Special Issue：Family Medicine and Community Health Research
本文对《欧洲全科医学/家庭医学和基本医疗保健科研纲要》的中文译稿进行了重点摘登。该文件由欧洲全科医学科研网络制订，包括7部分内容：序言、导言、方法、结果、独立章节，讨论和启示。作为在欧洲发展全科医学科研的核心指南，该文件对欧洲的全科医学学科和科研发展产生了深远的影响。欧洲的全科医学体系和以此为基础而构建的学科理论共识与我国全科医学当前的实际情况可能更为接近。因篇幅所限，本文刊登了其中最重要，对中国研究者也最实用的5部分内容，包括：（1）导言——全科医学的核心能力/特征以及全科医学科研的意义；（2）结果——全科医学的6个核心领域（基本保健管理、"以人为本"的照护、解决具体问题的技能、综合的方法、以社区为导向、整体的方法）的科研范畴，研究需求和适用方法；（3）独立章节——如何发展基本的科研能力和避免常见的科研失误；（4）讨论——未来的全科医学科研重点；（5）启示——科学协会、研究机构、患者参与、科研工作、期刊、科研政策在发展学科方面应注重的问题。因欧洲的全科医学体制和我国较为相似，且存在一定的科研发展代差，该文件在当前阶段也可为我国全科医学研究者所用，基于全科医学学科的视角，从概念、分类学、范围和科研方法等方面，为我国全科医学科研的发展提供参照。
Shared decision-making is a practice that fully reflects the idea of patient-centered care, but its clinical implementation process is not ideal. Physicians are main participants to promote the implementation of shared decision-making, but there are few studies on their behaviors in shared decision-making.
To explore the process and main behavioral characteristics of physicians' participation in shared decision-making, offering evidence for the promotion and implementation of shared decision-making in clinical practice.
A mixed-methods convergent design was used to collect quantitative and qualitative data. In the quantitative study, convenience sampling method was used to select in-service physicians (n=360) from a grade A tertiary hospital in Shanghai to attend a questionnaire survey from May to December 2020 to understand the status of their participation in shared decision-making. K-means clustering was conducted to analyze the distribution characteristics of physicians' participation in shared decision-making. In the qualitative study, 23 physicians selected from the participants of the quantitative study using convenience sampling and purposive sampling from June to December 2020 were recruited to attend semi-structured interviews to explore the process and experience of their participation in shared decision-making and identify the main behavioral characteristics of them in each part of the process of shared decision-making.
Quantitative data analysis: in all, 325 (90.3%) of the physicians who returned responsive questionaries were included for analysis. The average total score of their participation behavior in shared decision-making was (80.44±14.88) . The further analysis found that physicians had the highest participation in behaviors of "Explain the advantages and disadvantages of the treatment options to my patient" (4.38±0.74) and "I told my patient that there are different options for treating his/her medical condition" (4.30±0.84) ; physicians had the lowest participation in behaviors of "I made clear to my patient that a shared decision needs to be made" (3.72±1.22) and "My patient and I selected a treatment option together" (3.74±1.03) . The results of cluster analysis showed that the behavioral characteristics of physicians' participation in shared decision-making could be divided into three groups, namely informed consent group, partial patient participation group and shared decision-making group. Qualitative data analysis: physicians' participation behaviors in shared decision-making included building up the awareness of shared decision-making, providing the patient with information, examining patient comprehension of the information, clarifying patient values, co-assessment (of the feasibility of the options) , reaching a decision and decision implementation. Analysis of the mixed-methods research results showed that in the decision-making process, physicians paid more attention to the provision of information, and ignored the behavioral factors of promoting patient participation at the level of doctor-patient communication. The behavioral characteristics of physicians' participation in shared decision-making were different.
The physicians' participation behavior in shared decision-making was limited. And they may have misunderstandings about the behavior process of shared decision-making. To promote the practical implementation of shared decision-making in clinical practice, it is suggested to help physicians clarify the process of shared decision-making via interventions enhancing their knowledge and attitudes regarding shared decision-making, deepen their understanding of shared decision-making through scenario simulation and role-playing, and improve their recognition of patient values in decision-making.
General practice research focuses on a range of topics, such as patients' physical health and mental health, physicians' competencies and career motivation, quality of healthcare and physician-patient relationships and cooperation. However, these are not resolved well only using quantitative research which is still dominated in the field of general practice. In this case, qualitative method is often required, although it is considered to be subjective, and is mainly used to describe a phenomenon that is little known in a small sample. Mixed methods research, which incorporates qualitative and quantitative research and combines the advantages of both, can analyze specific problems more extensively and intensively, is suitable for studying complex problems, and for general practice research as an approach integrating clinical medicine and sociology. However, mixed methods research in general practice is still in its early phase in China, and the standardization of its design and implementation needs to be improved. For better elaborating the key points in the design and implementation of mixed methods research, we detailed a study using mixed methods, providing a reference for general practitioners to carry out mixed methods research.
With the deepening of health care reform in China, primary care and general practice researches have developed rapidly in recent years, and the number of papers published has increased rapidly.
Summarize and analyze the scientific research papers published in the field of primary care and general practice in China in 2021, explore the characteristics in the number of papers published, journals published, regions, institutions, research categories, research methods, and the number of authors.
Based on the disciplinary definition of the research concepts, themes and methods in this field, combining scoping review methods and bibliometric techniques, scientific research papers published by researchers in Chinese scientific research institutions in 2021 included in the CNKI, Wanfang, PubMed, and Web of Science database were retried, induced and analyzed. In this paper, combined with the scope review method and bibliometric technology, a systematic search and quantitative analysis were carried out on scientific research papers in the fields of primary care and general practice published by researchers in Chinese scientific research institutions in 2021 included in the CNKI, Wanfang, PubMed, and Web of Science databases.
There are 3 122 original research papers published in the fields of primary care and general practice in China in 2021. The number of papers published by primary care institutions accounted for 57.69%, but most of the papers were completed by a single authoramong such institutions. Papers published by the eastern primary care institutions accounted for 80.12%. The research category is dominated by clinical research (58.23%) and health services researches (27.07%) , the co-occurrence analysis of keywords by VOSviewer shows that the research themes focus on "chronic disease management" and "contracted family doctor services", these papers mostly used randomized controlled trials (40.87%) and cross-sectional survey studies (36.71%) in research methods. The vast majority of papers in primary care and general practice field are published in non-core and non-SCI/SSCI journals (76.75%) , and only 6.98% of papers are published in SCI/SSCI journals.
The productivity level of primary care and general practice research in China has now reached the highest level in the world, of which the primary care institutions in the eastern region have made major contributions. The research topics in the primary care and general practice field are close to institutional practice and national health policy. However, there are still a series of problems and challenges in this field, such as the lack of cooperation among researchers in primary care institutions, the large number of studies using randomized controlled trial methods may have problems such as quality concerns and low recognition of research in this field in China by international SCI/SSCI journals.
As a simple, rapid and effective research method, test-negative design (TND) has been widely used to support the evaluation of post-marketing effectiveness of vaccines and efficacies of interventions in healthcare institutions, showing a magnificent prospect of application. With the emergence of new derivative types such as real-time TND and cluster-randomized TND, TND has also been gradually applied to the exploration of disease risk factors and effectiveness evaluation of interventions. However, there are still few related research reports in China. We introduced the basic principles, methods and essentials of implementation, newly derivative types such as real-time TND and cluster-randomized TND, advantages and limitations of TND, as well as its applications in assessing post-marketing effectiveness for vaccines and efficacies of interventions, providing a theoretical and practical basis for researchers in China to carry out relevant research.
Special Issue：Family Medicine and Community Health Research
