General practitioners with sub-specialties can not only provide high-quality general medical services, but also provide a certain depth of specialized medical services. The combination of general practitioners with sub-specialties of different specialties can provide relatively comprehensive and certain depth of basic medical services for residents in their jurisdictions. Under the situation that the professional service capacity of mental health cannot meet the needs of residents, the necessity of encouraging some general practitioners to develop mental health subspecialties has become increasingly prominent. This article analyzes the necessity of training general practitioners with psychosis subspecialty, the advantages of developing psychosis subspecialty among general practitioners, the obstacles to promoting the development of psychosis sub-expertise of general practitioners in primary care are proposed: the construction of general practitioners training bases for psychosis sub-expertise, the learning platform for general practitioners with psychosis sub-expertise was expanded, construction of sub-specialty teachers of psychosis, policy and financial support, salary and promotion incentive policies, etc., are expected to help general practitioners develop psychosis sub-expertise.
Rare diseases, characterized by low prevalence and significant challenges in diagnosis and management, have increasingly gained attention in recent years due to advancements in medical technology. As gatekeepers of health and managers of patient and family health, general practitioners in many countries are now being integrated into the framework for managing rare diseases. The article discusses the current status of general practitioners in the diagnosis and management of rare diseases, including their role in the management process, efforts made, and the lack of knowledge about rare diseases. It highlights that despite challenges in recognizing rare diseases, most general practitioners are willing to improve their awareness and training. They can effectively participate in the comprehensive management of patients with rare diseases, playing a vital role in early identification, coordinating treatment, and providing integrated services.
Patients' experience as an important aspect of measuring and evaluating the quality of primary healthcare services, it's important to measure and evaluate it. However, the research about patients' experience in China started late, and there are even fewer studies focusing about patients who visit to the primary health care institutions.
To reflect the progress of primary healthcare services in China by measuring and evaluating patients' experience which from the primary health care institutions.
From March to April 2023, a patient questionnaire survey was conducted by trained and qualified investigators using an intercept method on patients of township health centers/community health service centers in 3 sample townships/streets in 12 national comprehensive primary health care pilot zones (hereinafter referred to as "the pilot zones"). The main survey tool was the Assessment Survey of Primary Care (ASPC) scale. In fact, 36 institutions and 1 157 patients were surveyed.
The scores for the dimensions of the first visit/first line care, service accessibility, continuity of the patient relationship, comprehensive services, and coordinated services for the patients surveyed who received primary healthcare services were (69.5±20.5), (74.1±20.1), (72.0±20.7), (75.1±21.0), and (68.5±21.7) respectively, with the total score of the ASPC scale being (71.8±17.3). There were statistically significant differences (P<0.05) between patients of different ages, literacy levels, employment statuses, whether they were signed up or not with prationers, and whether they were with chronic diseases as well as in the different pilot zones in all dimension scores and in total scores. The results of the multivariate linear regression analysis show that age, employment statuses, signed up or not with prationers, and different pilot zones are the influencing factors for the scores of the first visit/first line care in patient (P<0.05), while employment statuses, signed up or not with prationers and different pilot zones are the influencing factors for the scores of the other four dimensions and the total score of the scale (P<0.05). After adjusting for other factors, the scores on the five dimensions and the total score of the ASPC scale were all lower in unemployed patients than in employed patients (P<0.05). The scores on the five dimensions and the total score of the ASPC scale were all higher in patients who had signed up with prationers than in those who had not (P<0.05). The total score of the ASPC scale was higher in patients from Changting County, Xishui County than in those from Jiexiu City (P<0.05), while it was lower in patients from Haiyan County, Lu County, Dongfang City than in those from Jiexiu City (P<0.05). The total score of the ASPC scale was not statistically significant in patients from Suixi County, Shouguang City, Jiaxian County, Xinyuan County, Miyun District, and Shangsi County compared with those from Jiexiu City (P>0.05) .
The scores of ASPC reflect the current situation of primary health care services in China. The implementation of the family doctor contract service enhances the patient's experience of the first visit to the primary health care institutions, accessibility of services, continuity of the doctor-patient relationship, comprehensive services, and coordinated services. The capacity and quality of primary health service delivery varies across the pilot zones. The difference in the experience score of primary outpatients in different experimental areas is related to "patient-centered" and convenience measures.
General practitioners of traditional Chinese medicine (TCM), known as the "gatekeepers" of residents' health, provide continuous services to them. Recently, China has rolled out a series of policies aimed at supporting the growth of the workforce of TCM general practitioners and has made it a key development indicator, which holds great importance for advancing the TCM cause.
In alignment with the development goals outlined in the "14th Five-Year Plan" for the Development of TCM, this study analyzes the current status of the TCM general practitioner workforce in China, explores the optimization of statistical methodologies for TCM general practitioners, and proposes corresponding countermeasures and suggestions.
Based on data from the China Health Statistics Yearbook from 2021 to 2023 and special survey data, the difference between the actual number of TCM general practitioners in 2020 and 2022 and the planned number for 2025 was calculated. The completion rate of the planning targets was then computed based on these differences. A comparative method was used to analyze the data.
In 2022, the number of TCM general practitioners per 10 000 population was 0.75, representing an increase of 13.27% compared to 2020, with an average annual growth rate of 6.43%. There were significant regional disparities in the distribution of TCM general practitioners per 10 000 population, with the eastern, central, and western regions decreasing in that order, at 0.88, 0.68, and 0.61 respectively. The national completion rate for the TCM general practitioner workforce plan was 66.76%, indicating good overall progress. A total of 17 provinces (municipalities, autonomous regions) achieved a completion rate of 40% or higher for their TCM general practitioner workforce planning targets, with 11 of them exceeding their targets. Additionally, 14 provinces (municipalities, autonomous regions) made slower progress, including 9 provinces where the completion rate was negative. Based on special assessment data, calculations were made for TCM general practitioners from the perspectives of functional positioning and scope of practice, with 9 provinces and 20 provinces achieving their planning targets ahead of schedule, respectively.
Currently, the statistical count of TCM general practitioners is directly influenced by the number of general practitioners, leading to significant impacts on the count of TCM general practitioners when there are changes in the statistical criteria for general practitioners. It is necessary to further clarify the definition and statistical scope of TCM general practitioners, and strengthen the monitoring and evaluation of TCM general practitioner indicators to ensure the smooth achievement of planning targets.
The National Essential Public Health Services Programs (NEPHSP) is a systematic and overall basic public service system arrangement made by the Chinese government at the national level aiming at the main health problems existing in urban and rural residents and targeting at key population key diseases and the whole population. Year of 2019 is the tenth anniversary of the NEPHSP implementation. This article summarized the significance of implementing NEPHSP based on a 10-year evaluation of NEPHSP from four aspects: universal health coverage, Healthy China 2030 strategy, China's deepening health system reform and major institutional innovation. At the same time, several main experiences of successful projects were summarized, including the following five aspects: establishing and improving a strong project organization and management system, steadily increasing strength of financial support, following the principle of gradual implementation of projects, advocating and encouraging local exploration in accordance with local conditions, and adhering to clear reward and punishment performance appraisal. From the historical perspective, this paper summarized the implementation of the great project led by the Chinese government in order to introduce the Chinese way, Chinese practice and Chinese experience of primary health care work in the new era at home and abroad.
The national essential public health services programs (NEPHSP) is an important project led by the Chinese government to benefit the people, which is a Chinese practice towards universal health coverage. In 2009, the project was rolled out across the country, and its coverage and influence are second to none in the field of public health in China. It is necessary to review the 10-year progress of the project and clarify its effectiveness to maintain its sustainable development.
To systematically sort out and summarize the progress and achievements of the NEPHSP made over the past decade (2009-2019) .
We collected the monitoring data (2009-2016) of basic public health projects in 31 provinces (autonomous regions and municipalities directly under the central government) through correspondence, analyzed the monitoring data of the national basic public health service management platform (2017-2019) and the relevant indicators of the China Health Statistical Yearbook (2010-2020) , and analyzed the coverage of basic public health services in the country over the past ten years from the perspective of providers. From November to December 2019, a ten-year assessment survey of the national essential public health services was carried out in Zhejiang Province, Shanxi Province and Chongqing city to investigate the residents' awareness, utilization, satisfaction and self-assessment benefit rates of NEPHSP from the perspective of the consumers.
During the past decade, the coverage of various service items of basic public health in China has increased significantly: (1) the rate of construction of health file, the rate of construction of electronic health file, and the utilization rate of health file have increased from 48.78%, 35.07% and 22.14% in 2009 to 88.25%, 86.82% and 55.34% in 2019, with an average annual growth rate of 6.41%, 10.92% and 15.62% respectively; (2) A total of 6.311 billion printed health education materials were distributed nationwide, about 337million audio-visual health education materials were broadcasted, and a total of 1.144 billion people attended health education lectures; (3) By 2019, there were about 109 million registered hypertensive patients and about 31 357 100 diabetes patients nationwide. The standardized management rate of hypertensive / diabetes patients has increased by 29.28% and 27.25% respectively in the past decade. The blood pressure / blood glucose control rate in the population managed for hypertension / diabetes has increased by 16.84% and 24.69% respectively in the past decade, with an average annual growth rate of 3.28% and 5.56% respectively. The gap in each indicator among the eastern, central and western regions was gradually narrowing; (4) The rates of early pregnancy enrollment, antenatal examination, postpartum visit and system management increased by 6.06%, 4.60%, 7.79% and 9.40% respectively. The ten-year rates of neonatal visit and health management of 0-6-year-old children increased by 14.09% and 17.82% respectively, with an average annual growth rate of 1.74% and 2.30%. In 2019, the national elderly health management rate was 67.41%, an increase of 26.23% over 2009, with an average annual growth rate of 5.96%. The average annual growth rate of TCM health management services for the elderly and children was 15.00% and 12.97%, respectively; (5) The rate of establishing vaccination certificates and the vaccination rate of all kinds of vaccines among residents were stable at more than 90%; The standardized management rate of patients with severe mental disorders reached 89.17% in 2019, the management rate of pulmonary tuberculosis patients and the regular drug taking rate of pulmonary tuberculosis patients had been stable at more than 95% since 2015; (6) In 2019, the awareness rate of the national essential public health services programs for participating residents in the survey was 85.4%, the service utilization rate was 98.7%, the service satisfaction of the key groups was more than 90%, and the self-assessment service benefit rate was more than 85%; (7) The service capacity of primary medical and health service institutions had been improved, and the number of institutions had shown a continuous upward trend. The number of personnel in primary medical and health institutions, the proportion of doctors and nurses, and the proportion of Bachelor degree or above had all increased year by year.
Over the past decade, as an important part of basic health services in China, the population coverage of basic public health services had increased significantly, the goal of wide service coverage had been basically achieved, the health management level of the focused population had been significantly improved, the effect of health management had been presented, the residents' sense of access to basic public health services had been gradually improved, and the service capacity of basic medical and health institutions had been continuously improved. The comprehensive implementation of basic public health services in China is an important initiative towards the goal of "universal health coverage".
As an important measure to deepen the reform of the medical and pharmaceutical health system, the national essential public health services programs has been carried out for more than ten years. Therefore, it is of great significance to evaluate the effect and remaining problems of the programs over the decade of implementation period (2009-2019) and to further promote the country's basic public health services. With reference to Donabedian quality theory, this paper summarized and analyzed the key problems existing in China's basic public health services from the aspects of project objectives, project contents, operation mechanisms, implementation processes and effects, and make relevant suggestions from six aspects, mainly as follows: based on scientific reasoning, dynamically adjusting the programs; suggestion that the national basic public health services should be graded and managed by classification; timely revision of project specifications to improve service quality and efficiency; gradually promoting the effectiveness-oriented evaluation and assessment system; improving operational mechanisms and promoting sustainable development; fully playing the role of county medical community, and enhancing service coordination; establishing a scientific and long-term monitoring mechanism for national essential public health services programs. It provides reference for further improvement and optimization of national essential public health services progjects.
