Contracted family doctor services were implemented as a key action to reform primary care services in China. At present, the coverage of contracting has expanded stably. But the family doctor teams' evaluation of contracted family doctor services is not clear, which also highlights a number of issues that require further improvement in the provision of the services.
To study the contracted family doctor services for family doctor teams and associated factors.
In October 2022, a combination of purposive sampling and stratified cluster sampling was used for selecting family doctor team members from southern, central, northern and eastern Guangxi to participate in a questionnaire survey. The survey was conducted on the included subjects by using the provider version of the Primary Care Assessment Tools (PCAT-PS) , which contains 8 dimensions and 43 items. Multivariate Logistic regression analysis was used to research the influencing factors of family doctor teams' perception of PACT-PS of the services.
A total of 775 valid questionnaires were collected, with a valid response rate of 99.36%. The average score of the PCAT-PS of the family doctor team members was (32.55±3.90) . The dimensions with the relatively high score were family-centeredness and comprehensiveness, but the dimensions of first contact-access and ongoing care of the services had a relatively low-level perception. Multiple linear regression analysis showed that the type of organization, age, professional title, division of team responsibilities and working patterns were the factors that influence the PCAT-PS score of family doctor team members (P<0.05) .
The family doctor team members had an overall good evaluation on contracted family doctor services while differences in the quality of the services among primary health care institutions in urban and rural areas. The working mode of family doctor team has a positive effect on the improvement of contracted family doctor services quality. To further improve the family doctor teams' evaluation of contracted family doctor services, we need to accelerate the construction of family doctor teams with equal emphasis on "quality" and "quantity", explore the path of integrated salary and job development, and create a "government-community-family" shared governance and resource sharing network.
Bronchial asthma (asthma) is the most common chronic respiratory disease in childhood, with long disease course and repeated attacks, which affecting the development and life quality of children. As the main providers of primary healthcare, general practitioners play important role in the early diagnosis and grading management of childhood asthma. Understanding their level of prevention and treatment services for this disease can provide suggestions for improving the quality of primary care childhood asthma prevention and treatment services.
To investigate the service level of primary general practitioners in the prevention and treatment of childhood asthma, and the influencing factors on the service level.
From April to July 2022, 22 districts (counties) were randomly selected from the 38 districts (counties) in Chongqing Municipality, and conducted a questionnaire survey on primary general practitioners in the sampling. The questionnaire was designed by the research team based on relevant guidelines and literatures, and formed through two rounds of expert consultation and pre-investigation, including four dimensions of knowledge, attitude, behavior and self-evaluation. We investigated the knowledge, attitude, behavior and self-evaluation of primary general practitioners regarding the prevention and treatment of childhood asthma and analyzed the influencing factors.
A total of 234 general practitioners participated in the questionnaire survey. The knowledge score of general practitioners on the prevention and treatment of childhood asthma was (6.03±2.04) , with a pass rate of 44.9%; the attitude score was (49.42±4.94) , with a pass rate of 100.0%; the behavior score was (30.55±6.66) , with a pass rate of 87.2%; and the self-evaluation score was (21.57±5.30) , with a pass rate of 85.0%. Regarding the selection of referral indications, 98.7% (231/234) of the general practitioners believed that children with moderate or severe acute asthma attack that was not significantly relieved after emergency treatment needed to be referred, and 94.0% (220/234) of the general practitioners believed that children with asthma that could not be controlled effectively after standardized treatment needed to be referred. For children with poorly controlled symptoms, 33.8% (79/234) of the general practitioners would carefully analyze the cause of poor control, and 17.5% (41/234) of the general practitioners would advise patients to follow the doctor's advice, temporarily observe the condition and make an appointment for next reexamination. 33.8% (79/234) of the general practitioners held an uncertain or opposed attitude towards the diagnosis and treatment of childhood asthma in primary medical institutions. The main influencing factors of this attitude was the lack of disease-related knowledge and learning opportunities for general practitioners, reluctance of parents to visit primary medical institutions, strained pediatric doctor-patient relationship, the small number of children suffering from asthma, and the lack of related facilities and equipment. Multiple linear regression analysis showed that professional title and training experience on childhood asthma were the influencing factors of knowledge score (P<0.05) ; academic qualification and years of service in primary medical institutions were the influencing factors of attitude score (P<0.05) ; and pediatric work experience and training experience on childhood asthma were the influencing factors of behavior and self-evaluation scores (P<0.05) .
The general practitioners in Chongqing have some confidence in the management of children with asthma, but their knowledge of asthma prevention and treatment is poor. Their attitude and behavior were both positive, but there is a gap between the two. It is suggested that while optimizing the allocation of pediatric facilities and equipment in primary medical institutions and improving the trust of patients, knowledge and practical training is important to improve the knowledge, confidence and abilities of general practitioners. Academic education and continuing education training of general practitioners should be strengthened to effectively improve their learning and self-improvement ability.
With the gradual deepening of the comprehensive reform of community health services, the prevention and control of single diseases for the entire population in the community is also constantly being optimized, However, there is still a lack of appropriate evaluation methods in the community to reflect its prevention and control effectiveness evaluation.
By analyzing and exploring the cost effect of the existing whole-population prevention and control measures of osteoporosis in Fenglin community, from 2016 to 2022, this paper answers the initial results and possible problems of the whole-population prevention and control of single disease in the community.
This study conducted a cost-effectiveness analysis on 4 293 community residents who received osteoporosis prevention and treatment in Fenglin community from 2016 to 2022. Divide the research object into three states based on bone density values: healthy, low bone mass, and osteoporosis, and construct a Markov model to analyze the influencing factors of different state transitions. And based on the predicted values of the Markov model combined with quality adjusted life years (QALY) , the increment of quality adjusted life years (QALY) is calculated. All costs invested in prevention and control work from 2016 to 2022 are counted, and the effectiveness of prevention and control is evaluated by the cost/quality adjusted life year increment ratio. Quality adjusted life years (QALY) are obtained by calculating the health utility value and expected life determined through literature search.
The total cost of osteoporosis prevention and treatment in Fenglin community was 33 814 102.15 yuan. The total quality-adjusted life years of 4 293 community osteoporosis prevention and treatment population were 77 098.288 9 at the first diagnosis, the average per capita was 17.959, and the standard deviation was 9.34. At the second diagnosis, the total quality-adjusted life years were 79 616.936 1, the mean per capita was 18.546, the standard deviation was 9.342, and the difference between the two diagnoses was 2 518.647 2. The incremental cost-effectiveness ratio (ICER) is 2 132.907 0 yuan /QALY, and the incremental cost-effectiveness ratio (ICER) is less than 1 times (66 965.10 yuan) per capita GDP, indicating that the intervention scheme is fully cost-effective.
This study combined Markov model and quality-adjusted life years (QALY) to make a preliminary evaluation of the prevention and treatment effect of osteoporosis in Fenglin community. The results showed that the intervention program of osteoporosis prevention and treatment in Fenglin community was worth investing, and provided a certain basis for the accurate prevention and treatment decision of osteoporosis in the future.
