Community rehabilitation has much in common with primary health care. While providing primary health care for key groups, primary health care institutions will be of great significance if they can accurately provide rehabilitation services to people in need, reduce their degree of dysfunction, improve their quality of life, and realize the functional positioning of "rehabilitation at the grassroots level". This paper focuses on the coordinated development of community rehabilitation and primary health care, proposes several strategies in service delivery, service cooperation, and service financing, in order to provide references for the expansion of rehabilitation capabilities in primary health care institutions, and hopes to contribute to higher general public health standards and reduced medical expenditures.
Lifestyle Medicine, which emerged in the 1980s, is an interdisciplinary discipline involving various fields such as medicine, nutrition, exercise science, epidemiology, psychology, etc. It serves as a crucial bridge between public health promotion and clinical treatment, and plays a significant role in preventing, treating, and rehabilitating various diseases. This paper presents a comprehensive review of the definition, connotation, origin, development, and evaluation tools for assessing the effectiveness of Lifestyle Medicine. The findings reveal that Lifestyle Medicine aligns remarkably well with the principle of traditional Chinese medicine (TCM) regarding disease prevention and treatment. Despite notable research advancements in chronic disease management in China, the field of lifestyle medicine is still at an early stage of development. However, there remains a lack of specific, quantified, and standardized guidelines for implementing lifestyle interventions as well as clinical protocols and evaluation systems. The localization of Lifestyle Medicine in China still needs to consider local conditions, while increasing national policy support to establish a national data monitoring system and decision support system. Emphasizing health equity and optimising resource allocation across different regions are also essential aspects to be considered. Furthermore, integrating the advantages of TCM, including of its characteristic therapies, simplicity and cost-effectiveness, will promote the application and dissemination of Lifestyle Medicine for preventing and managing chronic diseases, thereby enhancing overall population health.
The diagnosis and treatment of medically unexplained symptoms (MUS) is complex and the cost of medical resources is large. MUS is a challenging clinical problem in general practice. The field of MUS is still in the preliminary stage of exploration in China. In this review, we systematically and comprehensively discuss the current challenges of MUS in the aspects of the concept, epidemiological characteristics, pathogenesis, diagnosis and treatment. We also propose some possible countermeasures combined with the actual situation. This article shows that there is no consensus on the concept, mechanism and diagnostic of MUS, suggesting the urgent need to draft relevant clinical guidelines and construct clinical pathways. At present, general practitioners have insufficient ability in the understanding, diagnosis and treatment of MUS, therefore, it is necessary to strengthen the training of MUS competence for general practitioners. More prospective, multi-center and multidisciplinary studies are needed to explore the characteristics and treatment strategies of MUS. This article provides a reference for general practitioners to understand and manage MUS scientifically and effectively.
Post-stroke patients are often left with different degrees of functional impairment, and in the process of returning from the medical institution to the community and home, it is necessary for medical institutions at all levels to cooperate and interact, so as to form a good full-cycle rehabilitation closed loop. At present, the application of full-cycle stroke rehabilitation is progressing, but some resistance still exists. This articel is based on the concept of full-cycle rehabilitation for stroke, combined with the current situation of the development of community-based rehabilitation, we also think about the development of the full-cycle rehabilitation and community-based rehabilitation link for stroke. The article emphasizes the importance of "community-based inflection-point rehabilitation" and the need to establish standards of community-based rehabilitation. Moreover, the article also mentions the need to emphasize the full-cycle stage of rehabilitation for stroke patients, explore the development strategy of community-based rehabilitation, and effectively improve the quality of life in community and family.
The primary healthcare system is key to achieving a health equity. In China, great obstacles are challenged by imbalanced medical resources, shortage of primary healthcare providers, and the prevention and treatment of chronic diseases. Artificial intelligence large language models have demonstrated strong advantages in the medical system. This article deeply explored the application of large language models in the primary healthcare system and the challenges. The large language models are expected to assist the diagnosis and treatment of common diseases in grassroot medical institutions, promote intelligent health education and chronic disease management, underpin primary health services in the undeveloped and remote areas, stimulate the leapfrog development of general medicine, and accelerate the industrialization of large language models in general diagnosis and treatment and primary health services, thus providing important support for the construction of healthy China.
The increasing prevalence of chronic diseases globally poses major challenges to the health of societies and individuals. Managing chronic diseases requires long-term treatment and monitoring, placing demands on patients' lifestyles. With the aging of the population and changes in lifestyle, chronic disease prevention and control are becoming more and more important. In recent years, as scientific and technological innovation in the field of healthcare develops in depth, and the application of artificial intelligence in healthcare has gradually become one of the important strategic directions of the country, the traditional method of chronic disease management relies too much on the offline communication between the doctor and the patient, which leads to the doctor not being able to maintain long-term and effective communication and follow up with the patient, and the patient may not be able to be detected and monitored by the doctor in a timely manner when his or her condition changes. In addition, the traditional chronic disease management approach is usually a generalized approach that fails to adequately consider the individual differences of each patient. Given the limitations of traditional chronic disease management methods, this study aims to provide more convenient and efficient primary care services using intelligent robots. Through personalized health management plans, assisted medical diagnosis, and timed medication reminders, the intelligent robot is committed to improving patients' quality of life, reducing the pressure on healthcare resources, and promoting the development of intelligent healthcare management globally.
The outbreak of COVID-19 has had a huge impact globally. After the infection, a considerable number of patients have been affected by a series of lingering symptoms or sequelae with strong heterogeneity, which we temporarily refer to as long COVID. Compared to the well-studied cardiovascular complications caused by COVID-19 during the acute phase, the cardiovascular sequelae in long COVID require greater attention. This review includes the clinical manifestations, mechanisms, and principles of diagnosis and management of cardiovascular sequelae in long COVID, aiming to improve the disease's understanding and reduce its harm scientifically.
Atrial fibrillation (AF) is the most common arrhythmia in cardiovascular disease, and it often coexists and interacts with sick sinus syndrome. In the past, pacemaker implantation combined with antiarrhythmic drugs was preferred for symptomatic atrial fibrillation with long interval treatment. However, in recent years, more and more studies have shown that compared with pacemaker implantation, radiofrequency ablation can reduce the hospitalization rate related to tachycardia, effectively control atrial fibrillation, and improve patient prognosis and hospitalization rate of heart failure. However, some patients present intrinsic sinus node dysfunction (SND), and SND may progress and worsen in some patients with atrial fibrillation. Therefore, the first-line treatment strategy for patients with atrial fibrillation with long interval remains controversial. This article reviews the selection of long-term intermittent treatment strategies for atrial fibrillation.
Building a high-quality and efficient people centered integrated care system with Chinese characteristics crucial for implementing the Healthy China strategy and essential for the high-quality development of the healthcare system. This article proposes that a people centered integrated care system should center on health, with efficient triage of urgent and non-urgent cases, linkage between different healthcare levels, and a synergy of prevention and treatment. The development of medical services requires collaboration between public medical and health institutions and societal forces. To construct such a system, transformation is necessary in seven key areas: service system, service concept, individual service decision-making, doctor-patient relationship, service mode, payment mechanism, and regulatory assessment. The key is to promote the strengthening, extension, and integration of the healthcare system and public health service system. This article highlights the importance of management system reform and the full use of information technology, stating that the core aim of building a peo-ple centered integrated care system is to meet the comprehensive health needs of the population, establish a rational and orderly medical framework, and ultimately support the creation of a robust health system in China.
This paper systematically reviewed the process of primary health care development of China over the past 45 years, and summarized the achievements of primary health care based on data related to primary health care draw from 2010-2012 China Health Statistics Year book, 2013-2017 China Health and Family Planning Statistical Yearbook and 2018-2022 China Health Statistics Year book. Data of the infant mortality rate, maternal mortality rate, and average life expectancy were from the World Bank in China and upper middle income countries in 2023. The development of primary health care of China was summarized into four phases, and the achievements included the improvement of the primary health care network, coverage expansion of basic health insurance, the increase of funding and coverage of basic public health services, the steady improvement of family doctor contracts, and the continuous improvement of women's and children's health, with major health indicators ranking among the top upper middle-income countries. The current challenges include the unbalanced development of infrastructure construction in the primary medical and health system, the decline in the proportion of medical insurance funds, the lack of vitality of the management system, the low level of remuneration and imperfect incentive system. This paper summarizes the enlightenment of international experience for China's primary health care, and puts forward the future development directions and strategies.
General practitioners (GPs) are an indispensable part of primary health care system in China and the implementation of the "Healthy China" strategy. In the past decade, the number of GPs in China has developed rapidly.
To summarize the experience and achievements of GP team construction from 2012 to 2022 (nearly ten years) , analyze the existing difficulties and deficiencies, and provide reference for the subsequent construction of GP team in China.
With the help of Donabedian model, policy support, capital investment and base construction were selected as the evaluation indicators of structural design process based on the SMART principle, the process quality was focused from two perspectives of standardized training of residents (referred to as standardized training) and job transfer, the construction of GP team in central and western China. The team size, structure, job satisfaction, resignation intention and career development opportunity were considered as the main analysis dimensions. The data were mainly obtained from Chinese government website and CNKI from 2012-01-01 to 2022-12-31, as well as Health Statistical Yearbook 2012-2022.
In the past decade, the structural design of the construction of GP team in China has been continuously optimized and improved, and the supporting facilities such as capital investment and base construction have been closely implemented. The policy end of process has responded to the practical needs with dynamic adjustments, the standardization of relevant systems for standardized training and job transfer has steadily improved, and the construction of GP team in the central and western regions has been strengthened year by year. Regional differences in the effectiveness of team building still exist, and some problems need to be solved.
Existing human resource statistics on GP cannot accurately measure the human resource supply for GP team in China, and the construction of team stability needs to be further improved. It is recommended to continuously promote the stability construction of the GP team focusing on enhancing career attractiveness, improve the stability of the whole cycle of training, employment and career development, and jointly promote the stability of GP team.
At a time when healthcare reforms are being implemented in the new era, the scientific research output in the field of general practice and primary care in China has grown rapidly in recent years. However, the methodological quality of the literature is unclear.
To evaluate the methodological quality of representative quantitative studies and systematic reviews/guidelines in the field of general practice and primary care in China in 2021, to reveal the overall methodological quality characteristics of scientific papers in this field.
A sample of 449 papers was selected from a total of 3 122 papers collected in the Primary Care and General Practice Research Paper Productivity Report in China in 2021. A methodological quality assessment group consisting of 22 researchers in the field of public health and general practice from different institutions was organized to evaluate the quality of 320 of these papers (71.3%) using six different quality assessment tools for different study designs (cross-sectional studies, cohort studies, pre- and post-intervention studies, randomized controlled trials, systematic reviews, guidelines and consensus) by working in pairs and under the training and guidance of an expert in evidence-based medical methodology. Descriptive statistics method was used to report the overall quality assessment results of the various types of research papers.
Of the 114 cross-sectional research papers, quality issues were prevalent in the areas of "whether the source population was representative of the study's target population" (41.2%) , "whether the reliability and validity of the survey instrument could be conclusively demonstrated" (32.5%) , "whether the survey is clinically meaningful" (26.3%) ; of the 25 cohort study papers, quality issues were more concentrated in the areas of "whether the cohort was adequately followed up" (44.0%) and "whether the co-intervention was similar among groups" (56.0%) ; of the 34 pre- and post-intervention studies, quality issues were mostly found in the areas of "whether the target outcome was measured multiple times before and after the intervention" (97.1%) , "whether the sample size was large enough to generate confidence in the study results" (82.4%) , and "whether the study participants were representative of the eligible population" (61.8%) ; of the 122 randomized controlled trials, quality concerns were mostly in the areas of "blinding of different stakeholders" (25.4%-61.5%) , "adequate concealment of random allocation" (41.8%) , and "other risks of bias" (72.1%) ; of the 19 systematic reviews, quality issues were mostly found in the areas "is the source of funding for the included studies reported" (100.0%) , "were the methods of the review developed before the start of the review" (94.7%) , "was heterogeneity reasonably discussed and explained" (84.2%) , and "was the risk of bias of individual studies considered" (84.2%) . Finally, the quality of all six clinical guidelines/consensus was rated low.
The scientific research output of recent years in the field of primary care and general practice in China is still of limited quality in general, which is particularly evident in the categories of cross-sectional studies, pre- and post-intervention studies, randomized controlled trials, guidelines and consensus. This highlights the urgency and importance of strengthening systematic training in basic research in this area of research in China, increasing the importance of research and evidence-based reporting standards, and developing pragmatic methodological specifications for the development of guidelines.
The COVID-19 pandemic has devastated human health and global economy. Diminished immune function of health-related vulnerable populations leads to insufficient protective effect of the vaccine with a higher risk of severe illness and death following infection, and there is a lack of adequate targeted drugs for the prevention and treatment of COVID-19. In the context that COVID-19 treated as a Category B disease in China, vulnerable populations have become the priority populations for epidemic prevention and control. Therefore, the strategies of individual immunization and prevention should be further optimized for vulnerable populations. In addition to vaccines, other prevention strategies should be supplemented, such as long-acting neutralizing antibodies. Based on this, this paper reviews the identification, immune function characteristics and prevention strategies of COVID-19 in vulnerable populations, to provide a reference for the prevention and control strategies for health-related vulnerable populations in China, expecting that more suitable preventive drugs for vulnerable populations can be developed in the future to reduce the risk of COVID-19 in vulnerable populations.
The prevention and control of communicable diseases is a major concern for the livelihood of the people.General practitioners play an irreplaceable role in the community-based prevention and control of communicable diseases as one of the key providers of primary care. This study discusses the shortcomings of general practitioners and the role they should play in the community-based prevention and control of communicable diseases based on their current situation by reviewing relevant domestic and foreign literature, and proposes that the laws and regulation system for the prevention and control of communicable diseases should be improved, a hierarchical medical system should be implemented, a robust information platform of prevention and control system should be enhanced, an efficient incentive and development mechanism should be established, and the financial and material investment in primary care, continuing medical education and regular drills should be enhanced, aiming to enhance the job attraction of general practitioners and the capabilities of community-based comprehensive prevention and control of communicable diseases.
General practitioners (GPs) are the"gatekeepers"of residents' health. In China, Up to 2021, 84.4% of GPs account for 22.7% of the total primary physicians. The quantity and quality of the GP workforce are related to the level of primary care services. In recent years, the central government and governments at all levels have attached great importance to the construction of the GP workforce and successively introduced many supportive policies. However, the number of GPs in China currently only accounts for 10.1% of practicing (assistant) physicians, and the lack of position attractiveness of GPs has become the main reason restricting the development and growth of the GP workforce. Based on the talent itself, this paper constructs a talent development mechanism-oriented model of "primary general practitioner-position attractiveness" to deeply analyze the dilemmas of GPs in seven aspects of education, recruitment, application, motivation, evaluation, development and support, explore countermeasures to solve the problems, in order to provide a scientific basis for enhancing the position attractiveness of GPs, stabilizing the talent team of GPs, and improving the quality and level of primary care services.
In the context of the new round of medical and health system reform in China, it is of great significance to improve primary healthcare service system and continuously improve the capacity and quality of primary healthcare service. Under the guidance of empowerment theory, this study systematically summarizes relevant research literature, and the results indicated that full empowerment can be achieved through strengthening the guidance for primary health care, focusing on the maintenance of primary healthcare talents, adjusting the allocation mechanism of health resources, and improving the service quality evaluation system, which is conducive to the establishment of a comprehensive, continuously coordinated, fair and accessible integrated high-quality primary healthcare service system. This study further proposes strategies for continuous improvement and enhancement of primary healthcare service quality, aiming to provide reference and basis for solving the structural difficulties in improving the quality and capacity of primary healthcare services.
