Under the "Healthy China 2030" strategy and the ongoing refinement of hierarchical medical systems, general practice departments in tertiary hospitals play an increasingly vital role in integrated healthcare delivery. However, their functional scope remains incompletely defined. Existing research has predominantly focused on inpatient services, with limited attention given to outpatient care in general practice departments of comprehensive hospitals, and a notable lack of stratified analysis of disease patterns across different demographic groups.
This study aimed to characterize the disease profile of patients attending the general practice outpatient clinic of a tertiary hospital in Beijing, and to explore the clinical and systemic role of such clinics within the integrated healthcare system.
A retrospective cross-sectional analysis was conducted on data from patients visiting the Department of General Practice, Fuxing Hospital of Capital Medical University in 2024. Demographic information, visit details, referral sources, and diagnoses were collected and analyzed.
A total of 20 212 outpatient visits were enrolled, including 8 204 male visits (40.59%) and 12 008 female visits (59.41%). The age ranged from 14 to 105 years, with a mean age of (64.1±18.8) years, and 12 245 visits (60.58%) were from patients aged 60 years and above. Among them, 3 168 visits (15.67%) were referred from primary medical and health care institutions, 4 685 visits (23.18%) were initial visits, and 12 359 visits (61.15%) were follow-up visits. The top three diagnoses were hyperlipidemia (5 366 visits, 26.55%), hypertension (5 323 visits, 26.34%), and respiratory tract infection (3 827 visits, 18.93%). The top three unspecified symptoms were constipation (1 265 visits, 6.26%), cough (1 053 visits, 5.21%), and sore throat (720 visits, 3.56%). The system distribution of diagnoses was concentrated, with the top three being circulatory system diseases (13 342 visits, 21.05%), endocrine, nutritional and metabolic diseases (11 066 visits, 17.46%), and respiratory system diseases (7 704 visits, 12.15%). A single disease was diagnosed in 5 757 visits (28.48%), and six or more diseases were diagnosed in 2 997 visits (14.83%).
General practice outpatient clinics in tertiary hospitals manage a wide spectrum of health issues, including common acute illnesses, chronic diseases, undiagnosed symptoms, and multimorbidity. Their case mix aligns with national residency training standards and supports the hierarchical medical system by serving as a crucial interface between primary care and specialized services. These clinics also provide a robust platform for clinical education and research, thereby contributing to the advancement of general practice as a discipline.
On August 27, 2018, the National Health Commission Office issued the "Notice on Issuing the Guiding Standards for the Establishment of General Practice Departments in Standardized Resident Training Bases (General Hospitals) (Trial) ", which stipulated that all general hospitals undertaking standardized resident training should independently establish a General Practice Department. Against this backdrop, the role and functional positioning of the General Practice Department become particularly important.
To explore the role and functional positioning of the General Practice Department in tertiary general hospitals by analyzing the disease characteristics of inpatients in the General Practice Department of a tertiary general hospital in Beijing.
Inpatients treated in the Department of General Practice, Fuxing Hospital of Capital Medical University, between 2021 and 2022 were selected as the study subjects. Basic patient demographics and clinical information were collected and retrospectively analysed, including gender, age, marital status, occupation, admission route, number of visits, admission diagnosis, discharge diagnosis, consultation details and clinical outcomes, and the prevalence of comorbidities was calculated.
A total of 1 441 patient visits were surveyed, comprising 702 male patients (48.70%) and 739 female patients (51.20%); ages ranged from 17 to 102 years, with a mean age of (79.5±13.6) years; 519 (36.01%) patient visits were for patients who had been hospitalised two or more times; 890 (61.76%) patient visits were for outpatients admitted to hospital, 489 (33.93%) were for emergency admissions, and 62 (4.30%) were referred from primary care facilities; 1 343 (93.20%) patients were discharged on medical advice. The top three admission diagnoses were pulmonary infection (197 cases, 13.67%), dizziness (167 cases, 11.59%) and cerebral infarction (150 cases, 10.41%); the top three primary diagnoses at discharge were pulmonary infection (343 cases, 23.80%), cerebral infarction (258 cases, 17.90%) and urinary tract infection (65 cases, 4.51%). The most common pattern of two chronic diseases was hypertension and hyperlipidaemia [806 cases (55.93%)], whilst the most common pattern of three chronic diseases was hyperlipidaemia, hypertension and cerebral infarction [584 cases (40.53%)]. Among the 1 441 patients, admission diagnoses covered 40 conditions within the general practice training curriculum, totalling 550 diagnoses; consultation diagnoses covered 63 conditions, totalling 1 137 diagnoses; and discharge diagnoses covered 83 conditions, totalling 12 328 diagnoses. Among admission diagnoses, conditions in internal medicine, surgery and rehabilitation medicine had a high coverage rate (>60%); among consultation diagnoses, conditions in surgery, infectious diseases, psychiatry and rehabilitation medicine achieved 100% coverage; and among discharge diagnoses, conditions in internal medicine, surgery, infectious diseases, psychiatry and rehabilitation medicine achieved 100% coverage.
In the daily clinical practice of general practice departments at tertiary general hospitals, chronic diseases, geriatric comorbidities and undiagnosed conditions predominate. These departments play a vital role in the comprehensive management of common diseases, provide an excellent teaching platform for the standardised training of general practitioners, establish a fast-track mechanism for collaboration between primary care and tertiary hospitals, and lay a solid foundation and provide safeguards for advancing clinical research in general practice.
Medically unspecified disease (MUD) refers to health conditions at any stage where a definitive diagnosis cannot be made based on clinical manifestations and examination results. In recent years, the prevalence of MUD has increased in various regions due to the aging population and the rising burden of chronic diseases. However, there is a lack of systematic studies on how regional differences influence the clinical manifestations, physical and mental health, and multimorbidity in MUD patients.
This study aims to compare the clinical characteristics, physical and mental health, and multimorbidity of MUD patients in northern and southern China, and to analyze the potential impact of regional differences on the health of MUD patients, in order to provide evidence for personalized treatment strategies.
This is a nationwide, multi-center, real-world study collecting clinical data of MUD patients from 14 research centers in China between July 1, 2022, and June 30, 2023. The patients were divided into northern and southern groups based on the Qinling-Huaihe Line. We compared patients' basic clinical data, lifestyle factors, psychological health assessments (PHQ-15, GAD-7, PHQ-9), quality of life (SF-36), fatigue (PFS), and multimorbidity status.
A total of 1 414 patients were included in this study, comprising 444 (31.4%) from the northern region and 970 (68.6%) from the southern region. The average age of patients in the northern region was significantly younger than that in the southern region (P=0.002). Northern patients had significantly higher BMI, smoking, and alcohol consumption rates compared to those in the south (P<0.001). In terms of the clinical manifestations of MUD, edema had an incidence of 39.9% (177/444) in the northern region, followed by fatigue at 30.6% (136/444), weight loss at 20.9% (93/444), chest pain at 1.6% (7/444), and dizziness at 0.9% (4/444). In the southern region, fatigue was most common at 41.1% (399/970), followed by edema at 22.4% (218/970), weight loss at 14.0% (136/970), dizziness at 8.6% (84/970), and chest tightness at 2.5% (25/970). The distribution of MUD categories differed significantly between the two regions (P<0.001). Southern patients had generally higher scores in physical and mental health assessments (PHQ-15, SF-36, PFS). Northern patients exhibited more severe anxiety (GAD-7) and depression (PHQ-9) symptoms (P<0.001). In terms of multimorbidity, the proportion of 51-60 years patients in the northern region with ≥3 comorbid conditions was significantly higher than in the southern region (P<0.05).
Significant regional differences exist in the clinical manifestations, physical and mental health, and multimorbidity of MUD patients between northern and southern China. To more effectively manage MUD patients, particularly in addressing the challenges of multimorbidity and uncertain health issues, individualized treatment strategies should be developed based on regional differences, with an emphasis on multidisciplinary interventions and comprehensive health assessments.
