The Present Situation of Chronic Disease Follow-up in Medical Institutions and the Analysis of Key Problems 
HUANG Xiaoxu,LI Ziyun,WANG Zhaoxin,CHEN Chen,HUANG Jiaoling,YU Wenya,CHEN Ning,LIU Qian,GONG Xin,SHI Jianwei
Chinese General Practice . 2020, (28): 3522 -3526 .  DOI: 10.12114/j.issn.1007-9572.2020.00.290