrated that G-ICSs have wide applicability in family diagnosis and community medical institutions, especially in areas with poor medical resources.

Survey on knowledge of obstructive sleep apnea among general practitioners in community medical institutions in Beijing Fengtai district

Objective To survey the knowledge levels of obstructive sleep apnea (OSA) among general practitioners in community medical institutions run by the Fengtai District government. Methods One hundred and eighteen general practitioners from 13 government-run community health service centers in Fengtai District were selected for a questionnaire survey on OSA awareness and attitude in December 2016. Results One hundred and nine valid questionnaires were recovered. The survey showed that the overall accuracy rate of cognitive problems was 68.6% (1 345/1 962), the accurate rates for etiology and pathogenesis, diagnosis, epidemiology, clinical manifestations and complications, and treatment were 84.7% (277/327), 75.9% (331/436), 59.0% (193/327), 79.1% (345/436) and 45.6% (199/436), respectively. Very few participants (0.9%,1/109) thought that OSA was not an important clinical disorder and not important for identification, while quite a few participants felt uncertain confidence in the identification (39.4%,43/109), management (62.4%,68/109) and treatment (65.1%,71/109) of the disease. The knowledge scores of general practitioners who had attended OSA related training were higher than those who had not [14 (13, 15) vs. 12 (10, 14), Z=-2.712, P=0.007]. Conclusion General practitioners in community medical institutions of Beijing Fengtai District generally have a positive attitude towards OSA, but are lack in the ability of diagnosis, management and treatment of the disease, indicating that further training is necessary. Key words: Sleep apnea, obstructive; Questionnaires; General practitioner

Methods for data collection in community nursing research

Objective To summarize the experience on data collection during community nursing research. Methods We analyzed the characteristics and difficulties of data collection in community by combining working experience of data collection during clinical nursing research in community medical institutions and in community nursing research. Results From the perspective of postgraduates, we shared information, such as the prerequisite of effective data collection, characteristics and difficulties of community data collection, methods of data collection (time, place of data collection, selection and appointment of subject investigated, influencing factors of evaluation results, considerations of data collection) . Conclusions Effectiveness and reliability of data collection is critical. In community nursing research, thinking and summarizing experience and skills actively about data collection can promote the smooth development of community nursing research. Key words: Community nursing; Data collection; Experience sharing

The clinical assessment of amyotrophic lateral sclerosis patients\u2019 prognosis by ZNF512B gene, neck flexor muscle power score and body mass index (BMI)

BackgroundAssessment on the prognosis of amyotrophic lateral sclerosis (ALS) is becoming a focus of research in recent years since there is no effective treatment. The aim of the research is to explore the major factors involving in prognosis of ALS patients through long-term follow-up.MethodsALS patients’ DNA extracted from peripheral blood white cells were detected for the risk allele by single nucleotide polymorphism (SNP) analysis. Neck flexor muscle score and body mass index (BMI) were recorded during Medical Research Council follow-up using manual muscle testing method.ResultsALS patients with risk alleles (C) deteriorated rapidly with poor clinical outcome. It seemed that the higher neck flexor muscle strength score in ALS patients with the longer survival time but without significant correlation (p > 0.05). The lower the basal body mass index, the shorter the survival time and the faster deterioration (p < 0.05). The patients with body mass index less than 22.04 seemed to have short survival time than those with BMI more than 22.04 (p < 0.05), however, the speed of deterioration in two groups of patients had no significant difference (p > 0.05).ConclusionThe risk (C) allele of the SNP (rs2275294) in the ZNF512B gene, cervical flexor muscle power and body weight index might have clinical potential for ALS prognostication, since these indicators is so simple to perform that they might be very suitable for primary clinics and even community medical institutions to carry out.

Twenty-seven year surveillance of blood transfusion recipients infected with HIV-1 in Hebei Province, China

We conducted an investigation of blood management in which blood transfusion recipients underwent molecular biological analysis, to trace the possible source of HIV infection. Epidemiological investigation was carried out among HIV-infected individuals. Blood transfusion recipients infected with HIV were tracked for the date of transfusion, reason for transfusion, hospital where transfusion was received, source of blood, components of transfusion, number of transfusions, and transfusion volume. A total of 285 blood transfusion recipients infected with HIV-1 were detected in Hebei over the study period, with 42.81% (122/285) detected through clinical diagnostic testing. These cases showed a concentrated distribution in southern Hebei, with local outbreak characteristics. A census of the population in Shahe County, which had a high concentration of cases, revealed that recipients of blood transfusions had an HIV infection rate of 15.54% (92/592). Post-transfusion infection frequently occurred among blood transfusion recipients at township medical institutions, with a peak in 1995. Owing to late detection of HIV infection among blood transfusion recipients, the rates of spousal transmission and mother-to-child transmission reached 20.87% and 28.05%, respectively. Around 1995, community medical institutions did not screen for HIV antibodies among paid blood donors, which was an important cause of the outbreak of HIV-1 infection among blood transfusion recipients. Our findings indicate that cases of blood transfusion-related infection decreased rapidly with gradual improvement in the HIV screening system for blood donors that began in 1995, particularly after full implementation of HIV nucleic acid testing of volunteer blood donors was begun in 2015.

지역사회 의료기관 거주 정신장애인의 삶의 만족도에 영향을 미치는 개인·가족·기관 요인

우리나라의 경우, 인권위원회가 활동하고 지역사회 복귀가 강조됨에 따라서 정신장애인의 삶의 만족도에 대해 관심을 더 가지게 되었다. 정신장애인들 중에서도 지역사회의 정신의료기관에 거주하고 있는 정신장애인은 경제적 여건이 취약하고 가족의 지지나 사회적 지지 체계를 제대로 갖추지 못하고 있는 경우가 많다. 따라서 이런 정신장애인의 삶의 만족도에 특히 주목할 필요가 있다. 이런 맥락에서 본 연구에서는 정신장애인과 관련된 개인·가족·기관 요인이 정신의료기관에 거주하고 있는 정신장애인의 삶의 만족도에 미치는 영향을 살펴보았다. 본 연구에서 가족관계, 여가활동, 사회적 지지는 정신의료기관에 입원하고 있는 정신장애인의 삶의 만족도에 유의미하게 영향을 미치는 것으로 나타났다. 본 연구에서는 이에 따른 제언도 제시하였다.

Understanding of hierarchical medical mode in chronic diseases management among medical staff and residents in Xiamen

Objective To estimate the status of understanding hierarchical medical mode in chronic disease management among medical staff and residents in Xiamen. Methods The multi-stage sampling was used in the study to select 49 physicians from the tertiary hospitals, 58 general practitioners (GPs) and health managers from 5 community health services centers, and 499 residents from 5 communities in Xiamen. We conducted a face-to-face survey to estimate their basic information, recognition for hierarchical medical mode, and patients' willingness for community first contact care. The data was described by mean value of frequency and constituent ratio, the chi-square test or Fisher's exact test was used for comparison among groups. Logistic regression was performed to analyze the factors influencing the residents' preference for treatment in community medical institutions. Results The physicians from tertiary hospitals or community health service centers were almost all familiar with Xiamen mode (91/107, 85%), and more than half of them knew about the hierarchical medical system (67/107, 62.6%), 86.9% (93/107) of them knew about the guide of hierarchical medical system, 58.9% (63/107) of them received the relative training before. The physicians from community had higher knowledge, more frequency training, more referral experiences and more effective evaluation than the physicians from hospitals (all P< 0.05). In our study, 86.2% (344/399) of residents were willing to see doctors in community health centers and 77.9% (311/399) of them were willing to return to community health service centers from tertiary hospitals for disease convalescence or chronic disease management; 53.6% (214/399) of residents preferred to utilize community first contact care when they got chronic diseases, and they were more satisfied with the consultation and diagnosis process in community. The residents who knew about the hierarchical medical system were more likely to utilize community first contact care and return to community for medical care. However, the female or the higher-income residents were less likely to see doctors in community. Patients who had experienced transfer to community or had higher satisfaction to community care were more willing to return from hospitals to community for disease convalescence. The mode showed that the system was more effective in measuring and controlling blood pressure or blood glucose for patients who joined the patients' network than for those did not join. (P<0.05). Conclusion Medical staff are familiar with hierarchical medical system, and the residents are likely to use community health service as their first contact care in Xiamen. The utilization of community first contact care is influenced by sex, family income, previous experience, knowledge of the system, and satisfaction to the system of patients. Key words: Disease management; Questionnaires; Hierarchical medical system