Elderly patients in community outpatient clinics often suffer from multiple chronic conditions and were particularly vulnerable to potentially inappropriate prescribing (PIP) .
To analyze the influencing factors of prescriptions for elderly patients becoming PIP in community outpatient clinics.
In March 2021, a combination of cluster sampling and simple random sampling was used to select drug prescriptions from elderly patients who visited a community health service center in Beijing from January 1 to December 31, 2019. The prescriptions were evaluated by two pharmacists with intermediate titles based on 2019 American Geriatrics Society Beers Criteria (abbreviated as Beers criteria) and Criteria of Potentially Inappropriate Medications for Older Adults in China (abbreviated as China criteria) , respectively. At the same time, the researchers collected the relevant data of the prescriber, elderly patients and the content of the prescription, and compared the differences in the characteristics of the prescriber, the prescription object and the prescription content of the prescriptions with different evaluation results. Binary Logistic regression method was used to analyze the factors affecting PIP prescribing and to conduct sensitivity analysis (selected prescriptions for patients≥65 years of age) . Descriptive analysis was used to describe the distribution of inappropriate medicine in PIP.
A total of 815 outpatient prescriptions for elderly patients were included, including 266 (32.6%) PIP under the Beers criteria or 182 (22.3%) PIP under the Chinese criteria, respectively. According to the Beers criteria, the differences were statistically significant when comparing the age of prescribers, the age of elderly patients, the proportion of those with the diagnosis of hypertension and insomnia, the number of drug varieties, and the proportion of those with the drug categories of cardiovascular system drugs, antithrombotic drugs, central nervous system drugs, and gastrointestinal system drugs between PIP and non-PIP (P<0.05) . According to the China criteria, the differences were statistically significant when comparing the age or title distribution of prescribers, the proportion of those with the diagnosis of hypertension, coronary heart disease, diabetes, insomnia and osteoarthritis, and the proportion of those with the drug categories of cardiovascular system drugs, antithrombotic drugs, non-insulin hypoglycemic drugs, central nervous system drugs and non-steroidal anti-inflammatory drugs (NSAIDs) between PIP and non-PIP (P<0.05) . The binary Logistic regression results showed that, no matter under the Beers criterion or the Chinese criterion: the prevalence of coronary heart disease or insomnia in elderly patients had an impact on the prescription of PIP, and the inclusion of antithrombotic agents in the prescription was an influencing factor affecting the formation of PIP (P<0.05) . The results of the sensitivity analysis showed that hypertension, coronary heart disease and insomnia in elderly patients have an impact on the prescribing of PIP; the inclusion of antithrombotic medication in the prescription was an influencing factor affecting the formation of PIP (P<0.05) . According to the Beers' criterion, 266 PIP involved a total of 302 cases of inappropriate drug use, of which antithrombotic drugs accounted for 46.4% (140/302) , central nervous system drugs accounted for 16.2% (49/302) , endocrine system diabetes (non-insulin) drugs accounted for 13.9% (42/302) . According to the Chinese criterion, 182 PIP involved inappropriate medications in a total of 205 cases, of which antithrombotic drugs accounted for 44.9% (92/205) , central nervous system drugs accounted for 25.9% (53/205) , oral NSAIDs accounted for 14.1% (29/205) .
Among the community outpatient prescriptions for elderly patients, PIP accounted for a relatively high proportion. In the future, emphasis should be placed on community physicians' knowledge of safe and rational drug use, the use of antithrombotic drugs should be standardized, and the review of drug prescriptions for patients with hypertension, coronary artery disease and insomnia should be strengthened.
China is seeing an increasing number of people suffering from dementia as aging advances and life expectancy prolongs. Early diagnosis is extremely important for dementia.
To understand the attitudes and views of community general practitioners (GPs) regarding dementia screening, providing suggestions for the development of dementia screening in the community.
In July 2021, by use of purposive sampling, GPs were recruited from community health centers (stations) in Lanzhou, Gansu, and invited to attend a semi-structured, in-depth, face-to-face individual interview for understanding their attitudes and views toward dementia screening. The interview results were analyzed using phenomenological analysis and thematic analysis.
Ten GPs from five community health centers and five community health stations were finally enrolled, including five males and five females, with an average age of (46.6±6.5) years〔range (35, 57) 〕, an average years of (14.90±8.46) working as a GP〔range (5, 26) 〕; seven with a bachelor degree; four with a title of attending physician. Three themes were extracted: insufficient basic conditions for carrying out community-based dementia screening, difficulties in carrying out community-based dementia screening, and improvement of community GPs' abilities to participate in dementia screening. Nine subthemes were also extracted.
Community GPs supported community-based dementia screening, but had insufficient capacities to carry out the screening. The following may be effective measures for promoting early screening and intervening dementia: improving the ability of community GPs to screen dementia, strengthening the publicity and popularization of dementia-related knowledge to reduce social discrimination against dementia, and deepening the development of contracted family doctor services.
In China, a country owning a large number of hypertensive patients, offline management is still a major approach for hypertension prevention and control, but the efficiency and effectiveness of this approach are unsatisfactory. Therefore, it is necessary to develop a closed-loop hypertension management path using online management approaches actively explored based on cognitive-behavioral models.
To assess the effect of cognitive-behavioral change model-based online health education in the management of hypertension.
A total of 122 essential hypertension outpatients and inpatients were recruited from General Practice Department, General Hospital of Medical University of Ningxia Medical University from November 2018 to October 2019, and randomly divided into online management group (n=61) and off-line management group (n=61) . Off-line management group received routine management. Online management group received online health education (including systematic courses and personalized self-management information in line with the five stages of behavior transformation of hypertension patients provided via the WeChat platform for gradually changing their health-related behaviors) based on the cognition-behavioral change model (a model built upon improved knowledge-attitudes-behavior model, health belief model, and transtheoretical model) . Systolic blood pressure (SBP) and health-related behaviors at baseline and 12 weeks after intervention were compared between the groups.
The average SBP levels at baseline demonstrated no significant difference between the groups (P<0.05) . After intervention, the average SBP level decreased significantly in both groups (P<0.05) , and it decreased more significantly in the online management group (P<0.05) . Two groups showed no significant differences in the prevalence of self-monitoring blood pressure, taking medications, eating a diet and exercising as well as taking actions to improve psychological state according to the doctor's advice at baseline (P<0.05) . After intervention, the prevalence of self-monitoring blood pressure according to the doctor's advice was significantly increased in the online management group (P<0.05) although the prevalence of other four of the above-mentioned health-related behaviors was still similar in both groups (P<0.05) .
This hypertension management approach developed based on mobile health technologies and the cognition-behavioral change model could help general practitioners to effectively manage hypertension patients, which will contribute to the improvement of work efficiency of general practitioners, and the achievement of long-term preservation and real-time analysis of patient management data. So this management is worthy of application and promotion.
Doctor-patient communication barrier is one of the major causes leading to medical disputes. Still, there are limited studies and rare instruments with good reliability and validity regarding doctors' ability to communicate with patients in China.
To construct the Five Habits Coding Scale (5HCS) and verify its reliability and validity.
The first draft of the Five Habits Coding Scale (5HCS) was formulated based on the Chinese version of the Four Habits Coding Scheme (4HCS) developed using Brislin's translation model in March 2014. Then from April to June 2014, the items of the first draft of 5HCS were revised in accordance with the expert consensuses obtained from two rounds of Delphi consultations, and after that, the final version of the 5HCS was developed, and utilized to evaluate 127 residents' abilities to communicate with patients in March 2018 for testing its internal consistency, inter-rater reliability, content validity and criterion-related validity.
The final version of 5HCS consists of 21 items fell under 5 dimensions, namely "Show respect and kindness, harmonize doctor-patient relationship" "Provide information, guide patients' views" "Demonstrate empathy, build up trust" "Risk disclosure, informed consent", and "Provide diagnostic information, shared-decision making". The Cronbach's α of the scale was 0.716. The dimension-total correlation coefficients (Pearson correlation coefficients) ranged from 0.524 to 0.692, and the content validity index of each item (I-CVI) ≥0.81. The inter-rater reliability was calculated by intraclass correlation (ICC) (Pearson coefficient=0.912, ICC=0.912, P<0.01) . And the criterion-related validity was testified by comparing to the Chinese version of SEGUE (r=0.377, P<0.01) .
The 5HCS has been proved to be highly reliable and valid, so it could be applied and promoted as a tool to evaluate the doctor-patient communication ability of residents in China.
