In order to promote the hierarchical diagnosis and treatment system and the construction of healthy China, the General Office of the State Council clearly pointed out that a medical community should be established in the county. Zhejiang Province took the lead in exploring the integrated outpatient service of chronic diseases in the construction of medical community. At present, the research on the integrated outpatient service of chronic diseases in China mainly focuses on the discussion of concepts, and less quantitative research is carried out on the current situation of services.
To analyze the current situation of the integrated outpatient service of chronic diseases in county medical communities in Zhejiang Province and explore its influencing factors, so as to provide countermeasures and suggestions for improving the operation of the integrated outpatient service of chronic diseases.
From October to November 2023, using the typical sampling method and taking into account the principle of geographical balance, 18 community health service centers/township hospitals under 6 medical communities in Linping District of Hangzhou, Yuhuan City of Taizhou, Jiangshan City of Quzhou and Jiashan County of Jiaxing in Zhejiang Province were selected, and outpatients were intercepted at the outpatient waiting offices of corresponding institutions as the research objects. A self-designed questionnaire was used to investigate the patients' evaluation of integrated outpatient services for chronic diseases. The evaluation content involved three aspects: service category, service approach and team building.
A total of 540 questionnaires were distributed and 510 valid questionnaires were recovered, with an effective recovery rate of 94.4 %. The overall score of patients' integrated outpatient service for chronic diseases was (4.4±0.5) points, and the scores of each service category were: pre-diagnosis service (4.4±0.5) points, in-diagnosis service (4.3±0.5) points, and post-diagnosis service (4.1±0.6) points. The average score of each item in the service approach dimension was ≥3.7 points, and the average score of each item in the service team building dimension was ≥3.9 points. The results of multiple linear regression analysis showed that factors such as age, education, monthly income, whether the overall medical services of the hospital could meet their own needs, and satisfaction with the hospital 's diagnosis and treatment environment would have an impact on the evaluation of the development of integrated outpatient clinics for chronic diseases (P<0.05) .
The current situation of integrated outpatient services for chronic diseases in county medical communities in Zhejiang Province is generally good, but there is still room for improvement in post-diagnosis services, service channels, and overall medical services. The primary medical and health institutions in Zhejiang Province should pay attention to the continuity of post-treatment services, strengthen the integrated outpatient service mode and team building of chronic diseases, promote the development of medical services in a diversified and high-quality direction, and enhance the residents' sense of medical experience.
For a long time, "emphasizing medicine over prevention" has fragmented China's medical and health service system, making it difficult for residents to obtain comprehensive, coordinated, high-quality and efficient health services. The integration of medicine and prevention plays an essential role in enhancing the continuity and coordination of medical and health services and improving the health of residents. As the providers of the integration of medicine and prevention services, the enthusiasm and initiative of medical staff directly affect the integration of medicine and prevention services.
To explore the current status and problems during the integration of medicine and prevention from the perspective of medical and public health service providers and to put forward appropriate countermeasures.
The data for this study was collected from a survey on the integration of medicine and prevention conducted in Anhui Province from July to August 2021, which combined typical sampling and stratified sampling methods, taking into account both representativeness and regional distribution. One county (district) was selected from the northern, central, and southern parts of Anhui Province for the survey. Based on the review of domestic and foreign literature and relevant policy documents, in consideration of the characteristics of the integration of medicine and prevention, the research team, after discussion and expert validation, developed a self-designed questionnaire for medical staff on the integration of medicine and prevention. The questionnaire mainly includes the basic information of the respondents, their cognition of the integration of medicine and prevention, the implementation and satisfaction of the integration of medicine and prevention. Binary Logistic regression analysis was used to explore the influencing factors of medical staff's satisfaction with the integration of medicine and prevention.
71.2% of medical staff expressed understanding of the integration of medicine and prevention, 18.6% expressed very good understanding, 50.4% considered the integration of medicine and prevention very important, and 48.5% considered it necessary. The primary way to provide services of integration of medicine and prevention was to guide healthy lifestyles, which accounted for 92.0% of the total, 83.3% of the total for education on health knowledge, and 84.1% for guidance on the rational use of medication. The main factors that affected the implementation of the integration of medicine and prevention included financial support, lack of human resources, lack of incentive mechanisms, etc. The satisfaction score of medical staff with the integration of medicine and prevention was (4.02±0.78). The regression results showed that career development, salary, and work pressure significantly affected overall satisfaction with the integration of medicine and prevention (P<0.05) .
This paper found that there are insufficients of the integration of medicine and prevention concerning service providing scope, ability, and guarantee mechanism. Therefore, to better provide residents with a high-quality integration of medicine and prevention, further expansion of the ways of service providing, optimizing the capacity and quality of the service team, and improving the guarantee mechanism are suggested.
The integration of medical care and prevention is an important measure for the implementation of the Healthy China Strategy. Family doctor teams as the mainstay and chronic disease management as the entry point are important tools for the implementation of the medical and preventive integration in primary health institutions.
To understand the current situation and obstacles of the integration of medicine and prevention in chronic disease management in Beijing urban areas, so as to provide a basis for decision-making on sustainable development of the medical and preventive integration services.
From December 2023 to February 2024, the purposive sampling was used to invite 20 participants, including the members of the family doctor teams and primary care managers working on the the medical and preventive integration and the chronic disease management in 12 primary health institutions in the urban area of Beijing, to conducted semi-structured interviews focus on the content, division of labour, resource allocation, and existing problems of above services. Thematic analysis was used to analyse and generalise the interview data.
Although the primary health institutions had explored a variety of service modalities to promote the implementation of the integration of medical care and prevention. The qualitative research showed that the main body of the current service was still the general practitioner and the community nurse, and continued the kernel of the chronic disease management service, with the content of the service yet to be innovated, and the service process of pre-consultation, consultation, and post-consultation yet to be promoted. In terms of the operating environment, there were insufficient members of the family medicine team, heavy workload, emphasis on "quantity" rather than "quality" in assessment and evaluation, "information silos", lack of top-level design, and lack of a special funding mechanism. The phenomenon of "medical and prevention fragmentation" is obvious, with the existence of "two lines" of the management systems, "two disconnections" between the main bodies, and regional dispersion of work areas of the medical and preventive integration.
Due to insufficient resources allocation and optimisation of the operation mode, it's necessary to strengthen talent training, reinforce medical insurance support, accelerate information sharing within the region, improve assessment and evaluation mechanisms, as well as strengthen the top-level design, clarify the service pathway, implement community functions, and form a replicable and scalable integrated service model with the participation of the government, community, hospitals and patients.
