There exist structural issues in China's healthcare system, where secondary and tertiary medical institutions are more likely to attract medical professionals with advanced academic degrees and high professional qualifications. Guiding the outreach of superior medical resources through a combination of administrative requirements and moderate incentives is an important measure to improve the quality of primary care services in the short term, with personnel outreach as the core priority of this initiative.

The outreach of specialists from county-level hospitals is one of the key measures to strengthen primary-level medical services. This study analyzed the potential classes of specialist outreach activities in a certain city and explored the impact of different classes on the job perception and competence of primary care providers, aiming to provide references for improving the practice of personnel downward mobility.

The study was conducted in a city of Shandong Province in October 2022, using multistage cluster sampling. First, 6 counties/county-level cities were selected; next, 6 townships/towns/subdistricts were randomly sampled from each of them, totaling 36 sites. Questionnaires were distributed to all on-duty medical staff (general practitioners, nurses, public health workers, etc.) on the day of investigation at sampled township health centers/community health service centers, plus 15 village doctors (active in family doctor teams) from each institution. Data were collected via a general information questionnaire, an evaluation of medical personnel outreach practices scale (assessing opportunities for case discussions, outpatient consultations, joint home visits, and training with higher-hospital specialists), a job satisfaction scale, and a diabetes management competence scale. Latent class analysis (LCA) identified patterns of outreach participation, and multiple linear regression examined how these latent classes affected primary staff's job satisfaction and diabetes management competence. A multi-stage cluster sampling method was used to select primary care providers in a certain city. Data were collected using a general information questionnaire, an evaluation questionnaire on personnel outreach practices, a job satisfaction scale, and a diabetes management capability scale. Latent class analysis was conducted on the participation of primary care providers in outreach activities, and multiple linear regression was used to analyze the impact of potential classes of outreach on the job satisfaction and diabetes management competence of primary medical personnel.

A total of 2 233 primary medical personnel were surveyed. Their participation in specialist downward mobility activities could be clustered into 3 potential classes: the comprehensive support group (31.66%, n=707), the in-hospital support group (16.93%, n=378), and the overall support deficiency group (51.41%, n=1 148). Results of multiple linear regression analysis showed that compared with the overall support deficiency group, both the comprehensive support group (B=4.798, P<0.001) and the in-hospital support group (B=3.241, P=0.002) positively predicted job satisfaction scores. Additionally, both the comprehensive support group (B=3.922, P<0.001) and the in-hospital support group (B=1.659, P<0.001) positively predicted diabetes management capability scores.

There are 3 potential categories of primary medical personnel's participation in specialist downward mobility activities. The richness of practical support activities varies, and more abundant support activities are positively correlated with job satisfaction and diabetes management competence. It is suggested to focus on specific and diversified support content in the downward mobility of specialists to truly improve the professional fulfillment and diabetes management competence of primary care providers.

我国医疗卫生体系存在结构性问题，二、三级医疗机构更易吸引高学历、高资质医务人员。以行政要求结合适度激励引导上级医疗资源下沉，是短期内提升基层服务质量的重要举措，其中以人员下沉为下沉重点。

县级医院专科医师下沉是强基层的重要措施之一，本研究分析某市专科医师下沉活动的潜在类别，并分析不同类别对基层医务人员工作感受和能力的影响，为完善人员下沉提供参考。

于2022年10月，在山东省某市展开。采用多阶段整群抽样调查，一阶段抽取该市6个区县或者县级市，二阶段随机抽取每个区县或者县级市的6个乡/镇/街道（共计36个乡/镇/街道），对其乡镇卫生院/社区卫生服务中心当日在岗所有医务人员（包括全科医生、护士、公共卫生人员、其余相关人员）以及在各乡镇卫生院/社区卫生服务中心随机抽取的15名村医（需参与家庭医生团队工作）进行调查。采用一般资料调查问卷、人员下沉做法评价问卷（包括与上级医院专科临床医师开展病例面对面讨论、进行门诊咨询、共同入户随访、共同参与培训或外出学习的机会）、工作满意度量表、糖尿病管理能力量表收集资料，对基层医务人员参加的下沉活动进行潜在类别分析，采用多元线性回归分析专科医师下沉帮扶的潜在类别对基层医务人员工作满意度和糖尿病管理能力的影响。

共调查2 233名基层医务人员，基层医务人员参与专科医师下沉活动可聚类为3个潜在类别：综合帮扶组（31.66%，n=707），院内帮扶组（16.93%，n=378），整体帮扶缺少组（51.41%，n=1 148）。多元线性回归分析结果显示，与整体帮扶缺少组相比，综合帮扶组（B=4.798，P<0.001）与院内帮扶组（B=3.241，P=0.002）均能正向预测工作满意度得分，且综合帮扶组（B=3.922，P<0.001）与院内帮扶组（B=1.659，P<0.001）均能正向预测糖尿病管理能力得分。

基层医务人员参加专科医师下沉活动存在3种潜在类别，现实帮扶活动丰富程度不同，更丰富的帮扶活动与工作满意度和糖尿病管理能力有正向相关关系。建议关注专科医师下沉政策中帮扶工作内容的具体化和丰富化、以"综合帮扶"模式为推荐路径，同时加强政策落实的完整度，以真正提高基层医务人员的获得感和糖尿病管理能力。