Cardiovascular diseases (CVDs) have become one of the leading causes of death globally and in China. With changes in lifestyle and an aging population, the prevalence of CVDs continues to rise, posing significant challenges to public health. Primary healthcare plays an important role in the prevention and the management of CVDs, with risk assessment and risk communication being the core components. Grassroots general practitioners can dynamically track patient risks through long-term doctor-patient relationships by conducting comprehensive assessments of the patient's health status and utilizing effective risk assessment tools such as the China PAR model and Framingham risk score to achieve personalized risk assessment, thanks to their service characteristics of "first visit, continuity, and accessibility". This grassroots risk communication mechanism is in line with the "patient-centered" prevention strategy advocated by international guidelines such as the American Heart Association (AHA) and the European Society of Cardiology (ESC) . Through risk visualization, it helps change health behaviors and improve medication adherence. However, grassroots risk communication still faces multiple challenges. This article explores the current status, application, and challenges faced by risk assessment and communication strategies for grassroots CVDs, and proposes suggestions for improving the communication skills and implementation strategies of grassroots general practitioners. The aim is to refine risk communication strategies to enhance the prevention and control effectiveness of CVDs and ultimately improve the health management level of grassroots patients.

Diabetes has become a significant global public health issue. In China, the prevalence of diabetes has been steadily increasing, placing a substantial burden on healthcare resources. The primary healthcare system plays a crucial role in diabetes management, yet there are still deficiencies in improving the quality of diabetes management services and achieving adequate blood glucose control.

This policy brief aims to explore and analyze evidence-based quality improvement interventions for diabetes management in primary healthcare settings, providing practical recommendations for policy and practice.

During July to December 2024, a systematic search was conducted using the PubMed, Epistemonikos, and Health System Evidence databases to identify relevant systematic reviews published in the past 10 years. The focus was on quality improvement interventions for type 2 diabetes management in primary healthcare systems, with an additional analysis of their effectiveness in China.

A total of 33 international systematic reviews and 22 original studies from China were included. The interventions were categorized using the Chronic Care Model (CCM), which identifies six key strategies: (1) high-quality healthcare service organization; (2) community resource linkages; (3) self-management support; (4) delivery system design; (5) decision support; and (6) information systems. Regarding the primary health outcome—blood glucose control—two types of interventions, including high-quality integrated interventions focused on service organization optimization and self-management support, showed positive effects in all studies. The evaluation of other interventions was inconsistent or lacked sufficient evidence. Studies conducted in China validated the positive effects of four intervention strategies on blood glucose control. However, evidence for the effectiveness of "enhancing community resource linkages" and "strengthening decision support" remains insufficient in China.

This policy brief summarizes effective interventions for diabetes management in primary healthcare systems, based on the best evidence available and the results from their implementation in China. It recommends prioritizing two key strategies: fostering a culture of quality improvement across the entire system and implementing a comprehensive chronic disease management model, while in areas where a full system-wide approach cannot be implemented, prioritizing interventions that support patient or community self-management. Additionally, the brief emphasizes expanding multi-sector collaboration and exploring more practices to strengthen community resource linkages, while also providing primary healthcare personnel with more direct and actionable guidelines.

Cardiovascular metabolic diseases are closely associated with depression. Although the management of cardiovascular metabolic diseases at the community level has been established, psychological issues such as depression in patients have not received sufficient attention. Moreover, there is a lack of simple, accurate, and efficient screening and assessment tools for depression.

To apply single-lead wearable electrocardiographic devices to predict the risk of depression in elderly patients with cardiovascular metabolic diseases at the community level of Ning Xia Hui Autonomous Region.

A total of 3 121 elderly patients (aged over 65) with hypertension, diabetes, coronary heart disease, and other cardiovascular metabolic diseases were selected from 20 primary medical and health care institutions in Ningxia between January 2022 and June 2023. Electrocardiographic data collected via single-lead wearable electrocardiographic devices were uploaded to a cloud platform. Additionally, sociodemographic, lifestyle, and mental health data were collected from the same platform. The data were divided into a training set (2 341 cases) and a validation set (780 cases) using a simple random sampling method at a 3∶1 ratio. LASSO regression analysis and cross-validation were performed using RStudio 4.1.1 software to identify the best predictors. A multivariable Logistic regression model was then established using the predictors selected by LASSO regression. A nomogram model for predicting the risk of depression in elderly patients with cardiovascular metabolic diseases was constructed. The model's efficacy was evaluated using the receiver operating characteristic (ROC) curve, calibration, and decision curve analysis.

In the training set, LASSO regression combined with Logistic regression analysis identified several significant factors associated with depression in elderly patients with cardiovascular metabolic diseases: gender (OR=1.747, 95%CI=1.258-2.434) , BMI (OR=1.073, 95%CI=1.024-1.125) , urban and rural areas (OR=1.684, 95%CI=1.172-2.456) , exercise (OR=0.610, 95%CI=0.460-0.799) , anxiety (OR=3.041, 95%CI=1.597-5.484) , coronary heart disease (OR=2.743, 95%CI=1.971-3.815), premature beats (OR=4.745, 95%CI=1.681-19.977) , standard deviation of average normal-to-normal Intervals (SDANN) (OR=4.745, 95%CI=1.681-19.977) , root mean square deviation (rMSSD) (OR=0.986, 95%CI=0.972-0.999) , and sleep efficiency (OR=0.988, 95%CI=0.982-0.995) . The differences were statistically significant (P<0.05) . The Logistic regression equation Logit (P) =4.322+0.558×gender+0.071×BMI+0.521×urban and rural areas-0.494×exercise+1.112×anxiety+1.009×coronary heart disease+1.557×premature beat-0.011×SDANN-0.014×rMSSD-0.012×sleep efficiency was used to construct a column chart prediction model. The area under the curve for predicting the risk of depression in elderly chronic disease patients in the training and validation sets were 0.748 (95%CI=0.707-0.786, P<0.001) , 75.2%, 63.4% and 0.751 (95%CI=0.692-0.809) , 76.7%, 60.6%, respectively. The clinical decision curve analysis showed that when the probability threshold for depression risk was between 8% and 35% in the training set and between 8% and 37% in the validation set, the net benefit of predicting the risk of depression in elderly patients with cardiovascular metabolic diseases was higher.

Gender, BMI, urban and rural areas, exercise, anxiety, coronary heart disease, premature beats, SDANN, rMSSD, sleep efficiency are contributing factors to the risk of depression in elderly patients with cardiovascular metabolic diseases. This study successfully constructed a nomogram model for predicting the risk of depression in elderly patients with cardiovascular metabolic diseases at the community level, based on single-lead wearable electrocardiographic devices. The model demonstrated good predictive efficacy and clinical application value. It can assist primary medical and health care institutions in conducting depression screening and formulating individualized intervention measures for patients, thereby aiding in the prevention and control of cardiovascular diseases at the community level.

With the deepening reform of China's primary health care system, scientific and systematic evaluation indicator systems have become crucial tools for measuring the capacity and development level of primary healthcare services. This article systematically reviewed the literature on evaluation indicator systems for primary healthcare services and management since the 2009 Healthcare Reform, covering six themes including performance evaluation, service capacity assessment, etc. It analyzed characteristics such as publication timeline, geographical distribution of research, indicator features, and research methods used. The study revealed that research themes have varied in focus across different periods. Existing research is concentrated in eastern China, with performance evaluation being the predominant subject. Literature review, the Delphi method, and the Analytic Hierarchy Process have been frequently employed to construct these indicator systems. While various indicator systems demonstrate unique characteristics and trends, limitations exist, including a lack of dynamic adjustment mechanisms, limited application and promotion, and subjectivity in indicator selection. Future research should focus on areas such as service quality and the integration of medical treatment and disease prevention, leveraging big data technology to enhance the objectivity of indicators. Furthermore, strengthening dynamic monitoring and field application of indicator systems is essential to more comprehensively and accurately reflect the effectiveness of primary healthcare development, providing a reference basis for policy optimization.

Upgrading and replacing existing medical information systems is one of the important means of digital transformation in primary healthcare, the Consolidated Framework for Implementation Research Constructs (CFIR) is widely used to guide implementation research across various stages and states, however, there are few research reports on the application of CFIR in medical service scenarios in China.

To analyze the implementation elements of digital transformation in primary healthcare based on CFIR.

In January 2023, 12 community health service institution managers and family doctor team members in Wuhou District, Chengdu, were selected as the subjects of the survey. A self-designed questionnaire was used for the survey, and statistical analysis was conducted using the SPSSAU software.

The effective recovery rate of the questionnaire was 100% (279/279), group and the family doctor team group is different (57.15% vs. 23.64%), and their perceptions of the sources of pressure for urgency also vary. The top three overall pressures are the demand for the supporting of the grassroots medical service model (59.14%), the strategic development needs of the institution (11.83%), and the efficiency support for personal business operations (9.68%). Respondents believe that the upgrade of the information system still needs adjustments in the transformation of service models and information technology function support (80.29%), the establishment of a unified organizational structure for promoting information technology construction (65.59%), and an independent data aggregation and management mechanism (65.23%). The top three tasks for completing digital transformation are the improvement of medical staff's health management and digital capabilities (6.21 points), the optimization and capability reshaping of the family doctor team (5.84 points), and the upgrade and transformation of the information system (5.22 points). 59.86% of the respondents support or strongly support the digital transformation goals and logic, but only 32.26% believe they can complete or lead other members to quickly implement digital transformation in their positions, and only 0.72% believe they can become members of the district-level "combat" team. The results of Logistic regression analysis showed that the clarity of the district-level strategic communication (OR=1.933), the degree of recognition of the transformation goals and logic of the above service model (OR=1.640), choosing to gain patient trust and support as the main external pressure (OR=1.159), and the expectations for the future district-level information system (OR=1.540) were positive influencing factors for individual efficiency; the impact of the current information system on daily business (OR=0.700) and the acceptance of the time for upgrading the system (OR=0.728) were negative influencing factors for individual efficiency. The above six influencing factors were distributed across five CFIR dimensions, and the implementation process accounts for two.

The timing for implementing the upgrade and transformation of the information system in Wuhou District, Chengdu, is relatively mature. Digital transformation is a systematic project involving multiple roles and links, and it requires a systematic organizational structure to drive the implementation process. CFIR can help enhance the insight into internal and external environments during the implementation process of digital transformation and successfully identify implementation elements.

The incidence of diabetes has been increasing year by year, and the management of type 2 diabetes has been included into the basic community health services as an important disease in China. However, at present, there is still a gap in the standard management of diabetes at the grass-roots level, especially in quality and ability.

To understand the current situation of diabetes management in Shanghai community health institutions and conduct systematic quality evaluation, and to put forward corresponding optimization suggestions for existing problems.

The research was conducted in May 2022, and the target population included, (1) community health service centres: all community health service centres in 16 administrative districts of Shanghai, with a total of 249 institutions; and (2) community general practitioners: 3 875 community general practitioners were selected by simple random sampling according to the proportion of 50% of the registered population. The questionnaire for medical institutions and the questionnaire for general practitioners were designed to investigate the implementation of diabetes management in community health centres and the implementation of standardized diagnosis and management of diabetes by community general practitioners.

A total of 249 questionnaires concerning diabetes management in primary healthcare institutions were distributed, with 249 valid responses collected, representing a 100.00% response rate. Additionally, 3 875 questionnaires assessing standardised diabetes diagnosis, treatment, and management practices among community general practitioners were distributed, yielding 3 874 valid responses, corresponding to a 99.97% response rate. HbA_1c test was available in all community health institutions in Shanghai, but the screening program for diabetes complications was insufficient, and only 16.9% of community health service centercould test nerve conduction velocity. The types of oral hypoglycemic agents are relatively complete, but the types of insulin are single, and only 7.6% of community health service center are equipped with the new hypoglycemic drug glucagon-like peptide-1 receptor agonist. 57.4% of community health service center have set up diabetes clinics. Community general practitioners have a high degree of recognition for the standardized management of diabetes and have a good grasp of the guidelines for the basic management of diabetes, but they have a poor grasp of the basic knowledge of diabetestreatment drugs, and the correct rate of the application knowledge of oral hypoglycemic drugs and insulin is only 27.9% and 29.0%. When the blood sugar of newly diagnosed diabetic patients is high and the diagnosis of diabetic nephropathy is confirmed, the community general practitioners are more inclined to refer the patients directly to the superior hospital specialty.

The results of this survey showed that the infrastructure, equipment and drugs of diabetes management service in Shanghai community health service center have basically met the quality requirements; Gaps in knowledge of drug use; It is necessary to further improve the diabetes management quality and medical capacity of primary medical and health institutions by increasing the examination and testing items related to the screening of diabetes complications, increasing the types of new hypoglycemic drugs and insulin, strengthening the construction of diabetes specialized clinics, improving the diagnosis and treatment level of general practitioners, and standardizing the diagnosis and treatment behaviors of general practitioners.

The diagnosis and treatment level of osteoporosis in Shanghai community health service institutions are still unclear, and systematic evaluation and monitoring are lacking.

To understand the current status of osteoporosis diagnosis and management in community health service in Shanghai, to evaluate their diagnosis and treatment capacity, and to explore their problems and improvement measures.

A questionnaire was distributed to 248 community health service centers and 1 873 community general practitioners (GPs) in 16 administrative districts of Shanghai in December 2023 to investigate the current status, knowledge and competence of community health service center and GPs in urban and suburban areas regarding osteoporosis diagnosis and management.

Of the 248 community health centers in the 16 administrative districts of Shanghai, 79 (31.9%) were in the urban area and 169 (68.1%) in the suburbs, and of the 1 873 GPs, 497 (26.5%) were in the urban area and 1 376 (73.5%) in the suburbs. In terms of inspection and testing equipment, the proportion of bone mineral density (BMD) in urban and suburban areas was 92.4% and 50.9%, and the proportion of bone turnover markers was 50.6% and 12.4%, respectively (P<0.05). In terms of drugs, the proportion of bisphosphonates in urban and suburban areas was 73.4% and 45.0%, and the proportion of active vitamin D and its analogues was 69.9% and 53.3%, respectively (P<0.05). In terms of non-drug treatment, the proportion of traditional Chinese medicine suitable technology in urban area and suburban area was 79.7% and 80.5% respectively (P>0.05). Exercise therapy, physical factor therapy and occupational therapy in urban areas were higher than those in suburban areas, 73.4% versus 50.3%, 73.4% versus 37.9%, 65.8% versus 38.5% (P<0.05). The difficulties of disease management mainly included insufficient examination equipment, inadequate treatment drugs, and limited doctors' diagnosis and treatment ability, especially in the suburbs. Regarding the cognition of GPs in community health centers on osteoporosis high-risk groups and screening, the proportion of urban and suburban GPs' cognition on postmenopausal women was 99.2% versus 97.8% (P<0.05), and the proportion of their cognition on the Osteoporosis Self-Screening Tool for Asians (OSTA) was 88.3% versus 84.4% (P<0.05). Regarding the cognition of common symptoms and examinations of osteoporosis, the proportion of urban and suburban GPs' cognition of compression fracture was 97.0% and 92.2% respectively (P<0.05), and the proportion of cognition of bone transformation markers was 67.6% and 45.2% respectively (P<0.05). Regarding the perception of osteoporosis treatment modalities, the proportion of urban and suburban GPs' perception of physical factor therapy and occupational therapy was 89.3% versus 84.7% and 86.3% versus 81.2%, respectively (P<0.05). The difficulties in diagnosis and treatment mainly included: insufficient experience in the use of new drugs, insufficient ability to identify high-risk groups, insufficient ability to assess the risk of osteoporosis, insufficient confidence in diagnosis, and insufficient ability to choose and mix drugs, especially among rural doctors.

All community health service institutions in Shanghai, especially those in the suburbs, need to strengthen the equipment of osteoporosis related examinations and tests such as bone mineral density and bone turnover markers, improve the types of therapeutic drugs such as bisphosphonates, active vitamins and their analogues, and strengthen the development of relevant appropriate technologies including exercise, physiotherapy and work. As for the systematic and comprehensive management of osteoporosis, it is suggested to improve the relevant information construction, coordinate and integrate multidisciplinary teams and multi-party resources.

As the global obesity issue becomes increasingly severe, weight loss has become a key task for improving public health and reducing the burden of chronic diseases. Grassroots medical health institutions can effectively advance the prevention and control of obesity, offering clear advantages such as proximity to community needs and strong accessibility of health services. This paper, based on policy background and practical needs, elaborates on the necessity and existing issues in the construction of weight loss clinics in grassroots medical and health institutions, and systematically explores their functional positioning, service models, and the development of both software and hardware capabilities. Furthermore, taking the Weight Loss Clinic at Huichengmen Community Health Service Station in Haidian District, Beijing, as a typical case, this paper analyzes its practical experiences, including relying on academic support from tertiary hospitals, establishing a two-way referral mechanism, and building an intelligent management system. The construction of grassroots weight loss clinics is an important initiative to promote the transformation of grassroots medical services from a "disease-centered" to a "health-centered" approach. Currently, the construction of grassroots weight loss clinics nationwide is still in its early stages, and this paper can provide references and insights for their standardized development.

Community health services are important in achieving universal health coverage, with nursing workforce allocation directly impacting service accessibility and quality. While existing researches mainly focuses on the allocation of nursing resources in hospital, data on community nurses in China remain limited.

This study aims to evaluates trends and equity in the allocation of community nurses in China from 2012 to 2022, providing insights for optimizing resource distribution.

Data were sourced from the 2013-2017 China Health and Family Planning Statistical Yearbook, the 2018-2022 China Health and Wellness Statistical Yearbook, the 2013-2022 China Statistical Yearbook, and the 2023 China Health Statistics Abstract. A descriptive analysis was conducted from February to May 2024. The Lorenz curve, Gini coefficient and agglomeration degree were employed to assess the distribution and equity of community nurses.

From 2012 to 2022, the number of community nurses increased from 128 652 to 252 568 with an average annual growth rate of 6.98%. By 2021, the proportion of community nurses with a bachelor's degree rose from 6.8% to 33.0%. The Gini coefficients for population and geographic distribution were 0.13 and 0.70, respectively, indicating significant regional disparities in nurse allocation.

The quantity and quality of community nurses in China have improved significantly, yet disparities persist. Regional variations in allocation remain, with population-based distribution being more equitable than geographical distribution. Future efforts should focus on strengthening the community nursing workforce and enhancing equity in resource allocation.

Alzheimer's disease and related cognitive disorders are characterized by an insidious onset and long disease course, making early identification a critical strategy for reducing disease burden. The 10th edition of the Guidelines for Preventive Activities in General Practice issued by the Royal Australian College of General Practitioners (RACGP) adopts a strong primary care orientation and emphasizes opportunistic case-finding among high-risk populations, integrating evidence-based principles on screening, selection of cognitive assessment tools, and multidimensional management of modifiable risk factors. Drawing on the 2024 Lancet Commission on Dementia Prevention, Intervention and Care, World Health Organization evidence, and the life-course management framework, this paper systematically interprets the key recommendations of the RACGP guideline from a general practice perspective, with a focus on risk identification, exclusion of reversible causes, stratified use of screening instruments, and longitudinal management. The analysis suggests that commonly used tools such as the MoCA, GPCOG, RUDAS and AD8 demonstrate complementary strengths across different community populations and clinical contexts, supporting their integration into opportunistic screening pathways in primary care. In addition, interventions targeting physical activity, metabolic control, hearing impairment, sleep disorders and medication optimization constitute a feasible life-course prevention package. In the Chinese primary care context, early identification of cognitive impairment remains constrained by insufficient linkage between screening and referral, limited workforce training and resource integration, and low public awareness. This paper proposes embedding cognitive screening into family doctor contract services and chronic disease management programmes, and leveraging integrated care networks to establish a closed-loop pathway encompassing screening, assessment, referral, intervention and follow-up, thereby advancing earlier prevention and strengthening the role of primary care in dementia risk reduction.

Despite a decade of promoting a hierarchical medical system in China, residents' willingness to seek initial care at primary healthcare settings remains low. An analysis of the factors influencing residents' first-contact preferences is therefore warranted.

To investigate the overall and relative utility of various measures within the hierarchical medical system on enhancing residents' willingness to choose primary healthcare institutions for their first visits.

A conjoint analysis experiment was conducted via an online questionnaire distributed on social media platforms between May and June 2024. Using convenience and snowball sampling, we recruited 300 adults aged 18 and above, yielding 293 valid responses (a 97.7% effective response rate). The experiment simulated patients' decision-making processes in various policy-mix scenarios. A multilevel linear regression model was employed to analyze the effects of differentiated insurance reimbursement rates, the development of medical consortia, family doctor contract services, and improvements of service capacity of primary healthcare institutions on residents' first-contact decisions. Willingness-to-pay (WTP) was estimated for different resource configurations. A conditional Logit regression model was used for robustness checks.

The likelihood of residents choosing a primary healthcare institution for their first visits was significantly higher with increased insurance reimbursement rates (P<0.010), a higher level of medical technology (P<0.001), closer proximity (P<0.050), and the regular presence of visiting specialists from Grade 3A hospitals (P<0.050). Regarding patient characteristics, healthier respondents were significantly more inclined to choose primary healthcare institution for their initial diagnosis (P<0.001). Compared to a low level of medical technology, a medium level at primary healthcare institutions was equivalent to a 42.50 percentage point increase in the insurance reimbursement rate (P=0.010) in terms of its effect on patient preference. The impacts of family doctor contract services and case information sharing mechanisms were not statistically significant (P>0.05).

Among all experimental attributes, enhancing the healthcare service level of primary healthcare institutions holds the highest economic value. These findings provide empirical support for optimizing the hierarchical medical system, underscoring the critical role of improving service quality at the primary level. The study reveals that relying solely on differentiated insurance payments is insufficient to guide patient flow effectively and highlights the potential value of increasing the visibility and efficacy of the family doctor system and information-sharing mechanisms.

Community screening and diagnosis of mild cognitive impairment (MCI) in the community are of great value in the prevention of dementia. Currently, there is still no consensus on the management of community screening and diagnosis in the MCI population. This study conducted a detailed review of the current management of community screening and diagnosis, specific items for screening and diagnosis, and peri-diagnostic support for the MCI population, and found that community screening and diagnosis of MCI need to be comprehensively assessed in terms of population definition, history taking, cognitive assessment and auxiliary testing; peri-diagnostic support should include post-diagnostic disclosure, development of post-diagnostic support program and guidance on post-diagnostic support. Thus, it is suggested that community healthcare workers should carry out comprehensive assessment and diagnosis of the MCI population, and actively carry out rapid post-diagnostic support actions to promote the dementia prevention to be really moved forward.

Multiple chronic diseases have become an important characteristic of the development of chronic diseases, the chronic disease response method based on community health services has been recognized as one of the most cost-effective solutions, the quality of community health services affects the well-being of the public. Ratchet effect is beneficial for behavioral research, and we can provide useful reference for the evaluation of community health service quality for patients with multiple chronic diseases based on the perspective of doctor-patient behavior.

Research on the influencing factors of community health service' quality evaluation for patients with multiple chronic diseases based on ratchet effect.

Using multi-stage sampling method to select patients with multiple chronic diseases as the research subjects from 18 communities in Guangzhou, Guangdong Province, during July to August 2023. The community health service quality assessment questionnaire was used the PCAT scale developed by the Johns Hopkins Primary Care Center in the United States. Exploring the impact on the evaluation of community health service quality for patients with multiple chronic diseases under the moderation effect of medical insurance by constructing a multiple linear regression model.

We included 282 subjects with 129 males and 153 females, their average age was (38.0±8.0) years old. Married accounted for the majority of the participants, with 165 (58.51%); local residents predominated, with 215 individuals (76.24%); the distribution of educational backgrounds was balanced, with postgraduates constituting the largest group: 112 individuals (39.73%); the majority of residents' monthly income were below 5 000 yuan, with 163 individuals (57.80%); a total of 242 participants (85.81%) reported their health status as good or very good; the majority of participants were covered by public healthcare, urban employee social insurance, and urban resident social insurance, with 239 individuals (84.75%). The PCAT score for patients with multiple chronic conditions was (104.47±13.63) points. Statistically significant differences (P<0.05) were observed in PCAT scores based on different monthly income levels and health statuses. There was a statistically significant difference (P<0.05) in PCAT among institutions which had two levels of familiarity with multiple chronic diseases' patients, and the same for variations in willingness to utilize primary care services. Medical insurance had a positive moderating effect on the evaluation of community health service quality for patients with multiple chronic diseases (P<0.05). The behavior indicators of doctor-patient relationship had a ratchet effect on the evaluation of community health service quality for patients with multiple chronic diseases. That is to say, the higher the familiarity of community health service institutions with patients with multiple chronic diseases and the stronger the intention of patients with multiple chronic diseases to seek medical treatment at the grassroots level, the higher the evaluation of the quality of community health services for patients with multiple chronic diseases, it showed a phenomenon of only increasing without decreasing.

Medical insurance can enhance the evaluation of community health service quality by patients with multiple chronic conditions. The state should continue to introduce beneficial policies for improving the patients' medical experience. At the same time, we should advocate for the establishment of effective two-way communication between doctors and patients. Furthermore, we should continue to strengthen the awareness of primary care for patients with multiple chronic diseases.

China has now launched the Alzheimer's disease prevention and treatment promotion action, and local communities are actively carrying out cognitive function screening around the community elderly population. However, there is no suitable evaluation standard to be used as the basis for the screening of cognitive impairment in the community.

To construct an evaluation system for cognitive impairment screening services applicable to the community, and to provide a reference for the appraisal and quality control of large-scale community-based cognitive function screening programs among older adults in various regions of China.

By literature research and policy analysis, the first draft of the indicator system was proposed around the five elements of the RE-AIM framework, and 15 experts were selected to carry out a Delphi expert consultation to construct an evaluation indicator system for community-based cognitive impairment screening services from October 2023 to January 2024. The weights of the indicators were determined using the multiplier method.

The positive coefficients of experts in the two rounds of Delphi were 100.0% and 93.3%, the experts' authority coefficients were 0.83 and 0.86, and the coordination coefficients of experts' opinions were 0.242 and 0.265 (P<0.001), and the final evaluation system consisted of 5 first-level indicators, 15 second-level indicators, and 20 third-level indicators. The first-level indicators and their weights were screening reachability (0.203 5), screening efficacy (0.203 5), program adoption by the organization (0.194 8), program implementation (0.203 5), and program maintenance (0.194 8).

The evaluation index system of the community cognitive impairment screening service initially constructed in this study, which contains 5 first-level indicators, 15 second-level indicators, and 20 third-level indicators, is of good scientific validity and reliability, and has certain reference value for improving the assessment system of cognitive impairment screening.

The hierarchical and progressive objectives of standardized training for general practice residents require that third-year residents (R3) develop the ability to manage patients independently. Supervisors provide guidance on complex and critical cases to foster clinical reasoning and enhance diagnostic and management skills among R3. However, community outpatient teaching often relies on limited content and methods, falling short in cultivating systematic recognition and management of critical diseases such as atypical acute coronary syndrome (ACS).

To investigate the application of the PQRST pain assessment method combined with cardiovascular risk assessment in community outpatient teaching, with the aim of improving R3's ability to recognize, diagnose, and manage atypical ACS, thereby optimizing the quality of outpatient teaching.

Case-based learning was employed using a patient presenting with "subxiphoid discomfort for 2 hours after alcohol consumption". The R3 independently conducted the consultation and documented the medical record, while the supervisor observed, supplemented the documentation, and identified problems. The PQRST method was used to systematically collect symptom information, complemented by cardiovascular risk stratification using validated assessment tools. Electrocardiogram (ECG) and cardiac injury markers were utilized to confirm the diagnosis of ACS, followed by prehospital emergency management and referral. Mind map were incorporated into the teaching process to facilitate recording and feedback, reinforcing the R3's clinical reasoning and summarization skills.

Using the PQRST pain assessment method, the patient's symptoms were confirmed to be consistent with atypical chest pain. Cardiovascular risk assessment categorized the patient as being at"very high-risk". ECG and myocardial injury marker findings confirmed ST-segment elevation myocardial infarction (STEMI). Under the supervisor's guidance, the R3 successfully completed rapid assessment, prehospital management, and orderly referral. After the teaching session, the R3 demonstrated significantly improved ability to recognize atypical ACS, enhanced clinical logical reasoning, and greater familiarity with emergency referral procedures.

The combination of the PQRST pain assessment method and cardiovascular risk assessment improves R3's capacity for early recognition and management of atypical ACS. The integration of mind maps for feedback and summarization helps establish a systematic framework for differential diagnosis. This approach is applicable to teaching critical care management in community outpatient teaching and holds promise for broader implementation.

Lifestyle prescriptions are essential for managing chronic diseases patients' behaviors and have been recommended in several international guidelines. Primary healthcare workers play a critical role in delivering lifestyle services, yet their competencies are still insufficient. While existing trials indicate that training can enhance healthcare workers' capacity for health behavior management, comprehensive evidence on the effectiveness of lifestyle education interventions remains limited. This paper systematically reviews the current training programs aimed at improving primary healthcare workers' skills in health behavior management, analyzing their content, format, and outcomes. The paper also identifies existing gaps in chronic disease behavior management training and offers recommendations for improvement. It highlights that current training programs inadequately address patient stress, sleep and social engagement, and there is a lack of standardized training on the fundamental theories and skills of behavior change. While educational interventions have shown some effectiveness in enhancing the knowledge and skills of primary healthcare workers, their impact on improving patient health outcomes remains limited. This paper provides valuable insights for enhancing the quality of chronic disease management by primary healthcare workers.

Improving the patient medication experience is a key factor in improving patient medication adherence, and it is also necessary to improve patient outcomes and medical safety. At present, there is a lack of measurement tools for the primary medication experience of patients with chronic diseases in China, which seriously restricts the research and practice of pharmaceutical service and management in primary medical institutions.

The purpose of this study was to develop the Primary Medication Experience Scale for Chronic Disease Patients, which is applicable to the practice of chronic disease management in China, and to conduct reliability and validity tests, with the aim of providing instrumental support for research and practice of health management for chronic disease patients.

This study used a combination of qualitative and quantitative methods to develop the scale. First, a pool of scale items was generated through the literature review method, and a preliminary primary medication experience scale for patients with chronic diseases was formed through the semi-structured interview method and under the guidance of the perceived value theory. Through the Delphi expert consultation method, the preliminary primary medication experience scale for patients with chronic diseases was consulted and validated, and revised and improved. In October 2023, a random sampling method was used in primary healthcare institutions in Shandong Province to select chronic disease patients attending primary healthcare institutions for on-site research, to debug the scale in terms of language and culture and to test the reliability and validity of the scale, and to make further optimization and adjustment of the scale, to finally form the Scale of Experience of Primary Medication Use for Chronic Disease Patients.

Through literature analysis, 14 dimensions related to medication experience were extracted. A preliminary scale item pool comprising 8 dimensions and 40 items was constructed through semi-structured interviews. The scale was modified and refined using the Delphi expert consultation method. The expert response rates in two rounds were 95% and 100%, respectively, with mean expert authority coefficients of 0.86 and 0.88, respectively. The experts provided scientifically sound and authoritative suggestions and recommendations for revisions, resulting in a scale containing 7 dimensions and 29 items. Through field investigation, the reliability and validity testing results of the scale were satisfactory. The critical ratio analysis of scale items showed that all P values were <0.05. Cronbach's α coefficients for the total scale and all dimensions were >0.800, split-half reliability coefficients were all >0.700, and intraclass correlation coefficients (ICC) were all >0.800. After rotation, all item factor loadings were >0.500. The confirmatory factor analysis model fit indices were: chi-square to degrees of freedom ratio (CMIN/DF) = 1.485, goodness-of-fit index (GFI) = 0.902, root mean square error of approximation (RMSEA) = 0.039, root mean square residual (RMR) = 0.03, comparative fit index (CFI) = 0.981, normed fit index (NFI) = 0.945, incremental fit index (IFI) = 0.981. The composite reliability (CR) values were all >0.7, and average variance extracted (AVE) values were all >0.500. Ultimately, a primary care medication experience scale for patients with chronic diseases was developed, comprising 3 first-level dimensions (functional value, emotional value, and social value), 7 second-level dimensions, and 28 measurement items.

The primary medication experience scale for chronic disease patients developed in this study has good reliability and validity, has certain local appropriateness and scientific validity, and can be used in the survey research of primary medication experience for chronic disease patients.

Primary healthcare services play a significant role in health system in China. Yet, constrained by poor capacity and skills of the professionals, there remains significant room for improvement in its service effectiveness. Artificial intelligence has the potential to empower primary health care system. This article thoroughly examined the progress and challenges of applying artificial intelligence to primary health care system. Artificial intelligence has been widely used in diagnosis and treatment, health management and health education, public health service management, and the optimization of health resource allocation. However, there is a lot of public concern about data quality, date safety, and ethical issues. To achieve Healthy China 2030, the following suggestions merit consideration: pooling expert resources at the national level to advance the development of artificial intelligence, accelerating the industrialization of artificial intelligence in primary health care system, and closing legislation and regulation gaps in artificial intelligence.

Recent years have seen novel respiratory infectious diseases impose significant health and economic burdens in China. Community health service centers play a crucial role in managing and preventing these diseases. As such, it is imperative that medical staff at these centers develop specific emergency health capabilities to handle the increasing challenges posed by respiratory disease prevention and control. Yet, research into the emergency capabilities of community medical staff for respiratory diseases and their influencing factors remains limited.

To explore and analyze the different dimensions of the emergency response capacities of community medical staff in respiratory infectious diseases, and to explore the related factors, so as to provide a basis for the evaluation and training of the health emergency response capacities of community medical staff in respiratory infectious diseases.

In November 2023, a staged convenience sampling method was used to select three districts, Xicheng District, Fengtai District, and Daxing District from the central, urban, and suburban regions of Beijing, and three community health service centers from each district, with about 50 medical staff recruited from each of the community health service centers as the survey respondents. A self-designed questionnaire on health emergency capacities of community medical staff for respiratory infectious diseases was used for this survey.

A total of 509 community medical staff were surveyed in this study, and 507 valid questionnaires were obtained after excluding 2 questionnaires in which the survey respondents' department was a non-operational department or these content of the work was not related to the department's business. The results of the survey showed that the average score of the health emergency response capacities of health care workers in community health service centers in Beijing was (0.598±0.136). Of the 2 primary indicators, the healthcare workers scored (0.602±0.152) for response capabilities and (0.590±0.173) for knowledge preparation. The results of multiple linear regression analyses showed that doctors (β=0.322, P<0.001), senior titles (β=0.118, P=0.012), and those who had participated in 6 or more relevant trainings and emergency response drills in the past year (β=0.225, P<0.001) had a higher emergency response capability scores. Medical staff with a clinical medicine background (β=-0.210, P=0.015) had lower emergency response capability scores among medical staff.

The emergency health capacities of community medical staff in Beijing require enhancement. There is a need for intensified training in deficient areas such as "Legal, Regulations and Standards""Monitoring and Early Warning", and "Reporting". Further attention should be directed towards nurses, medical technicians, pharmacists, staff with lower professional titles, and staff less frequently involved in training and emergency drills.

Community pharmacy has significant advantages in curbing medication misuse and managing chronic diseases. Nevertheless, pharmacists encounter challenges such as complex job duties, inadequate professional knowledge, and low public awareness. Under the background of government support for innovating and expanding pharmacists' roles, the healthcare alliance has emerged as an ideal solution to the dilemma in community pharmacy.

This research devote to establish a community pharmacy studio to enhance the quality of community pharmacy services and the outcomes of chronic disease management based on the healthcare alliance model.

Three randomized controlled trials were implemented in three communities within a healthcare alliance from April 2023 to March 2024, while all control groups served as negative controls. In Trial one, 254 healthcare professionals were randomly and equally divided into two groups. The experimental 1 group received pharmaceutical literacy training, after which the outcomes were compared with those of the control 1 group. In Trial two, 540 residents were randomly divided into two groups, the experimental 2 group received services from the community pharmacy studio. Pharmaceutical literacy, medication adherence, pharmacist recognition, and service satisfaction were compared between the two groups. In Trial three, 118 chronic disease patients were randomly divided into two groups. The experimental 3 group received individualized medication guidance, and the rates of chronic disease indicator control were compared between the two groups. Data were collected through questionnaires, interviews, and medical record reviews and analyzed by SPSS 24.0 software.

Survey results indicated that the proportion of participants with high pharmaceutical literacy in the experimental 1 group (86.61%, 110/127) was significantly higher than in the control 1 group (68.50%, 87/127), showing a statistically significant difference (χ²=11.966, P<0.01). The research found that the experimental 2 group had a higher proportion of residents with high pharmaceutical literacy compared to the control 2 group (P<0.001), according to comprehensive assessment of community residents' pharmaceutical literacy and service satisfaction. Additionally, the proportion of community residents exhibiting high medication adherence was higher in the experimental 2 group compared to the control 2 group (P<0.05). Furthermore, respondents in the experimental 2 group were satisfied with the pharmacy studio, the degree of satisfaction was significantly higher than that in the control 2 group (P<0.001). Also, the experimental 2 group had a higher proportion of residents recognizing the professional the pharmacist team compared to the control 2 group (P<0.01). The experimental 3 group demonstrated a higher rate of achieving chronic disease control targets than the control 3 group, and a higher proportion of positive evaluations regarding the pharmacist's role compared to the control 3 group (P<0.05).

Supported by healthcare alliance, the community pharmacy studio model, effectively overcame the challenges of community pharmacy development, enhanced the quality of pharmacy services, improved outcomes of patient disease management, and set new standards for the future of community pharmacy. This model provides valuable insights and practical experience for the development and innovation of community pharmacy services in China.

In China, the national public health emergency response system was originally established in 2003 to address emerging respiratory infectious diseases. In response to the COVID-19 pandemic, fever clinics were instituted within Primary Healthcare Centers (PHC) to serve as a supplementary measure to the existing healthcare infrastructure during public health emergencies. The final goal is leading to the subsequent development of a more sophisticated public health emergencies medical care system.

Over the past three years, the utilization rates and visitation numbers of fever clinics have fluctuated irregularly. This study seeks to summarize the operational processes of PHC fever clinics during this period, identify existing challenges, and propose potential strategies for improvement.

A convenience sampling method was employed to select 16 PHC fever clinics, with one clinic chosen from each of the 16 districts in Shanghai. Managers of these fever clinics were invited to participate in semi-structured, in-depth interviews conducted from November 23, 2023, to June 18, 2024. The interview guide was developed by integrating insights from existing literature, government regulations, and a preliminary survey. The interviews centered on themes related to the establishment, operation, and challenges encountered by the clinics in recent years. The framework analysis method was employed to manage the qualitative data. Quantitative data were collected on the number of patients visiting fever clinics over the past three years, alongside population statistics and jurisdictional areas of each PHC. The correlation among clinic visits, population size, and population density was examined. Additionally, the SWOT framework was applied to assess the strengths, weaknesses, opportunities, and threats associated with PHC fever clinics.

Of the 16 participants interviewed, 14 individuals (87.5%) possessed either vice-high or superior professional titles, with an average professional tenure of (20.0±6.6) years. The qualitative interviews identified five distinct themes pertaining to functions, hardware configurations, operational processes, current operational challenges, and underlying influencing factors. The fever clinics were classified into urban or suburban categories according to their geographic location. Over the past three years, the mean frequency of visits to urban fever clinics had been lower compared to their suburban counterparts. The results of the SWOT analysis revealed that PHC fever clinics had established a more advanced sentinel surveillance network for the prevention and control of respiratory infectious diseases. Nonetheless, the analysis also identified shortcomings in human resources, infrastructure, and inefficiencies in the allocation and use of medical resources.

The PHC fever clinics are strategically located closer to communities, offering a more convenient and cost-effective option for patient access. Additionally, these fever clinics play a crucial role in forming a comprehensive network for the prevention and control of infectious diseases. In Shanghai, there is a notably higher demand for fever clinics situated in suburban areas. However, when compared to the standardized requirements for fever clinic settings, there are deficiencies attributed to the structural limitations of PHC facilities. Furthermore, there was a notable inefficiency in human resource allocation due to the intermittent nature of seasonal respiratory infectious disease epidemics. It is advisable to dynamically adjust the human resource management in PHC fever clinics in accordance with sentinel monitoring data and the prevailing trends of respiratory infectious disease epidemics. Supportive governmental policies and media advocacy can enhance the operational efficiency of fever clinics. The PHC has recommended active service implementation to ensure optimal utilization of these clinics.

Cardiovascular disease remains the leading cause of morbidity and mortality globally. Cardiovascular health scores are closely associated with cardiovascular disease. Conducting cardiovascular health assessments for individuals can significantly contribute to the improvement of cardiovascular health across the entire life span.

To investigate the cardiovascular health status, distribution characteristics, and associated factors among community residents in Nanjing, and provide evidence for the prevention and control of cardiovascular disease.

From September 2022 to August 2024, a total of 45 901 community-dwelling residents aged 35-79 years in Nanjing were selected using a multistage, stratified, cluster random sampling method. All participants completed questionnaires, physical examinations, and laboratory tests. Cardiovascular health was quantitatively assessed using the "Life's Essential 8" scoring system, which included four health behaviors (diet, physical activity, smoking, and sleep) and four health factors (BMI, blood lipids, blood glucose, and blood pressure). Scores <50 were defined as low cardiovascular health, 50-80 as moderate cardiovascular health, and >80 as high cardiovascular health.

The mean overall cardiovascular health score of the participants was (66.9±12.8). Scores were higher in women, married individuals, urban residents, and those not at high risk of cardiovascular disease than men, unmarried individuals, rural residents, and those at high risk of cardiovascular disease (P<0.05). Scores declined with increasing age and improved with higher educational attainment (P<0.05). The mean scores for diet, physical activity, smoking, sleep, body mass index, blood lipids, blood glucose, and blood pressure were (37.7±31.0), (79.8±38.8), (71.6±40.3), (84.7±24.0), (58.8±31.4), (67.4±29.5), (79.9±25.4), and (45.8±33.9), respectively. Of all participants, 7 524 (16.4%) had high cardiovascular health, 34 071 (74.2%) had moderate cardiovascular health, and 4 306 (9.4%) had low cardiovascular health. Multivariable Logistic regression analysis showed that, compared with those with low cardiovascular health, women, individuals aged 55-64 and 65-79 years, those with junior or senior high school or college and above, individuals in other occupations, and those not at high risk of cardiovascular disease were more likely to have moderate cardiovascular health, whereas service workers, white-collar employees, and rural residents were less likely (P<0.05). Women, individuals with junior or senior high school or college and above, those in other occupations, and those not at high risk of cardiovascular disease were more likely to have high cardiovascular health, while individuals aged 45-54 and 55-64 years and rural residents were less likely (P<0.05).

Cardiovascular health among community residents in Nanjing was at a moderate level. Men, older individuals, those with lower education levels, rural residents, and those at high risk of cardiovascular diseases should be prioritized for targeted interventions. Comprehensive improvement in cardiovascular health can be achieved by strengthening interventions on key risk factors such as diet, smoking, and blood pressure.

Providing continuous health services is a key task in community-dwelling integrated medical and elderly care, policy design plays a crucial role in the construction of continuous health service system, but previous research is limited in analyzing the continuous health service policy of community-dwelling integrated medical and elderly care in China.

To analyze the characteristics and shortcomings of policies of community-dwelling integrated medical and elderly care in China, and provide policy recommendations for improving the continuous health service system of community-dwelling integrated medical and elderly care.

In May 2024, search policy documents on the website "www.pkulaw.com", using the title keywords "integrated medical and elderly care" "elderly care service" "elder" "ageing", the leading department of introduction is national level (Central Committee of the Communist Party of China, State Council), or competent departments of health service (National Health Commission, National Healthcare Security Administration, National Administration of Traditional Chinese Medicine, or National Disease Control and Prevention Administration), introduced from January 2000 to May 2024, and related to continuous health service of community-dwelling integrated medical and elderly care, select as samples (n=41). Based on the indicators system of continuous health services, policy tool types, and policy effectiveness scores, establish a three-dimensional analysis framework to quantitatively analyze the policies.

The proportion of policy effectiveness scores for the indicators of relationship continuity, information continuity, and management continuity accounted for 8.62% (264/3 063), 10.61% (325/3 063), and 80.77% (2 474/3 063), respectively. The proportion of policy effectiveness scores and importance weights in the tertiary indicators were severely mismatched, with a Pearson correlation coefficient of only -0.10 (P>0.05). The effectiveness scores of market-oriented tools, business management techniques, and socialization methods account for 22.62% (693/3 063), 67.29% (2 061/3 063), and 10.09% (309/3 063), respectively. The overall average score for policy effectiveness is 12.20, while the average scores for policy effectiveness for relationship continuity, information continuity, and management continuity are 13.89, 16.25, and 11.67, respectively. The average scores for the effectiveness of market-oriented tools, business management techniques, and socialization methods policies are 16.90, 11.45, and 10.30, respectively. The average effectiveness scores of policy measures and targets are 3.25 and 2.80, respectively, with a difference of 16.07%. The overall average effectiveness score of policy measures and targets is only 3.03, close to 3.00 which is the critical value of specificity.

There is room for improvement in the effectiveness distribution, tool selection, and specificity of China's continuous health service policy of community-dwelling integrated medical and elderly care. We suggest that the effectiveness of policy should scientifically cover the continuity indicators of health service and enhance the sense of gain of elderly people in home-based communities. Increase the use of market-oriented tools and strengthen economic stimulation for market entities. Balance the effectiveness of policy measures and targets, and improve the specificity of policy.

The high prevalence and persistent growth of chronic diseases pose significant health challenges in China. This study, grounded in the antifragility development theory, explores intervention strategies for primary healthcare services to enhance chronic disease prevention and management. It systematically reviews the vulnerabilities of the primary healthcare system in addressing chronic disease management, including imbalances in medical resource allocation, challenges in policy implementation, underdeveloped information systems, and shortages of professional personnel. By innovatively introducing the concept of antifragility, the study emphasizes that the primary healthcare system can strengthen its capabilities by adapting to and improving under conditions of uncertainty and pressure. A series of intervention measures based on the antifragility framework are proposed, such as integrating interdisciplinary teams and information technology to deliver personalized health services, enhancing risk identification and health education, and implementing multi-level interventions to comprehensively reduce chronic disease risks. Other recommendations include increasing the flexibility and adaptability of family doctor contracting services, optimizing policy support and resource allocation, and establishing scientific evaluation and improvement mechanisms. This study aims to build a resilient, adaptive, and continuously optimized primary healthcare system, ultimately improving the quality of chronic disease management, residents' health outcomes, and overall quality of life.

The aging process in China is accelerating, and the number of older adults with chronic diseases is increasing. The association between hypertension, along with its comorbidities, and dementia in older adults requires further investigation.

To investigate the association between hypertension, its comorbidities, and dementia in community-dwelling older adults, and to provide evidence for dementia prevention.

This study utilized cross-sectional data from 14 732 individuals aged ≥65 years from the China Multicenter Dementia Survey (CMDS, 2018-2023). Data on sociodemographic characteristics, chronic diseases, and cognitive function were collected. We employed a multivariate Logistic regression model to analyze the association between hypertension and its comorbidities and dementia in the total population and different age and sex groups.

Among the 14 732 older adults (≥65 years), 8 293 (56.3%) had two or more comorbidities, and 7 786 (52.9%) had hypertension along with other comorbidities. Of these hypertensive individuals, the numbers with 1, 2, 3, and 4 comorbidities were 2 569 (17.4%), 2 064 (14.0%), 1 018 (6.9%), and 443 (3.0%), respectively. Dementia was identified in 1 111 participants (7.5%). After adjusting for covariates, multivariate Logistic regression results showed that the risk of dementia in the hypertension-only group was 1.516 times (95%CI=1.014-2.267, P=0.042), and the risk of dementia among those with hypertension and 1 to 4 comorbidities was 1.879 times (95%CI=1.312-2.692, P=0.001), 2.071 times (95%CI=1.428-3.004, P<0.001), 2.338 times (95%CI=1.612-3.392, P<0.001), 2.591 times (95%CI=1.634-4.108, P<0.001). The highest risk of dementia was observed in individuals with hypertension coexisting with cerebrovascular disease (OR=2.550, 95%CI=1.384-4.700, P=0.003). In analyses stratified by sex and age, the risk of dementia increased significantly with the number of hypertension comorbidities (P<0.05). The strongest association was observed for hypertension coexisting with cerebrovascular disease, with adjusted odds ratios of 2.842 (95%CI=1.095-7.375, P=0.032) in men and 2.348 (95%CI=1.060-5.203, P=0.036) in women. In the group aged <75 years, the highest risk was observed for hypertension coexisting with diabetes (OR=2.833, 95%CI=1.046-7.675, P=0.041), while in the group aged≥75 years, the highest risk was observed for hypertension coexisting with cerebrovascular disease (OR=2.707, 95%CI=1.168-6.273, P=0.020). Among participants with hypertension and two comorbidities, the highest dementia risk was observed in those with coexisting heart disease and cerebrovascular disease (OR=3.559, 95%CI=1.338-9.468, P=0.011). Similarly, among those with hypertension and three comorbidities, the highest prevalence of dementia was observed in individuals with coexisting heart disease, cerebrovascular disease, and autonomic dysfunction (OR=3.881, 95%CI=1.736-8.677, P=0.001).

The prevalence of hypertension and its comorbidities is high among Chinese older adults. Patients with hypertension and its comorbidities have a significantly elevated risk of dementia, which varies by age and sex. These findings underscore the importance of optimized management of chronic diseases in this population. Implementing tailored prevention and treatment strategies based on individual characteristics could contribute to reducing the risk of dementia.

Against the background of population aging and the increasing burden of chronic diseases, the traditional model of "focusing on treatment but not prevention" can hardly cope with the challenges and there is an urgent need to build a comprehensive prevention and treatment system that integrates medicine and prevention. Although many policies have been issued at the national level to promote the integration of healthcare and prevention, primary healthcare organizations still face many difficulties in the process of implementation: firstly, there is a lack of systematic guidance on the implementation pathway; secondly, the practice models in different regions vary greatly, and there is a lack of common mechanisms for refining; thirdly, the existing research focuses on the level of the healthcare community, and there is insufficient research on the model of healthcare-preventive integration of the primary healthcare organization as an independent subject. Therefore, this study focuses on primary care institutions as the core carrier, and analyzes the mechanism through multiple cases, aiming at solving the common problem of "how to achieve effective integration" and proposing optimization countermeasures.

This study analyzes the key mechanisms for primary care institutions to realize the business model of integration of chronic disease care and prevention, and provides reference for local primary care institutions to explore the service model of integration of chronic disease care and prevention that meets the actual situation of the local area.

In November 2024, a literature review was conducted to systematically collect and summarize research studies on the integration of medical treatment and disease prevention. Subsequently, building upon the four-level, seven-condition framework of the Rainbow Model, a qualitative comparative analysis (QCA) was performed on 14 cases of chronic disease management initiatives implemented by primary healthcare institutions, aiming to identify the mechanisms underlying effective integration of treatment and prevention. Semi-structured interviews were then carried out to derive actionable recommendations for optimization.

A total of four configurational pathways can effectively improve the effect of chronic disease healthcare and prevention integration in the primary community, configurational pathway 1 meso-micro integration, configurational pathway 2 micro and support element level integration, configurational pathway 3 multilevel integration and configurational pathway 4 full-level integration, the combined coverage of the four configurational pathways is 0.857, which can explain the good healthcare and prevention integration effect in most cases, and the combined consistency is 1.000 can well explain the paths that produce good healthcare defense integration effects. Service integration and functional integration are the core foundations for achieving good health care and prevention integration effects, emphasizing the importance of continuous chronic disease health management and supervision and assessment mechanisms, respectively, while system integration highlights the key role of policy support. Differences in core conditions, integration levels and support elements among the different groupings suggest that the pathway for realizing healthcare-prevention integration can be flexibly adjusted according to different regional resources and policy conditions, and is not a single model.

In order to realize the sustainable and good development of chronic disease medical and preventive integration business in primary care institutions, it is necessary to strengthen policy support and system integration at the macro level, promote multilevel collaboration and resource sinking at the meso level, strengthen service integration and focus on team staff integration to ensure continuity of health management at the micro level, and set up an effective supervision and assessment mechanism and performance incentive mechanism in terms of the support elements.

Practice-based research networks (PBRN) enable collaborative primary care research. In China, since 2023, healthcare reforms emphasizing community-based primary care have spurred PBRN development. However, the research environment and incentives for primary care practitioners (PCPs) to belong to these networks remain under-explored.

This study investigates the research environment and support needed by PCPs in the Shanghai General Practice Research Network (SGPRN) to maximize PBRN development in China.

This study employed a mixed-methods explanatory sequential design. The quantitative component involved an online survey of 145 PCPs from the SGPRN, selected through purposive sampling, who expressed interest in research activities. The survey collected data on their background, research capabilities, research environment, and preferred incentives for participating in PBRN-organized research. Descriptive statistical analysis and the Kano Model were used to analyze and categorize the data. The qualitative component involved one focus group discussion and 21 semi-structured interviews with 24 PCPs from the survey sample, selected to validate and complement the quantitative findings. Interview data were analyzed iteratively using a qualitative descriptive approach. Quantitative and qualitative data were integrated through joint display and meta-synthesis.

Most PCPs (84.83%) reported a supportive research environment, with 68.97% integrating research with clinical practice. However, only 42.75% had sufficient research time, and 50.34% access to collaborators. Qualitative findings revealed limited professional support and fragmented time as key barriers. Incentives required included opportunities to acquire research skills, leading personally relevant studies, securing primary authorship, and accessing shared data, all contingent on transparent collaboration and trust. All these preferences aligned with institutional performance-driven policies.

The SGPRN research environment is currently neutral to slightly favorable, strongly driven by performance-oriented policies. PCPs participate in PBRN research primarily to enhance their research expertise and achieve publication-driven career advancement. Despite these motivations, China's PBRN need to draw on international strategies, enhancing research training, fostering collaborative platforms, and prioritizing practice-oriented, high-quality research to improve patient care, while aligning with local general practitioners' professional aspirations for advancing the discipline and clinical practice, to reconcile and overcome the limitations of output-focused, impractical research policies.

Emergency response capacity of primary healthcare institutions in epidemic prevention and control greatly practiced and improved during the prevention and control of COVID-19 epidemic, and in this context, the construction of a more targeted and practical emergency response capacity evaluation indicators system for major infectious diseases in primary medical institutions is necessary.

To construct an emergency response capacity evaluation indicators system for major infectious diseases in primary medical institutions in Beijing, based on the theory of emergency management and resilience.

From October to November in 2022, a preliminary emergency response capacity evaluation indicators system for major infectious diseases in primary medical institutions in Beijing, was constructed by literature analysis method, policy induction method, and focus group discussion method. From March to May in 2023, two rounds of correspondence were conducted using the modified delphi method, and the emergency response capacity evaluation indicators system for major infectious diseases in primary medical institutions in Beijing, was determined according to the results of modified Delphi method, and the weights of all of the evaluation indicators were determined by analytic hierarchy process.

The effective recovery rates of the questionnaires in the two rounds of modified Delphi method was 94.4% (17/18) and 100.0% (17/17), respectively, and the expert authority coefficient was 0.84. The coordination coefficients of the importance and operability of the indicators was 0.144 (P<0.05), 0.190 (P<0.05), respectively, in the first round of modified Delphi method; was 0.104 (P<0.05), 0.155 (P<0.05), respectively, in the second round of modified Delphi method. In the eventually formed emergency response capacity evaluation indicators system for major infectious diseases in primary medical institutions in Beijing, there were 3 first-level indicators (preparedness capacity, disposal capacity, and assessment and recovery capacity), 18 second-level indicators, and 56 third-level indicators, and the weight of the 3 first-level indicator was 0.528, 0.333 and 0.140, respectively.

Based on the theoretical framework of emergency management and the concept of resilience, we constructed the emergency response capacity evaluation indicators system for major infectious diseases in primary medical institutions in Beijing, in which the indicators can be dynamically adjusted according to the actual situation, so as to more truly reflect the emergency response capacity for major infectious diseases, and to provide a reference for the evaluation of emergency response capacity for major infectious diseases in primary healthcare institutions.

After years of practice, the service of general practitioners (GP) has achieved certain results in the health management of key groups such as the elderly, pregnant women, children, and patients with chronic disease. However, the services of "functional community" groups represented by young and middle-aged working people still needs to be improved.

Based on the role theory, this study conducts a qualitative research on the role expectations of GP in functional communities from the perspectives of GP and residents. The aim is to enhance the role image and function of GP and better meet the service demand.

From September to November 2023, a semi-structured interview was conducted among 8 GPs and 16 residents of 4 community health service centers in Jiading District, Shanghai, with the method of snowball sampling combined, and a directional content analysis was conducted on the interview results.

Taking the four important contents of "quality expectation, image expectation, obligation expectation and behavior expectation" in the role expectation theory as the theme, it extracts the 14 sub-themes of clinical ability, work quality, culture, science and education, medical ethics, communication efficiency, work spirit, emotional expectation, treatment service, consultation service, consultation coordination, cost control obligation, service effectiveness, service accessibility and service standardization. It is found that both parties have the same expectation on medical ethics, good communication, life-saving, effective service and standard service, but have different expectations on cost control obligations, and other expectations are different.

The expectation of consistency between the supply and demand sides stems from the traditional ideal image of general practitioners, and the expectation of difference between the supply and demand sides stems from the misperception of the role and function of family doctors on both sides. The strategy to solve the contradiction between the misperception of family doctors in functional communities and the actual service of family doctors in reality is proposed.

With the intensification of population aging, bone health diseases (e.g., osteoporosis, osteoarthritis, scoliosis) have become a major public health challenge in China. Traditional healthcare models, centered on acute-phase diagnosis and treatment, suffer from shortcomings such as overemphasis on treatment over prevention, fragmented services, and inadequate continuity of rehabilitation, leading to low early screening rates, poor patient compliance, and high recurrence risks. This study analyzes the core characteristics and management bottlenecks of bone health diseases. Drawing on international chronic disease management frameworks and domestic practical experience, and leveraging the resource integration advantages of family doctor contracted services, we innovatively constructed a "smart hierarchical early warning-multidisciplinary collaborative intervention-integrated medical and preventive care" model for full-cycle closed-loop management of bone health, aiming to address systemic challenges in bone health management. The innovation of this study lies in enhancing management efficiency through intelligent tools, optimizing resource allocation via multidisciplinary collaboration, and strengthening the sustainability of healthcare services through policy reforms, thereby providing a systematic paradigm for grassroots bone health management.

Sarcopenia is an age-related geriatric syndrome characterized by decreased muscle mass, reduced muscle strength, and/or impaired physical function. It is closely associated with adverse health outcomes such as frailty, falls, fractures, disability, and even death. In community-dwelling populations, sarcopenia often presents in early or subclinical stages, making it easy to overlook and resulting in missed opportunities for timely intervention. Standardized screening for sarcopenia among older adults in the community is of great significance for early detection, targeted intervention, delaying functional decline, preventing and mitigating disability, reducing healthcare costs, and responding to the challenges of an aging society. However, there is currently a lack of evidence-based expert consensus on community-based sarcopenia screening for older adults in China. To bridge the gap, the China Rehabilitation Science Institute, Community-Based Rehabilitation Committee of the China Association of Rehabilitation of Disabled Persons, Geriatric Rehabilitation Committee of Chinese Association of Geriatric Research, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) /Southern Medical University and the Guangzhou Association of Rehabilitation Medicine led the development of this consensus. Using the Delphi method to form a list of key questions and recommendations, the GRADE system to assess the quality of evidence and strength of recommendations, and the RIGHT checklist to standardize reporting, a total of 14 evidence-based recommendations were established. This expert consensus on community-based sarcopenia screening in older adults provides a scientific and feasible screening pathway, supports the construction of an early detection, early identification, and early intervention system for sarcopenia prevention and control in the community, and ultimately aims to improve the health and quality of life of the older population.

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.

Hypertension is a major chronic disease managed by primary healthcare institutions in China. Cardiac autonomic dysfunction is a key cause of blood pressure regulation imbalance and adverse cardiovascular events. Therefore, in primary healthcare institutions, the use of efficient and portable single lead wearable electrocardiogram (ECG) devices can help explore the relationship between elderly hypertensive patients and the autonomic nervous system, providing a simple, efficient, low-cost, and sustainable suitable method and objective basis for the management and prevention of cardiovascular disease in primary hypertensive patients.

To investigate the correlation between the duration of hypertension and autonomic nervous system damage in elderly patients in Primary Care institutions in the Ningxia Hui Autonomous Region using a single lead wearable ECG device.

A total of 2 137 elderly hypertension patients aged 65 years or older from 20 primary medical institutions in the Ningxia Hui Autonomous Region were enrolled in this study. ECG data of 72 hours, along with basic information, psychological health, and lifestyle data, were collected and uploaded to the cloud platform using a single-lead wearable ECG device from January 2022 to December 2022. Based on the heart rate variability (HRV) time-domain parameter standard deviation of all sinus rhythm RR intervals (SDNN), subjects were divided into two groups: a normal group (SDNN>100ms, n=470) and an abnormal group (SDNN<100 ms, n=1 667). Propensity score was used to match subjects on a 1∶1 basis, adjusting for confounding factors with a caliper value of 0.02, and the matching effect was verified using inverse probability weighting. Single-factor and multivariate Logistic regression analyses were conducted to investigate the relationship between the onset of hypertension and autonomic nerve damage, and the matching effect was further verified. Subgroup analyses were performed using propensity score matching based on the onset of hypertension and autonomic nerve damage, with sensitivity analyses conducted before and after matching. Additionally, a nonlinear association between the duration of hypertension and autonomic nerve damage was examined using restricted cubic splines (RCS) analysis to test interaction effects.

Among the patients, 479 had grade 1 hypertension, and 1 658 had grade 2 hypertension. Disease duration was categorized as follows: 1 203 patients had less than 5 years of disease duration, 753 had 5-<10 years, 110 had 10-<15 years, 41 had 15-<20 years, 26 had 20-<30 years, and 4 had more than 30 years. The multivariate Logistic regression analysis showed that the relationship between autonomic nerve damage and hypertension duration was positive after matching (P<0.001). Subgroup analysis showed that the relationship between hypertension duration and autonomic nerve damage was stronger in the 80-year-old and younger, lower-educated, no comorbidities of coronary heart disease, female, and those with obstructive sleep apnea (OSA) subgroups before and after matching, with statistically significant differences (P<0.05) and interaction effects (P<0.05). However, the RCS analysis showed no nonlinear relationship between the course of hypertension and autonomic nerve damage in matched patients.

There was a positive correlation between the course of hypertension and autonomic nerve damage in elderly hypertension patients from the primary healthcare centers of the Ningxia Hui Autonomous Region. Primary healthcare facilities should strengthen health education for patients to improve their treatment adherence, which can delay autonomic nerve damage in hypertensive patients.

Constipation is a common complication in cancer patients, with an incidence rate ranging from 30% to 90%. It is particularly prevalent among those using opioids and patients with advanced cancer. Currently, standardized screening and assessment systems for constipation in community-dwelling cancer patients are lacking. Unmanaged constipation may lead to severe complications such as bowel obstruction and malnutrition, significantly impacting patients' quality of life. Chinese Expert Consensus on Constipation Screening and Assessment for Community Cancer Patients (2025 Edition) developed by the Community Rehabilitation Working Committee of Chinese Rehabilitation Medicine Association with a multidisciplinary expert panel, addresses 8 core issues: definition of constipation, risk factors, screening/assessment tools, management for special populations, and referral indications. Based on relevant literature, 12 recommendations are proposed. The consensus aims to establish evidence-based standardized assessment tools, integrate risk evaluation, self-monitoring, and referral strategies, and guide community healthcare providers in early identification of high-risk patients while optimizing screening and assessment protocols.

Community health service institutions are the bottom of the infectious disease prevention and control system, and it's crucial to the control of urban epidemic situations. After the COVID-19, the prevention and control capacity of community health service institutions in Beijing has been improved, but there is a lack of evaluation, and the direction of future improvement is not clear.

To evaluate the changes in the infectious disease prevention and control capacity of community health service institutions in Beijing during the COVID-19 period, analyze the influencing factors, and put forward suggestions for improvement measures, so as to provide a scientific basis for further enhancing the prevention and control capacity of infectious diseases at the grass-roots level.

From 2019 to 2022, questionnaires were conducted on 334, 354, 405 and 405 community health service centers and independent community health service stations willing to cooperate with the survey in Beijing. The quantitative scoring method was used to measure the comprehensive capacity of infectious disease prevention and control of various institutions from the sentinel setting (20 points), pathogen detection of common infectious diseases (30 points), and the emergency capacity of responding to infectious diseases and public health emergencies (50 points). Linear mixed model is used to compare the changes in the prevention and control capacity of various institutions from 2019 to 2022, and the factors affecting the improvement of the prevention and control capacity of infectious diseases are analyzed.

The median scores of comprehensive capacity for infectious disease prevention and control in 2019-2022 were 50 (43, 60), 63 (43, 70), 70 (50, 80) and 70 (50, 80), respectively. The differences between each year were statistically significant (P<0.05) .Linear mixed model showed that, organization category, whether to set up preventive health care department, whether to have P2 laboratory, the actual number of employees have an impact on the comprehensive ability of infectious disease prevention and control (P<0.05). The comprehensive capacity of infectious disease prevention and control in community health service centers was 18.94 (95%CI=15.73-22.15, P<0.05) higher than that of independent community health service stations, and the comprehensive capacity of the prevention and health care department was 6.50 (95%CI=4.00-9.01, P<0.05) higher than those without, the institution of infectious disease prevention and control with P2 laboratories was 2.59 (95%CI=0.62-4.55, P<0.05) higher than those without, and the capacity for infectious disease prevention and control of institutions with a larger number of on-the-job staff was increased by 0.05 (95%CI=0.03-0.07, P<0.05) .

During the period of COVID-19 disease, the prevention and control capacity of the community health service institutions in Beijing has been improved year by year, mainly influenced by factors such as the type of institutions, the setting of prevention and health care departments, the setting of P2 laboratories and the actual number of people on duty. It is suggested to invest continuously, rationally allocate resources, strengthen personnel training, and establish a sound working mechanism.

The prevalence of multimorbidity is high among disabled persons, and the problem of their treatment burden is particularly severe. However, the treatment burden for disabled persons with multimorbidity in the community and its influencing factors have not been well studied.

This study aimed to elucidate the current situation and factors influencing the treatment burden of multimorbidity among disabled persons living in the community. The findings were intended to inform the formulation of policies for managing community-based multimorbidity and to enhance the quality of healthcare services.

This study was conducted in a community in Hangzhou from November 2023 to January 2024, a random sampling method was employed to select disabled individuals with chronic comorbidities participating in community rehabilitation programmes within a specific neighbourhood as survey subjects. Relevant information about disabled persons was collected through home visits using tools such as the General Information Questionnaire, Objective and Subjective Social Isolation Scale, Center for Epidemiologic Studies Depression Scale (CES-D) , European Quality of Life Five Dimension Five Level Scale Questionnaire (EQ-5D-5L) , and Multimorbidity Treatment Burden Questionnaire (MTBQ) . The analysis of the collected data was performed using both descriptive statistics and ordinal logistic regression to delineate the current status of treatment burden and to identify its significant influencing factors.

A total of 235 disabled persons were surveyed, with 220 valid questionnaires recovered, yielding a response rate of 93.6%. The mean age of the disabled persons was (71.1±10.2) years, with a roughly equal gender distribution, including 109 females (49.5%) . Six types of disabilities were included, among which physical disability accounted for the largest proportion (164 cases, 74.5%) ; grade 3 disability was the most common (100 cases, 45.5%) . Sixty-eight cases (30.9%) were in the abnormal BMI range group, and 120 cases (54.5%) took ≥3 types of medications. Regarding the MWI, 83 cases (37.7%) scored over 3-6 points (excluding 3 points) , and 78 cases (35.5%) scored >6 points. A total of 41 types of chronic diseases were included, with hypertension having the highest prevalence (118 cases, 53.6%) . The median Barthel Index of disabled persons was 75 (55, 90) , with 76.3% of disabled persons experiencing moderate to severe disability. The mean score of depressive symptoms was (15.8±8.8) , and 53.1% had depressive tendencies or depression. Seventy-two cases (32.7%) had objective social isolation (score of 3-5 points) , and 100 cases (45.5%) had subjective social isolation (score of 19-27 points) . The median health utility value for quality of life was 0.48 (0.23, 0.74) , and 125 cases (56.8%) had self-rated health status≤50 points. Seventy-five cases (34.1%) had moderate multimorbidity treatment burden (10-<22 points) , and 93 cases (42.3%) had high multimorbidity treatment burden (≥22 points) . Ordinal Logistic regression analysis showed that Barthel index (OR=0.957, 95%CI=0.936-0.978) , taking 3 types of medications (OR=2.517, 95%CI=1.454-4.362) , higher MWI (>3-6 points: OR=3.908, 95%CI=1.931-7.909; >6 points: OR=2.954, 95%CI=1.468-5.948) , subjective social isolation≥20 points (OR=1.906, 95%CI=1.112-3.271) , objective social isolation 3-5 points (OR=1.863, 95%CI=1.009-3.435) , presence of depressive symptoms (OR=4.711, 95%CI=2.625-8.457) , and self-rated health status ≤50 points (OR=4.609, 95%CI=2.524-8.423) were influencing factors for the severity of multimorbidity treatment burden of chronic diseases in disabled persons (P<0.05) .

The majority of disabled persons within this community bear a high level of treatment burden due to multimorbidity. Policies catering to the management of chronic illnesses and the provision of healthcare services for this demographic ought to take into account the factors influencing treatment burden. Particularly, there is a need for improvement in daily living capabilities and mental health status, along with addressing polypharmacy and social isolation issues.

In primary healthcare institutions, due to insufficient staffing of radiologists, it is impossible to ensure that they are on duty 24/7, and general practitioners have limited interpretation ability of chest images, which affects the quality and efficiency of medical services.

To explore the application effect of artificial intelligence assisted diagnosis system for chest diseases in primary healthcare institutions, with a focus on evaluating its role in improving the diagnostic efficiency, accuracy, and patient satisfaction of general practitioners.

During the vacation period of radiologists in April 2024, 16 general practitioners from Donghua Community Center were selected as the research subjects. They were randomly divided into a general practitioner+AI group of 8 and a control group of 8. At the same time, a total of 100 respiratory system disease patients who required X-ray imaging examination were included in the two groups of doctors, with 50 patients in each group. The general practice+AI group uses the assisted diagnosis system for chest diseases (ADSC) to identify X-ray images and assist general practitioners in making disease diagnoses. The control group receives diagnosis and treatment according to routine procedures, records the time spent by the two groups of doctors for comparison, and uploads the X-ray images of the two groups of patients to the regional imaging center for review and evaluation of the diagnostic accuracy of the two groups of doctors; Conduct a satisfaction survey on patients and evaluate the ADSC usage experience of two groups of doctors.

The gender, age, education, and professional title of the two groups of doctors were compared, and there was no statistically significant difference (P>0.05) . The gender and age of the two groups of patients were compared, and the difference was not statistically significant (P>0.05) . The time required for diagnosis in the general practice+AI group was significantly shorter than that in the control group [ (92.47 ± 24.52) s vs (249.31 ± 56.46) s, P<0.001], and the diagnostic accuracy was higher than that in the control group (96% vs 72%, P=0.002 7) . The satisfaction of patients in the general practice+AI group was significantly higher than that in the control group (98% vs 84%, P=0.036) . In terms of user experience evaluation of ADSC, ≥80% of general practitioners believed that it was meaningful in terms of convenience (81.25%) , diagnostic decision-making (93.75%) , professional knowledge assistance (87.50%) , and application feasibility (87.50%) . 93.75% of general practitioners were satisfied with the use of the system and willing to continue using it.

The artificial intelligence assisted diagnosis system for chest diseases has significantly improved the diagnostic efficiency, accuracy, and patient satisfaction of general practitioners in primary healthcare institutions, and most doctors hold a positive attitude towards the use of ADSC.

Obesity-related hypertension (ORH) , as a long-term persistent chronic disease, is growing in prevalence in China. Exercise is an important means of prevention and treatment for ORH, but due to the limitations of space, distance and cost in exercise rehabilitation, exercise completion and compliance are mostly difficult to ensure, and the health benefits of exercise are greatly reduced. Therefore, it is important to explore appropriate exercise prescription and management models.

To evaluate the clinical efficacy and safety of five-body balance exercise based on the "hospital-gym-community" model for patients with ORH.

This was a prospective randomised controlled study. 84 ORH patients recruited at Guang'anmen Hospital, China Academy of Traditional Chinese Medicine from June 2022 to December 2023 were selected and randomly divided into the experimental group (n=42) and the control group (n=42) by using the SPSS 26.0 online random number generator. Subjects in both groups received the same lifestyle intervention. The control group was provided with moderate-intensity aerobic exercise, and the experimental group was provided with the five-body balance exercise training based on the "hospital-gym-community" rehabilitation model for a period of 6 months. Systolic blood pressure (SBP) , diastolic blood pressure (DBP) , mean arterial pressure (MAP) , waist circumference (WC) , body weight (BW) , BMI, hip circumference (HC) , waist-to-hip ratio (WHR) , waist-to-height ratio (WHtR) , fasting blood glucose (GLU) , total cholesterol (TC) , low-density lipoprotein cholesterol (LDL-C) , very low-density lipoprotein cholesterol (VLDL-C) , triglycerides (TG) , serum ceramides (Cer) , Self-rating Anxiety Scale (SAS) , Self-rating Depression Scale (SDS) , Short-form Health Survey-36 (SF-36) , and Pittsburgh Sleep Quality Index (PSQI) were observed before and after the intervention in the two groups of subjects. The major adverse cardiovascular events (MACE) and exercise injuries that occurred during the intervention were also recorded.

Eventually 37 subjects in the experimental group and 36 subjects in the control group completed the trial. After 6 months of rehabilitation, SBP, DBP, MAP, WC, BW, BMI, HC, WHR, WHtR, LDL-C, Cer, SAS, SDS, and PSQI in the experimental group were lower than those in the control group (P<0.05) , SF-36 was higher than that in the control group (P<0.05) , and there was no statistically significant difference between GLU, TC, VLDL-C, TG in the experimental group and the control group (P>0.05) . After intervention, SBP, DBP, MAP, WC, BW, BMI, HC, WHR, WHtR, GLU, LDL-C, VLDL-C, TG, Cer, SAS, SDS, and PSQI were lower than before the intervention in the experimental group (P<0.05) , SF-36 was higher compared to the pre-intervention in the experimental group (P<0.05) , and the difference in TC before and after the intervention was not statistically significant (P>0.05) . There were no MACE or exercise injuries in both groups.

The five-body balance exercise based on the "hospital-gym-community" rehabilitation model can promote the blood pressure and morphological indexes of patients with ORH, improve the quality of life, and its efficacy is better than the conventional aerobic exercise, with good safety. It also reduces serum Cer levels, reflecting to some extent the potentially beneficial effects of the exercise programme in reducing cardiovascular risk.

In January 2022, Longhua District, Shenzhen piloted a digitally enabled generalist and specialist collaborative care model to deliver consistent, continues services for patients with chronic conditions managed in community health centers. This system-level initiative integrated hospital-based specialists and community-based general practitioners through a vertically aligned care model supported by a shared digital platform.

To evaluate the effect of this digitally enabled generalist-specialist collaborative care model on hypertension management capacity at community health centers.

We employed a difference-in-difference approach to examine changes in center level outcomes before and after the model was implemented during 2021-2024. The treatment group included 84 health centers in Longhua District, and the comparison group included 448 health centers in the rest of districts that were not influenced by the policy. Health centers in treatment group used the collaborative care model to delivery follow-up services, whereas health centers in comparison groups continued to provide routine services in accordance to the National Basic Public Health Services Program Standards (Third Edition) . Multivariate linear regression with district and time fixed effects was constructed, controlling for health center characteristics and adjusting for inverse probability of treatment weights, with standard errors clustered at the center level. Robustness checks were conducted to evaluate the reliability and stability of the model.

After the implementation of the digitally enabled collaborative care model, compared to centers in comparison groups, on average, quarterly standardized hypertension management rate and hypertension control rate in the treatment group increased by 4.3-percentage-point (DID=0.043, SE=0.011, P<0.001) and 11.5-percentage-point increase (DID=0.115, SE=0.012, P<0.001) per center, respectively. On average, the quarterly number of upward referrals per center decreased by 17.1% (P=0.038) , and the quarterly number of total patient visits per centers increased by 22.1% in treatment group (P=0.003) , as compared to comparison groups.

Our study highlights the significance of the digitally enabled specialist and generalist collaborative care model in enhancing health center capacity in hypertension management, reducing upward referrals, and optimizing resource utilization. Our study underscores the importance of incorporating this initiative into national health strategies, such as the National Basic Public Health Services Program, to strengthen chronic care management services delivery in more areas of China. Future policies and research should focus on scaling up this approach to a broader range of medical conditions and prioritizing investments in health centers by ensuring stable funding streams and optimizing the implementation strategies for digital integration pathway.

The advancement of high-quality national basic public health services continues to faces critical challenges, including insufficient quality resources in primary care and limited diagnostic and treatment capabilities. Since January 2022, Longhua District, Shenzhen initiated a pilot of the digitally enabled generalist-specialist collaborative care, aiming to enhance the capacity of primary healthcare service in managing hypertension and diabetes. This initiative leveraged the national basic public health services platform and the integration of medicine and prevention. Through policy guidance, system development, and digital support, the model sought to facilitate the efficient distribution and utilization of quality medical resources. This study presented the practical experiences of implementing the model from three key dimensions: policy mechanisms, practical measures, and early achievement. The preliminary practical achievements included: (1) Patient monitoring and enrollment: from 2022 to 2024, the proportion of hypertensive patients enrolled due to two consecutive instances of poor blood pressure control within six months was 35.3%, 37.5%, and 36.2%, respectively; the proportion of diabetic patients enrolled due to two consecutive instances of poor blood glucose control within six months was 55.5%, 64.0%, and 47.5%, respectively. (2) Specialist consultation: the timely consultation rates for hypertension and diabetes increased by 46.3% and 53.9%, respectively, in 2024, as compared to 2022, following the inclusion of the timely consultation rate in the performance evaluation of the medical consortium at the end of 2023. (3) Implementation by general practitioners: from 2022 to 2024, the timely implementation rate for hypertension increased from 73.7% to 84.3%, and for diabetes, from 73.9% to 80.8%. (4) Outcomes of patients managed by general practitioners and specialists: the average control rates during 2022 and 2024 for enrolled patients with hypertension and diabetes were 57.1% and 50.9%, respectively. The pilot experiences indicated that the digitally enabled generalist-specialist collaborative care effectively improved the management capacity of hypertensive and diabetic patients in primary care settings, contributing to better patient outcomes. At this critical juncture in advancing the high-quality development of national basic public health services, it was essential to establish implementation standards, strengthen supporting policy mechanisms and implementation strategies, and optimize the assessment and evaluation framework for basic public health services. These steps were vital to ensuring the successful nationwide adoption of this innovative policy model.