Since the number of chronic disease patients is increasing, relevant prevention and treatment services have become important long-term tasks for primary care institutions. However, problems in the provision of primary care services seriously affect the perception of such services in residents, especially chronic disease patients.
To understand chronic disease patients' assessment of the quality of primary care services, providing evidence for improving the quality of chronic disease management services in primary care.
A survey was conducted between July and August, 2020 with chronic disease patients (n=630) selected from primary care settings in Guangdong's Chaozhou by use of multistage stratified random sampling. The Primary Care Assessment Tool-Adult Simplified Version (PCAT-AS) (consists of 10 domains, including first contact accessibility, coordination, ongoing, comprehensiveness, community orientation and other 5 domains) was used in the survey for understanding chronic disease patients' assessment of the quality of primary care services. Multiple linear regression was adopted to identify factors potentially associated with the PCAT-AS score.
Altogether, 553 cases (87.8%) who returned responsive questionnaires were enrolled for analysis. The average total PCAT-AS score for all respondents was (95.88±13.44) . The top three domains ranked in terms of average standardized score were comprehensiveness (services needed) (7.89) , first contact accessibility (7.72) , and first contact utilization (7.58) , and the bottom three-ranked domains were coordination (referrals) (5.61) , community orientation (6.11) and patient and family centeredness (6.40) . Multiple linear regression analysis indicated that higher total PCAT-AS score was associated with living in urban areas in contrast to rural areas〔b (95%CI) =-6.983 (-10.598, -3.368) 〕, senior high school and higher education level instead of junior high school and lower education level〔b (95%CI) =4.046 (0.966, 7.125) 〕, permanent residents without the local hukou in contrast to those with local hukou〔b (95%CI) =-5.360 (-9.517, -1.202) 〕, good self-rated health instead of relatively poor self-rated health〔b (95%CI) =-4.962 (-8.438, -1.486) 〕 or poor self-rated health〔b (95%CI) =-7.787 (-12.789, -2.786) 〕, having a contracted family doctor instead of having no contracted family doctor〔b (95%CI) =4.686 (2.508, 6.865) 〕, first choosing a community health center for treating common diseases instead of a village clinic〔b (95%CI) =-5.865 (-9.951, -1.779) 〕 or a district/county-level hospital or tertiary hospital〔b (95%CI) =-6.061 (-11.330, -0.792) 〕, 4-6 primary care visits instead of 1-3 primary care visits〔b (95%CI) =5.876 (3.367, 8.384) or 7 or more primary care visits instead of 1-3 primary care visits〔b (95%CI) =9.045 (6.512, 11.579) 〕, and high satisfaction with primary care services instead of fair satisfaction〔b (95%CI) =-2.844 (-4.817, -0.870) 〕 or dissatisfaction〔b (95%CI) =-10.418 (-17.050, -3.786) 〕.
Overall, Chaozhou chronic disease patients reported a sound level of treatment experience in primary care. Specifically, they reported good primary care experience in three domains, including comprehensiveness, first contact accessibility and first contact utilization, but poor experience in community orientation, and coordination (including information systems and referrals) . However, urban patients reported better primary care experience than rural patients. So continued efforts are needed to strengthen primary care performance in rural areas.
One key to the development of the tiered diagnosis and treatment system lies in the establishment of a gatekeeping system in primary care supporting the implementation of first contact in primary care and the achievement of orderly healthcare-seeking. And the serving capacities of primary care professionals are essential in implementing first contact in primary care.
To understand the overall level of Henan primary care physicians' capabilities of diagnosing and treating common diseases, and to put recommendations for solving the problems.
In August 2020, by use of typical sampling method, physicians were selected from all primary care hospitals in four areas of Henan Province (Kaifeng's Xiangfu District and Lankao County, and Jiaozuo's Weidu District and Yanling County) . An online self-administered questionnaire survey was conducted with them for collecting information about their demographics, and capabilities of diagnosing and treating common diseases (involving the identification and diagnosis of common diseases, interpretation of relevant auxiliary examinations, and prescription of common medications) .
In all, 1 844 cases attended the survey, and 1 669 of them (90.51%) who effectively responded to the survey were included for final analysis. Among the 1 669 respondents, 917 (54.94%) had secondary health school education level or below, 663 (39.72%) had no professional title, 524 (31.40%) had a rural doctor certificate, and 509 (30.50%) had a practicing certificate. Among the 1 117 village doctors, 722 (64.64%) were 45 years old and above, 83 (7.43%) were 60 years old and above, and 848 (75.92%) had secondary health school education level or below. Among 1 631 respondents, 1 564 (95.89%) were basically able to diagnose and identify common diseases, 1 402 (86.00%) could interpret the results of common auxiliary examinations, 1 542 (94.54%) could prescribe common medications, and 1 336 (81.91%) had capabilities to diagnose and treat common diseases. Compared with urban primary care physicians, rural primary care physicians had higher level of capabilities in identifying and diagnosing common diseases as well as prescribing common medications, but lower level of capabilities in interpreting biochemical tests and electrocardiogram results (P<0.05) .
In general, the overall level of professional qualities was unsatisfactory in Henan primary care physicians, especially in those working in rural areas. Their level of capabilities for diagnosing and treating common diseases was generally satisfactory, although there is still much room for improvement. A sound cooperative mechanism between primary care hospitals and higher level hospitals should be established to ensure the safety in primary care.
In China, team-based service delivery model is a major emerging model for contracted family doctor services, but there is a lack of a tool for assessing the overall effectiveness of the family doctorteam.
To develop a IMOI model-based system for assessing the effectiveness of family doctor teams in Beijing, aiming at proving a tool for guiding the improvement and continuous development of the family doctor team.
The first draft of the Family Doctor Team Effectiveness Evaluation System (FDTEES) was developed using literature review and personal interview. Then the indicators of the system were assessed and revised according to consensuses of our analysis and the results of two rounds of consultations carried out between May and July 2021 using the Delphi technique (one was conducted with 24 experts, and the other with 21 experts) . The weight of the indicators of the system was determined by and analytic network process.
The response rate of experts in the first, and second round of consultation was 87.5% (21/24) , and 100.0% (21/21) , respectively. The authority coefficients for the consultations ranged from 0.88 to 0.91. Kendall's W for the importance and applicability of the indicators of the FDTEES was 0.138 (P<0.001) , and 0.263 (P<0.001) , respectively, in the first round of consultation, was 0.255 (P<0.001) , and 0.257 (P<0.001) , respectively, in the second round of consultation. The final FDTEES consists of 71 indicators, including 7 first-level indicators〔team building (0.155) , quality of team members (0.155) , team member relationship (0.097) , team process (0.141) , team service results (0.155) , perception and satisfaction (0.155) , team redevelopment (0.141) 〕, 16 second-level indicators, and 48 third-level indicators.
The IMOI model-based FDTEES developed by us assesses the effectiveness of family doctor teams in Beijing from a team perspective, which may be a reference for effectiveness evaluation and development of family doctor teams in Beijing.
