Quality of primary health care (PHC), as an important dimension of universal health coverage, is receiving increasing attention globally. A correct understanding of the concept of PHC quality is a prerequisite for measuring, evaluating, and improving quality. PHC quality in China is not clearly defined, and there is no standardized definition and evaluation methodology. Research and policies on PHC quality face enormous challenges. This systematic review searched CNKI, VIP, Wanfang, PubMed, Embase, Google Scholar as well as official websites. Thematic analysis was used for data analysis. After screening, 31 studies/reports covering both low- and middle-income and developed countries were included. The current concepts of PHC quality can be categorized into three themes: (1) content-driven definitions, (2) goals-driven definitions, and (3) characteristics-driven definitions. The content of PHC includes basic medical services, public health services, and quality improvement. The goals of PHC include safety, effectiveness, timeliness, efficiency, equity, appropriateness, patient satisfaction, and patient-centeredness. The characteristics of PHC include access, continuity, coordination, comprehensiveness, family/community-centeredness, and integration. China should define PHC quality combining the content, goals, and characteristics of PHC that considers the stage of economic and social context and health care system context.
In recent years, the incidence of chronic noncommunicable diseases in China has gradually increased, and how to effectively manage chronic diseases has become an urgent problem to be solved. In chronic disease management, it is not only necessary for medical personnel to provide standardized and scientific medical programs, but also for patients to have good self-health management and obtain various social support and resources to implement proactive health management. In view of China's current problems such as low health literacy level at the patient level, insufficient self-management ability, lack of active health awareness, and limitations of chronic disease management mode at the community level, this paper, from the perspective of active health management, combined with the connotation of community empowerment and its application in chronic disease management, proposed the implementation strategy of community-based chronic disease management under the guidance of active health. The aim is to provide suggestions for chronic disease management in China.
The "14th Five Year" Plan for National Economic and Social Development and the Long Range Obj ectives for 2035 points out the need to steadily improve the quality of contracted family doctor services. The contracted family doctor services system has been comprehensively promoted in Guangxi for six years, but there are few reports on the changes of such service.
To understand the changes of contracted family doctor services in Guangxi and analyze the reasons, so as to provide reference for the high-quality development of contracted services.
In July 2018 and October 2022, the study adopted purposive sampling method to select representative cities according to the geography, economic development level and the progress of contracted family doctor services in 14 prefecture-level cities in Guangxi as samples. The medical staff in the family doctor team and residents were selected by convenience sampling method to hand out questionnaires. In 2018, a total of 1 560 questionnaires were distributed to residents, and 1 285 valid questionnaires were returned, with an effective rate of 82.37%. A total of 627 questionnaires were distributed to family doctor team members, and 595 valid questionnaires were returned, with an effective rate of 94.90%. In 2022, a total of 1 800 questionnaires were distributed to residents, and 1 740 valid questionnaires were returned, with an effective rate of 96.67%. A total of 780 questionnaires were distributed to family doctor team members, and 775 valid questionnaires were returned, with an effective rate of 99.36%. Through literature review and expert consultation, the questionnaire of residents' cognition and satisfaction with contracted family doctor services and the questionnaire of family doctors' work situation and satisfaction were designed in combination with the actual situation in Guangxi. Multivariate Logistic regression analysis was used to analyze the influencing factors of satisfaction.
Perspective of suppliers: there was no significant difference in the proportion of medical staff who thought that their work content had increased, working methods had changed, and working hours had increased in 2022 compared with 2018 (P>0.05). Among them, the proportion of medical staff who increased their working hours by more than 2 hours per working day and by more than 4 hours on weekends increased from 30.5% to 40.0% and 25.2% to 32.0%, respectively. The increase in working hours is mainly for essential public health services. The proportion of medical staff with an average monthly income of less than 4 000 yuan in 2022 was lower than that in 2018, and the proportion of medical staff with an average monthly income of 4 000-6 000 yuan and more than 6 000 yuan was higher than that in 2018, and the difference was statistically significant (P<0.05). The job satisfaction of medical staff in the family doctor team in 2022 and 2018 was "average". Perspective of the demand side: The proportion of community health service centers/township health centers as the first choice of medical institutions for residents in 2022 was higher than that in 2018 (P<0.05), from 69.3% to 78.3%. There was no significant difference in the proportion of residents who knew contracted family doctor services in 2022 compared with 2018 (P>0.05). In 2022, the proportions of residents who understood the relevant policies of contracted family doctor services, basic service packages and their free service items, and personalized service packages and their corresponding charging rates were higher than those in 2018 (P<0.05), from 35.3%, 35.6% and 26.9% to 54.0%, 53.6% and 49.2%, respectively. At present, the channels for learning about contracted family doctor services are mainly offline activities, with few online forms. The proportion of residents willing to sign contracted family doctor services and personalized service packages in 2022 was higher than that in 2018 (P<0.05), from 80.5% to 91.0% and 67.4% to 73.0%, respectively. Among them, about 70% of residents are willing to sign up for personalized service packages under 100 yuan in 2022 and 2018. In 2022, more residents enjoyed health consultation, home visits, and personalized health management services. And 94.7% of the contracted residents had a positive change in health management awareness. The overall satisfaction, trust, satisfaction with technical ability, and satisfaction with diagnosis and treatment process and results of residents in 2022 were all higher than those in 2018 (P<0.05), reaching the "satisfied" state. The results of multivariate Logistic regression analysis showed that the influencing factors of residents' satisfaction with contracted family doctor services included whether they preferred primary medical institutions for treatment, whether they understood the personalized service package and its corresponding charging standard, and whether they trusted family doctors (P<0.05) .
The family doctor team members have a heavy workload. It is necessary to accelerate the construction of information technology and gradually expand the team. Performance appraisal and incentives should be improved to enhance the enthusiasm of medical staff. Residents' willingness to seek medical treatment in primary care has increased, and their trust and cognition of contracted services have been improved. In the future, we should increase the publicity and improve the service capacity of contracted family doctor services. Residents' willingness to sign personalized services has increased. It is necessary to improve the supporting mechanism according to local conditions.
