Family physician-contracted service is an important way to change the mode of primary health care, and it is also the key and breakthrough to realize tiered diagnosis and treatment. How to strengthen the construction of family physician team and thus improve job satisfaction has become an urgent problem.
To explore the relationship between the network structural characteristics within family physician team and job satisfaction at the team level, and to provide a reference for strengthening the construction of family physician team.
From October 2021 to December 2023, we combined convenience sampling and cluster sampling to conduct field research on family physician teams in Qianjiang, Hubei, Changsha, Hunan and Nanyang, Henan. The Family Physician Team Members' Basic Information Questionnaire, the Family Physician Team Interaction Network Questionnaire and the Family Physician Team Job Satisfaction Scale were used to collect data. We used hierarchical linear regression analysis to verify the impact of the network density and centralization within family physician team on job satisfaction.
The transition processes of family physician team showed obvious network structure characteristics of low density (0.29±0.11) and high centralization (0.88±0.19). The average job satisfaction score of family physician team was (20.30±2.42), which was moderately high. The results of the hierarchical linear regression analysis showed that the centralization of transition processes positively affected job satisfaction (β=0.576, t=7.091, P<0.001) ; the density of transition processes positively affected job satisfaction (β=0.228, t=2.478, P<0.05) ; the density of action processes positively affected job satisfaction (β=0.324, t=2.624, P<0.05) ; the density of interpersonal processes positively affected job satisfaction (β=0.368, t=3.549, P<0.001) .
There is room for optimizing the network structural characteristics within family physician team in Central China. The network density and centralization of family physician teams have positive effects on job satisfaction. It is recommended to improve the internal collaboration mechanism and optimize the centralized network structure within family physician team.
As the aging of the population intensifies and the burden of non-communicable diseases continues to rise, traditional health service models have become insufficient to meet people's health needs. Therefore, promoting the integration of medical and preventive care has become crucial for improving residents' health levels. Family doctor teams, as the main implementers of these integrated care, play a pivotal role. However, the current lack of effective multidisciplinary collaboration among family doctor teams has severely hindered the effective implementation and provision of integrated medical and preventive care.
To investigate the teamwork of family doctors in the integration of medical and preventive care in Shandong Province, explore its influencing factors, so as to provide a reference for further improving the contract service of family doctors and the integration of medical and preventive care.
In August 2023, a multi-stage stratified random sampling method was employed, selecting Yantai City, Weifang City, and Liaocheng City from the eastern, central, and western regions of Shandong Province, taking into account geographical location and economic development levels. Within each city, one district and one county city were randomly selected as sample areas, resulting in a survey of 481 family doctors. Based on extensive searches of relevant domestic and international literature and consultations with experts, a specialized questionnaire for primary care doctors was designed for the survey. This questionnaire encompassed three key sections: a general information survey, an assessment of the provision of integrated medical and preventive care services, and an evaluation of the collaboration levels among family doctor teams within these services. Questionnaires were used to investigate the implementation of integrated medical and preventive care and the collaboration among family doctors within these services. Binary Logistic regression analysis was employed to examine the factors influencing the collaboration among family doctors in integrated medical and preventive care.
76.1% (366/481) of family doctors exhibited a high level of teamwork in the integration of medical and preventive care. The results showed that family doctors with bachelor's degree or above (OR=2.343), professional titles of primary (OR=1.887) and intermediate and above (OR=2.978), understanding of the integration of medical and prevention system (OR=6.618), believe that the institution attaching importance to integration of medical and preventive care (OR=2.861), and participating in one (OR=2.561) and two or more trainings within half a year (OR=3.833) had a higher level of teamwork in integration of medical and preventive care (P<0.05) .
At this stage, there is still a lot of room for improvement in the teamwork level of family doctors in the integration of medical and preventive care. It is necessary to continue to improve the awareness of family doctors on the integration of medical and preventive care, improve the system of providing institutional medical and prevention integration services, provide reasonable economic subsidies and policy incentives for family doctors, strengthen training, and further improve the level of teamwork of family doctors.
At present, the unbalanced and inadequate development of primary healthcare services does not meet people's growing demand for them in the new era. Identifying the influencing factors and their action paths on the performance of primary healthcare services has always been an issue of common concern in the academic circles.
To clarify the combination of multiple factors and their action paths that affect the performance of primary healthcare services in China, and to provide decision-making basis for further improvement of primary healthcare services.
The study was conducted from November 2022 to August 2023, and the data were obtained from the 2021 China Health Statistics Yearbook and the 2021 China Statistical Yearbook. A fuzzy set qualitative comparative analysis (fsQCA) was conducted with the performance of primary healthcare services in 31 provinces (autonomous regions and municipalities) as the outcome variables, and application of big data, medical technology, government attention, system integration, medical resources and health demand as the conditional variables.
The quality of performance of primary healthcare services is the result of a combination of various factors. The results of configuration analysis show that there are 4 configurations to improve the performance of primary healthcare services, which can be classified into 3 patterns: "technology-environment" "organization-environment" and "technology-organization-environment". Configuration 1: Application of Big Data * - Medical Technology * - Government Attention * - System Integration * Medical Resources. Configuration 2: -Application of Big Data * - Medical Technology * System Integration * Medical Resources * - Health Demand. Configuration 3: Application of Big Data * Medical Technology * System Integration * Medical Resources * Health Demand. Configuration 4: Application of Big data * - Government Attention * System Integration * Medical Resources * Health Demand. (* means "and", - means "non"). The consistency of the four configuration solutions was 0.926, the coverage of the solution was 0.612, the original coverage ranged from 0.314 to 0.396, and the unique coverage was from 0.017 to 0.083. The configurations that improve the performance of primary healthcare services are different in eastern, central and western regions of China.
At present, increasing the investment of medical resources at the grass-roots level is still a universal measure to improve the performance of primary healthcare services in China, but attention should also be paid to effectively combine technological, organizational and environmental (T-O-E) conditions. The action paths of the influencing factors are notably different in the eastern, central and western regions of China. Therefore, regions should choose different action paths based on their own development endowments and conditions, reasonably allocate limited medical resources, improve TOE conditions in a targeted manner, so as to improve the performance of healthcare services and realize the high-quality development of primary healthcare services.
The inheritance, innovation, and development of traditional Chinese medicine have received high attention from the country. However, the development of grassroots traditional Chinese medicine diagnosis and treatment in China is still uneven, and the operational efficiency of traditional Chinese medicine diagnosis and treatment services in different institutions varies greatly.
By analyzing the operation of traditional Chinese medicine diagnosis and treatment services in grassroots medical institutions in Tianjin in 2021, this study provides a reference for the development of traditional Chinese medicine in grassroots medical institutions.
In 2021, a comprehensive survey method was used to collect relevant data from a total of 270 primary healthcare institutions in 16 administrative regions of Tianjin (Dis1-6 being the six districts within the city, Dis7-10 being the four districts around the city, Dis11 being the Binhai New Area, and Dis12-16 being the five districts in the suburbs), and two methods, BCC and CCR models in Data Envelopment Analysis (DEA) and Stochastic Frontier Analysis (SFA), were comprehensively applied to analyze the operational efficiency of traditional Chinese medicine diagnosis and treatment services in institutions from different perspectives. Through literature research, the input indicators of the DEA model were set as the number of traditional Chinese medicine practitioners, the number of traditional Chinese medicine beds, and the number of traditional Chinese medicine diagnosis and treatment equipment; The output indicators were set as traditional Chinese medicine medical income, number of traditional Chinese medicine diagnosis and treatment personnel, number of discharged patients mainly using traditional Chinese medicine, and number of on-site traditional Chinese medicine service personnel. The SFA model was consistent with the indicators set by DEA, except for the addition of total income as an output indicator.
The operation of traditional Chinese medicine diagnosis and treatment services in grassroots medical and health institutions in 7 districts was effective, Dis9 DEA was weakly effective, and DEA was ineffective in 8 districts. There were 8 districts with increasing returns to scale, 7 districts with unchanged returns to scale, and Dis3 showing decreasing returns to scale. There were 8 non DEA effective regions, and all 3 input indicators in each region have redundancy. The phenomenon of insufficient income from traditional Chinese medicine and medical services in the output indicators was more serious in each region. The efficiency of Dis1-6 technology in SFA results (0.733-0.838) was within the high efficiency range; Dis7-10 technology efficiency (0.691-0.912), 3 high efficiency zones and 1 medium efficiency zone; Dis11 technology efficiency of 0.885 was in the high efficiency zone; Dis12-16 (0.399-0.849) had 3 high efficiency zones and 2 medium efficiency zones. The DEA results were basically consistent with the SFA results, indicating that the number of traditional Chinese medicine practitioners had a positive impact on operational efficiency.
The overall operational efficiency of traditional Chinese medicine diagnosis and treatment services in grassroots medical institutions in various districts of Tianjin is relatively low, but the overall development trend is positive and has regional characteristics. Overall, Dis1-6 is better than Dis7-10, and Dis7-10 is better than Dis11-16. Each district should plan reasonably according to the actual situation, avoid excessive resource input and insufficient output, and especially increase support for Binhai New Area and the five districts in the suburbs.
This study provides a review of the current status of service capabilities, strategies for improving service capabilities, and improvement measures of grassroots traditional Chinese medicine clinics in Haizhou District, Lianyungang City. It describes the current work status of grassroots traditional Chinese medicine clinics in the construction of characteristic departments, family doctor contract services, and medical prevention integration. It is found that there are problems in the operation of traditional Chinese medicine clinics, such as uneven resource allocation, non-standard management, insufficient facilities and equipment, and the need to improve service capabilities. A survey and analysis were conducted on the construction of traditional Chinese medicine clinics in 19 grassroots medical and health institutions to identify common and individual problems. Targeted suggestions and improvement st rategies were proposed to enhance the service capabilities of traditional Chinese medicine clinics, form a characteristic of medical prevention integration, and give full play to the functions and roles of grassroots medical care. Residents received high-quality traditional Chinese medicine services in the community.
