Family Doctor Contract Research Articles

The Application Effect of Regional Family Doctor Contract Service Based on Internet Platform in the Management of Hypertensive Patients in Primary Hospital

Objective: To analyze the application effect of regional family doctor contract service based on Internet platform in the management of hypertension patients in community hospitals. Methods: Since June 2017, the Yetang Health Center has established a model of family doctors contracted chronic disease management based on the Internet platform under the guidance of the General Medical Department of the First People’s Hospital of Changshu City. The Internet platform for patient management was developed, and a regional data sharing center for hypertensive patients was established. The combination with the family doctor contract model enabled the effective management of hypertensive patients. In the 12 months before the model was implemented, 525 patients with hypertension were selected, and 2173 patients with hypertension after 12 months of implementation were included in the control group and the observation group. The differences in treatment compliance, selfmanagement rate and other indicators between the two groups were compared to analyze the application effect of the model. Results: Compliance, compliance rate, self-management rate and awareness rate of hypertensionrelated knowledge in the observation group were higher than those in the control group, and the difference was statistically significant (P < 0.05). The total management cost, unit management cost and standard management cost of hypertension patients in the observation group were lower than those in the control group. The satisfaction rate of hypertension management in the observation group was 96.87% (2105/2173), which was higher than 63.05% (331/525) in the control group (P < 0.05). The awareness rate of diagnostic criteria, risk factors, hazards and treatment methods of hypertension in the observation group was higher than that in the control group, and the difference was statistically significant (P < 0.05). Conclusion: The regional family doctor contract service based on Internet platform can significantly improve the effectiveness and efficiency of community hospital management of hypertension patients, and it is also an effective way to reduce management costs and ensure patient satisfaction, which is worth further optimization and promotion.

Clinical study of TIP technique combined with acupuncture and oral administration of Chinese medicine on chronic insomnia with syndrome of heart-kidney imbalance

Objective To evaluate the efficacy of low resistance thought induction psychotherapy (TIP) technique combined with acupuncture and oral Chinese medicine in treating chronic insomnia elderly patients with syndrome of heart-kidney imbalance. Methods One hundred sixty-four chronic insomnia patients with syndrome of heart-kidney imbalance were randomly divided into four groups with 41 cases in each group. The control group was treated with family doctor contract, sleep health education and Tianwang-Buxin decoction as the basic treatment, the group A was treated with acupuncture and the basic treatment, the group B was treated with TIP technique and the basic treatment, the group C was treated with the combination of acupuncture and TIP on the basic treatment. After one month' treatment, scores of Pittsburgh sleep quality index (PSQI) were used to evaluate sleep quality, sleep efficiency, and the clinical efficacy. Results After treatment, scores of sleep time, sleep efficiency, sleep time, sleep disturbance, daytime function of the group A, B, and C were significantly lower than those in the control group (F value were 44.322, 92.808, 107.131, 79.467, 98.638 respectively, all Ps<0.001), and the group C were significantly lower than those of the test group A and B (P<0.01). Scores of upset, dizziness, tinnitus, hot flashes, and night sweats, hand foot and heart fever, forgetfulness, sores on the tongue and dry stool of the group A, B, and C were significantly lower than those of the control group (F value were 103.32, 135.91, 93.35, 77.61, 57.514, 92.283, 126.097, 53.217, respectively, all Ps<0.001), and the group C were significantly lower than those of the test group A and B (P<0.01). The total clinical efficacy of TCM syndrome and insomnia in group A,B and C was significantly higher than that in the control group (χ2=16.169, P<0.01), and the group C was significantly higher than the group A and B (χ2=8.504, P<0.01). The total clinical efficacy of sleep efficiency in group A, B and C was significantly higher than that in the control group (χ2=14.078, P<0.01), and the group C was significantly higher than the group A and B (χ2=8.856, P<0.01). Conclusions TIP technique combined with acupuncture and oral Chinese medicine can improve sleep quality of chronic insomnia elderly patients with syndrome of heart-kidney imbalance. Key words: Insomnia; Low resistance thought induction psychotherapy; Acupuncture therapy; Tianwang-Buxin decoction; Syndrome of disharmony between heart and kidney

Study on the effect of family doctor team service under medical association model on empowerment behavior and health status of elderly diabetic patients in community

Objective To explore the effect of family doctor team service in the medical association model on empowerment behavior and health status of elderly patients with diabetes in the community. Methods A total of 158 patients with diabetes who were diagnosed with free physical examination and were diagnosed as diabetic patients in 4 communities under the jurisdiction of Fuzhong Community Health Service Center From March 2018 to May 2018, we conveniently divided into intervention group (79 cases) and the control group (79 cases), according to whether or not to sign a family doctor. The control group was older people who did not sign up for a family doctor, the control group was given routine intervention according to the community chronic disease follow-up mode, while the intervention group gave the contracted family doctor on the basis of routine intervention, and carried out individual assessment, group management, group intervention, one-on-one guidance, and the body mass index, abdominal circumference, fasting blood glucose, HbA1c, self-management ability of the two groups were evaluated before intervention and 6 months after intervenation. Results There was no significant difference between the two groups before intervention (P >0.05). After 6 months of intervention,abdominal circumference, fasting blood glucose and HbA1c was (79.5±5.0) cm, (6.1±0.7) mmol/L, (6.3±0.6)% in the intervention group, (85.2±11.4) cm, (6.5±0.8) mmol/L, (6.8±0.7)% in the control group, and there was significant difference between the two groups (t=2.142, 3.345, 4.820, P<0.05 or 0.01); the self-empowerment ability and the self-management was (37.7±1.7), (44.3±6.8) in the intervention group, (30.1±2.5), (36.5±2.8) in the control group, and there was significant difference between the two groups (t=22.344, 9.427, P<0.01) . Conclusion The family doctor team service under the model of medical association can improve empowerment behavior of elderly diabetic patients in the community and improve their health status. Key words: Medical association; Family doctor team service; Diabetes; Empowerment behavior; Health status

Factors associated with contracted services of Chinese family doctors from the perspective of medical staff and consumers: a cross-sectional study

BackgroundThe family doctor system has developed rapidly all over the world, and in the past few years, China has actively explored family doctor-type contracted services. This study aimed to explore the related factors of Contracted Family Doctors Services (CFDS) from the perspectives of medical staff and consumers, and to provide a stronger basis for the development and promotion of CFDS.MethodsA combination of quantitative and qualitative methods were used in this study. A self-reported questionnaire was designed through a literature analysis, group discussions, expert consultations and a pre-investigation, and conducted among community health service providers in 12 community health service centres across four provinces of China. A total of 389 participants participated, and 320 valid questionnaires were obtained, with an effective response rate of 82.3%. A total of 36 consumers participated in in-depth interviews, and the effective rate was 100.0%. An exploratory factor analysis, a confirmatory factor analysis, inductive methods, and expert consultations were used to analyse the related factors of CFDS.ResultsThe related factors of CFDS from the perspectives of medical staff were divided into four dimensions, with the following weighting coefficients: national government factors (31.9%), community health service agency factors (24.7%), consumer-related factors (22.6%), and contracted doctor-related factors (20.8%). The related factors of CFDS from the perspectives of consumers were divided into four dimensions, with the following frequency sequence: national government factors, contract doctor-related factors, community health service agency factors, and consumers-related factors. National government factors played an important role in CFDS from the perspectives of medical staff and consumers.ConclusionsThe related factors of CFDS were the same from the perspective of medical staff and consumers, but the weight of each factor was different. The development of CFDS is inseparable from the support of policies. It is suggested that the government should strengthen the publicity of CFDS, expand the coverage, introduce personalised contract programs that meet the needs of different groups, and promote the rapid development of CFDS.

Status of outpatient service for cancer patients in Beijing Yuetan Community Health Service Center

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. Key words: Malignancies; Ambulatory care; Family doctor service

Residents' Awareness of Family Doctor Contract Services, Status of Contract with a Family Doctor, and Contract Service Needs in Zhejiang Province, China: A Cross-Sectional Study.

In China, family doctor services originated in 2009. After two years, the Chinese government proposed the establishment of a family doctor contract system suitable for China’s national conditions. Then, in 2016, a multi-department jointly issued an important document, which further clarified the development goals of family doctor contract services in the next five years. Zhejiang Province has been exploring responsible doctor contract services since 2012, which was promoted throughout the province in 2015. Objectives: The aim of this study was to investigate the residents’ awareness of Zhejiang Province, China, of family doctor contract services, the status of signing such a contract, and the demand for service items in the contracted service package. Further, we sought to explore the relevant influential factors in order to provide a reference and evidence-based recommendations for the further development of family doctor contract services. Design: We enrolled 3960 residents from nine counties in Zhejiang Province using a multistage stratified random sampling method. A survey using a self-designed questionnaire was used to collect the demographic data, residents’ awareness of family doctor contract services, the status of contracting, and demand for different items from October to December 2017. Data were analyzed by SPSS 21.0. Results: In total, 3871 residents returned valid questionnaires, with a response rate of 97.75%. The awareness rate of residents of family doctor contract services was 71.58% (2771/3871). Age, education level, and chronic medical history status were the influencing factors affecting residents’ awareness. The contracted rate was 50.43% (1952/3871). Age, education level, personal monthly income, chronic disease history, and awareness of family doctor contract services were the influencing factors. Residents who have a contract with family doctors have a higher demand for family doctor contract services, and different residents have different needs for the project because of their physical condition, education level, marital status, household registration, and personal monthly income level. The top three needs of the residents for contracted services were health consultation (84.64%), regular physical examination (81.71%), and increasing the proportion of medical insurance reimbursements (80.06%). Conclusions: The awareness rate of family doctor contract services and the contracting rate are unsatisfactory among residents of Zhejiang Province. It is suggested that the government should more heavily publicize family doctor contract services, expand the coverage, introduce personalized contract schemes to meet the needs of different groups, and promote the rapid development of family doctor contract services in Zhejiang Province.

Community intervention in elderly patients with insomnia

Community intervention was conducted for 60 elderly patients with insomnia who attended the clinic of Sanlihe NO.1 Community Health Service Station of Yuetan Community Health Service Center from October 2016 to December 2016. Community intervention strategies included appointed visit to contracted family doctors, health counseling by specialists, lifestyle interventions, drug interventions, psychological interventions, individualized interventions, regular home visits and follow-up, self-management and referral to specialist service. After 1 year of community intervention, the differences of sleep quality self-assessment score [(29.77±7.20) vs. (28.62±6.79) ; t=7.48, P<0.01] and COOP/WONCA score [(17.38±3.35] vs. (16.00±3.09); t=8.69, P<0.01] before and after the intervention were statistically significant. Community intervention is helpful to improve the quality of sleep and life of the elderly insomnia patients. Key words: The elder; Insomnia; Community intervention

The preferences of general practitioners regarding family physician contract in the underprivileged areas of Iran in using conjoint analysis

Background: One of the most important methods for improving the fair access of people to health services is the family physician program, which is facing many challenges. One of these challenges is the lack of policymakers' understanding of physicians' preferences regarding the provisions of the family physician contract. Therefore, this study was aimed to investigate general practitioners' preferences regarding the type of family doctor contract in one of the underprivileged regions of Iran. Methods: An analytical-cross-sectional study was conducted among 150 general practitioners (GPs) who registered in Ministry of Health and Medical Education (MoHME) family physician plan and were working in the health network of deprived regions in Iran. A discrete choice experiment (DCE) questionnaire was developed by the researchers and then distributed to GPs. Results were analyzed using Ordered Logistic Regression. Data were collected using a questionnaire designed by orthogonal method in SPSS 20. Data analysis was performed using logistic regression model in Stata 13 software. Results: Findings revealed that “type of employer” had the most significant effect on GPs’ preferences (OR = 2.5), followed by “allocating quota for admission to medical specialty courses after 5 years” (OR = 2.25), being allowed to give medical services to population without geographical restriction (OR = 2.8), being allowed to provide services out of the defined service packet (OR = 1.4), and “decreased length of contract” (OR = 0.93). Conclusion: The amendment of the provisions of the family physician contract in accordance with physicians' preferences increases the probability of their participation in and compliance with the family physician program. However, the compliance of the provisions of this contract with relevant international standards and upstream laws of the country should be maintained as much as possible.

Determinants of Willingness of Patients with Type 2 Diabetes Mellitus to Receive the Seasonal Influenza Vaccine in Southeast China.

Willingness of patients with Type 2 diabetes mellitus (T2DM) to receive the seasonal influenza vaccine is low in China. A cross-sectional study on a representative sample of T2DM patients was conducted in Ningbo, a city in southeast China, to assess T2DM patients’ willingness to be vaccinated against influenza and identify the influence factors of this willingness. Data regarding the participant’s history of influenza, the knowledge, willingness and uptake of the influenza vaccine, demographic characteristics, reasons for willingness or unwillingness to be vaccinated was collected. Only 19.55% of a total of 1749 participants reported a willingness to be vaccinated. Factors positively associated with willingness to be vaccinated were perceived susceptibility to influenza (OR = 1.9, 95% CI: 1.5–2.5), awareness of the vaccine (OR = 1.7, 95% CI: 1.3–2.3) and previous history of influenza vaccination (OR = 4.4, 95% CI: 3.0–6.4). Patients with T2DM who were farmers (OR = 0.6, 95% CI: 0.4–0.8) and those managed by contracted family doctors (OR = 0.8, 95% CI: 0.6–1.0) expressed less willingness to be vaccinated. Targeted interventions such as enhancing health education and strengthening medical staff training should be conducted to increase T2DM patients’ willingness to be vaccinated and enhance influenza vaccine uptake among this population.

Contracted family doctor service in Shanghai Weifang Community Health Service Center

Weifang Community Hearth Service Center started a pilot program of contracted family doctor service in 2011, and the program included 3 stages: 1st stage was the establishment of the health archives of the residents; 2nd stage was the service signed with key groups in the community; 3rd stage was extension of contracted service to whole community. The working mode of responsible family doctor team was formed, and the health service for contracted residents was managed by the family doctor teams. The individualized service was provided to residents according to their different needs. As a trial, the Pediatrics Studio was designed to provide special service for focused group among signed residents. Through a series of measures, the signing rate and the extended prescriptions in Weifang community both ranked the first in Pudong New Area, and the visiting rate by the signed patients increased from 30% to 41%. The preliminary impact of the contracted family doctor service has appeared in Weifang community. Key words: Community health service; Family practitioner; Health services administration

Implementation and effectiveness of "Three-in-One" family doctor contract service model in Xiamen

A Three-in-One model of family doctor contract service was proposed in July 2014 and then implemented in Xiamen. In this model the health service was provided to contracted residents by a team consisted of specialists from tertiary hospitals, general practitioners and health manager in community health service centers. After the implementation of the model, the proportion of visiting in primary care institutions among the residents surpassed that in hospital visiting, appearing a inflection point. The satisfaction of the residents increased significantly, meanwhile the income of primary care medical staff increased substantially and the position of primary care seemed to be more attractive. The Three-in-One service model of Xiamen may provide valuable experiences for implementation of family doctor contract service and hierarchichal medical service system in other areas of China. Key words: General practitioners; Family doctor contract

Effect evaluation for family doctor precision contract service in Sijiqing Community Health Service Center

Hangzhou Sijiqing Community Health Service Center has started the precise contract service mode with the characteristics of competitive contract, regional medical alliance and team service form 2016, which improved hypertensive and diabetic patients management in community.After adopting the precision contract service mode, the contracting rate of hypertensive and diabetic patients increased from 56.1% (2 680/4 777)to 81.6% (5 602/6 863), the rate of referral to regional medical alliance increased from 26.1%(2 678/10 259)to 44.4%(5 589/12 589), consultation rate of contracted doctor increased from 47.1%(54 603/115 986) to 56.3%(93 219/165 725), contract renewing rate increased from 41.3%(5 794/10 822) to 67.2%(7 282/10 838), and the rate of home nursing care in increased from 9.5%(47/495)to 61.5%(392/637). The precise family doctor contract service is an effective mode for primary care, which improves the management rate of hypertensive and diabetic patients, provides continuous medical service, facilitates referral and home nursing service, and promotes the continuity of contract service. Key words: Community health center; Contractual services; Patient transfer

Effects of the Integrated Healthcare Delivery System on 270 pilot cities in 2016: a mixed methods study

BackgroundIn the end of 2015, a new round health reform—the Integrated Healthcare Delivery System—was issued by the National Health and Family Planning Commission. The policy emphasises capability building of primary care providers by recruiting more qualified family doctors, improving infrastructure, and building coordination between tertiary hospitals and community health centres. This reform will contribute to transformation of the current health-care delivery system, shifting more health resources and transferring patients to the community level to improve accessibility and affordability of health care, facilitate the achievement of the 13th Five Year Plan (the most important national development plan), and emphasise the development of an integrated health-care delivery system. The aim of this study was to evaluate the progress of the Integrated Healthcare Delivery System during the past 2 years in pilot cities. MethodsIn a mixed-methods study, we integrated cross-sectional research from 270 pilot cities, to get an overall understanding of the current status of the Integrated Healthcare Delivery System, with 15 pioneered field research centres including Shanghai, Luohu District in Shenzhen, Tianchang in Anhui province, Qingyang in Gansu province, and Haidong in Qinghai province, to highlight advanced experiences for system design optimisation. We used a combination of institutional data, face-to-face interviews, institutional surveys, and expert consultation. FindingsThe relationship between primary care providers and patients was improved by the Family Doctor Strategy, in which health facilities provide training and recruitment and contract qualified family doctors to build up a stable relationship with residents; more patients were willing to having a contracted family doctor, and regarded general practitioners (family doctors) as a first point of contact for seeking treatment in the health system. Additionally, the infrastructure improvement of community-based clinics, general practitioner competency, and promotion of Chinese traditional medicine were strengthened. Finally, vertical coordination among primary, secondary, and tertiary health facilities has been established, which is a key strategy to optimise resource allocation, and provide technical support and shifting of resources to primary care health providers. InterpretationThe preliminary results of Integrated Healthcare Delivery System include a great improvement in gatekeeper capability, effective resource allocation, patient satisfaction, and access to primary care. FundingWorld Health Organization China.

Effectiveness of long-term prescription of hypertensive and diabetic drugs in family doctor contracted service

Objective To assess the effectiveness of long-term prescriptions of hypertensive and diabetic drugs in family doctor contracted service. Methods A survey on long-term prescription in family doctor contract service was conducted from November 2015 to December 2015 in Shanghai Changning district. Ten center managers, 101 family doctors and 208 contracted patients from 10 community health service centers were surveyed with 3 different types of questionnaires, respectively. The relevant information of long-term prescription, including medication information, health management, contracted service, patient′s acceptance and performance status were collected and assessed. Results The 1-month and 2-month prescriptions accounted for 76.5% (156/204) and 13.2% (27/204), respectively. The survey showed that 87.1% (88/101) of family doctors were willing to make long-term prescriptions; 95.6% (195/204) of patients felt convenience of long-term prescription; 88.1% (89/101) of family doctors affirmed that long-term prescriptions effectively reduced the number of re-visits; 93.6% (191/204) of patients thought that long-term prescriptions reduced the visit number and 60.8% (124/204) thought that it reduced medical expenses. The main factors influencing family doctors′ choice of long-term prescription were the stability of disease condition (72.3%, 73/101), the compliance of patients (68.3%, 69/101), the accurate diagnosis (50.5%, 51/101) and long-term regular medication (45.5%, 46/101); 70.6% (144/204) of patients thought that the hypertensive and diabetic drugs included in the long-term prescription catalogue met their needs. Conclusion The long-term prescriptions can effectively reduce the re-visits and medical expenses of patients, which is highly recognized and accepted by both family doctors and patients. Key words: Prescription; Chronic disease; Hypertension; Diabetes mellitus