Primary Care Physicians In China Research Articles

An online survey of primary care physicians’ knowledge of common respiratory diseases in China

China has a huge population with respiratory diseases, these diseases should be managed well in primary care, however, primary care physicians’ knowledge level of these diseases were unknown. The aim of the study was to assess primary care physicians’ knowledge of asthma, CAP, COPD, and influenza in China. An e-questionnaire was distributed to attendees of respiratory diseases academic conferences in China from July, 2017 to December, 2018. 7391 questionnaires were returned and 4815 valid questionnaires were analyzed, 3802 (79.0%) from community health service centers and 1013 (21.0%) from township hospitals. The average score of the questionnaire was 83.3 (±20.397) and 72.1 (±20.898) in township and community hospitals, respectively (P < 0.05). 61.4%, 48.7%, and 42.5% of the primary care physicians were aware of clinical manifestations of COPD, asthma, and simple influenza. 85.7%, 8.1%, 16.1%, and 1.0% knew how to diagnose COPD, asthma, CAP and influenza, respectively. 94.4% of the physicians lacked the knowledge of treating COPD with bronchodilators; 53.7% knew non-pharmacological treatments for COPD. 73.6% were unable to deal with asthma attacks. 65.1% did not know what the most essential and important treatment for influenza was. 92% of physicians did not know the management for stable COPD; 3.0% knew all prevention and management measures for asthma. 37.9% knew all the preventive measures for CAP. 44.9% did not know the important role of influenza vaccine in preventing influenza and its complications. Primary care physicians in China had a poor knowledge of CAP, asthma, Influenza, COPD. There is a need for improved training of common respiratory diseases.

Follow-up care delivery in community-based hypertension and type 2 diabetes management: a multi-centre, survey study among rural primary care physicians in China

BackgroundFollow-up care is crucial but challenging for disease management particularly in rural areas with limited healthcare resources and clinical capacity, yet few studies have been conducted from the perspective of rural primary care physicians (PCPs). We assessed the frequency of follow-up care delivered by rural PCPs for hypertension and type 2 diabetes – the two most common long-term conditions.MethodsWe conducted a multi-centre, self-administered survey study built upon existing general practice course programmes for rural PCPs in four provinces. Information on follow-up care delivery were collected from rural PCPs attending centralised in-class teaching sessions using a set of close-ended, multiple choice questions. Binary logistic regression analysis was performed to examine physician-level factors associated with non-attainment of the target frequency of follow-up care for hypertension and type 2 diabetes, respectively. The final sample consisted of rural PCPs from 52 township-level regions. The Complex Samples module was used in the statistical analysis to account for the multistage sample design.ResultsThe overall response rate was 91.4%. Around one fifth of PCPs in rural practices did not achieve the target frequency of follow-up care delivery (18.7% for hypertension; 21.6% for type 2 diabetes). Higher education level of physicians, increased volume of daily patients seen, and no provision of home visits were risk factors for non-attainment of the target frequency of follow-up care for both conditions. Moreover, village physicians with less working experiences tended to have less frequent follow-up care delivery in type 2 diabetes management.ConclusionsEfforts that are solely devoted to enhancing rural physicians’ education may not directly translate into strong motivation and active commitment to service provision given the possible existence of clinical inertia and workload-related factors. Risk factors identified for target non-attainment in the follow-up care delivery may provide areas for capacity building programmes in rural primary care practice.

The Impact of M-Protein Screening-Driven Early Diagnosis on Mortality from Multiple Myeloma in China

Introduction:The annual incidence of MM in China is 0.6/100,000, much lower than that in United States (6.6/100,000). Despite ethnic disparities and hereditary distinction, the difference in incidence between China and US may also be attributed to unscientific health-seeking behavior that Chinese people are less likely to receive routine body examination and often delay seeking health service. Furthermore, primary care physicians in China often lack awareness of early signs of myeloma. Therefore, most myeloma patients in China were diagnosed and treated only until severe complications occurred, with 85.8% of patients staged as Durie-Salmon stage III at diagnosis. Meanwhile, Chinese myeloma patients suffer from an inferior outcome, with a median overall-survival of only 4.5 year.In Zhongshan Hospital, Fudan University, a large national reference center in Shanghai delivering medical service for over 3,400,000 patients annually, serum protein electrophoresis (SPEP) is routinely incorporated into liver biochemical and function tests, and therefore providing us unique opportunities to observe the prevalence of monoclonal gammopathy in a hospital population, to screen and identify patients with myeloma or other monoclonal immunoglobulins (M-protein) related disorders at earlier stage, and to evaluate the impact of M-protein screening on baseline characteristics and outcome of patients with MM.Methods:Given every patient receiving liver biochemical tests were routinely screened for M-protein by SPEP in our institute, we initiated a standardized M-protein screening procedure based on SPEP screening in hospital population (Figure Panel A),In this retrospective cohort study, we examined records of hospitalized newly diagnosed MM patients with complete data from January 2013 to December 2016. MM patients with concurrent cardiac amyloidosis were excluded due to distinct prognosis. Patients were categorized by the means of detection of the disease. Patients were considered in screening-driven group if they had an incidental finding of M-protein during workup of unrelated medical conditions and had a visit with hematologist in M-protein specialized clinic or during consultation. Symptom-driven group included patients visited or were referred to hematologic department due to suspected myeloma-related end-organ damage. Baseline characteristics, treatment, overall survival (OS) and progression-free survival (PFS) were compared. Institutional ethics committee approved the study and informed consent was waived.All tests were 2-sided (SPSS version 21.0 was used) and a P -value < 0.05 was considered statistically significant.Results:We identified 193 eligible MM patients. The Table summarizes the baseline features. Compared to symptom-driven group, patients in screening-driven group had earlier DS stage disease (DS III 74.3% vs 89.9%, P= .004), lower frequency of anemia (66.2% vs 81.5, P= .016) and bone lesion (73.0%vs 90.8%, P= .001), and lesser number CRAB symptoms (P= .000).The Figure (panel B and C) depicts survival of MM patients. Patients diagnosed via M-protein screening demonstrated significantly (HR 0.358, 95% CI, 0.138-0.932; P= .035) better outcome (2-yr OS, 89.9%; 95% CI, 75.9%-95.9%) than those in symptom-driven subgroup (2-yr OS, 73.1%; 95% CI, 62.2%-81.3%; HR 1) after adjusted for age, gender, treatment and number of CRAB symptoms with a Cox proportional hazards model.Discussion:Although M-protein screening in normal population is not currently recommended, the impact of myeloma screening in hospital population has not been studied. This very first report reveals increased detection of early stage myeloma and remarkable survival improvement resulted by M-protein screening in hospital population in China. Early detection and prolonged survival implies improvement in health-related Quality of Life and more opportunities to receive further lines of treatment when disease relapses, which is critical for Chinese MM patients, given that most of them were diagnosed and treated only after severe complications developed. Moreover, our data suggests that shortening the time between initial occurrence of end-organ damage and myeloma-targeted treatment by early detection may lead to better outcome.Limitations of this report include its retrospective observational design, relying on data from a single center, and relatively insufficient follow-up. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Psychological Distress Reported by Primary Care Physicians in China During the COVID-19 Pandemic.

Primary care physicians (PCPs) play a key role in responding to the COVID-19 epidemic. The objective of this study was to explore the influencing factors associated with self-reported psychological distress among a sample of PCPs in China in relation to COVID-19. An online survey was distributed to a sample of PCPs in Chengdu city between February 10 and February 13, 2020. The survey consisted of three sections: demographic characteristics, COVID-19-related questions, and the General Health Questionnaire-12 (GHQ-12). After 5 months, a follow-up survey investigating the change of the GHQ-12 was conducted. A total of 712 PCPs completed the baseline survey (11.8% of those invited), 55.6% were female and 74.4% were aged between 30 and 49 years. High levels of psychological distress (GHQ-12 ≥3) were observed in 29.2% and were associated with low preparedness, high work impact, working with infected residents, personal life impact, and concerns, as well as older age and being married (p values < .05). Logistic regression analysis showed that psychological distress was associated with low preparedness (odds ratio [OR] = 0.91, 95% confidence interval [CI] = 0.87-0.96), high work impact (OR = 1.11, 95% CI = 1.03-1.20), personal life impact (OR = 1.12, 95% CI = 1.07-1.17), and safety-related concerns (OR = 1.09, 95% CI = 1.02-1.16). At the 5-month assessment point, high psychological distress was less frequent (21.8%). COVID-19 has resulted in high levels of distress in approximately 30% of PCPs in China. Factors associated with high psychological distress levels include low preparedness and high levels of work impact, personal life impact, and concerns. These findings highlight the importance of enhancing psychological health throughout the course of infectious pandemics.

A study of knowledge, attitudes, and practices of primary care physicians toward anticoagulant therapy in patients with non-valvular atrial fibrillation in Shanghai, China

BackgroundAs a large number of Community Health Service (CHS) centers in China face the majority of patients with non-valvular atrial fibrillation (NVAF), primary care physicians (PCPs) play a primary role in the prevention of embolization. Therefore, an awareness of anticoagulant management in patients with NVAF must be brought into focus among PCPs in China. This study investigated PCPs’ knowledge, attitudes, and practices toward anticoagulant therapy in patients with NVAF, to help them understand their shortcomings regarding oral anticoagulant (OAC) therapy in preventing embolization.MethodThis was a cross-sectional observational study of 462 PCPs in CHS centers across Shanghai. We used a self-administered questionnaire to collect data from September to December 2017. A stratified random cluster sampling was adopted in the 90 CHS centers with the family medicine residency program.ResultAmong 462 participants, 69.3% (320/462) of females received a medical bachelor’s degree and over 50% of participants had more than 10 years of work experience. Each section for knowledge, attitude, and practice were categorized as poor (≤39.0%), fair (40.0–69.0%), and good (≥70.0%). The level of knowledge of OAC therapy for patients with NVAF among PCPs was insufficient in over half (75.8%) of the participants. The majority (89.8%) of PCPs had a positive attitude and 68.0% had modest performance in the anticoagulant management of patients with NVAF.ConclusionsThe knowledge and behaviors of PCPs were insufficient for OAC therapy to prevent embolization in patients with NVAF. The study also revealed that there is good potential for PCPs’ educational interventions to positively impact the care of patients with NVAF.

The potential contribution of mixed methods research to primary care

Dear editor, We read with great interest the article regarding mixed methods research by Creswell and Hirose.[1][1] As primary care physicians in China, we would like to hereby express our...

Provider payment to primary care physicians in China: background, challenges, and a reform framework.

Aim: To provide a framework for provider payment reform for primary care physicians in China. Background: Primary health care is central to health system reform and payment incentives have significant consequences for the equity and efficiency of it. Methods: This paper describes the special payments system for public primary health institutions and the subsequent internal salary remuneration to primary care physicians in China. Based on an analysis of the major challenges, we suggest a reform framework including the pattern of governance, and payments to primary health institutions and employed physicians. Findings: A mixed system of input-based and output-based payments to institutions would probably be appropriate under a long-term and relational contract with the government. It was also advised that internal remuneration is provided by a basic salary plus a bonus based on performance, and an extra-regional allowance. We hope that the results can be used to shift the passive budgeting of in-house staff within the public primary health institutions toward strategic purchasing.

Factors associated with cardiovascular multimorbidity among primary care patients in southern China

Purpose Management of the rising prevalence of long-term conditions is one of the major challenges facing China’s current primary care reform. Better understanding of factors associated with cardiovascular multimorbidity is necessary to develop a comprehensive strategy to support primary care physicians in China to provide patient-centred and continuous care. This study aimed to examine factors on individual socio-economic status in relation to the prevalence of cardiovascular multimorbidity among patients in primary care. Methods The study settings were the community health centres (CHCs) in Guangdong province in southern China. Multistage cluster sampling methods were adopted to select patients aged above 18 who had a usual source of primary care. Socio-demographic characteristics and health care information of patients were collected during November 2010 to April 2011 by on-site face-to-face interviews and paper-based medical record. Factors associated with cardiovascular multimorbidity were explored using one binary logistic regression model. Results The data from a total number of 5,370 Chinese primary care patients were analysed and 7.1% (95% CI: 6.4–7.8%) developed at least two cardiovascular conditions. However, more than one fourth (27.5%; 95% CI: 24.4–30.7%) of patients aged above 65 years were cardiovascularmultimorbid. Advanced age (aged above 65 years; adjusted odds ratio (aOR) 5.48; 95% CI: 4.21–7.13, p Conclusion Our study implied that cardiovascular multimorbidity were more likely to occur among older patients and those who had higher income with household registry in the primary care setting. Further longitudinal studies are also needed to explore the associations with cardiovascular multimortality thus to provide evidence on how best to organise tailor-made disease management services for people suffering from cardiovascular multimorbidity.

A Survey of Anxiety and Depression Symptoms among Primary-Care Physicians in China

Anxiety and depression disorder are the most prevalent mental health problems. However, few studies are available pertaining to these problems among Chinese doctors, especially the assessment of the anxiety and depression symptoms among primary-care providers. The aim of this study was to assess the anxiety and depression symptoms among Chinese primary-care physicians and their associated factors. A cross-sectional study was conducted among 451 primary-care physicians in Shanghai China (effective response rate was 79.8%). There were 177 male physicians and 274 female physicians with average age of 37.8 (SD +/- 11.1) years. Questionnaire pertaining to depression disorder was indicated by the Zung Self-Rating Depression Scale (SDS) and anxiety disorder was indicated by the Zung Self-Rating Anxiety Scale (SAS). The average SAS and SDS standard scores of the primary-care physicians were 41.1 +/- 11.5 and 46.5 +/- 11.8 respectively. Both of the scale scores were higher than those of Chinese national norms (P both < 0.001). SDS standard score > or = 53 and SAS standard score > or = 50 were regarded as screening-positive criteria. SAS and SDS screening positive rates of primary-care physicians were 18.0% and 31.7% respectively. In addition, married/cohabited and divorced/widowed physicians aged over 30 years with educational background of junior college had higher risks of anxiety and depression disorders. Chinese primary-care physicians were at considerably high risk of anxiety and depression disorders, which was worthy of attention during healthcare system reform in China.

Characteristics of Chinese patients with cough in primary care centre

BackgroundCough is one of the most common respiratory symptoms and is well characterized in specialized cough clinics with high success rates of diagnosis and treatment. However, there is a paucity of data regarding cough in primary care settings. The present study aimed at investigating clinical epidemiology of cough through a national study of two questionnaire surveys sent to primary care physicians in China.MethodsApproximately 18,000 subjects recruited were having daytime or night symptoms of cough and diagnoses of respiratory disease from February 2005 to April 2006 as Survey 1 and from June 2007 to December 2007 as Survey 2. Patients suffering from respiratory malignancy, hyperthyroidism, hypertension, heart disease, diabetes, severe hypohepatia or renal dysfunction, pregnancy, possible pregnancy or lactation, neutropenia were not eligible. Information regarding demography, history of allergies, symptomatic profile, treatment and curative effects for cough was elicited.Results8216 questionnaires were collected in Survey 1 and 9711 in Survey 2. The mean values of ages were 25.7 and 22.3 years old, respectively. Symptoms included expectoration (74% and 76%), wheeze (59% and 74%), breathlessness (22% and 26%), chest pain (9% and 13%) and fever (15% and 18%). About 15% and 23% patients had hypersusceptibility, of whom 6% to 17% had a family history. More than 50% of the cases had histories of allergic rhinitis, asthma, conjunctivitis or atopic dermatitis. Asthma, COPD, and bronchitis were dominant etiologies of cough. Procaterol or the combination of antibiotics and steroids were used as the treatment.ConclusionCauses and outcomes of cough differed with ages and time in this particular national study, while successful and precise diagnosis and management of cough in primary care settings need to be further improved in China.

The Prevalence of Late-Lifedepression and Physicians’ Attitude Toward it in Primary Care Settings of China

Late-life depression is associated with physical and psychological comorbidity, functional and cognitive impairment, and increased mortality due to suicide and other causes. However, studies in the west show that the identification of depression in older people is problematic and consequently the illness is underdiagnosed and undertreated. We investigated the prevalence of late-life depression and physicians’ attitude toward it in primary care settings of China.The survey was performed in urban primary care settings of Hangzhou, China. 1000 patients aged ≥ 55 years and 300 primary care physicians were recruited, of which 689 patients and 247 physicians provided complete data. The Geriatric Depression Scale (GDS-30) was used for investigating the prevalence of late-life depression in patients, and the Depression Attitude Questionnaire (DAQ) for investigating physicians’ attitudes and knowledge about depression.Of the 689 patients, 23.4% (n=161) scored ≥ 11 on the GDS-30, including 3% (n=21) who scored ≥ 21. Among the physicians, 72% (n=178) endorsed that “Becoming depressed is a natural part of being old”, and 70% (n=173) of them thought “Working with depressed patients is heavy going”; in their clinical practice. Only 6.6% of physicians prescribed anti-depressants.Primary care physicians in China are ill prepared to diagnose and treat depression in older adults, which presents at high rates in primary care clinics. How to improve their attitudes and clinical practice is crucial to the well-being of older people in China.