Table of Content

05 October 2025, Volume 28 Issue 28

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Standard·Specifications·Guidelines

Implementation Recommendations for Quality Management and Control in General Practice at Primary Healthcare Institutions (2025 Edition)

The General Practice Branch of the Chinese Medical Doctor Association

2025, 28(28):  3473-3482.  DOI: 10.12114/j.issn.1007-9572.2025.0139

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As the cornerstone of primary healthcare services, the quality of general practice directly impacts the effectiveness of the hierarchical medical system and the health rights of the people, and is pivotal to the success of China's healthcare reform. To comprehensively implement the general practice quality management system, strengthen standardized clinical protocols, enhance the evaluation, assessment, and improvement of clinical quality in general practice, and elevate the medical quality of primary healthcare institutions, the General Practice Branch of the Chinese Medical Doctor Association has formulated the Implementation Recommendations for Quality Management and Control in General Practice at Primary Healthcare Institutions (2025 Edition) based on domestic practices. These recommendations elaborate on the core elements and principles of medical quality control, outline the objectives and implementation principles for conducting quality management in general practice at primary healthcare institutions, define the responsibilities of quality control bodies, and provide detailed methodologies for executing general practice quality control. They aim to offer guidance and reference for advancing quality management in general practice at primary healthcare institutions across China.

Article·Focus on General Practice Education

Development, Reliability and Validity Testing of the General Medical Teacher Training Effectiveness Evaluation Scale

XU Yang, JIANG Fan, WANG Xiaoxu, FENG Mei

2025, 28(28):  3483-3488.  DOI: 10.12114/j.issn.1007-9572.2024.0698

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Background

Although general practice teacher training has been implemented in China for over a decade, a unified and effective tool for evaluating its outcomes is still lacking, which hampers the improvement of training quality.

Objective

Grounded in the Kirkpatrick model, we developed and validated a comprehensive evaluation scale for assessing the effectiveness of general practice teacher training, thereby providing a scientifically rigorous tool for monitoring training quality.

Methods

From January 8 to May 8, 2021, the initial scale was developed through a combination of literature review, expert interviews, and group discussions. During this process, four dimensions were determined: reaction, learning, behavior, and results, with each dimension comprising five items. From June to July 2021, a convenience sample of general practice (GP) residency training instructors from Jincheng and Yangquan in Shanxi Province, who were participating in the provincial GP faculty training program, were selected for two rounds of pilot testing (pre-survey and formal survey). Exploratory factor analysis was conducted on the pre-survey data (n=201), and confirmatory factor analysis was performed on the formal survey data (n=286). The reliability and validity of the scale were evaluated using Cronbach's αcoefficient, composite reliability, content validity, and other indices.

Results

During the pilot testing phase, a total of 209 pre-test questionnaires were distributed, with an effective response rate of 96.2% (201/209). In the formal testing phase, 292 questionnaires were distributed, achieving an effective response rate of 97.9% (286/292). The final scale demonstrated a Cronbach's α coefficient of 0.967. The Cronbach's α coefficients for the four dimensions were 0.92, 0.83, 0.81, and 0.89, respectively. The composite reliability (CR) ranged from 0.82 to 0.92. The comparative fit index (CFI) was 0.858, the normed fit index (NFI) was 0.829, and the incremental fit index (IFI) was 0.859. The model fit index χ²/df was 4.804. The square roots of the average variance extracted (AVE) were all greater than the inter-factor correlation coefficients, indicating that all model fit indices performed well. Ultimately, a general practice faculty training effectiveness evaluation scale comprising four dimensions and 17 items was constructed.

Conclusion

The General Practice Teacher Training Effectiveness Scale demonstrates strong reliability and validity, serving as an effective tool for assessing training outcomes and for ongoing quality monitoring and continuous improvement.

Application of Milestones 2.0 Evaluation System Based on ACGME Core Competency in Standardized Training of General Practitioners

DU Xueqing, CHENG Ruijie, XU Mengdan, YAO Yuting, JIANG Yun, LIANG Yanyan, LIU Liyan, SHEN Hua, LOU Lihong

2025, 28(28):  3489-3494.  DOI: 10.12114/j.issn.1007-9572.2024.0170

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Background

With the advancement of China's medical and healthcare undertakings, general practice, as an emerging discipline, has gained increasing recognition among a growing number of individuals. Standardized training for resident physicians is an indispensable stage for medical students on their journey to becoming proficient doctors. Nevertheless, general practice residency training diverges substantially from traditional disciplines in numerous aspects. Consequently, there was an urgent need to optimize the educational system for general practice residency training.

Objective

The Milestones 2.0 evaluation system is applied to conduct self-assessment and peer assessment for general practice residents in training, and the effectiveness of this evaluation system in the training and education of general practice residents is explored.

Methods

Thirty-three general practice resident physicians undergoing training at the First Affiliated People's Hospital of Shanghai Jiao Tong University School of Medicine in September 2023 were selected as research subjects. They were divided into first-year, second-year, and third-year groups based on their residency duration. The Milestones 2.0 assessment system, revised by the research team in line with the standards of the Accreditation Council for Graduate Medical Education (ACGME) in the United States and actual circumstances, was utilised to conduct a quantitative evaluation of 19 secondary indicators related to the six core competencies of resident physicians: patient care, medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills. Self-assessment data from the residents and corresponding evaluations from their supervising mentors were collected through electronic questionnaires. Differences in competency performance across different residency years, discrepancies between the residents' self-assessments and their mentors' evaluations, and differences in assessment results among individuals with varying educational backgrounds were compared.

Results

The comparison of scores across the dimensions of patient care, medical knowledge, system-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills in the Milestones 2.0 self-assessment system among general practice resident physicians at different training levels showed statistically significant differences (P<0.001). A comparison between self-assessment and external evaluation scores for the secondary indicator "evidence-based medicine and evidence-informed medical practice" in the Milestones 2.0 assessment system revealed statistically significant differences (P=0.040). Additionally, the comparison of medical knowledge scores in the Milestones 2.0 self-assessment system between undergraduates and four-certification integrated general practice resident physicians in training also showed statistically significant differences (P<0.05) .

Conclusion

The Milestones evaluation system represents a relatively objective and comprehensive assessment approach, which is of great significance in providing crucial references for formulating the subsequent training plans of resident physicians. When applying this evaluation system to assess the capabilities of general practice residents and highlighting the importance of interaction and feedback throughout the training process, it can effectively contribute to the improvement of the overall professional proficiency and ethical qualities of resident physicians. Ultimately, this effort plays a vital role in advancing the high-quality development of the national medical and healthcare undertakings.

Article·Primary Health Care Resource Allocation Research

Measurement of the Allocation Mismatch of Primary Medical Resources in China and Its Spatial and Temporal Evolution Analysis

LI Liqing, PENG Yin, LU Zuxun, YUAN Gang

2025, 28(28):  3495-3506.  DOI: 10.12114/j.issn.1007-9572.2023.0831

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Background

With the aging of the population and the increase of the proportion of patients with chronic diseases, the people's demand for primary medical resources is diversified and complicated. There are differences in the demand for primary medical resources among different regions and different groups of people. Some areas are facing the problem of lack of primary medical resources, which seriously restricts the coverage and quality of primary medical and health services, and greatly affects the medical experience and health status of residents.

Objective

In order to promote the high-quality development of the primary medical and health service system, the health distance model is introduced to analyze the spatial and temporal evolution process of the allocation mismatch of primary medical resources in China from 2011 to 2021, so as to provide reference for rationally formulating regional health plans, optimizing the allocation of medical resources, improving the capacity of primary medical and health services, and promoting the high-quality development of medical and health services.

Methods

An evaluation index system for the mismatch of primary medical resources was established from the three levels of health material resources, human resources and security resources. Data were obtained from the China Statistical Yearbook and China Health Statistics Yearbook. The bi-level programming model and the health distance model were used to measure the mismatch of primary medical resources allocation from 2011 to 2021.

Results

From 2011 to 2021, the overall mismatch degree of primary medical resources allocation in China has a significant downward trend, but the mismatch degree differences between regions and provinces continue to expand. The average values of mismatch in the eastern, central and western regions in 2011 were 0.633, 0.624 and 0.754, respectively, which were moderate mismatch, mild mismatch and severe mismatch. In 2021, the average values of mismatch in the eastern, central and western regions are 0.479, 0.522 and 0.639, respectively, which were moderate matching, mild matching and moderate mismatch.

Conclusion

Promoting the expansion of high-quality medical resources and promoting the balanced layout of regional medical resources are the premise of building a high-quality and efficient medical and health service system. In order to further optimize the allocation of primary medical resources and improve China's medical and health service system, we should formulate reasonable macro policies in combination with the characteristics of each region, improve the level of economic development, optimize the structure of fiscal expenditure, improve the administrative capacity of local governments, reduce the mismatch of primary medical resources allocation, and realize the high-quality development of primary medical and health service system.

The Fairness of Human Resource Allocation of Geriatric General Practitioners in China under the Background of Population Aging

LIANG Zhenning, ZHOU Qingping, LIU Hanyue, ZHAN Shengfan, YU Yao, QIAN Yi

2025, 28(28):  3507-3511.  DOI: 10.12114/j.issn.1007-9572.2024.0110

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Background

China entered an aging society in 1999, characterized by rapid growth rate, large population base, and the distinctive pattern of "aging before affluence". The intensifying aging trend poses significant challenges to the pension system, making the implementation of elderly health management a scientifically sound response strategy. As gatekeepers of primary healthcare, general practitioners play a pivotal role in advancing elderly health management and implementing the "comprehensive health management" philosophy, serving as the primary force in addressing aging-related challenges.

Objective

This study investigated the dynamic geographical distribution and equity disparities in the allocation of geriatric general practitioner human resources across China from 2012 to 2021, while analyzing the influencing factors of human resource allocation levels. The findings aim to provide evidence-based references for policymakers to formulate scientific human resource allocation strategies for elderly healthcare services.

Methods

This study collected relevant data from the China Statistical Yearbook and China Health Statistics Yearbook spanning 2013 to 2022. By calculating the changing trends of Gini coefficients and Theil indices based on the total and elderly population distributions, we assessed the equity in human resource allocation of geriatric general practitioners. Furthermore, a two-way fixed effects panel model was constructed to examine the province-level allocation of general practice human resources across various regions.

Results

During the period from 2012 to 2021, the total number of general practitioners in China increased by 325 074, with all provinces demonstrating varying degrees of growth in their general practitioner workforce. The number of general practitioners per 10 000 elderly population reached 21.66, while the Gini coefficient decreased from 0.38 to 0.33. Both the overall Theil index and its inter-group and intra-group components exhibited declining trends. The results of the panel two-way fixed effects model analysis revealed that among healthcare resources: the number of nurses exerted a significant negative effect, whereas bed capacity and licensed physicians demonstrated significant positive effects on resource allocation. Population size and aging rate showed positive associations with resource distribution. Road density exhibited a negative impact on resource allocation. However, economic development level, educational indicators, and outpatient service volume did not exhibit statistically significant effects.

Conclusion

From 2012 to 2021, China witnessed sustained development in the allocation of human resources for geriatric general practitioners, accompanied by progressive improvements in equity. Given this trend, policymakers should holistically consider multiple factors—including population aging rates—when formulating workforce allocation strategies for general practitioners, to achieve more scientifically grounded and rational resource distribution.

Equity Analysis and Demand Forecast of General Practitioner Allocation in Xinjiang Uygur Autonomous Region

CHEN Dongran, XU Peilan, DING Lei, LI Yuhua

2025, 28(28):  3512-3517.  DOI: 10.12114/j.issn.1007-9572.2023.0366

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Background

General practitioners, as the gatekeepers of resident health, are the main force in China's grassroots medical and health services. The prominent problems of shortage of grassroots talent resources and unreasonable talent structure in Xinjiang Uygur (Xinjiang) urgently need to be solved.

Objective

On the basis of understanding the current situation of the allocation of general practitioners in Xinjiang, to evaluate the fairness of allocation and predict the number of general practitioners in demand and gaps in the autonomous region from 2025 to 2030, so as to provide a reference for the rational allocation and training of general practitioners in the region.

Methods

Data on general practitioners in Xinjiang from 2012 to 2019 was collected, with sources including the China Statistical Yearbook (2021), the China Health Statistics Yearbook (2013-2020), and documents from the Health Commission of the Xinjiang Uygur Autonomous Region. The allocation fairness of general practitioners was analysed using the concentration index, lorenz curve, and gini coefficient. Additionally, the average growth model and health demand forecasting method were utilised to predict the required number of general practitioners and the corresponding shortfall.

Results

The average annual growth rate of general practitioners in Xinjiang was 16.58%. It is predicted that by 2025, 9 411-9 452 general practitioners will be needed, with a gap of 3 938-3 979; the agglomeration degrees of area allocation were all less than 1, and the agglomeration degrees of both were declining year by year; the number of general practitioner training places in each region and the overall Gini coefficient were less than 0.300, and the overall and northern Xinjiang regions were all allocated according to geographical area. The Gini coefficients were 0.415 and 0.457, and the Gini coefficients of other regions were all less than 0.300.

Conclusion

The allocation and training of general practitioners in Xinjiang has made some progress, the growth rate is fast, and the number has reached the overall goal, but there is still a big gap. The fairness of general practitioner resources allocation based on population is better than allocation based on geography. It is the main source of unfair allocation of training places according to geographical area. Therefore, in the further allocation and training of general practitioners, it is necessary to continue to strengthen the team of general practitioners on the basis of reference to the forecasted demand and gap, and to continuously improve the fairness of allocation based on geographic area with key areas as the starting point. While ensuring the number of general practitioners, the accessibility of health services should be taken into account.

Article

Construction of Evaluation Index System Inter-professional Collaboration in Family Doctor Team

ZHENG Caiyun, WU Shuanger, YU Ganquan, WANG Xin

2025, 28(28):  3518-3524.  DOI: 10.12114/j.issn.1007-9572.2023.0528

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Background

Implementing effective inter-professional collaboration based on family doctor teams is key to meeting the increasingly complex health demands of residents and providing high-quality integrated care. However, there is currently a lack of tools for assessing inter-professional collaboration in Chinese family doctor team.

Objective

To develop a D'Amour model-based system for assessing inter-professional collaboration in family doctor team, aiming at development of inter-professional collaboration of family doctor team.

Methods

The first draft of index system was established by literature analysis, policy induction and semi-structured interview. From April to June 2023, a two-round expert consultation with 24 experts was conducted using the modified Delphi method, and the evaluation index system was determined according to the results of expert consultation. The weights of the index were determined by analytic hierarchy process and entropy weight method.

Results

The effective questionnaire recovery rate of the two-round expert consultation was 100.0% (24/24), and the authority coefficients of experts were 0.874 and 0.885, respectively, and the Kendall coordination coefficients were 0.157 (χ²=166.005, P<0.05) and 0.146 (χ²=151.145, P<0.05), respectively. An evaluation index system for inter-professional collaboration in family doctor team was constructed, which included 5 first-level indicators, 11 second-level indicators, 27 third-level indicators and their weights, and the weights of the first-level indicators "shared goals and vision" "internalization""governance" "formalization" and "incentive" were 0.126 7, 0.190 4, 0.291 3, 0.118 0 and 0.275 4, respectively.

Conclusion

The evaluation index system for inter-professional collaboration in family doctor team is scientific and feasible, with theoretical and practical significance for promoting inter-professional collaboration in family doctor teams.

The Treatment of Chronic Disease and Symptoms of an Unknown Etiology in the General Medicine Ward of Tertiary Comprehensive Hospital in Beijing

PANG Shu, CHEN Xiangxue, DIAO Yang, WANG Yini, JIANG Chunyan

2025, 28(28):  3525-3531.  DOI: 10.12114/j.issn.1007-9572.2024.0366

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Background

Under the government's great concern and support to the development of general practice, general practice departments have been successively set up in general hospitals. The disciplinary characteristics of general practice has significant advantages in the treatment management of chronic disease and symptoms of an unknown etiology. However, the treatment and management of chronic disease and symptoms of an unknown etiology in the general medicine ward of tertiary comprehensive hospitals is currently unclear.

Objective

This study aims to analyze the current situation and management of chronic disease and symptoms of an unknown etiology in the general medicine ward of a tertiary comprehensive hospital, to analyze the existing problems, and explore the direction of continuously improving the management quality and efficiency of the general medicine department.

Methods

Taking the general medical ward of Beijing Friendship Hospital, Capital Medical University as an example, the clinical data of all the inpatients since the establishment of the general medical ward of the hospital (from November 2019 to January 2024) were extracted through the electronic medical record system in February 2024. The general conditions, admission sources, discharge diagnoses and prognosis of the participants were analyzed retrospectively.

Results

A total of 2 725 cases included in the study. The ages ranged from 12 to 95 years old, with the average age of (57.4±15.8) years old, including 1 400 (51.38%) patients aged 60 years and older. The median (quartile) hospitalization time was 7 (5, 9) days and the median (quartile) hospitalization cost was 9 053.71 (6 551.53, 12 380.82) yuan. 1 724 cases (63.27%) were admitted from general outpatient clinics and 1 001 cases (36.73%) were transferred from emergency department or specialties. The top three diseases with the largest number of hospital visits were acute pancreatitis (9.06%, 247/2 725), abdominal pain (7.41%, 202/2 725) and pneumonia (7.30%, 199/2 725), respectively. A total of 1 899 (69.69%) patients suffered from chronic diseases, 1 085 (39.81%) patients had multiple diseases coexisting and 1 016 (37.18%) patients had polypharmacy. 1 658 patients (60.84%) had a clear diagnosis at admission and 1 067 patients (39.16%) were admitted with one or more symptoms of an unknown etiology. The top three symptoms of an unknown etiology with the largest numbe of hospital visits were abdominal pain (7.41%), dizziness (5.43%) and abdominal distension (5.03%), respectively. The top five systems ranked as the main discharge diagnosis were digestive system in 1 166 cases (42.79%), respiratory system in 334 cases (12.26%), endocrine system in 317 cases (11.63%), cardiovascular system in 279 cases (10.24%) and blood system in 176 cases (6.46%), respectively. The top ten most diagnosed cases were 249 cases (9.14%) of acute pancreatitis, 238 cases (8.73%) of pneumonia, 220 cases (8.07%) of chronic gastritis, 175 cases (6.42%) of type 2 diabetes with chronic complications, 174 cases (6.39%) of acute cholecystitis, 154 cases (5.65%) of malignant tumors, 109 cases (4.00%) of hypertension, 73 cases (2.68%) of coronary atherosclerotic heart disease, 62 cases (2.28%) of colorectal polyps and 59 cases (2.17%) of thyroid nodules. 2 411 cases (88.48%) were cured and discharged and 96 cases (3.52%) were transferred to specialist departments due to definite specialist diseases were diagnosed. The hospitalization costs of patients with symptoms of an unknown etiology were higher than those with definite diagnosis at admission (P<0.05), and there was no statistical difference in the hospitalization time (P>0.05). The hospitalization time and costs of patients with chronic diseases were higher than those without chronic diseases (P<0.05). The hospitalization time and costs of patients with multiple coexisting diseases were higher than those without multiple coexisting diseases (P<0.05) .

Conclusion

Inpatients in the general medicine department of the tertiary general hospital cover a wide range of ages. The disease spectrum involves common diseases in multiple systems, chronic diseases and symptoms of an unknown etiology. The coexistence of multiple diseases is common. Thus the general medicine ward meets the basic medical needs of patients. General medicine is closely related to grassroots health institutions, emergency departments and specialties, which is of great significance in the graded diagnosis and treatment of chronic diseases and symptoms of an unknown etiology, as well as in the multidisciplinary diagnosis and treatment. The long length of hospital stay and high hospitalization costs of patients with chronic diseases, symptoms of an unknown etiology and multiple coexisting diseases suggest that general practitioners need to continuously refine management processes and service content in the management process of chronic diseases and symptoms of an unknown etiology as well as continuously improve management quality.

Association of Mental-physical Multimorbidity with Cognitive Decline among Middle-aged and Elderly People in China, India and Indonesia

ZHAO Siqi, YE Xing, ZHAO Yang, Anindya Kanya, Marthias Tiara, Daniel Mercian, ZHAO Tianhao, HAN Li

2025, 28(28):  3532-3540.  DOI: 10.12114/j.issn.1007-9572.2024.0703

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Background

There is evidence showing that multimorbidity is associated with brain health among the elderly. Limited studies examined the combined impacts of physical and mental diseases on cognition performance.

Objective

This study aims to explore the relationship between mental-physical multimorbidity and cognitive decline in middle-aged and elderly people in China, India and Indonesia.

Methods

This study based on three national-representative data from China (China Health and Retirement Longitudinal Study), India (Longitudinal Aging Study in India), and Indonesia (Indonesian Family Life Survey), with a total sample of 73 119 respondents. Three domains of cognitive function were considered in the analysis, including time orientation, word recall, and numeracy. Five categories of mental-physical multimorbidity were constructed according to the number of non-communicable diseases and the existence of depressive symptoms, reported by participants. Multivariable linear regression models were applied to examine the association of physical and mental multimorbidity with cognitive decline.

Results

The mean cognitive function score was (54.7±19.9) among 9 951 participants in China, (51.1±20.0) among 54 802 participants in India, and (50.7±18.4) among 8 446 participants in Indonesia. The cognitive score was significantly lower in those middle-aged and elderly people with mental-physical multimorbidity in China (β=-6.99, 95%CI=-8.26 to -5.71), India (β=-2.76, 95%CI=-3.41 to -2.11) and Indonesia (β=-2.75, 95%CI=-4.10 to -1.41) than in those individuals without any non-communicable disease (P<0.05), after adjusting for socio-demographic and lifestyle behavioral covariates.

Conclusion

Cognitive decline is associated with mental-physical multimorbidity among middle-aged and elderly people in China, India and Indonesia, particularly in females. Paying attention to and actively addressing mental health problems among patients with multimorbidity may reduce the risk of cognitive impairment in the elderly.

Analysis of the Difference of Primary Medical Service Quality between Urban and Rural Areas in Chengdu from the Perspective of Patients

HUANG Chuanying, LIU Lidi, ZHANG Peng, ZHANG Yalin, YANG Rong, YANG Ziyu, WU Jia, CHENG Yu, DAI Hua, LIAO Xiaoyang

2025, 28(28):  3541-3547.  DOI: 10.12114/j.issn.1007-9572.2024.0079

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Background

The imbalance and uneven distribution of resources among primary healthcare institutions constitute the primary issues between urban and rural ones. To enhance the quality of primary medical services in urban and rural areas and promote standardized construction, it is of vital significance to accurately grasp the disparities in the quality of primary medical services between them.

Objective

To evaluate and compare the service quality of urban and rural primary medical institutions in Chengdu, and to analyze the impact of different patient characteristics on the quality and experience of medical services.

Methods

A survey was carried out from November 2019 to January 2020 covering all primary healthcare institutions in 22 districts (counties) of Chengdu City. In this study, all registered general practitioners' patients who had received treatment at these institutions were selected as the research subjects through a convenient sampling method. A Questionnaire on the Quality of primary healthcare services and costs (QUALICOPC) was utilized, and a questionnaire on the quality of primary healthcare services in Chengdu was compiled by integrating it with the actual situation in Chengdu. It encompasses four dimensions: accessibility, continuity, coordination, and comprehensiveness of medical services, and multiple stepwise linear regression analysis was employed to analyze the influencing factors of the quality of primary healthcare services.

Results

A total of 2 153 patients were included, with the scores of the accessibility, continuity, coordination, and comprehensiveness dimensions of rural health clinics being (0.45±0.26) points, (0.68±0.41) points, (0.48±0.41) points, and (0.37±0.40) points, respectively. The scores of the dimensions of community health service centers were (0.45±0.27) points, (0.69±0.39) points, (0.46±0.42) points, and (0.29±0.38) points, respectively. The comprehensiveness dimension score of rural health clinics was higher than that of community health service centers, with a statistically significant difference (P<0.05). The current working conditions (rural health clinics: β=-0.031, P=0.006; community health service centers: β=-0.028, P=0.003) and whether there was a contracted doctor (rural health clinics: β=0.128, P<0.001; community health service centers: β=0.169, P<0.001) are influencing factors of the comprehensiveness of primary healthcare services.

Conclusion

The level of accessibility, coordination, and continuity of PHC quality in urban and rural primary medical and healthcare institutions in Chengdu is relatively high; the comprehensive score of township healthcare centers is higher than that of community healthcare service centers. The current working status has a negative prediction effect on the comprehensive service experience of primary medical and health institutions, and some contracted doctors have a positive prediction effect on the comprehensive service of primary medical and health institutions.

Investigation on the Status Quo of "Internet +" Home Care Quality in 60 Medical Institutions

ZHAN Yang, ZHAO Ruyi, SUN Hongling, JIANG Nan, NI Zijun, ZHU Lingli

2025, 28(28):  3548-3553.  DOI: 10.12114/j.issn.1007-9572.2023.0447

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Background

"Internet +" home care is an essential path to precisely address the diverse and multi-level health needs of service recipients, and will become an inevitable trend of the realization of the Healthy China strategy. However, the current status of service quality remains unclear, which hinders its vigorous development.

Objective

To investigate the quality of "Internet +" home care in medical institutions, so as to provide a reference for objectively evaluating and improving the quality of "Internet +" home care.

Methods

From September to November 2022, 60 medical institutions of different levels in 11 cities of Zhejiang Province were investigated by convenience sampling using the "Internet +" home care quality rating scale. The comprehensive scoring method was used to calculate the total score of each institution and the scores of structure, process and outcome dimensions.

Results

The overall average score of "Internet +" home care quality in 60 medical institutions was (87.04±5.32) (71.88-96.38). The average scores of structure, process and outcome dimensions were (17.02±2.94) (26.70±3.31) and (43.33±2.47), respectively. The overall average scores of "Internet +" home care quality in tertiary hospitals, secondary hospitals and community health service centers were (88.29±4.16) (87.13±6.48) and (81.90±4.76), respectively. The scoring rate of eight evaluation indicators was lower than 70%, mainly focusing on information system construction and security guarantee indicators.

Conclusion

The overall quality of "Internet +" home care in Zhejiang medical institutions is acceptable, but there are still some problems, such as insufficient information platform construction, incomplete responsibility ascribable mechanism and safety management system, insufficient self-protection awareness of some nurses, and low follow-up rates for service recipients. These areas should be prioritized for improvement in the future.

Practice and Prospects for the Construction of "Combination of General and Specialized disciplines" Characteristics in Communities Based on the Medical Alliance: Taking Fenglin Street Community Health Service Center in Xuhui District, Shanghai as an Example

LIN Qiyi, YANG Yunfeng, GU Wenqin, XU Liping, DING Hongjuan, SU Jin, ZHOU Peng, YI Chuntao

2025, 28(28):  3554-3557.  DOI: 10.12114/j.issn.1007-9572.2023.0460

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The primary entities in community medical activities are the community health service centers. Amidst the backdrop of new medical reforms, the community health service centers have continuously sought appropriate development strategies. The Fenglin Street Community Health Service Center in Xuhui District, Shanghai, has pioneered the "combination of general and specialized disciplines" model, merging general medicine with specialized disease management, which has significantly contributed to the advancement of core disciplinary areas and the enhancement of medical service standards. This paper provides a comprehensive summary of the "combination of general and specialized disciplines" practice in Fenglin, with the aim of offering insights and guidance to related grassroots medical institutions based on the findings.

A Study on the Influence of Health Education Based on the Know-Belief-Act Model and Self-efficacy Theory on the Consumption of Sugary Drinks among Grade 4 Elementary School Students

HUANG Lili, JIANG Yan, TANG Min, ZHANG Jialei, HE Jiabei, ZHUANG Jianlin

2025, 28(28):  3558-3565.  DOI: 10.12114/j.issn.1007-9572.2024.0140

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Background

Adolescents represent the future of a nation, and their current physical health status will significantly impact their health in adulthood. Currently, the intake of free sugars among children and adolescents is generally high, posing potential risks to their health.

Objective

To explore the impact of health education based on the Knowledge-Attitude-Practice (KAP) model and self-efficacy theory on the sugar-sweetened beverage (SSB) consumption behavior of fourth-grade primary school students. This study aimed to provide a theoretical basis for schools to implement health promotion actions and for relevant departments to formulate strategies for controlling SSB consumption.

Methods

From March to June 2023, a cluster randomized sampling method was employed. Two streets were randomly selected from the 10 sub-districts under Changning District in Shanghai, and one primary school was randomly selected from each of the chosen streets. Subsequently, the two schools were cluster-randomized into a control group (n=262) and an intervention group (n=230) using block randomization for a parallel controlled trial. The control group received routine health education, while the intervention group adopted a self-efficacy and KAP education model centered on a "Weekly Behavior Log for SSB Intake". The evaluation of the intervention effects was conducted using a standardized sugary beverage questionnaire designed by the Shanghai Center for Disease Control and Prevention, both before the intervention and four months after. This included basic knowledge about sugary beverages, weekly consumption of eight common types of drinks (carbonated beverages, freshly squeezed fruit juice, non-freshly squeezed fruit and vegetable juice drinks, plant protein-based packaged drinks, probiotic drinks, formulated milk beverages, tea drinks, and milk tea), as well as a self-efficacy scale related to health behaviors among adolescents (exercise control efficacy scale and dietary control efficacy scale) .

Results

A total of 492 participants were included in the study, with 262 in the control group and 230 in the intervention group. Regarding basic knowledge about sugary beverages, the intervention group had a statistically significant higher awareness compared to the control group on statements such as "Regularly drinking sugary beverages will not make me gain weight" and "Sugary beverages are the best choice for quenching thirst" (P<0.05). In terms of weekly consumption of eight common beverages, the frequency and consumption of carbonated drinks, freshly squeezed juice, non-freshly squeezed standardized fruit and vegetable juice, and yogurt drinks in the intervention group were lower compared to before the intervention (P<0.05). After the intervention, the comparison of weekly consumption of freshly squeezed juice, non-freshly squeezed standardized fruit and vegetable juice, and yogurt drinks between the control and intervention groups showed statistically significant differences (P<0.05). In terms of scores on the self-efficacy scale for health-related behaviors among adolescents, after the intervention, there were statistically significant differences between the control and intervention groups in the dietary control efficacy subscale scores and the overall self-efficacy score (P<0.05) ; the intervention group had higher scores in exercise efficacy, dietary control efficacy subscales, and overall self-efficacy after the intervention compared to before (P<0.05). After the intervention, the proportion of participants in the intervention group who reported not drinking or drinking less sugary beverages was significantly higher than that in the control group (P<0.05) .

Conclusion

Health education combining the KAP model and self-efficacy theory can improve students' knowledge, enhance their intention and ability to control SSB consumption, and facilitate the development of healthy habits and behaviors. This approach is worthy of further exploration in future practice and application.

Medication Counseling

Study on the Influencing Factors of Medication Adherence to Single-pill Combination Antihypertensive Drugs and Blood Pressure Control among Community Hypertension Patients

CHEN Danxiang, XIE Shu, WANG Li, ZHANG Hao, LI Xueqin

2025, 28(28):  3566-3572.  DOI: 10.12114/j.issn.1007-9572.2024.0070

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Background

Single-pill combination (SPC) for hypertension is an intensive treatment that can improve a patient's adherence to medication and antihypertensive efficiency. However, few studies have been conducted on the present status and factors that affect adherence to medication and blood pressure control rate in hypertensive patients in the community, who are taking SPC therapy in China.

Objective

The present study aims to determine the medication adherence and blood pressure control rate of community hypertension patients using SPC drugs in Huai'an, Jiangsu Province.

Methods

The present cross-sectional study was conducted by performing a questionnaire survey to investigate 387 hypertensive patients who took SPC antihypertensive drugs in Huai'an, Jiangsu Province, from June 2022 to December 2022. Multivariate Logistic regression was performed to analyze the factors for blood pressure control, and Pearson's correlation analysis was conducted to determine the relationship among medication adherence, self-efficacy, and medication satisfaction. A structural equation model was established for medication adherence and blood pressure control rate, with self-efficacy and medication satisfaction, in this population (SEM), in order to determine the path relationships among variables.

Results

The blood pressure control rate for the 387 hypertensive patients who took SPC drugs was 32.30%. Furthermore, the proportion of patients who were unmarried/divorced/widowed, and overweight or obese was significantly lower in the blood pressure controlled group, when compared to the blood pressure uncontrolled group (P<0.05). The questionnaire survey results revealed that the medication compliance, self-efficacy, and medication satisfaction scores were significantly higher for patients in the blood pressure controlled group, when compared to those in the blood pressure uncontrolled group [ (6.45±1.10) vs. (6.00±1.50), (32.10±6.65 ) vs. (30.65±6.66), and (52.45±8.83) vs. (48.27±11.85), respectively; P<0.001]. Furthermore, the multivariate Logistic regression analysis results indicated that overweight or obese (OR=1.717, 95%CI=1.058-2.787, P=0.029), medication adherence (OR=1.461, 95%CI=1.202-1.775, P<0.001), self-efficacy (OR=1.052, 95%CI=1.011-1.095, P=0.013), and medication satisfaction (OR=1.025, 95%CI=1.000-1.051, P=0.048) were the factors that affected the blood pressure control rate. The Pearson's correlation analysis results revealed a linear positive correlation among treatment adherence, self-efficacy, and medication satisfaction (r=0.294, 0.226 and 0.280, respectively; P<0.05). The SEM results revealed that both self-efficacy and medication satisfaction were positively correlated to adherence (path coefficient=0.29 and 0.13; P<0.05), and that adherence was positively correlated to the blood pressure control rate (path coefficient=0.15, P<0.05) .

Conclusion

The blood pressure control rate for community hypertensive patients who take SPC drugs remains low. Factors, such as overweight or obese, medication adherence, self-efficacy and medication satisfaction, can influence the blood pressure control rate. Improving the self-efficacy and medication satisfaction of community hypertensive patients who take SPC drugs can effectively improve the medication adherence of patients, and in turn, improve the blood pressure control rate.

Mechanistic Investigation of Kuntai Capsule in Endometriosis Treatment: a Network Pharmacology, Molecular Docking, and Molecular Dynamics Simulation Approach

LI Shanshan, SHEN Longhui

2025, 28(28):  3573-3582.  DOI: 10.12114/j.issn.1007-9572.2025.0051

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Background

Endometriosis (EMT) is a common gynecological disorder. Although Kuntai capsule has been shown to alleviate EMT-related symptoms, its pharmacological and molecular mechanisms remain to be systematically elucidated.

Objective

To explore the mechanism of action of Kuntai capsule in the treatment of EMT.

Methods

From January 1 to April 30, 2024, the active components and corresponding targets of Kuntai capsule were obtained from the TCMSP, BATMAN-TCM, Pubchem, and SwissTargetPrediction databases. EMT-related disease targets were retrieved from GeneCards, DisGeNET, TTD, OMIM, and Drugbank. A Venn diagram was employed to identify the intersection targets of Kuntai capsule and EMT. The disease-component-target network was constructed using Cytoscape, and the common target protein-protein interaction (PPI) network was built using the STRING database. Topological analysis of the PPI network was performed using Cytoscape to screen for core targets. Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed using the DAVID database. Molecular docking was performed with AutoDockTools. The stability of the optimal binding energy model was further validated using GROMACS molecular dynamics simulations.

Results

A total of 182 common targets were identified. The core components included sitosterol, panicolin, and rivularin. Among them, TNF, GAPDH, and AKT1 were found to play significant roles in the biological network of Kuntai capsule in treating EMT. These core targets were primarily involved in processes such as the negative regulation of apoptosis pathway and oncogenic pathway such as the PI3K-Akt signaling, which plays a ther-apeutic role in EMT. Molecular docking and molecular dynamics simulations further confirmed the stable and tight binding of sitosterol to AKT1.

Conclusion

Kuntai capsule may exert therapeutic effects in EMT by activating multiple signaling pathways through the regulation of core targets such as TNF. These findings not only enhance our understanding of the mechanism of action of Kuntai capsule but also provides new insights into the potential clinical applications of traditional Chinese medicine (TCM) in EMT treatment. Future research can further explore how TCM drugs can intervene in the pathological processes of EMT.

Research Methodology

Systematic Text Condensation and Interpretation

ZHANG Le, JING Chengyang, WU Xue, WANG Le, LIAO Xing

2025, 28(28):  3583-3589.  DOI: 10.12114/j.issn.1007-9572.2023.0584

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Systematic text condensation (STC) is a new type of qualitative data analysis method, which can analyze different types of qualitative data across cases. The method is intersubjective, which provides a reflective and actionable process for novice researchers while maintaining methodological rigor. STC includes the following steps: (1) total impression–from chaos to themes; (2) identifying and sorting meaning units–from themes to codes; (3) condensation–from code to meaning; (4) synthesizing–from condensation to descriptions and concepts. We made an introduction on the background, principles and process of the development of this analytical method and compared it with other qualitative data analysis methods, so as to provide a reference for medical qualitative researchers, especially for researchers in China.

Preliminary Development of a TCM Syndrome Evaluation Scale for Hashimoto's Thyroiditis with Normal Thyroid Function: Based on Expert Consultation and Clinical Survey

MA Wenyuan, QI Shuo, SHANG Jianwei, CHEN Xiaoheng, LI Zhe, LI Huilong, HU Rui, LI Lu, SI Xinying, DING Zhiguo

2025, 28(28):  3590-3600.  DOI: 10.12114/j.issn.1007-9572.2024.0167

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Background

The efficacy of traditional Chinese medicine (TCM) on the treatment of Hashimoto thyroiditis with normal thyroid function is increasingly pronounced. Under the current diagnosis and treatment mode combining both the disease itself and the relevant syndrome, TCM syndrome evaluation serves as an evaluation index that superiorly reflects the advantages of TCM. However, most clinical studies lack quantitative and standardized evaluation methods for the efficacy of TCM syndromes.

Objective

To preliminarily develop a TCM syndrome evaluation scale for Hashimoto's thyroiditis in patients with normal thyroid function.

Methods

The study period was from August to December 2023. Guided by the TCM theory and international scale development methods, a theoretical framework for developing a TCM syndrome evaluation scale for Hashimoto's thyroiditis in patients with normal thyroid function was established. An initial scale item pool was generated through literature review and preliminary clinical surveys by the research team. Items were refined using a combination analysis of subjective selection via the Delphi method and objective selection methods of item distribution, dispersion trends, Cronbach's alpha coefficient, and correlation coefficient analyses.

Results

A total of 22 valid questionnaires were collected in both rounds of expert consultation, making a total of 44 valid questionnaires, with the participation rate of 95.83% and 100.00%, respectively, and authority coefficient of 0.827 and 0.831, respectively. Eight key syndromes and 71 diagnostic information items associated with TCM syndrome evaluation were screened. A total of 369 valid questionnaires were collected from clinical surveys. Through the integration of four mathematical statistical methods and discussions with the expert panel, 5 items for Qi stagnation syndrome, 4 for Qi deficiency syndrome, 3 for Phlegm syndrome, 8 for Yin deficiency syndrome, 3 for Blood stasis syndrome, 6 for Yang deficiency syndrome, 5 for Fire (Heat) syndrome, and 2 for Blood deficiency syndrome were removed. A preliminary formation of the TCM syndrome evaluation scale for Hashimoto's thyroiditis in patients with normal thyroid function was yielded, containing 51 diagnostic items in eight syndromes: 9 items for Qi stagnation syndrome, 10 for Qi deficiency syndrome, 8 for Phlegm syndrome, 9 for Yin deficiency syndrome, 5 for Blood stasis syndrome, 13 for Yang deficiency syndrome, 8 for Fire (Heat) syndrome, and 8 for Blood deficiency syndrome.

Conclusion

This study has preliminarily developed a TCM syndrome evaluation scale for Hashimoto's thyroiditis with normal thyroid function, laying a foundation for the quantification of items and providing a methodological reference for the development of relevant scales.