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Background After being completely promoted for less than seven years, China's contracted family doctor service work still faces a number of development problems. The primary obstacle impeding the work of contracted family doctor service is an inadequate guarantee mechanism. There is an urgent need for scientific and reasonable policies on contracted family doctor service to guarantee the effective development of the work. Objective To quantitatively analyze the textual content of China's contracted family doctor service policies, to explore the focus and shortcomings of the existing policies, and to provide the basis and reference for the development and optimization of the subsequent contracted family doctor service policies. Methods Policy texts were collected by visiting the official websites of the China government and the National Health Commission of the People's Republic of China on 2023-01-10, and 15 policy texts on contracted family doctor service from 2015—2022 were selected to construct a three-dimensional analytical framework of policy tools-stakeholders-policy strength, to categorize, code, and analyze the policy documents. Results Supply-based, demand-based, and environment-based tools accounted for 30.5% (69/226), 19.0% (43/226), and 50.5% (114/226) of the policy tool dimension. Family doctors, contractors, non-contractors, primary medical and health care institutions, hospitals (secondary and above), and the government accounted for 29.2% (123/422), 14.7% (62/422), 9.2% (39/422), 21.3% (90/422), 13.3% (56/422), and 12.3% (52/422) of the stakeholder dimension. The average strength of China's contracted family doctor service policies was 2.2 points. In the cross-dimension of policy tools-stakeholders, the distribution of stakeholders in supply-based and environment-based tools was relatively poor. There were some sub-tools that were absent from the policy tools. In the cross-dimension of policy tools-policy strength, environment-oriented policy instruments were used more often as policy strength increased. In the cross-dimension of stakeholders-policy strength, there were large differences of the policy strength matching scores among various stakeholders. Family doctors had the highest score (311 points) with non-contractors the lowest score (90 points) . Conclusion From the perspective of policy tools, policy tools should be allocated rationally, with the weight of use continuously adjusted, the internal structure optimized, and the rationality of the distribution of policy tools among stakeholders improved. From the stakeholder's perspective, all stakeholders should be taken into account, their respective positions need to be clarified, and the demand of the non-contractors should be emphasized. From the perspective of policy strength, the policy supervision and management capacity ought to be strengthened to continuously improve the implementation of the policy of contracted family doctor service.

Background Contracted family doctor services were implemented as a key action to reform primary care services in China. At present, the coverage of contracting has expanded stably. But the family doctor teams' evaluation of contracted family doctor services is not clear, which also highlights a number of issues that require further improvement in the provision of the services. Objective To study the contracted family doctor services for family doctor teams and associated factors. Methods In October 2022, a combination of purposive sampling and stratified cluster sampling was used for selecting family doctor team members from southern, central, northern and eastern Guangxi to participate in a questionnaire survey. The survey was conducted on the included subjects by using the provider version of the Primary Care Assessment Tools (PCAT-PS) , which contains 8 dimensions and 43 items. Multivariate Logistic regression analysis was used to research the influencing factors of family doctor teams' perception of PACT-PS of the services. Results A total of 775 valid questionnaires were collected, with a valid response rate of 99.36%. The average score of the PCAT-PS of the family doctor team members was (32.55±3.90) . The dimensions with the relatively high score were family-centeredness and comprehensiveness, but the dimensions of first contact-access and ongoing care of the services had a relatively low-level perception. Multiple linear regression analysis showed that the type of organization, age, professional title, division of team responsibilities and working patterns were the factors that influence the PCAT-PS score of family doctor team members (P

Background 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. Objective 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. Methods 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. Results 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. Conclusion 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.

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

Background Since the comprehensive implementation of the contracted family doctor service in 2016, the willingness of residents to have their first contact in primary care has gradually increased, but the effectiveness evaluation of contracted residents' first contact in primary care needs to be further explored. Objective To understand the current status of contracted residents' first contact evaluation, explore its influencing factors and propose improvement strategies. Methods A multi-stage stratified random sampling method was used to select 54 community health service institutions/township health centers in three cities in Shandong Province, with a total of 4 000 contracted residents. The first contact dimension questionnaire of the Chinese version of the Primary Care Quality Assessment Scale (PCAT) was used to conduct the survey, comparing the first contact dimension scores of contracted residents with different characteristics and using multiple linear regression to analyse the factors affecting the first contact evaluation of contracted residents. Results A total of 3 859 valid questionnaires were collected, with the effective recovery rate of 96.48%. Among them, 2 086 (54.1%) were residents of township health centers and 1 773 (45.9%) were residents of community health centers; the total score of the first contact dimension in the three regions was 3.49, with the highest score being "Is your contracted institution open on Saturdays and Sundays?" (3.74) ; the item with the lowest score was "During non-business hours, if you were sick at night, would your contracted facility have a doctor or nurse available?" (3.05). The results of the multiple linear regression analysis showed that the contracted facility, personal monthly income, education level, marital status, occupation, physical health and diagnosis of chronic disease were the factors influencing the scores of the first contact dimension of contracted residents (P

Background The development of traditional Chinese medicine (TCM) has been listed as a national development strategy with vigorous improvement of TCM service capacity in primary care institutions as the important elements, however, there are few studies on the disease spectrum of TCM in community health service institutions. Objective To analysis the TCM disease spectrum in outpatient clinics of contracted residents by family doctors in Shenzhen community health service centers (abbreviated as CHSC) and understand the capability of TCM in Shenzhen health centers, thus providing a theoretical basis for promoting the development of TCM in primary care in China. Methods From May to June 2022, the records of outpatient consultations with treatment cost of 10 Shenzhen CHSCs from 2021-01-01 to 2021-06-30 were extracted by the unified information platform of the Health Commission of Shenzhen Municipality (Hangchuang Community Health Service Center Business System) . The 385 138 records with purpose of TCM treatment, matching diagnosis and treatment costs, first diagnosis can be coded in Classification and Codes of Diseases and ZHENG of Traditional Chinese Medicine (TCD) were collected. The disease spectrum was analyzed based on the classification of disease in TCD, mainly involving department categories, specialty system classifications, and TCM disease terms. Results A total of 385 138 records of TCM diagnosis and treatment were selected in this study, including 170 077 (44.16%) male cases and 215 061 (55.84%) female cases, with an average age of (36.7±9.4) years. All of the 7 TCD categories of disease spectrum were involved, including internal medicine accounting for 56.98% (219 445 cases) , pediatrics accounting for 20.56% (79 201 cases) , otolaryngology accounting for 12.45% (47 965 cases) , gynecology accounting for 7.95% (30 620 cases) , surgery accounting for 1.51% (5 797 cases) , orthopedics accounting for 0.37% (1 407 cases) and ophthalmology accounting for 0.18% (703 cases) . Apart from the specialty system classifications of tumor diseases, cancer diseases in each category, classifications of middle canthal disease, black eye disease, pupillary disease, traumatic eye disease in Ophthalmology, the disease spectrum involves all specialty system classifications in 7 categories. The cumulative diagnosis and treatment volume of several disease spectrums accounted for 90.00% of the total diagnosis and treatment in each category. The top 5 system diseases in the spectrum included respiratory system diseases accounting for 54.19% (208 701 cases) , musculoskeletal system diseases accounting for 19.05% (73 369 cases) , gynecological system diseases accounting for 7.95% (30 620 cases) , cardiovascular and cerebrovascular system diseases accounting for 7.15% (27 539 cases) , and the digestive system diseases accounting for 4.98% (19 162 cases) . Patients aged

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.

Background In recent years, with the development of mobile medicine and telemedicine technology, health management models such as Internet hospitals, online and offline cooperation have gradually become a development trend. However, the elderly have limitations in the use of "Internet+" technology, which affects the mobile health of the elderly, and develops a remote management model based on family members, helping improve the coverage and efficiency of health management for the elderly. Objective To construct an "Internet+" family nursing management model for the elderly, focusing on the contracting problem of the elderly in the context of contracted family doctor services. Methods From June 2020 to February 2021, the "Internet+" family nursing management model for the elderly was preliminarily formulated according to the policies related to the health management of the elderly, combined with domestic and foreign literature research and preliminary basic research. Applying the Delphi method, 15 experts were selected for two rounds of expert consultation, forming the final draft of the "Internet+" family nursing management model for the elderly. Results The positive coefficients of the two rounds of expert consultation were 100%, with the authority coefficients of 0.87 for both, and Kendall coordination coefficients of 0.253 and 0.226, respectively (P

Background 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. Objective 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. Methods 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. Results 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. Conclusion 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.

Background It is urgent to improve the effectiveness of contracted family doctor services due to high prevalence of problems such as uninformed contracting, and contracting but making no appointments. Objective To analyze the mechanism influencing the effectiveness of contracted family doctor services. Methods From September 2021 to January 2022, in-depth interviews were conducted with 24 family doctors, 8 institutional managers, and 25 contracted residents purposively sampled from Weifang, Heze, and Jinan of Shandong Province, using an interview guide regarding implementation status of relevant policies and their work status, performance distribution and supervision and management, and sense of gain obtained from the contracting and desired services, respectively. The grounded theory using three levels of coding was used to systematically analyze the mechanism affecting the effectiveness of contracted family doctor services. Results Through the coding, 90 concepts (such as "residents' weak health awareness"), 24 categories (such as "awareness of the contracting"), and 8 core categories (such as "capacity in primary care") were obtained. A theoretical model of mechanisms influencing the effectiveness of contracted family doctor services was constructed, mainly including the implementation deviation of policies related to contracted family doctor services, capacity of primary care, and characteristics of residents. Conclusion The effectiveness of contracted family doctor services is affected by the deviation in implementing relevant policies, the capacity of primary health services and characteristics of residents. Therefore, to improve the effectiveness of these services, it is necessary to optimize the implementation path of relevant policies, improve family doctors' capacities, and improve residents' health literacy level.

Enhancing doctor-patient trust is the key to improving medical service quality in the context of the general pracitce service system. This paper explores the doctor-patient trust in general practice services in depth based on doctor-patient trusted source model combining with literature analysis. It is concluded that the intensity of supervision of contracted services by the health administration, the facility environment of community health service institutions, the quality of services provided by general practitioners, and residents' own trust tendency are the key factors affecting the doctor-patient trust. From the perspective of the above four subjects, suggestions including strengthening the supervision of health administration, enhancing institutional trust, strengthening doctor-patient communication, enhancing interpersonal trust, and giving full play to residents' social supervision power are put forward in this paper, in order to improve the willingness to access primary health care services of residents and the quality of general practice services.

Background There is an issue of mismatch between supply and demand of medical care resources in China. The implementation of contracted family doctor services is an effective measure to address the issue, and to improve the hierarchical diagnosis and treatment system. Therefore, it is urgent to speed up the training and ensure the training quality of general practice workforce. Objective To develop a comprehensive and systematic general practitioner (GP) competency model after analyzing the concept and structural domains of competencies (including inner competencies) required for GPs to deliver contracted healthcare services, providing insights into the realization of training eligible GPs in terms of quantity and quality, and the improvement of quality and efficiency of contracted services. Methods From December 2020 to September 2021, we conducted in-depth, semi-structured interviews with 38 GPs from 10 medical institutions in four cities (Zhenjiang, Taizhou and Suzhou in Jiangsu Province, and Foshan in Guangdong Province) , then treated the interview results applying the three-level coding and theoretical saturation used in the grounded theory. After that, we developed a General Practitioner Competency Model. Results The model consists of 10 items, which belong to four domains: general care capability, humanistic practice capability, team cooperation capability, learning and development capability. General care capability and learning and development capability belong to external competencies, which represent the external performance and driving force of competencies, and determine the level of competencies of GPs to provide contracted services. Humanistic practice capability and team cooperation capability reflect the internal traits and competencies, which belong to the inner competencies, and determine the potential of GPs to provide contracted services. Conclusion The model developed by us is complete and comprehensive, in which the inner competencies of GPs have been fully explored, which may be contributive to the training of GPs delivering contracted services, and to the development of a GP competency assessment system using quantitative empirical methods.

Background Population aging is getting worse in our country. Family doctor contract service plays an important role in boosting the construction of hierarchical diagnosis and treatment system and establishing a reasonable and orderly medical order. Current research about family doctor contract service policy mainly focus on qualitative evaluation, and there are few researchers use tools to quantitatively evaluate each individual representative policy. Objective This study aims to quantitatively evaluate the pros and cons of six Chinese central government policies about family doctor contract service, thus, proposing strategies and measures to promote the high-quality development of our country's family doctor contract service, and helping the construction of healthy China. Methods We searched Peking University's PKULAW.com and websites of some relevant ministries of the State Council of China from January 1, 2015 to April 30, 2022. The key word was "family doctor". The software ROSTCM 6.0 was used for text mining. Based on the results, this study selected central government policies about family doctor contract services, then used the PMC index model to quantitatively evaluate these policies. Results This study included thirty-two policies based on inclusion and exclusion criteria. The top five high-frequency keywords in the field of family doctor services are "contract service" (n=274) , "health" (n=272) , "medical" (n=264) , "family doctor" (n=225) , and "contract" (n=180) . They were marked as P1-P6, respectively. In terms of methods and other aspects, the scores of each dimension are relatively high. The results of quantitative evaluation showed that the ranking of policies is P1>P3>P2>P6>P4>P5. Three policies were rated as excellent, the other three were rated as acceptable. The scores were relatively high in the policy content, policy nature, policy evaluation, policy field and policy role. Conclusion Our country's family doctor contract service policy had a relatively broad content and is relatively mature. It is suggested to pay attention to the combination of long-term, medium-term and short-term validity of the policies, improve incentive approaches from multiple perspectives, enhance the sense of professional honor of family doctors, and use a variety of policy tools and policy action.

Background The competencies of general practitioners (GPs) have become a basis for promoting the implementation of tiered diagnosis and treatment, and effective supply of primary healthcare services against the backdrop of the initiation and implementation of contracted services provided by GPs in primary care in China. The regular competency-based assessment systems with clear objectives and strong operability can positively stimulate GPs to provide contracted services with higher quality and efficiency. Objective To develop a competency rating scale for GPs, providing a tool applicable to scientific evaluation of GPs' competencies in China. Methods By use of a GP competency model, and review results of relevant studies and competency scales, the measurement items and the draft of the scale were developed, then were revised according to the results of a questionnaire survey conducted with GPs in primary care in major provincial administrative regions from April to August 2021. Among the 402 responders, the answers of 201 cases (sample A) were used for exploratory factor analysis, and those of the other 210 cases (sample B) were used for confirmatory factor analysis. Based on this, the reliability and validity of the final scale were tested. Results The final General Practitioner Competency Rating Scale includes four dimensions (general service competency, humanistic competency during practice, teamwork and cooperation competency, learning and development competency) and 21 items. The Cronbach's α for the scale, and the afore-mentioned four dimensions was 0.929, 0.877, 0.850, 0.812, and 0.811, respectively. The P-value of Bartlett's test of sphericity was less than 0.001 (approximate χ2=2 319.759, P

Background With the continuous progress of the New Medical Reform, contracting service by family physicians has increasingly become an important guarantee for the basic medical care and health of the people, and the agreements of family doctors' contracting service has become the premise of achieving "everyone has a family doctor". However, the standardization and binding force of the agreement still remain to be studied. Objective By analyzing the agreements of family doctors' contracting services, we expected to further standardize the contracting services and improve the standardized management level of the services contracted by family doctors. Methods According to the purpose of the survey, the contracting agreements of the 14 community health service centers were finally selected as subjects by random sampling among 1-3 community health service centers in each of the nine main districts of Chongqing in July 2021. The main analysis framework was based on the contracting subject, contracted service, contracting fee mechanism, and the rights and obligations of the contracting subject. Finally, descriptive analysis of the agreements was performed by means of content analysis. Results When compared the agreements in different districts, the contents of basic medical services and basic public health services were relatively similar (basic medical services included diagnosis and treatment services for common diseases, frequently occurring diseases and traditional Chinese medicine, etc., and basic public health services included establishing resident health files, providing health consultation, and vaccination, etc.) . There were differences in the terms of years of service, personalized services, etc. among family doctors in different regions of Chongqing: there were 12 agreements that specified a binding period of 1 year, 1 agreement whose duration was decided by the parties, and 1 agreement that did not specify the binding period. Among all agreements, the definition of the rights and obligations of contracting subjects and parties was vague. Among them, contracting subjects of 6 agreements included community health service centers, superior guidance hospitals, family doctors and representatives of heads of households or family representatives, 6 agreements included community health service centers, family doctors and representatives of heads of households or family representatives, 1 agreement included community health service centers and household heads, and 1 agreement did not specify the contracting subject. Conclusion It is necessary to further clarify the objects and agreements of contracting service, and improve the rights and obligations of the contracting subjects in Chongqing. Combined the experience of implementation of contracting services by family doctors of various regions, it is necessary to improve the performance effectiveness and the quality of the contracted services, and promote the implementation and development of the family doctors' contracting services.

Promoting contracted family doctor services is an important way to implement tiered diagnosis and treatment, and to safeguard people's health, as well as a cornerstone of achieving Health China 2030 goals. However, the development of this system is constrained by some problems, such as contracting a family doctor but making no appointments. Many countries have introduced competition mechanisms in the supply of contracted services in different degrees to enhance the quality of family doctor services. However, China is now lack of theoretical and empirical studies about introducing competition mechanisms inthe delivery of contracted family doctorservices. We reviewed the latest developments in theoretical and empirical studies involving the use of competitive mechanisms in the provision of contracted family doctor services, which will contribute to the study and implementation of family doctor system in China.

Background Since the full implementation of contracted family doctor services in 2016, we have achieved phased results. Further work needs to be paid equal attention to "quality" and "quantity", focusing on improving the residents' sense of service access and satisfaction, however, at present, the residents' evaluation of contracted family doctor services is not clear. Objective To investigate the contracted residents' evaluation for the continuity of family doctor contract, explore its influencing factors, and propose improvement strategies. Methods This study used a multi-stage stratified random sampling method to select 1 193 contracted residents from 9 community health service institutions and 9 township health centers in Heze City, Shandong Province in January 2021. A household survey was conducted on the included residents by using the continuity dimension of the Chinese version of the Primary Care Assessment Tools (PCAT) , which contains 15 items. We compared the PCAT-continuity dimension scores of contracted residents with different characteristics, and used multiple linear regression to analyze the factors influencing the PCAT-continuity dimension scores of contracted residents. Results A total of 1 098 valid questionnaires were collected, with a valid response rate of 92.04%. 541 (49.27%) of them were contracted to community health service institutions and 557 (50.73%) of them were contracted to township health centers. The average score of the PCAT-continuity dimension of the contracted residents was (3.38±0.51) . The item with the highest score was "Does your family doctor listen to you patiently", with a score of (3.64±0.59) . The item with the lowest score was "Would you be willing to change your family doctor if it was easy to do so", with a score of (2.98±0.92) . Multiple linear regression analysis showed that the type of contract organization, age, education, marital status, occupation, and chronic diseases were the factors that influence the PCAT-continuity dimension score of contracted residents (P

Background For building a healthy China, it is essential to expand the coverage of family doctor services. In young and middle-aged office building occupants, the rate of contracting family doctor services is low. Shanghai has taken the lead in exploring building-based family doctor services, and providing on-demand health management services. So it is particularly meaningful to study the health needs in young and middle-aged office building occupants. Objective To investigate the needs and associated factors of contracted family doctor services among young and middle-aged office building occupants in Shanghai. Methods A questionnaire survey was conducted from December 2019 to December 2020 with a cluster random sample of young and middle-aged office building occupants (aged 18-59 years) selected from representative office buildings in Shanghai's Hongkou District, Pudong New District, and Jing'an District of Shanghai for understanding their sociodemographic characteristics, health and healthcare-seeking conditions, knowledge of family doctor services, and needs of essential and personalized family doctor services. Multiple Logistic regression analysis was used to analyze the factors affecting the needs of family doctor services. Results In all, 2 366 cases attended the survey, and 2 272 of them (96.03%) who completed the survey effectively were included for analysis. Among them, 87.65% (1 874/2 138) had general, moderate or strong needs for essential family doctor services, and 70.59% (1 452/2 057) had needs for personalized family doctor services. Multiple Logistic regression analysis indicated that age, education level, self-assessed social class, understanding of one's own health, self-assessed health status, chronic disease prevalence, mental health status, preferred healthcare setting for treating common diseases, treatment experience in a community health institution, understanding of and degree of trust in a family doctor, and understanding of building-based family doctor services and the specific scope of the services were associated with the needs of essential family doctor services (P

Background Shanghai is gradually expanding the supply of family doctor contract service to building functional communities, but the prevalence of met needs of such services in young and middle-aged office building occupants is still unknown, and relevant studies on the prevalence and associated factors could inform the development and improvement of policies regarding building-based family doctor services. Objective To explore the prevalence of met needs for contracted family doctor services and associated factors in young and middle-aged office building occupants. Methods A questionnaire survey was implemented from December 2019 to December 2020 in the setting of office buildings selected by typical sampling from Hongkou District, Pudong New District and Jing'an District of Shanghai. Among the young and middle-aged occupants (n=2 272, 18-59 years old) selected from the buildings by use of cluster random sampling to attend the survey, 1 137 with an experience of using contracted family doctor services were determined as the participants. The survey involved four aspects, including sociodemographic and economic characteristics, health status, understanding level of contracted family doctor services, and met needs of these services (containing essential and personalized service needs assessed using a 5-point Likert scale). Multinomial and ordinal Logistic regression was used to analyze factors associated with met needs of contracted family doctor services. Results The prevalence of having needs of essential family doctor services considerably/completely met was 39.61% (425/1 073). And that of having needs of personalized family doctor services considerably/completely met was 39.01% (419/1 074). Multinomial and ordinal Logistic regression analysis revealed that registered place of household (Shanghai or not), occupation, annual income, self-rated health, understanding of the "1+1+1" type of contracted family doctor services, level of trust in family doctors, and evaluation of family doctors' service capabilities were associated with met needs of essential family doctor services (P

Background The prevalence of sub-health problems is increasing in young and middle-aged office building occupants, in which the percentage of mental health problems is on the rise. Shanghai took the lead in delivering family doctor services via the health station set in an office building in June 2018, but mental health in young and middle-aged people has not yet been insufficiently covered by the services. Objective To assess the prevalence of anxiety and influencing factors in young and middle-aged office building occupants in Shanghai. Methods A questionnaire survey for estimating anxiety prevalence was carried out in typically sampled office buildings from Hongkou District, Pudong New District and Jing'an District of Shanghai during December 2019 to December 2020. Cluster random sampling was used to sample young and middle-aged occupants (18-59 years old) in the buildings, and 2 198 cases of them who completed the survey were included as the participants for analysis. Anxiety was diagnosed by the score of the Zung's Self-Rating Anxiety Scale. Multiple linear regression was used to estimate the association of anxiety prevalence with socio-demographic and economic characteristics, and health status as well as lifestyle. Results Among the participants, the prevalence of no anxiety, mild, moderate and severe anxiety was 60.42% (1 328/2 198), 18.61% (409/2 198), 12.46% (274/2 198), and 8.51% (187/2 198), respectively. Multiple linear regression analysis found that registered place of household (Shanghai or not), education level, self-rated social class, self-rated health, frequency of physical examination, level of fatigue, chronic disease prevalence and regular medication were associated with anxiety prevalence (P

Abstract Background Improvement of health literacy constitutes a cornerstone to improving public health. However, the overall health literacy of Liangshan Yi Autonomous Prefecture (Liangshan Prefecture) in the southwest Sichuan Province of China has kept extremely low for a long time. How to improve health literacy of the Yi nationality residents is key to be urgently solved. Notably, Family Branch System is a distinctive patrilineal bloodline organization of Yi nationality, which plays an important role in the daily life of Yi nationality. Meanwhile, Contracted Family Doctor Services is conducted in Liangshan Prefecture. Therefore, this study proposes an intervention model of health education based on Family Branch System and Contracted Family Doctor Services, which is a Family-based Improvement for Health Literacy among the Yi nationality (FAMILY) in Liangshan, when improving traditional Innovative Care for Chronic Conditions Framework (ICCC) framework. Methods An open cohort stepped wedge cluster randomized trial design is used to implement health literacy education interventions including project preparation, core group building, promotion within family branch and competition between family branches while using Contracted Family Doctor Services as control measure. The study will be conducted among Yi nationality residents in Meigu County and Yanyuan County, with health literacy level of residents as the primary outcome. Finally, mixed-effects model and causal inference method will be used to evaluate intervention effect. Discussion This study highlights family, using the unique Family Branch System and Contracted Family Doctor Services in Liangshan Prefecture to design intervention among improved ICCC framework, and combines the mixed-effects model with complier average causal effects (CACE) to estimate the intervention effect under non-compliance for the first time. Besides, other key technologies to be adopted include construction of electronic questionnaire quality control system, with quality control based on artificial intelligence. This trial contributes to exploring an effective way to improve health literacy of Yi nationality residents in Liangshan Prefecture, which will provide reference for other areas, especially poor areas, to improve residents’ health literacy. Trial registration ISRCTN11299863 on June 1, 2022; https://www.isrctn.com/ .

Background In China, team-based service delivery model is a major emerging model for contracted family doctor services, but there is a lack of a tool for assessing the overall effectiveness of the family doctorteam. Objective To develop a IMOI model-based system for assessing the effectiveness of family doctor teams in Beijing, aiming at proving a tool for guiding the improvement and continuous development of the family doctor team. Methods The first draft of the Family Doctor Team Effectiveness Evaluation System (FDTEES) was developed using literature review and personal interview. Then the indicators of the system were assessed and revised according to consensuses of our analysis and the results of two rounds of consultations carried out between May and July 2021 using the Delphi technique (one was conducted with 24 experts, and the other with 21 experts) . The weight of the indicators of the system was determined by and analytic network process. Results The response rate of experts in the first, and second round of consultation was 87.5% (21/24) , and 100.0% (21/21) , respectively. The authority coefficients for the consultations ranged from 0.88 to 0.91. Kendall's W for the importance and applicability of the indicators of the FDTEES was 0.138 (P

The contracted family doctor services (CFDSs) is a key action selected to be implemented to deepen the reform of the pharmaceutical and healthcare system, enrich primary care services, and achieve the strategic goals of health China. Moreover, the implementation of CFDSs is a main approach to better safeguarding people's health. To effectively promote the development of CFDSs, China has successively launched various relevant supportive policies, and the local governments have been actively exploring practicing approaches. So far, remarkable results have been achieved nationwide, yet there are still many challenges, among which implementation difficulty is a major factor influencing further promotion of CFDSs. We analyzed the implementation process of CFDSs using Smith's policy implementation process model, and identified many barriers to the implementation of CFDSs, such as lack of rule of law, low level of policy executors, insufficient incentives, and impact of policy environment. In view of this, we put forward the following recommendations on exploring innovative policies for sustainable development of CFDSs: designing top-level policy objectives for CFDSs development from perspectives of law and system, improving qualities and professional identity of providers of CFDSs, establishing mutual trust between doctors and patients, and optimizing the policy implementation environment.

With the advancement and development of the family doctor system, family doctor teams have become a main provider of primary health services, which has raised new requirements for the evaluation of their services. We comprehensively reviewed recent developments in evaluation tools for family doctor teams: examples from the UK, the US, European countries, Australia and Canada have shown that traditional evaluation tools based on the structure-process-outcome model are being replaced by some models that focus more on the team's organizational environment, internal relationships, psychological state and continuous improvement. In China, the development of assessment tools for family doctor teams has been initiated recently, with major manifestations of various research approaches but lack of high-quality theoretical models, and high-quality reliability and validity tests. Moreover, the assessment tools are lack of diverse domains, and indicators for assessing team relationships, emotions and psychology as well as continuous improvement. On the basis of international experience, we recommend using the input-mediator-output-input model as a theoretical basis to develop highly applicable tools for assessing family doctor services in China.

BackgroundBurnout has become a prominent issue as the increase of workload in family doctor team members in primary healthcare institutions during the promotion of contracted family doctor services. There is still a lack of research comparing the differences in burnout among family doctor team members in different types of primary healthcare institutions.ObjectiveTo compare burnout prevalence and associated factors between family doctors in community/township health centers, and those in community health stations/village clinics, providing a basis for improving the mental health status and team stability of family doctors, as well as the quality of services provided by them.MethodsFrom August 1 to 21, 2020, a multistage cluster random sampling method was used to select 760 family doctor team members〔201 (26.4%) working at community/township health centers, and 559 (73.6%) working at community health stations/village clinics〕 as the participants from primary healthcare institutions in 6 counties/county-level cities /districts of Taian City, Shandong Province. They were invited to attend a survey to complete Demographic Questionnaire and the Chinese version of Maslach Burnout Inventory-General Survey (MBI-GS) .ResultsOverall, the prevalence of burnout among the participants was 68.9% (524/760) . Overall, the prevalence of burnout among the participants was 68.9% (524/760) , and the prevalence of burnoutof family doctor team members in community/township health centers and community health stations/village clinics was 63.7% (128/201) and 70.8% (396/559) , respectively. The levels of burnout of family doctor team members in community health stations/village clinics was higher than that of those in community/township health centers, with a statistically significant difference (P4 000 yuan is lower than that with monthly income

BackgroundImproving the effectiveness of a family doctor team, the main provider of primary healthcare, is an important means to enhance the effectiveness of community health services. The evaluation of team effectiveness has gained increasing attention.ObjectiveTo classify and summarize the assessment indicators and analyze the core dimensions of each indicator set regarding the effectiveness of a family doctor team using the input-mediator-output-input (IMOI) framework.MethodsStudies about the development of indictors for assessing the effectiveness of a family doctor team were systematically retrieved from databases of PubMed, CNKI, Wanfang Data and VIP from January 2000 to October 2020. Indicator mapping was used to classify and compare the indictors according to the structure of IMOI framework.ResultsFourteen studies were included, 4 of which were published abroad, and 10 in China. The indicators were classified using the IMOI framework: organizational environment, team building, and team member quality were classified as input (I) , team emergent state and team process were classified as mediator (M) ; service achievement and personal feedback were classified as output (O) , but no indicators were classified as input (I') .ConclusionThe qualities of theoretical models and research methods used for developing assessment indicators regarding the effectiveness of a family doctor team need to be improved. The assessment system developed based on the IMOI framework may be a good tool for evaluating team effectiveness, but the indicators need to be supplemented further.

BackgroundThe elderly residents in the mountainous area of northern Beijing have a high incidence of chronic diseases, a weak economic foundation, limited access to health knowledge, and a long distance from community health service institutions. At present, the team of family doctors in the mountainous area of northern Beijing is composed of community doctors and rural doctors. Both of them play an important role in contracting services for elderly residents in mountainous areas.ObjectiveTo explore the current status of family doctor contracted services in the northern mountain areas of Beijing and put forward appropriate suggestions on family doctor contracted services with the elderly residents in mountain areas.MethodsA combination of qualitative research and quantitative research was adopted. From September to October 2019, eight townships were selected in the northern mountain areas of Huairou District in Beijing. A total of 141 community doctors, 133 rural doctors and 345 elderly residents were selected proportionally from each township for questionnaire research. The elderly resident's questionnaires included basic information of the elderly, the way and the content of services which they want family doctor team to provide, the channels to obtain health consultation, and the satisfaction evaluation of the contracted services; the rural doctors and the community doctors' questionnaires included basic information, the use of internet in the contracted services, and the content of services provided to the elderly residents. During the same period, 16 cases of elderly residents, 24 cases of community doctors, and 24 cases of rural doctors were selected by using the purposive sampling method for personal in-depth interviews, in order to understand the level of awareness of the responsibilities of community doctors and rural doctors in the linkage contracted services, their views on the contracted services and the application of the internet in this service model, their suggestions on the development of the contracted services, etc. A content analysis method was used to analyse qualitative data.ResultsAccording to the quantitative research results, the top three services that elderly residents in the northern mountain areas of Beijing want the family doctor team to provide are ranked as follows: carrying out the health education in countryside〔199 (57.7%) 〕, physical examination in countryside〔197 (57.1%) 〕, the delivery of medical service and medicine in the countryside〔169 (49.0%) 〕; the top three ways or channels of services that elderly residents want the family doctor team to provide are ranked as follows: outpatient clinicservice, in-home medical services, organizing health education lectures in the community; the top three channels that elderly residents consider most effective to obtain health information are ranked as follows: publicity by rural doctors or loudspeaker in the village〔253 (73.33%) 〕, face-to-face publicity by community doctors during consultation〔134 (38.84%) 〕, posting and distribution of publicity materials〔126 (36.52%) 〕. The results of multiple linear regression analysis showed that service attitude, service effectiveness, service items, and communication ability were the influencing factors of elderly residents' satisfaction with community doctors and rural doctors' linkage contracted services (P0.05) . The qualitative research results showed that the elderly residents had low demand for online services and high dependence on rural doctors, but the technical level of rural doctors were limited, community doctors had little communication with elderly residents, and they mainly focused on the coordination of medical resources.ConclusionThe development of contracted services for elderly residents in the northern mountain areas of Beijing cannot be carried out without the joint efforts of community doctors and rural doctors. Currently, the elderly residents highly depend on rural doctors because of close-up services and show a great demand on community doctors for high-level technology and medical resources platform. It's recommended to take the needs of elderly residents as the guide, give full play to the advantages of rural doctors in terms of location and people, and the advantages of community doctors' technology and platform, and optimize the effectiveness of community doctors and rural doctors' linkage contracted services.

BackgroundTreatment adherence is closely related to disease control for patients with diabetes. Primary care is general, and continuous, which may satisfy the general and continuous healthcare needs of diabetic patients. But the association of core values of general practices with adherence of diabetic patients is not yet clear.ObjectiveTo explore the effect of core values of general practice (first contact/first line care, continuity, accessibility, comprehensiveness, coordination and patient-oriented) on the adherence (medication adherence, diet adherence, exercise adherence, self-monitoring adherence and regular hospital visits adherence) of type 2 diabetic patients, providing a reference for improving the adherence of such patients by precisely enhancing the core values of general practices.MethodsA survey was conducted between August and September 2019 with a convenience sample of type 2 diabetics receiving contacted family doctor services from Shayuan Community Health Center of Guangzhou using a questionnaire consisting of three parts〔demographic information, the Chinese version of Primary Care Assessment Survey (ASPC) , and Adherence to Out-of-hospital Treatment of Type 2 Diabetics (AOTTD) 〕. Treatment adherence was compared by various personal factors. Multiple linear regression was used to analyze the association of the core values of general practice with treatment adherence.ResultsAltogether, 224 cases who handed in responsive questionnaires were included for final analysis. The average scores of AOTTD, and ASPC of the respondents were (80.57±11.27) and (72.95±11.40) , respectively. The scores of AOTTD differed significantly by sex and understanding level of type 2 diabetes (P

To investigate community residents’ perception of specialist doctors’ participation in family doctor contract service, this study conducted a random sample survey based on residents from three community health service centers in South Anhui, Central Anhui and North Anhui. We investigate the general status of community residents, family doctor signing and access to services. It also focuses on residents’ awareness and demand for specialist doctors in core hospitals of medical alliances participating in contracted family doctor services. Among 1 279 community residents, 686 signed the contract with a signing rate of 53.6%. 64.11% of the residents were willing to signup with the family doctor team involving specialist doctors from the medical alliance. The decision to sign, the understanding of the medical alliance and its specific region were the influencing factors of whether the community residents were willing to sign family doctor service with medical alliance specialists. The top three services contracted residents received were “establishing health records” (97.38%), “health testing” (85.28%) and “telephone follow - up” (76.97%). The top three demands of community residents in this service are “treatment of common diseases” (71.07%), “healthcare guidance” (67.63%) and "prevention and treatment of chronic diseases” (63.72%). We suggest strengthening the publicity, promoting the integration of medical prevention and treatment and building a long -term mechanism for specialized doctors in medical alliances to participate in the contracted service of family doctors. [ABSTRACT FROM AUTHOR]

Background: Improvement of health literacy constitutes a cornerstone to improving public health. However, the overall health literacy of Liangshan Yi Autonomous Prefecture (Liangshan Prefecture) in the southwest Sichuan Province of China has kept extremely low for a long time. How to improve health literacy of the Yi nationality residents is key to be urgently solved. Notably, Family Branch System is a distinctive patrilineal bloodline organization of Yi nationality, which plays an important role in the daily life of Yi nationality. Meanwhile, Contracted Family Doctor Services is conducted in Liangshan Prefecture. Therefore, this study proposes an intervention model of health education based on Family Branch System and Contracted Family Doctor Services, which is a Family-based Improvement for Health Literacy among the Yi nationality (FAMILY) in Liangshan, when improving traditional Innovative Care for Chronic Conditions Framework (ICCC) framework.Methods: An open cohort stepped wedge cluster randomized trial design is used to implement health literacy education interventions including project preparation, core group building, promotion within family branch and competition between family branches while using Contracted Family Doctor Services as control measure. The study will be conducted among Yi nationality residents in Meigu County and Yanyuan County, with health literacy level of residents as the primary outcome. Finally, mixed-effects model and causal inference method will be used to evaluate intervention effect.Discussion: This study highlights family, using the unique Family Branch System and Contracted Family Doctor Services in Liangshan Prefecture to design intervention among improved ICCC framework, and combines the mixed-effects model with complier average causal effects (CACE) to estimate the intervention effect under non-compliance for the first time. Besides, other key technologies to be adopted include construction of electronic questionnaire quality control system, with quality control based on artificial intelligence. This trial contributes to exploring an effective way to improve health literacy of Yi nationality residents in Liangshan Prefecture, which will provide reference for other areas, especially poor areas, to improve residents' health literacy.Trial Registration: ISRCTN11299863 on June 1, 2022; https://www.isrctn.com/ . [ABSTRACT FROM AUTHOR]