Family physician-contracted service is an important way to change the mode of primary health care, and it is also the key and breakthrough to realize tiered diagnosis and treatment. How to strengthen the construction of family physician team and thus improve job satisfaction has become an urgent problem.

To explore the relationship between the network structural characteristics within family physician team and job satisfaction at the team level, and to provide a reference for strengthening the construction of family physician team.

From October 2021 to December 2023, we combined convenience sampling and cluster sampling to conduct field research on family physician teams in Qianjiang, Hubei, Changsha, Hunan and Nanyang, Henan. The Family Physician Team Members' Basic Information Questionnaire, the Family Physician Team Interaction Network Questionnaire and the Family Physician Team Job Satisfaction Scale were used to collect data. We used hierarchical linear regression analysis to verify the impact of the network density and centralization within family physician team on job satisfaction.

The transition processes of family physician team showed obvious network structure characteristics of low density (0.29±0.11) and high centralization (0.88±0.19). The average job satisfaction score of family physician team was (20.30±2.42), which was moderately high. The results of the hierarchical linear regression analysis showed that the centralization of transition processes positively affected job satisfaction (β=0.576, t=7.091, P<0.001) ; the density of transition processes positively affected job satisfaction (β=0.228, t=2.478, P<0.05) ; the density of action processes positively affected job satisfaction (β=0.324, t=2.624, P<0.05) ; the density of interpersonal processes positively affected job satisfaction (β=0.368, t=3.549, P<0.001) .

There is room for optimizing the network structural characteristics within family physician team in Central China. The network density and centralization of family physician teams have positive effects on job satisfaction. It is recommended to improve the internal collaboration mechanism and optimize the centralized network structure within family physician team.

As the aging of the population intensifies and the burden of non-communicable diseases continues to rise, traditional health service models have become insufficient to meet people's health needs. Therefore, promoting the integration of medical and preventive care has become crucial for improving residents' health levels. Family doctor teams, as the main implementers of these integrated care, play a pivotal role. However, the current lack of effective multidisciplinary collaboration among family doctor teams has severely hindered the effective implementation and provision of integrated medical and preventive care.

To investigate the teamwork of family doctors in the integration of medical and preventive care in Shandong Province, explore its influencing factors, so as to provide a reference for further improving the contract service of family doctors and the integration of medical and preventive care.

In August 2023, a multi-stage stratified random sampling method was employed, selecting Yantai City, Weifang City, and Liaocheng City from the eastern, central, and western regions of Shandong Province, taking into account geographical location and economic development levels. Within each city, one district and one county city were randomly selected as sample areas, resulting in a survey of 481 family doctors. Based on extensive searches of relevant domestic and international literature and consultations with experts, a specialized questionnaire for primary care doctors was designed for the survey. This questionnaire encompassed three key sections: a general information survey, an assessment of the provision of integrated medical and preventive care services, and an evaluation of the collaboration levels among family doctor teams within these services. Questionnaires were used to investigate the implementation of integrated medical and preventive care and the collaboration among family doctors within these services. Binary Logistic regression analysis was employed to examine the factors influencing the collaboration among family doctors in integrated medical and preventive care.

76.1% (366/481) of family doctors exhibited a high level of teamwork in the integration of medical and preventive care. The results showed that family doctors with bachelor's degree or above (OR=2.343), professional titles of primary (OR=1.887) and intermediate and above (OR=2.978), understanding of the integration of medical and prevention system (OR=6.618), believe that the institution attaching importance to integration of medical and preventive care (OR=2.861), and participating in one (OR=2.561) and two or more trainings within half a year (OR=3.833) had a higher level of teamwork in integration of medical and preventive care (P<0.05) .

At this stage, there is still a lot of room for improvement in the teamwork level of family doctors in the integration of medical and preventive care. It is necessary to continue to improve the awareness of family doctors on the integration of medical and preventive care, improve the system of providing institutional medical and prevention integration services, provide reasonable economic subsidies and policy incentives for family doctors, strengthen training, and further improve the level of teamwork of family doctors.

The integration of medical care and prevention is an important measure for the implementation of the Healthy China Strategy. Family doctor teams as the mainstay and chronic disease management as the entry point are important tools for the implementation of the medical and preventive integration in primary health institutions.

To understand the current situation and obstacles of the integration of medicine and prevention in chronic disease management in Beijing urban areas, so as to provide a basis for decision-making on sustainable development of the medical and preventive integration services.

From December 2023 to February 2024, the purposive sampling was used to invite 20 participants, including the members of the family doctor teams and primary care managers working on the the medical and preventive integration and the chronic disease management in 12 primary health institutions in the urban area of Beijing, to conducted semi-structured interviews focus on the content, division of labour, resource allocation, and existing problems of above services. Thematic analysis was used to analyse and generalise the interview data.

Although the primary health institutions had explored a variety of service modalities to promote the implementation of the integration of medical care and prevention. The qualitative research showed that the main body of the current service was still the general practitioner and the community nurse, and continued the kernel of the chronic disease management service, with the content of the service yet to be innovated, and the service process of pre-consultation, consultation, and post-consultation yet to be promoted. In terms of the operating environment, there were insufficient members of the family medicine team, heavy workload, emphasis on "quantity" rather than "quality" in assessment and evaluation, "information silos", lack of top-level design, and lack of a special funding mechanism. The phenomenon of "medical and prevention fragmentation" is obvious, with the existence of "two lines" of the management systems, "two disconnections" between the main bodies, and regional dispersion of work areas of the medical and preventive integration.

Due to insufficient resources allocation and optimisation of the operation mode, it's necessary to strengthen talent training, reinforce medical insurance support, accelerate information sharing within the region, improve assessment and evaluation mechanisms, as well as strengthen the top-level design, clarify the service pathway, implement community functions, and form a replicable and scalable integrated service model with the participation of the government, community, hospitals and patients.

The leader of family physician team plays an important role in performing the contracted service functions and is a key player in influencing the task interaction of the members within the team.

To identify the mechanisms of the impact of leadership effectiveness on task interaction in family physician teams, and examine the mediating role of team cohesion in the relationship between the two and the moderating role of team support.

From October to December 2021, 593 family physician team members from 12 township health centers/community health service centers in Qianjiang City, Hubei Province, and Changsha City, Hunan Province, were sampled by random sampling and cluster sampling methods to conduct a questionnaire survey, which covered the basic information of the members, leadership effectiveness, task interaction, team cohesion, and team support. PROCESS was used to test the mediating effect of team cohesion in the relationship between leadership effectiveness and task interaction and the moderating effect of team support in it, and a simple slope diagram was drawn.

A total of 580 cases were included with the effective response rate of 97.8%. The leadership effectiveness score of family physician team members was (4.28±0.73), the team cohesion score was (4.21±0.64), the task interaction score was (4.37±0.65), and team support score was (4.09±0.83). The Pearson correlation analysis showed that the four scale scores were linearly and positively correlated with each other (P<0.05). Team cohesion mediated the relationship of leadership effectiveness with task interaction (with a size of indirect effect of 0.08, accounting for 12% of the total effects). Team support moderated the relationship of leadership effectiveness with team cohesion (β=-0.12, P<0.01). The results of simple slope tests showed that the effect of leadership effectiveness on team cohesion was greater for family physician teams with lower team support.

The empirical analysis found that leadership effectiveness had a significant positive effect on task interaction; team cohesion mediated the relationship between leadership effectiveness and task interaction; and the positive effect of leadership effectiveness on team cohesion was moderated by team support.

The organizational identity that rural doctors have towards the family doctor team will exert an impact on the work enthusiasm of rural doctors and the work quality of the family doctor team, which is related to the quality of the family doctor contracted service enjoyed by rural residents.

To explore the influencing elements of the organizational identity of rural doctors with respect to the family doctor team, and to provide practicable measures for the better operation of the family doctor team in rural districts and the improvement of the quality of the family doctor contracted service in rural areas.

From November to December in 2021, through the use of the stratified random sampling approach, a total of 1 004 rural doctors in 3 cities in Shandong Province were selected. By employing a self-designed questionnaire, the demographic characteristics, work situation and the organizational identity situation towards the family doctor team of rural doctors were investigated. Pearson correlation analysis was utilized to explore the correlation between the organizational identity of rural doctors and work-family conflict, work stability, business training and organizational isolation, and multiple hierarchical regression analysis was adopted to explore the influencing factors of the organizational identity of rural doctors.

The organizational identity of rural doctors towards the family doctor team was relatively high, with a score of (3.757 ± 0.713) points. The results of the correlation analysis showed that there is a positive correlation between business training and organizational isolation (r=0.156, P<0.01), and a negative correlation between organizational isolation and organizational identity (r=-0.287, P<0.01). The regression analysis results indicated that business training (β=0.154, P<0.001) and organizational identity (β=-0.262, P<0.001) were the influencing factors of the organizational identity of rural doctors towards the family doctor team.

Rural doctors have a relatively strong sense of identity towards the family doctor team. Doing a good job in the business training of rural doctors and reducing the degree of organizational isolation among family doctor team members will help to further strengthen the organizational identity of rural doctors towards the family doctor team.

The effectiveness of family physician teams under the county medical community is low, and the current status of team management is not yet clear, the perceived status of team management for members with different characteristics is not yet clear.

To understand the current situation of family doctor team management under the county medical community, and to provide a basis for further refinement and improvement of family doctor team management.

From October to December 2022, a total of 1 724 key members of 429 family doctor teams under the county medical communities in Hubei Province were surveyed using a self-developed questionnaire, which included the management of team configurations, the management of team interactions and the results of team management. Differences in perceptions of team management between family doctor team members with different characteristics were analysed using chi-squared test and ANOVA, and Pearson correlation was used to analysis the correlation between team interaction management and team management outcome factors.

Among 1 724 survey respondents, 62.9% (1 084/1 724) perceived that team assessment and incentive measures were effective, and 88.7% (1 530/1 724) perceived that they had a reasonable allocation of family doctor team personnel. The respondents had a score of (22.3±5.3) for the intensity of internal team interactions and a score of (22.0±5.3) for the perceived intensity of the team's interaction and liaison with the outside. Regarding family doctor team members' perception of team management results, team members' perceived team goal achievement, i.e., team task performance, scored (33.1±7.4), perceived satisfaction with the team scored (22.3±4.9), and perceived team's ability and potential for future development scored (27.9±6.3), while the total scores of the three dimensions were 0-36, 0-24, 0-30. Comparison of team configuration management, team interaction management, and perceptions of team management outcomes between family doctor team members of different positions, titles, and ages showed statistically significant differences (P<0.05). There was a positive correlation between team interaction management factors and team management outcome factors (P<0.05) .

Family doctor team members perceive that team configuration management is relatively good, and there is still room for improvement in team assessment and incentives; family doctor team interactions are better managed, and team interactions play an important role in improving team management results; family doctor team members have a better perception of team management results, and perceive task performance to be lower than satisfaction and development ability; there are large differences in the perceptions of team management among family doctor team members of different positions, titles, and age groups.

Knowledge sharing of family doctor teams under the county medical community is an important way of interaction between the county and rural institutions, which plays an important role in enhancing the quality of regional medical and health services and improving the health of residents.

To investigate the knowledge sharing among family doctor teams under the county medical community, to explore its influencing factors, and to provide a scientific basis for promoting knowledge management and capacity enhancement within family doctor teams.

From October to December 2022, multistage sampling was used for selecting 381 family doctor teams under two county medical communities were selected as study subjects in Hubei Province using the convenience sampling method, and a self-administered team knowledge-sharing questionnaire was used to investigate the knowledge-sharing level of the included subjects, and multivariate linear stepwise regression analyses were used to explore the influencing factors of the knowledge-sharing of family doctor teams, including two dimensions of explicit knowledge sharing and implicit knowledge sharing.

The total knowledge sharing score of family doctor teams under county medical communities was (27.84±3.84), and the mean item level scores of the two dimensions of explicit and implicit knowledge sharing were (5.51±0.79) and (5.61±0.77), respectively; the results of the multivariate linear stepwise regression analysis showed that the heterogeneity of academic qualifications, intensity of team communication, intensity of team activities, motivation of members to learn, the use of platform carriers, and the team leader's role were the influencing factors of knowledge sharing of family doctor teams under the county medical community (P<0.05) .

Knowledge sharing within the family doctor team under the county medical community is at a good level, and there is still room for improvement. It is recommended to improve the level of knowledge sharing among family doctor team members by increasing the frequency of family doctor team activities, improving the intensity of team communication, adopting relevant incentives, and expanding knowledge sharing channels.

The existing family doctor team performance appraisal system is lack of incentive effect, which has hindered the quality development of contracted family doctor services. However, the performance appraisal system based on family doctor teams includes two processes of "primary distribution" and "secondary distribution", which is more capable of mobilizing the work motivation of the family doctor team members. At present, there is a lack of performance evaluation indicator systems for family doctor assistants and public health physicians, although these two groups of people play an important role in the family doctor team.

To construct "secondary distribution" indicator system of family doctor team performance based on contracted service fee, with regard to the roles of family doctor assistants and public health physicians.

The draft of the "secondary distribution" indicator system of family doctor team performance was preliminarily formulated through literature analysis and semi-structured interview. On the basis of the draft, an expert consultation questionnaire was designed, and two rounds of expert consultation were implemented and completed from October 2021 to April 2022 to develop the "secondary distribution" indicator system of family doctor team performance based on contracted service fee was established.

The recovery rates of the two rounds of expert consultation questionnaires was 100.0%. For the secondary distribution system of family doctor assistants and public health physicians, the authority coefficient for the first round of correspondence was 0.742 2 and 0.742 0, respectively. Finally, the "secondary distribution" indicator system of family physician assistants, including 3 first-level and 10 second-level indicators, and the "secondary distribution" indicator system of public health physicians, including 3 first-level and 13 second-level indicators, were constructed.

The final "secondary distribution" indicator system of family physician assistants with 3 primary indicators and 10 secondary indicators and "secondary distribution" indicator system of public health physicians with 3 primary indicators and 13 secondary indicators is logical and scientific to a certain extent, reflecting the labor value of family doctor assistants and public health doctors in the family doctor team in providing contracted services, which is conducive to the special incentive function of contracted service fee and needs to be optimized and improved in the actual assessment in the future.

The family doctor contract service is being vigorously promoted. Compared with the individual performance appraisal scheme, the performance appraisal scheme based on the family doctor team including the two processes of "first distribution" and "secondary distribution" is more capable of mobilizing the work motivation of family doctor team members, thus improving service efficiency and quality.

To develop the "first distribution" indicator system of family doctor team performance based on contract service fee.

The draft of the "first distribution" indicator system of family doctor team performance was preliminarily formulated through literature analysis and semi-structured interviews. On the basis of the draft, an expert consultation questionnaire was designed, and two rounds of expert consultation were implemented and completed from October 2021 to April 2022 to develop the "first distribution" indicator system of family doctor team performance based on contract service fee.

The recovery rate of the two rounds of expert consultation questionnaires was 100.0%. The authority coefficient of the first round of correspondence was 0.761 6, and the Kendall coordination coefficients of the two rounds of consultations were 0.067 (P<0.001) and 0.712 (P<0.001), respectively. Finally, the "first distribution" indicator system of family doctor team performance was finally constructed, including 3 primary indicators and 15 secondary indicators.

The performance allocation system constructed in this study based on contract service fee, which includes three primary indicators (effective contracting, effective service, and effective fee control), has a certain degree of logic and scientificity that reflects the labor value of the contracted service provided by the family doctor team, and is conducive to special incentive effect of the contract service fee.

At present, polypharmacy is common among residents with high risk of unsafe medication due to the lack of drug reorganization and whole-course drug management. Community pharmacy services provided by community health service centers (CHSC) with regional advantages is in line with its functional orientation, but there is still a large gap between the supply of pharmacy services in CHSCs and the demand of the public.

To understand the current situation of community pharmacy services and the integration of pharmacists into family doctor team in Shanghai, as well as the problems faced by community pharmacy services, so as to provide suggestions for promoting the development of community pharmacy services.

A combination of qualitative and quantitative research was adopted. In December 2020, a stratified sampling method was used to conduct a questionnaire survey on 307 pharmacy staff on duty with licensed pharmacist qualification from 29 CHSCs, including 6 in the central urban area, 8 in the near urban area, and 15 in the far urban area. The questionnaire included the basic information of pharmaceutical staff, the development of community pharmacy services, and the participation of community pharmacists in the family doctor team. In the same period, a convenience sampling method was used to invite 29 key insiders, including 11 pharmacy section chiefs, 6 family doctor representatives, 12 community center directors and health commission managers from central urban area, near urban area and far urban area, to conduct a semi-structured focus interview on pharmacy service needs, pharmacy resource allocation and pharmacy service process.

The quantitative research results showed that the highest proportion of community pharmacists participating in training is 1-2 times〔139 (45.3%) 〕, and the main form of training is continuing education, accounting for 252 (82.1%). The three most frequently conducted pharmacy service projects by community pharmacists are prescription dispensing〔284 (92.5%) 〕, prescription review〔253 (82.4%) 〕, and pharmaceutical window or outpatient consultation guidance〔196 (63.8%) 〕. The three longest service hours occupied by pharmacists are prescription dispensing〔280 (91.2%) 〕, prescription review〔244 (79.5%) 〕, and prescription comment〔145 (47.2%) 〕. A total of 78 (25.4%) pharmacists joined the family doctor team. The qualitative study showed that the elderly residents in the community had a great demand for pharmacy service, but their awareness of rational drug use was weak. In the allocation of community pharmacy resources, the pharmacists are lacjing, the professional quality needs to be improved, the community pharmacy drug list remains uncompleted, and the role of informatization needs to be strengthened. In the process of community pharmacy service, the recognition degree of community pharmacists is not high, with single service content and relatively little targeted training on rational drug use, and pharmacists fail to play a role in the family doctor team.

At present, the resource allocation and supply capacity of community pharmacy service cannot meet the needs of residents, and the pharmacy service process needs to be improved and optimized. The role played by the only part of pharmacists joining the family doctor team is limited. Therefore, it is necessary to increase the incentive mechanism, clarify the service content and improve the service model.

Currently, there are many studies on family doctor contracting services from the perspective of residents, but few scholars have conducted studies on the current situation of family doctor team contracting based on the perspective of general practitioners (GPs) .

To understand the current situation of family doctor contracting services in primary health care institutions in Guangdong Province, and explore the factors affecting the contracted number from the perspective of the supplier.

From July 5—31, 2021, GPs in primary health care institutions in Guangdong Province were selected as the study subjects by using a multi-stage stratified cluster sampling method to conduct the survey with a self-designed questionnaire. The contracted number was compared by different GPs and their family doctor team characteristics. A two-level Logistic regression developed by R 4.2.2 software was used to identify influencing factors of contracted number above 2 000.

A valid sample of 3 252 cases in family doctor team with contracted number more than 100 was screened, and the median contracted number was 1 400 (2 499) in 2020. The differences were statistically significant when comparing the contracted number by gender, age, education level, position, employment form, working years, working unit, working area, training acceptance, and annual income, number of team members, population size under jurisdiction, willingness of specialists from medical community to join the team, inpatient bed resources and guidance from superior departments (P<0.05). Zero model fitting showed that contracted number was clustered at the regional level (P<0.05). Two-level Logistic regression model showed that, with master's degree or above as the reference, the contracted number of the team including GPs with college〔OR (95%CI) =2.79 (1.84, 3.74) 〕and secondary/high school〔OR (95%CI) =2.83 (1.80, 3.86) 〕degrees were more likely to be above 2 000; taking no position as reference, the contracted number of the team including unit leaders〔OR (95%CI) =0.66 (0.33, 0.99) 〕was more likely to be above 2 000; taking temporary staff as reference, the contracted number of the team including formal staff〔OR (95%CI) =2.02 (1.53, 2.51) 〕was more likely to be above 2 000; taking the team with size of 3 or less people as reference, the contracted numbers of the teams with size of 4 to 6 people〔OR (95%CI) =1.31 (1.05, 1.57) 〕, 7-10 people〔OR (95%CI) =2.06 (1.75, 2.37) 〕, 11-19 people〔OR (95%CI) =3.67 (3.31, 4.03) 〕and≥20 people〔OR (95%CI) =3.46 (2.74, 4.18) 〕were more likely to be above 2 000; taking population size under jurisdiction at 2 000 or less as reference, the contracted numbers of the team with population size under jurisdiction at 2 001 to 9 999〔OR (95%CI) =2.37 (2.12, 2.62) 〕, 10 000 to 29 999〔OR (95%CI) =2.92 (2.65, 3.19) 〕and more than 30 000〔OR (95%CI) =2.86 (2.55, 3.17) 〕were more likely to be above 2 000; taking condition of having inpatient bed resources as reference, the contracted number of the teams without such resources〔OR (95%CI) =1.38 (1.14, 1.62) 〕was more likely to be above 2 000 (P<0.05) .

The population under jurisdiction and the large number of team members create favorable conditions for contracting; family doctor teams with GPs with positions, inpatient bed resources and high education level have a good understanding of family doctor contracting service policies and control the number of contracted patients better; comparing with temporary staff, GPs team with formal staff may undertake more contracting tasks.

The integration mechanism of medical treatment and prevention based on family doctor teams is a key way to break down the barrier between "medical" and "prevention". In this paper, we explain the definition and connotation of treatment-prevention integration, review the development history of family doctor teams, systematically review the typical practice strategies and the shortcomings of treatment-prevention integrationon family doctor teams in China. Measures should be taken to promote the treatment-prevention integration, including improve the talent training system, change views of "attaching importance to treatment and neglecting prevention", strengthen the organization and management, innovate the assessment and incentive mechanism, reform the medical insurance payment method, encourage diversified forms of services, etc. The study aims to provide reference for improving the quality of services and developing treatment-prevention integration in the future.

The family doctor team dynamics mainly refer to inter-member interaction state of the family doctor team in the process of providing services. Improving the team dynamics among family doctors can help promote the enhancement of team effectiveness. The Primary Care Team Dynamics Scale (PCTDS) developed by Sara J. Singer's team at Harvard University, which can be used to comprehensively assess the primary care team dynamics.

To translate the PCTDS into a Chinese version, and test the reliability and validity of the Chinese version.

The Brislin's model for translation, back translation and cross-cultural adaptation was utilized to translate the PCTDS into a Chinese version (PCTDS-C) strictly following the principle of scale introduction, and the PCTDS-C was revised in accordance with an email-based expert consultation and a pre-test. Then a total of 569 family doctor team members were selected from 17 cities (including Guangdong's Shenzhen, Hubei's Wuhan, Zhejiang's Hangzhou, and so on) by the convenience sampling method from November 2021 to February 2022 to attend a survey using a self-developed Demographic Questionnaire and the PCTDS-C. The critical ratio (CR) method and item-total correlation were used for item analysis. The content validity of the scale was assessed by the expert consultation. The structural validity of the scale was tested by the KMO test, Bartlett's test of sphericity, exploratory factor analysis, and confirmatory factor analysis. And the reliability of the scale was evaluated by the Cronbach's α.

Three hundred and nine of the 569 cases (54.3%) who returned responsive questionnaires were included for analysis. The absolute CR value for each of the entries was greater than 3.000 (P<0.001), and the average r-value of the correlation between each item score and the total scale score was greater than 0.300 (P<0.001). The I-CVI was 0.692-1.000, and S-CVI was 0.896. A significant KMO value of 0.946 and a significant value of Bartlett's test of sphericity〔χ²=4 488.198 (df= 406, P<0.001) 〕indicated that the scale was suitable for factor analysis. Four common factors with an eigenvalue greater than 1.000 were extracted, including the conditions of team effectiveness (4 items), team shared understanding (6 items), team collaboration process (9 items), and team effectiveness (9 items), explaining 74.2% of the total variance. The load value of each item on the common factor was 0.561-0.802. Confirmatory factor analysis indicated that the performance of fit indices of the initial model was not satisfactory. After the correlations between the error variables e20 and e31, e6 and e7, e19 and e31, e24 and e25, e18 and e23, e4 and e10, e3 and e9 were added according to the indicator prompts, except for χ²/df, IFI and CFI, the performance of the other fit indices of the modified model was still unsatisfactory (χ²/df =2.313, RMSEA=0.091, GFI=0.748, AGFI=0.699, NFI=0.866, IFI=0.919, CFI=0.919). The Cronbach's α for the total scale was 0.978. And the Cronbach's α was 0.826 for the conditions of team effectiveness, 0.945 for team shared understanding, 0.957 for team collaboration process, and 0.956 for team effectiveness.

The PCTDS-C has proven to have a good reliability and a fair validity, which can be used as a tool to evaluate the family doctor team dynamics in China. However, there is still much room for the scale improvement. Future research can focus on in-depth exploration of the dimensions and item classification of the scale, and the adding of dimensions in line with the actual situation of family doctor teams in China.

Problems existing in the operation of a family doctor team, such as unclear work content, inappropriate division of labor, and assigning a team member to a position below his true potential, restrict the overall development of the family doctor team.

To perform a standardized workload-based analysis of the services delivered by the family doctor team in a central urban community health institution in Shanghai, to understand the major factors associated with the development of the family doctor team, and to provide guidance for the improvement of the work pattern of the team.

The family doctor team of Xietu Subdistrict Community Health Center, Xuhui District, Shanghai was selected during July to Novermber 2021. The service projects, parameters of standardized workload and the number of services carried out by the team between August and September 2019, and between August and September 2021 were collected, respectively. The team services were analyzed from three aspects: 1. dividing the team services into essential medical services and public health services according to the nature of the service items, then calculating the total amount of standardized workload and total time used in performing the two kinds of services; 2. dividing the team services into five parts (involving community-based mobilization, screening, diagnosis, intervention and follow-up) according to the idea of integration of medical and preventive services, then calculating the total amount of standardized workload and total time used in performing each part; 3. using the TOPSIS method to comprehensively evaluate the value of all service items included in community-based mobilization, screening and follow-up.

The standardized workload of the team in delivering public health services increased to 16 961 in August 2021 from 11 486 in August 2019, and increased to 18 089 in September 2021 from 10 433 in September 2019, demonstrating an average increase of 59.9%. Pearson correlation analysis showed that the standardized workload involved in delivering essential medical services had no correlation with that involved in delivering public health services (r=-0.72, P=0.27). The total amount of standardized workload of the five parts of community health work was ranked as follows in a descending order: community-based diagnosis, community-based follow-up, community-based intervention, community-based mobilization, and community-based screening. The total standardized workload and total time used of the latter three were relatively less. According to TOPSIS evaluation results, 13 projects such as updating health records of patients with chronic diseases, follow-up management of patients with hypertension or diabetes, and information maintenance of contracted residents can be considered to be outsourced or to reduce the execution labor cost.

The family doctor team has not yet formed an effective work model to deliver integrated medical and preventive services, which leads to excessive waste of human resources in the implementation of public health services that need not to be performed by family doctors, affecting the delivery of essential medical services. It is suggested to strengthen the training of professional skills related to community-based interventions for family doctors, and increase relevant facilities and equipment, optimize the allocation of human resources in all parts of community health work, mainly reducing the implementation cost of community-based mobilization, screening and follow-up.