The Current Status and Factors Influencing Long-term Proton Pump Inhibitor Use and Deprescribing among Community Residents

doi:10.12114/j.issn.1007-9572.2023.0527

Chinese General Practice ›› 2024, Vol. 27 ›› Issue (19): 2344-2351.DOI: 10.12114/j.issn.1007-9572.2023.0527

Special Issue: 用药最新文章合辑

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The Current Status and Factors Influencing Long-term Proton Pump Inhibitor Use and Deprescribing among Community Residents

1. Department of General Practice, Peking University First Hospital, Beijing 100034, China
2. Department of Health Management Centre, Peking University First Hospital, Beijing 100034, China
3. Department of Pharmacy, Beijing Xicheng District Shichahai Community Health Service Centre, Beijing 100035, China
4. Department of General Practice, Beijing Xicheng District Shichahai Community Health Service Centre, Beijing 100035, China
5. Department of Cardiovascular, Boai Hospital of Zhongshan, Zhongshan 528400, China
6. Department of General Section, Xiaoguan Township Health Centre, Suiyang County, Zunyi 569900, China
7. Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China

Received:2023-09-08 Revised:2024-03-18 Published:2024-07-05 Online:2024-04-28
Contact: LI Junxia

社区居民长期服用质子泵抑制剂和处方精简的现状及影响因素研究

1．100034　北京市，北京大学第一医院全科医学科
2．100034　北京市，北京大学第一医院健康管理中心
3．100035　北京市西城区什刹海社区卫生服务中心药剂科
4．100035　北京市西城区什刹海社区卫生服务中心全科医学科
5．528400　广东省中山市博爱医院心血管科
6．569900　贵州省遵义市绥阳县小关乡卫生院综合科
7．100034　北京市，北京大学第一医院消化内科

通讯作者: 李俊霞
作者简介:
作者贡献：
荆冠宁提出研究理念，负责数据收集、数据整理、统计分析、绘制图表、论文撰写；邹颖、禚小琪、时司宴、宋应柳负责数据收集、数据整理；姚弥进行文章审查和修订；迟春花进行论文章监督和审查；李俊霞进行项目管理、思路指导、提供资源，对文章监督管理和审查，对文章整体负责。

Abstract

Abstract:

Background

The potential risks of long-term use of proton pump inhibitor (PPI) and the potentially inappropriate medication are gradually being taken into account, and PPI deprescribing has been widely recognised, but the situation of long-term use of PPI and the willingness to deprescribing of PPI among the community residents in our country are not yet clear.

Objective

To understand the current situation of long-term PPI use and PPI deprescribing among community residents, explore its influencing factors and propose improvement measures.

Methods

From April 2018 to January 2020, a survey was conducted among 389 residents of the Shichahai Community Health Service Center in Xicheng District, Beijing, who had been taking proton pump inhibitors (PPIs) chronically. Data on participants' demographics, PPI usage patterns, concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or antiplatelet agents, presence of comorbid chronic diseases, medication quantities, potential for PPI deprescribing, and polypharmacy status were collected via the community electronic health information system and telephone-administered questionnaires. Subsequently, between June and December 2020, telephone interviews were conducted with 92 residents still using PPIs long-term to assess their perceptions regarding prolonged PPI use and attitudes toward deprescribing. Multivariate Logistic regression analysis was employed to identify factors influencing the continuous PPI use exceeding six months among those deemed eligible for deprescribing.

Results

After excluding individuals who declined to participate, could not be reached, or had not taken PPIs continuously, the final study population consisted of 318 residents who were chronically using PPIs. The mean age of long-term PPI residents was (63.9±12.5) years, 61.0% were female, the mean number of types of comorbid chronic diseases was (3.3±1.4) , and the mean number of medications was (6.1±3.3) , and the majority of the residents were able to carry out PPI deprescribing (231, 72.6%) . The prescribing indications for PPIs to prevent nonsteroidal anti-inflammatory drugs (NSAIDs) and antiplatelet drugs for gastrointestinal damage were the most frequent (202, 63.5%) . Multifactorial Logistic regression analysis showed that residents' age and number of medications were influential factors for taking PPIs continuously for >6 months[OR=1.044, 95%CI (1.016-1.073) ; OR=1.175, 95%CI (1.009-1.376) , P<0.05]. Residents who were still taking PPIs chronically between June and December 2020 and were available to carry out deprescribing was available for a total of 92 residents, 82.6% of respondents were aware of the indications for medication use, 70.7% (65/92) of respondents were unaware of the potential risks of long-term PPI use, 71.7% (66/92) were willing to deprescribe PPI with the help of their GP, and the main concern about deprescribing was recurring symptoms.

Conclusion

Long-term PPI residents in community health services are older and predominantly female, with a high proportion of multiple medication use; attention should be paid to the use of PPI medication by residents who are older and use a larger number of medications, and there is a need to strengthen the education on the potential risks of long-term use of PPIs, and long-term PPI users have a positive attitude towards PPI deprescribing, and there is a need to strengthen the management of long-term use of PPIs.

Key words: Proton pump inhibitor, Long-term use, Deprescribing, Telephone questionnaire survey, Community health services, Root cause analysis

摘要：

背景

质子泵抑制剂（PPI）长期服用的潜在风险和潜在不合理用药问题逐渐得到重视。PPI处方精简已得到广泛认同，我国社区居民中长期服用PPI的情况及进行PPI处方精简的意愿尚不明确。

目的

了解社区居民长期服用PPI及PPI处方精简的现状，探讨其影响因素并提出改进措施。

方法

于2018年4月—2020年1月对在北京市西城区什刹海社区卫生服务中心就诊长期服用PPI的389例居民进行调查，通过社区电子健康信息系统和电话问卷调查收集居民一般情况、PPI使用情况、是否同时使用非甾体类抗炎药（NSAIDs）和/或抗血小板药物、合并慢性疾病情况、用药数量、是否可开展PPI精简处方、多重用药情况等。通过电话问卷调查2020年6—12月仍长期服用PPI的92例居民对PPI长期服用的认知和处方精简态度。对可开展处方精简居民连续服用PPI时间>6个月的影响因素采用多因素Logistic回归分析。

结果

本次调查排除拒绝回答或无法联系、未连续服用PPI的患者后，最终318例长期服用PPI的居民纳入研究，平均年龄（63.9±12.5）岁，女性占61.0%，合并慢性疾病的数量平均为（3.3±1.4）种，用药数量平均为（6.1±3.3）种。可开展PPI处方精简的居民231例（72.6%）。PPI的处方指征中预防NSAIDs和抗血小板药物消化道损伤最多[202例（63.5%）]。多因素Logistic回归分析显示：居民的年龄（OR=1.044，95%CI=1.016~1.073）、用药数量（OR=1.175，95%CI=1.009~1.376）是连续服用PPI >6个月的影响因素（P<0.05）。2020年6—12月仍长期服用PPI且可开展处方精简的居民中82.6%（76/92）知晓药物使用适应证，70.7%（65/92）不了解长期服用PPI的潜在不良反应，71.7%（66/92）的愿意在全科医生的帮助下精简PPI处方，对于处方精简的主要担心是症状反复。

结论

社区卫生服务机构长期服用PPI居民的年龄较大、女性居多，多重用药比例高；应关注年龄大、用药数量较多居民使用PPI药物的情况，需加强对PPI长期服用潜在风险的宣教；长期服用PPI的居民对PPI处方精简的态度积极，但需加强对PPI长期用药管理。

关键词: 质子泵抑制剂, 长期服用, 处方精简, 电话问卷调查, 社区卫生服务, 影响因素分析

JING Guanning,ZOU Ying,ZHUO Xiaoqi, et al. The Current Status and Factors Influencing Long-term Proton Pump Inhibitor Use and Deprescribing among Community Residents[J]. Chinese General Practice, 2024, 27(19): 2344-2351. DOI: 10.12114/j.issn.1007-9572.2023.0527.
荆冠宁,邹颖,禚小琪等. 社区居民长期服用质子泵抑制剂和处方精简的现状及影响因素研究[J]. 中国全科医学, 2024, 27(19): 2344-2351. DOI: 10.12114/j.issn.1007-9572.2023.0527.

Figures/Tables 8

References 36

[1]	FREEDBERG D E，KIM L S，YANG Y X. The risks and benefits of long-term use of proton pump inhibitors：expert review and best practice advice from the American gastroenterological association[J]. Gastroenterology，2017，152（4）：706-715.
[2]	VAEZI M F，YANG Y X，HOWDEN C W. Complications of proton pump inhibitor therapy[J]. Gastroenterology，2017，153（1）：35-48.
[3]	THOMPSON W，FARRELL B. Deprescribing：what is it and what does the evidence tell us?[J]. Can J Hosp Pharm，2013，66（3）：201-202.
[4]	FARRELL B，POTTIE K，THOMPSON W，et al. Deprescribing proton pump inhibitors：evidence-based clinical practice guideline[J]. Can Fam Physician，2017，63（5）：354-364.
[5]	广东省药学会. 预防性使用质子泵抑制剂及处方精简专家指导意见[J]. 临床医学研究与实践，2019，4（21）：封3.
[6]	尹钢，张石革. 2010—2013年全国医院系统质子泵抑制剂应用趋势及相关问题分析[J]. 中国医院用药评价与分析，2016，16（6）：817-819.
[7]	By the American Geriatrics Society Beers Criteria® Update Expert Panel. American geriatrics society 2019 updated AGS beers criteria® for potentially inappropriate medication use in older adults[J]. J Am Geriatr Soc，2019，67（4）：674-694.
[8]	JENSEN B E S，HANSEN J M，JUNKER A B，et al. High prevalence of ulcer bleeding risk factors in dual antiplatelet-treated patients after percutaneous coronary intervention[J]. Dan Med J，2015，62（6）：A5092.
[9]	中华医学会消化病学分会. 2020年中国胃食管反流病专家共识[J]. 中华消化杂志，2020，40（10）：649-663.
[10]	ROONEY M R，BELL E J，ALONSO A，et al. Proton pump inhibitor use，hypomagnesemia and risk of cardiovascular diseases：the atherosclerosis risk in communities（ARIC）Study[J]. J Clin Gastroenterol，2021，55（8）：677-683.
[11]	国家卫生健康委办公厅关于印发质子泵抑制剂临床应用指导原则（2020年版）的通知[EB/OL].（2020-12-09）[2023-08-06].
[12]	OTHMAN F，CARD T R，CROOKS C J. Proton pump inhibitor prescribing patterns in the UK：A primary care database study[J]. Pharmacoepidemiol Drug Saf，2016，25（9）：1079-1087.
[13]	PASINA L，NOVELLA A，ELLI C，et al. Overuse of proton pump inhibitors in nursing homes：An Italian multicenter observational study[J]. Pharmacoepidemiol Drug Saf，2020，29（4）：461-466.
[14]	SU S，GAO L L，MA W Y，et al. Number-dependent association of potentially inappropriate medications with clinical outcomes and expenditures among community-dwelling older adults：a population-based cohort study[J]. Br J Clin Pharmacol，2022，88（7）：3378-3391.
[15]	ROUX B，SIROIS C，SIMARD M，et al. Potentially inappropriate medications in older adults：a population-based cohort study[J]. Fam Pract，2020，37（2）：173-179.
[16]	DOELL A，WALUS A，TO J，et al. Quantifying candidacy for deprescribing of proton pump inhibitors among long-term care residents[J]. Can J Hosp Pharm，2018，71（5）：302-307.
[17]	NOTHELLE S K，SHARMA R，OAKES A H，et al. Determinants of potentially inappropriate medication use in long-term and acute care settings：a systematic review[J]. J Am Med Dir Assoc，2017，18（9）：806.e1-806.e17.
[18]	POTTEGÅRD A，BROE A，HALLAS J，et al. Use of proton-pump inhibitors among adults：a Danish nationwide drug utilization study[J]. Therap Adv Gastroenterol，2016，9（5）：671-678.
[19]	LANZA F L，CHAN F K L，QUIGLEY E M M，et al. Guidelines for prevention of NSAID-related ulcer complications[J]. Am J Gastroenterol，2009，104（3）：728-738.
[20]	SCHEIMAN J M，YEOMANS N D，TALLEY N J，et al. Prevention of ulcers by esomeprazole in at-risk patients using non-selective NSAIDs and COX-2 inhibitors[J]. Am J Gastroenterol，2006，101（4）：701-710.
[21]	IWAKIRI K，FUJIWARA Y，MANABE N，et al. Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021[J]. J Gastroenterol，2022，57（4）：267-285.
[22]	RANE P P，GUHA S，CHATTERJEE S，et al. Prevalence and predictors of non-evidence based proton pump inhibitor use among elderly nursing home residents in the US[J]. Res Social Adm Pharm，2017，13（2）：358-363.
[23]	National Institute for Health and Care Excellence：Guidelines[M]. Gastro-oesophageal reflux disease and dyspepsia in adults：investigation and management. London；National Institute for Health and Care Excellence（NICE）Copyright © NICE 2019. 2019.
[24]	LUKACENA K M，KECK J W，FREEMAN P R，et al. Patients' attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists[J]. Ther Adv Drug Saf，2022，13：20420986221116465.
[25]	GALAZZI A，LUSIGNANI M，CHIARELLI M T，et al. Attitudes towards polypharmacy and medication withdrawal among older inpatients in Italy[J]. Int J Clin Pharm，2016，38（2）：454-461.
[26]	TONELLI M R，SULLIVAN M D. Person-centred shared decision making[J]. J Eval Clin Pract，2019，25（6）：1057-1062.
[27]	MURRAY E，POLLACK L，WHITE M，et al. Clinical decision-making：Patients' preferences and experiences[J]. Patient Educ Couns，2007，65（2）：189-196.
[28]	KUA K P，SAW P S，LEE S W H. Attitudes towards deprescribing among multi-ethnic community-dwelling older patients and caregivers in Malaysia：a cross-sectional questionnaire study[J]. Int J Clin Pharm，2019，41（3）：793-803.
[29]	BURGHLE A，LUNDBY C，RYG J，et al. Attitudes towards deprescribing among older Adults with limited life expectancy and their relatives：a systematic review[J]. Drugs Aging，2020，37（7）：503-520.
[30]	张莎，蒙龙，杨佳丹，等. 重庆市某社区老年慢性病患者对处方精简态度的调查研究[J]. 中国药房，2018，29（10）：1408-1411.
[31]	WALSH K，KWAN D，MARR P，et al. Deprescribing in a family health team：a study of chronic proton pump inhibitor use[J]. J Prim Health Care，2016，8（2）：164-171.
[32]	WALDUM H L，QVIGSTAD G，FOSSMARK R，et al. Rebound acid hypersecretion from a physiological，pathophysiological and clinical viewpoint[J]. Scand J Gastroenterol，2010，45（4）：389-394.
[33]	NIKLASSON A，LINDSTRÖM L，SIMRÉN M，et al. Dyspeptic symptom development after discontinuation of a proton pump inhibitor：a double-blind placebo-controlled trial[J]. Am J Gastroenterol，2010，105（7）：1531-1537.
[34]	REEVE E，TO J，HENDRIX I，et al. Patient barriers to and enablers of deprescribing：a systematic review[J]. Drugs Aging，2013，30（10）：793-807.
[35]	BRUNNER L，RODONDI N，AUBERT C E. Barriers and facilitators to deprescribing of cardiovascular medications：a systematic review[J]. BMJ Open，2022，12（12）：e061686.
[36]	RIECKERT A，BECKER A，DONNER-BANZHOF N，et al. Reduction of the long-term use of proton pump inhibitors by a patient-oriented electronic decision support tool（arriba-PPI）：Study protocol for a randomized controlled trial[J]. Trials，2019，20（1）：636.

PPI处方用药指征	占比
预防NSAIDs和抗血小板药物消化道损伤	202（63.5）
反流性食管炎	75（23.6）
胃食管反流病	29（9.1）
胃溃疡	9（2.8）
慢性胃炎	2（0.6）
糜烂性胃炎	1（0.3）

PPI处方用药指征	占比
预防NSAIDs和抗血小板药物消化道损伤	202（63.5）
反流性食管炎	75（23.6）
胃食管反流病	29（9.1）
胃溃疡	9（2.8）
慢性胃炎	2（0.6）
糜烂性胃炎	1（0.3）

主要慢性疾病	占比
高血压	256（80.5）
冠心病	171（53.8）
2型糖尿病	158（49.8）
高脂血症	154（48.4）
骨关节病	91（28.6）
骨质疏松症	50（15.7）
缺血性脑血管病	49（15.4）
哮喘	25（7.9）
前列腺增生症	18（5.7）
腰腿痛	15（4.7）
便秘	12（3.8）

主要慢性疾病	占比
高血压	256（80.5）
冠心病	171（53.8）
2型糖尿病	158（49.8）
高脂血症	154（48.4）
骨关节病	91（28.6）
骨质疏松症	50（15.7）
缺血性脑血管病	49（15.4）
哮喘	25（7.9）
前列腺增生症	18（5.7）
腰腿痛	15（4.7）
便秘	12（3.8）

指标	>6个月（n=64）	≤6个月（n=167）	χ²（t）值	P值
年龄（±s，岁）	68.1±11.9	61.1±12.5	3.866^a	<0.001
BMI（±s，kg/m²）	24.5±1.9	24.1±2.8	1.006^a	0.316
合并慢性病数量（±s，种）	3.4±1.1	2.9±1.5	2.298^a	0.022
用药数量（±s，种）	6.9±3.4	5.1±2.8	4.031^a	<0.001
性别[例（%）]			0.931	0.335
男	27（42.2）	59（35.3）
女	37（57.8）	108（64.7）
是否签约[例（%）]			0.010	0.974
是	52（81.3）	136（81.4）
否	12（18.7）	31（18.6）
是否吸烟[例（%）]			0.884	0.347
是	15（23.4）	25（15.0）
否	49（76.6）	137（82.0）
是否饮酒[例（%）]			0.010	0.972
是	7（10.9）	18（10.8）
否	57（89.1）	149（89.2）
单联抗血小板治疗[例（%）]			4.905	0.027
是	38（59.4）	72（43.1）
否	26（40.6）	95（56.9）
同时使用NSAIDs药物治疗[例（%）]			1.636	0.201
是	1（1.6）	26（15.6）
否	63（98.4）	141（84.4）
是否多重用药[例（%）]			7.754	0.005
是	47（73.4）	89（53.3）
否	17（26.6）	78（46.7）

The Current Status and Factors Influencing Long-term Proton Pump Inhibitor Use and Deprescribing among Community Residents

社区居民长期服用质子泵抑制剂和处方精简的现状及影响因素研究

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因素	B	SE	Waldχ²值	P值	OR（95%CI）
年龄	0.043	0.014	9.401	0.002	1.044（1.016~1.073）
合并的慢性病数目	0.031	0.132	0.010	0.921	0.987（0.763~1.277）
用药数量	0.162	0.078	4.307	0.038	1.175（1.009~1.376）
是否多重用药	0.020	0.489	0.002	0.967	1.020（0.392~2.659）
单联抗血小板	0.240	0.489	0.519	0.471	0.787（0.410~1.510）

指标	占比
1.是否知道药物使用适应证
知道	76（82.6）
比较模糊	10（10.9）
不知道	6（6.5）
2.药物适应证（多选）
有反酸、胃灼热、上腹痛症状	59（77.6）
预防NSAIDs或抗血小板药物相关损伤	27（35.5）
有消化道溃疡病史	12（15.8）
慢性浅表性胃炎	5（6.6）
萎缩性胃炎	4（5.3）
3.是否了解长期使用的药物潜在风险
了解	27（29.4）
不了解	65（70.7）
4.了解药物长期使用风险的途径（多选）
医生	24（88.9）
药师	3（11.1）
说明书	11（40.7）
网络、社区宣传	3（11.1）

指标	占比
1.开始服药后是否进行过胃镜检查
是	8（8.7）
否	77（91.3）
2.是否与全科医生或药师讨论过PPI继续使用问题
是	39（42.4）
否	41（44.6）
不需要	12（13.0）
3.曾在医生指导下进行停药、减药
是	28（30.4）
否	64（69.6）
4.曾自行停药、减药
是	71（77.2）
否	21（22.8）
5.过去1年时间里是否与医生核对长期药物名单
是	37（40.2）
否	55（59.8）

指标	占比
1.目前长期服用的药物数量
药物多，但都必要	37（40.2）
药物多，可以减少	16（17.4）
不多	39（42.4）
2.是否愿意在全科医生的帮助下精简PPI药物
愿意	66（71.7）
不愿意	18（19.6）
不确定	8（8.7）
3.对于PPI处方精简的担忧（多选）
症状反复	70（76.1）
其他药物消化道损伤风险	19（20.7）
没有与消化专科医生沟通	14（15.2）

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[3]	WEI Jiaohua, PENG Huiru, PENG Jianye, TAN Wenting, HUANG Jine, FANG Li. Expression of the Serum MOTS-c and Its Correlation with Atrial Remodeling in Patients with Atrial Fibrillation [J]. Chinese General Practice, 2025, 28(26): 3271-3276.
[4]	YU Zizi, LIU Duli, LI Ximin, RUAN Chunyi, YIN Xiangyang, CAI Le. Analysis of the Prevalence and Self-management of Hypertension and Its Influencing Factors in Rural [J]. Chinese General Practice, 2025, 28(25): 3137-3143.
[5]	JI Bing, JIANG Dudu, CHEN Chen, ZHENG Yanling, SHI Jianwei, FANG Lizheng, DU Xueping. Constructing a Comprehensive Community Clinical Pathway for Herpes Zoster under Graded Treatment Framework [J]. Chinese General Practice, 2025, 28(25): 3110-3118.
[6]	FAN Boyang, ZHANG Yu, SUN Wenning, ZHANG Huifang, WANG Yingjie, ZHANG Ao, ZHAO Yang, WANG Haipeng. Study of Behavioral Intention and Influencing Factors of Integrated Medical and Preventive Care Provided by Grassroots Doctors for Patients with Chronic Diseases [J]. Chinese General Practice, 2025, 28(25): 3144-3150.
[7]	WANG Rupeng, NAN Jing, HU Yiran, YANG Shenghua, JIN Zening. Predictive Value of the Triglyceride-Glucose Body Mass Index for Slow Flow/No-reflow Phenomenon in Patients with Type 2 Diabetes Mellitus and Acute Myocardial Infarction Undergoing Emergency Percutaneous Coronary Intervention [J]. Chinese General Practice, 2025, 28(24): 2985-2992.
[8]	WU Yue, WANG Xuetong, KE Bilian. Evaluation of Vision-related Quality of Life in Myopic Macular Degeneration Patients with Low Vision and Associated Factors [J]. Chinese General Practice, 2025, 28(23): 2908-2914.
[9]	DING Zijun, ZHOU Nannan, LUO Xing, LUO Jieyu, HAO Wenjuan, ZHANG Chunjiang, JIN Xin, ZHAO Dan. Cognitive Impairment in Patients on Maintenance Hemodialysis and Its Influencing Factors: a Multicenter Cross-sectional Study [J]. Chinese General Practice, 2025, 28(23): 2885-2893.
[10]	SHI Jiarui, WANG Zili, ZHANG Xueqing, SONG Yulei, XU Guihua, BAI Yamei. The Current Status of Initial Cognitive Screening Services in Community-based Cognitive Services Centers in Nanjing [J]. Chinese General Practice, 2025, 28(22): 2784-2790.
[11]	CHEN Youlan, LAN Yanqi, WU Ahua, ZHANG Haixia, HUANG Jiankang, GUO Zhinan. The Health Management Effect of Contracted Family Doctor Services under the Joint Management of Three Teachers in Xiamen City on Elderly Hypertensive Patients [J]. Chinese General Practice, 2025, 28(22): 2769-2775.
[12]	WEI Xiaoxia, CHEN Nuo, WANG Juanjuan, ZHU Jingfen. The Effects of Depression and Anxiety on Smoking Behavior among Vocational School Students [J]. Chinese General Practice, 2025, 28(22): 2826-2832.
[13]	ZHAO Xiaoqing, GUO Tongtong, ZHANG Xinyi, LI Linhong, ZHANG Ya, JI Lihong, DONG Zhiwei, GAO Qianqian, CAI Weiqing, ZHENG Wengui, JING Qi. Construction and Validation of a Risk Prediction Model for Cognitive Impairment in Community-dwelling Older Adults [J]. Chinese General Practice, 2025, 28(22): 2776-2783.
[14]	LIU Hongya, YU Dehua. Construction and Practice of Clinical Diagnosis and Treatment Technology Combining General Practice and Specialist in Shanghai Community [J]. Chinese General Practice, 2025, 28(19): 2390-2397.
[15]	HAO Aihua, ZENG Ziying, JIN Aiqiong, TANG Lingling, ZHENG Zique, MA Jingtai, ZHAO Jianguo, ZENG Weilin, XIAO Jianpeng, NIE Hui, YANG Ying. Analysis of Factors Influencing Avoidable Hospitalization for Elderly Hypertensive Patients [J]. Chinese General Practice, 2025, 28(19): 2370-2375.