First contact in the primary care setting and the development of a gatekeeping system are crucial for the implementation of a hierarchical medical system. Additionally, the implementation of first contact in the primary care setting depends on the serving capacities of primary care practitioners.
This study aims to assess the capabilities of primary care general practitioners in diagnosing and managing common diseases, referral practices, and evidence-based practice; and to explore their training needs to inform demand-driven training programs in Hunan Province.
From April to May 2023, a convenience sampling method was used to recruit primary care general practitioners who participated in the residency training or general practitioner transfer training at Xiangya Hospital, Central South University. A self-developed questionnaire consisting of four sections was used, covering basic characteristics, self-assessment of the capabilities for common diseases diagnosis and treatment, and evidence-based practice, and demands for capabilities improvement. Questionnaire Star platform was used to collect data, and descriptive analysis was used to present the results.
A total of 337 valid questionnaires were collected from each prefecture-level city and autonomous prefecture in Hunan Province, with 128 coming from community health service centers and 209 from township health institutions. The differences in gender, age, professional title, years of service at the grassroots level, and staffing status between general practitioners in township health institutions and community health service centers are all statistically significant (P<0.05). The results show that 75.1% (253/337) of participants consider themselves competent in the diagnosis and treatment of common diseases; 16.6% (56/337) of participants reported a lack of competence in certain diseases, with the top six including depression[89.3% (50/56) ], stress incontinence[69.6% (39/56) ], dementia[66.1% (37/56) ], stroke[53.6% (30/56) ], co-morbidities[51.8% (29/56) ]and tuberculosis[46.4% (26/56) ]. These findings consistent between community and township respondents. Furthermore, 71.8% (242/337) of participants reported being unfamiliar with referral practices. 73.0% (246/337) of participants indicated limited knowledge of evidence-based practice, and 85.8% (247/288) of participants have limited use of evidence-based practice. Additionally, 77.2% (260/337) of participants lacked sufficient knowledge of clinical practice guidelines; 90.8% (306/337) of participants rarely consulted guidelines when facing decision-making difficulties, mainly because they felt guidelines could not address complex cases[50.0% (153/306) ], were unclear on how to search for guidelines[43.1% (132/306) ]and the resources available for retrieving guidelines[34.3% (105 /306) ]; participants mainly obtain the guidelines through the WeChat official account[72.5% (237/327) ] and databases such as the China National Knowledge Infrastructure [50.2% (164/327) ]. 97.0% (327/337) of participants expressed a demand for training to improve their capabilities, suggesting that training should be tailored to the specific needs of primary care institutions[60.8% (205/337) ]; the preferred approaches are advanced training in higher-level hospitals[71.3% (233/327) ]and primary care institutions with high diagnostic and treatment capabilities[56.3% (184/327) ]; the preferred training programs are on standardized treatment of common diseases[78.0% (263/337) ]and multiple coexisting diseases[69.4% (234/337) ].
The majority of primary care general practitioners in Hunan Province consider themselves competent in the treatment of common diseases, but some are relatively incompetent in diseases such as depression, stress urinary incontinence, dementia, stroke, co-morbidities and tuberculosis; the majority of participants need to improve their capabilities in standardized referral, evidence-based practice, retrieval and application of clinical practice guidelines, suggesting that these items could be focus of training. The primary care general practitioners have a high demand for training, they prefer to engage in advanced training in high level institutions, and training in standardized treatment of common diseases and multiple coexisting diseases is needed. The training programs should be individualized based on the demands of primary care institutions.
With the promotion of "strengthening the primary health" measures, the number of primary health professionals in China has increased significantly, but there is still a gap between the ability of primary care physicians and basic medical needs of residents.
To understand the current situation, characteristics and deficiencies of Chinese primary care doctors' community rehabilitation service ability, so as to provide scientific basis for making countermeasures to improve ability.
The method of multi-stage stratified sampling combined with typical sampling was adopted to carry out an online questionnaire survey on doctors in primary health institutions in Jiangsu province, Anhui province, Henan province, Chongqing City and Gansu province. The current situation of community rehabilitation service ability of primary care physicians was evaluated from four aspects: rehabilitation function evaluation, rehabilitation medical service, traditional Chinese medicine health guidance and traditional Chinese medicine physiotherapy.
A total of 8 374 questionnaires were analyzed. Among the primary doctors surveyed, 4 697 cases (56.1%), 6 396 cases (76.4%), 5 833 cases (69.7%) and 4 834 cases (57.7%) were equipped with the ability of rehabilitation function assessment, rehabilitation medical services, TCM health guidance and TCM physiotherapy, respectively. Moreover, the abilities of primary doctors in rural areas were better than that in urban areas, and the difference was statistically significant (P<0.05). There were statistically significant differences in the rates of rehabilitation medical service guidance, traditional Chinese medicine health care guidance and traditional Chinese physiotherapy ability of primary doctors in different ages, educational qualifications, and positions (P<0.05). The pairwise comparison results showed that in terms of age. In terms of assessment ability of rehabilitation function, doctors under 30 years old and over 60 years old had a higher rate than those 30-<45 years old and 45-<60 years old (P<0.016), and doctors 45-<60 years old had a higher rate than those 30-<45 years old (P<0.016). The rate of rehabilitation medical service guidance ability of primary doctors under 45 years old was lower than that of primary doctors over 45 years old (P<0.016). The ability rate of doctors under 30 years old to provide TCM health care guidance and TCM physiotherapy was lower than that of 30-< 45 years old, 45-< 60 years old and over 60 years old (P<0.016), and the ability rate of doctors 30-<45 years old was lower than that of 45-< 60 years old and over 60 years old (P<0.016). The ratio of doctors aged 45-<60 years old was lower than that of doctors aged over 60 years old (P<0.016) .The ability rate of primary doctors with high school/secondary school education or below was higher than that of college degree and bachelor degree (P<0.016), and the ability rate of junior college degree doctors was higher than that of bachelor degree (P<0.016). The possessing rate of general practitioners was higher than that of rural physicians and practicing (assistant) physicians (P<0.016), and the possessing rate of rural physicians was higher than that of practicing (assistant) physicians (P<0.016). The rate of basic doctors in TCM post possessing TCM health care guidance and TCM physiotherapy ability was higher than that in clinical post and other post (P<0.016), and the rate of clinical post possessing was higher than that in other post (P<0.016). The rate of comprehensive ability of rehabilitation medicine was higher than that of traditional Chinese medicine (P<0.05) .
The ability of community rehabilitation was insufficient on the whole, and the ability of traditional Chinese medicine rehabilitation was relatively weak. It is necessary to improve the construction of the tiered diagnosis and treatment system, promote primary care physicians' experience and abilities. Also to strengthen the joint training of traditional Chinese medicine rehabilitation and modern Western medicine rehabilitation techniques, complete the training and construction of primary rehabilitation personnel, so that they can assume the responsibility of community rehabilitation.
Hospice care service has been practiced deeply in our country. Many cities have taken primary medical and health institutions as the prime places to carry out hospice care, such as in Shanghai. The main community hospice care service are provided by the teams which are composed of general practitioners and nursing staff. Meanwhile, there is still a lack of unified assessment standards and requirements for the abilities of community medical staff.
Based on the actual situation hospice care service, this study compilies an evaluation tool for the hospice care service ability of medical staff in community health service centers and conducts a research of the reliability and validity.
From June 2022 to March 2023, through literature review, qualitative interview and two rounds of Delphi expert consultation, the project was tested by a questionnaire and analyzed. 1 281 medical staff of community health service centers in Pudong New Area, Shanghai, China, were surveyed from 2023-04-01 to 2023-05-12. A questionnaire survey which was covering general information, knowledge and experience of hospice service. Hospice service competence evaluation tool and humanistic care competence scale were conducted to test the reliability and validity of the hospice service, and a multiple linear regression analysis was used to explore the influencing factors of hospice service competence.
Through literature search analysis and qualitative interviews with experts, 49 initial entries were formed. The Delphi expert consultation method invited a total of 15 authoritative experts in Shanghai who study and carry out hospice services, in which the expert authority coefficient was 0.87, and the Kendall harmony coefficient of the overall index system was 0.624 (P<0.01), and the evaluation tools for the 50 entries were finally formed after two rounds of Delphi expert consultation. A total of 1 300 questionnaires were distributed in the questionnaire survey part, and 1 284 questionnaires were recovered, the effective recovery rate of the questionnaires was 98.77% (1 284/1 300). The reliability coefficient of standardized evaluation tools was 0.993 with Cronbach's α coefficient. The data of Spearman-Brown's broken half reliability was 0.935, that means the overall reliability coefficient is good. Besides, KMO value was 0.987, Bartlett spherical value was 119 119.104, P<0.001, indicating that the scale had a good validity and was suitable for factor analysis. Factor analysis showed that the factor loading of all items was≥0.4 and the commonality was >0.2, so all 50 items were retained. Four common factors were selected, and the cumulative variance contribution rate was 86.517%. Correlation analysis showed that there was a significant positive correlation between the total score of the hospice care service ability evaluation tool constructed in this study and the total score of the humanistic care scale (r=0.819, P<0.001), indicating that the evaluation tool had a good calibration correlation validity. The results of multiple linear regression analysis showed that: gender, education, years of working in the community, whether or not they experienced the death of a relative, whether or not they experienced hospice training, the length of hospice service work, and whether or not they were willing to engage in hospice service were the influencing factors of hospice service competence (P<0.05) .
In this study, it proofs that the questionnaire tool for evaluating the ability of community health service center medical staff is scientific, reliability, and validity, and can be used to evaluate the various abilities of community general practitioners in hospice care services.
