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Background Graded diagnosis and treatment is one of the main goals of medical reform. In 2015, the General Office of the State Council issued the"Guiding Opinions on Promoting the Construction of Graded Diagnosis and Treatment System" (Guo Ban Fa[2015]No. 70), which stated that in 2017, the proportion of diagnosis and treatment in grassroots medical institutions was over 65.0%, but that proportion was 54.2% that year, and in recent years, it has shown an overall downward trend. Previous literature has mostly focused on the demand side (patients) for research, while as one of the suppliers of graded diagnosis and treatment, there have been few surveys on the willingness of general practitioners to participate in graded diagnosis and treatment. Objective This article aims to take Suzhou City as an example to investigate and study the willingness of general practitioners to participate in graded diagnosis and treatment, analyze its influencing factors, and provide suggestions to improve the willingness of general practitioners to participate in graded diagnosis and treatment, providing reference for formulating policies related to graded diagnosis and treatment. Methods In June 2022, a multi-stage convenient sampling method was adopted to select 1 451 general practitioners from 175 grassroots medical and health institutions (hereinafter referred to as grassroots institutions) in 4 counties and 6 districts of Suzhou City. A self-developed survey questionnaire was used to conduct the survey. The questionnaire includes the survey of general practitioners' basic situation (demography characteristics), survey of general practitioners' willingness to participate in hierarchical diagnosis and treatment (this part of the questionnaire is based on the expanded model of influencing factors of general practitioners' willingness to participate in hierarchical diagnosis and treatment, which is a fusion model of theory of planned behavior (TPB) and technology acceptance model (TAM) combined with Document retrieval and interview collection content). According to the survey results, use structural equation model SEM analysis to test the influencing factors of general practitioners' willingness to participate in graded diagnosis and treatment, expand the model's fit, and determine the model's fit effect. Exploratory factor analysis was used to calculate the weight (influence) of each influencing factor of general practitioners' willingness to participate in graded diagnosis and treatment, and to build a Relational model of influencing factors of general practitioners' willingness to participate in graded diagnosis and treatment. Results One thousand four hundred and fifty-one general practitioners participated in this questionnaire survey, and 1 302 valid questionnaires were collected, with an effective rate of 89.73%. The expanded model of influencing factors on the willingness of general practitioners to participate in graded diagnosis and treatment is well fitted. In the influencing factors of general practitioners' willingness to participate in graded diagnosis and treatment, participation attitude, subjective norms, and perceived behavioral control jointly affect the willingness of general practitioners to participate in graded diagnosis and treatment, with weights of 46.22%, 9.75%, and 44.02%, respectively. Perceived benefits and perceived usefulness jointly explain participation attitudes, with weights of 15.14% and 31.08% respectively. Disposable resources and expected resistance jointly explain perceptual behavioral control, with weights of 27.07% and 16.95%, respectively. Conclusion The degree of recognition of the medical service capabilities of higher-level hospitals by general practitioners, the complexity of referral procedures, and the degree of openness of medical resources from higher-level hospitals to general practitioners have a significant impact on the willingness of general practitioners to participate in graded diagnosis and treatment. It is recommended to strengthen communication and interaction among personnel within the medical association at the administrative, organizational, and personal levels, and use information technology to simplify referral processes and procedures Encourage higher-level hospitals to provide targeted and quantitative access to medical resources such as outpatient number sources and ward beds for general practitioners, and take various measures to increase their willingness to participate in graded diagnosis and treatment.

Abstract Introduction Non-ophthalmologists often lack sufficient operational training to use a direct ophthalmoscope proficiently, resulting in a global deficit of basic ophthalmological skills among general practitioners. This deficiency hampers the timely diagnosis, referral, and intervention of patients. Consequently, the optimization of teaching tools and methods to enhance teaching efficiency is imperative. This study explores the effectiveness of the Eyesi Direct Ophthalmoscope Simulator (Eyesi) as an innovative tool for fundus examination training. Methods Medical undergraduates were randomly assigned to Group A or B (n = 168). All participants completed a pre-training questionnaire. Group A received Eyesi training, while Group B underwent traditional direct ophthalmoscope (TDO) training. Subsequently, participants answered questionnaires relevant to their respective training methods. Both groups exchanged training tools and completed a summary questionnaire. Results After training, 54.17% of participants believed that images presented by the Eyesi were consistent with the real fundus. Group A scored significantly higher than Group B in fundus structure recognition and self-confidence in examination. The degree of mastery over fundus theory score increased from 6.10 ± 0.13 to 7.74 ± 0.16 (P

Background Community health service center is the main gatekeeper for breast cancer screening, while its efficacy of screening is difficult to guarantee for the re-striction of screening process by various factors. Objective To analyze the focus issue of breast cancer screening program in the real world and explore corresponding solutions. Methods A mixed-methods convergent design was used to collect quantitative and quali-tative data. In the quantitative study, typical sampling method was used to select one community health service center in each of the four districts of Tianjin as the investigation institution from April 2021 to November 2022, accidental sampling method was used to select age-eligible women within 3 km of the four institutions as resident survey respondents, so as to explore the issues existing in the on-site operation of breast cancer screening. In the qualitative study, 9 residents, 12 physicians participating in the screening and 4 leaders were selected through purposive sampling from June to November 2022 for semi-structured in-terviews. The grounded theory was used to analyze the interview content, and the grounded theory framework of the focus issues of breast cancer screening was plotted. Combined with literature and typical investigation data, a mixed methods study was conducted to determine the focus issues of breast cancer screening. Results The quantitative study showed that in the advocacy work, the promotion method is traditional, the awareness rate and participation rate of residents was 46.3% (143/309) and 32.4% (100/309) , respectively; in the screening work, the institutions invested different human and material resources, and the average waiting time of screening residents accounted for 62.2% (40.5/65.1) of the total time; in the follow-up and referral work, the invested human and material resources were little, the mammography referral compliance of residents was 29.9% (59/197) . The qualitative study showed that a total of 38 comprehensive open codes were formed in the interview and converged into 10 axial codes and 3 core codes, including advocacy organization, screening organization, follow-up and referral. The mixed methods study showed that 3 focus issues were identified in final, including how to improve residents' participation rate, how to ensure adequate human and material resources in screening institutions, and how to improve residents' mammography referral compliance. Conclusion The efficacy of breast cancer screening is influenced by advocacy organization, screening organization, follow-up and referral. It is necessary to rationally allocate resources to ensure adequate human and material resources for screening institutions; innovate promotion methods, expand coverage of promotion and improve residents' health literacy, participation rates and mammography referral compliance, to ensure the substantial progress of breast cancer screening and provide reference for opti-mizing the efficacy of breast cancer screening.

Background Due to many barriers, it is difficult for primary medical institutions to ensure substantial achievements in breast cancer screening. So it is particularly important to establish a system for scientifically and effectively assessing the capacities of primary care institutions in conducting breast cancer screening. Objective To construct a system for assessing the capacities of primary care institutions for conducting breast cancer screening. Methods From September to October 2022, through literature review and group discussion, we developed an item pool of the initial version of Breast Cancer Screening Capacity Assessment System for Primary Care Institutions (BCSCASPCI) . Then we conducted an online Delphi survey between November and December 2022 using a self-developed questionnaire with a purposive sample of 21 experts for understanding their views regarding the initial version of BCSCASPCI, and the response coefficient, authority coefficient, and the Kendall's W of the survey were calculated. Finally, based on the results of the survey and a group discussion, the final version of the BCSCASPCI was determined. The Analytic Hierarchy Process was used to determine the weight coefficients of its indicators and to examine the logical consistency of indicators. Results All the experts returned effective questionnaires, achieving a response rate of 100.0%, and the authority coefficient was 0.812, and the Kendall's W was 0.209 (P

Introduction: Non-ophthalmologists often lack sufficient operational training to use a direct ophthalmoscope proficiently, resulting in a global deficit of basic ophthalmological skills among general practitioners. This deficiency hampers the timely diagnosis, referral, and intervention of patients. Consequently, the optimization of teaching tools and methods to enhance teaching efficiency is imperative. This study explores the effectiveness of the Eyesi Direct Ophthalmoscope Simulator (Eyesi) as an innovative tool for fundus examination training. Methods: Medical undergraduates were randomly assigned to Group A or B (n = 168). All participants completed a pre-training questionnaire. Group A received Eyesi training, while Group B underwent traditional direct ophthalmoscope (TDO) training. Subsequently, participants answered questionnaires relevant to their respective training methods. Both groups exchanged training tools and completed a summary questionnaire. Results: After training, 54.17% of participants believed that images presented by the Eyesi were consistent with the real fundus. Group A scored significantly higher than Group B in fundus structure recognition and self-confidence in examination. The degree of mastery over fundus theory score increased from 6.10 ± 0.13 to 7.74 ± 0.16 (P < 0.001) in Group A, but Group B did not demonstrate a significant difference. We also compared undergraduates' tendencies for different learning purposes, 75.59% of participants preferred the Eyesi to TDO as a training tool, and 88.41% of participants were receptive to introducing the Eyesi in training. Conclusion: According to subjective participant feedback, Eyesi outperformed TDO in fundus observation, operational practice, and theoretical learning. It effectively equips undergraduates with fundus examination skills, potentially promoting the use of direct ophthalmoscopes in primary medical institutions. [ABSTRACT FROM AUTHOR]

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

Objective To understand the current situation of nosocomial infection management in primary medical institutions in Guizhou Province, and to provide reference for standardizing the professional development of nosocomial infection management in primary medical institutions. Methods By using the method of electronic questionnaire survey, the management of nosocomial infection in primary medical institutions in Guizhou Province from April 1 to 30, 2022 was investigated, and 611 valid questionnaires were retrieved. Results Among the 611 primary health care institutions, 401 medical institutions set up nosocomial infection committees, 149 medical institutions set up independent nosocomial infection management departments, 321 medical institutions were equipped with full-time staff for nosocomial infection management, and 573 medical institutions were equipped with part-time staff for nosocomial infection management. In total, 321 primary health care institutions were equipped with 334 full-time staff for nosocomial infection management. The average age was (35.19±8.57) years old, the gender was mainly female, the major was nursing, and the degree was bachelor degree or below. The management of nosocomial infection in different types of primary health care institutions was compared and analyzed, and there were differences in age, professional background, educational background, and working years of nosocomial infection department (P < 0.05). The focus of the full-time staff of nosocomial infection management was the issue of salary. Conclusion The construction of the organizational structure of nosocomial infection management in private grass -roots medical institutions in Guizhou Province needs to be strengthened, and some full-time staff are engaged in nosocomial infection management for a short time, so they need to strengthen their ability and training. [ABSTRACT FROM AUTHOR]

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BackgroundThe implementation of family doctor contract service is a pivotal measure to enhance primary medical services and execute the hierarchical diagnosis and treatment system. Achieving service coordination among various institutions is both a fundamental objective and a central element of contract services.ObjectiveThe study aims to assess residents’ evaluations and determining factors related to the coordination of health services within primary medical institutions across different regions of Shandong Province. The findings intend to serve as a reference for enhancing the coordination services offered by these institutions.MethodsThe study employed a multi-stage stratified random sampling method to select three prefecture-level cities in Shandong Province with different economic levels. Within each city, three counties (districts) were randomly sampled using the same method. Within each county (district), three community health service centers and township health centers implementing family doctor contract services were selected randomly. Face-to-face questionnaire surveys were conducted with contracted residents using the coordination dimension of the revised Primary Care Assessment Tools Scale (PCAT) developed by the research team. Data analysis was conducted using such methods as one-way analysis of variance and multiple linear regression.ResultsThe sample included 3,859 contracted residents. The coordination dimension score of primary medical institutions averaged 3.41 ± 0.18, with the referral service sub-dimension scoring 3.60 ± 0.58 and the information system sub-dimension scoring 3.34 ± 0.65. The overall score of the referral service sub-dimension surpassed that of the information system sub-dimension. Regression results indicated that the city’s economic status, the type of contracted institutions, gender, education, marital status, income, occupation, health status, and endowment insurance payment status significantly influenced the coordinated service score of primary medical institutions (p

BackgroundThe cloud-based platform for electrocardiography (ECG) analysis plays a supporting role in the prevention and treatment of cardiovascular diseases. During the construction of a cloud-based platform for ECG analysis, problems that should be focused and addressed are exploring ways to better use artificial intelligence (AI) technologies supporting ECG analysis, and improving the process and effectiveness of AI-aided diagnosis of a critical ECG.ObjectiveTo explore the use of AI technologies in a cloud-based platform for ECG analysis to support the diagnosis of a critical ECG in primary care.MethodsThe 12-lead resting ECGs (n=20 808) uploaded to Nalong Cloud-based ECG Analysis Platform by primary healthcare institutions were selected from June 2019 to June 2021. After being interpreted by AI-based algorithms and physicians, respectively, ECG findings were classified into critical group (critical ECGs) , normal group (normal ECGs) , and positive group (abnormal but not critical ECGs) . The results interpreted by the AI-based algorithm were compared with those interpreted by physicians (defined as the gold standard) to assess the diagnostic agreement and coincidence rate between AI-based and physician-based interpretations, and to assess the diagnostic sensitivity, and positive predictive value of AI-based interpretation. And the mean time for making diagnoses of three groups of ECGs was calculated.ResultsBy the AI-based interpretation, 619, 15 634 and 45 55 ECGs were included in the critical, positive, and normal groups, respectively. And by the physician-based interpretation, 619, 15 759 and 4 430 ECGs were included in the critical, positive, and normal groups, respectively. There was high agreement between AI-based and physician-based interpretation results of ECGs〔Kappa=0.984, 95%CI (0.982, 0.987) , P

The aging of the population is unstoppable, and chronic non-communicable diseases have become a public health problem that seriously affects people's health and safety. As an age-related chronic disease, osteoporosis has the characteristics of high incidence rate, high disability rate, high medical expenses, long course of treatment, long course of treatment and low quality of life, there’s still not enough social focus. As an important part of China’s medical system, primary medical institutions plays a vital role in the prevention and treatment of osteoporosis. However, in the process of prevention and treatment, there are still some problems, such as low awareness rate, unclear drug choice, unclear self-orientation, unestablished medical information sharing platform and primary medical institutions to be improved. Based on the actual situation and characteristics of primary medical institutions, this paper holds that the prevention and treatment model of integrated Chinese and Western medicine is the key, and puts forward the six-word policy of “Nutrition, Sunshine and sports”, it is suggested that the development of disciplines and academic organizations should be continuously promoted, public health education and primary health care Continuing education should be strengthened, and osteoporosis should be included in the management of chronic diseases and classified diagnosis and treatment should be promoted, to achieve overall management and integrated management. [ABSTRACT FROM AUTHOR]

ObjectivesBased on the background of the implementation of graded diagnosis and treatment policy (GDT) in China, this paper studied the service optimization of primary medical institutions from the perspective of the primary medical treatment rate.MethodsFirst, the difference-in-difference (DID) empirical strategy is used to analyze the impact of the implementation of the GDT on the improvement of the primary medical attendance rate, and the parallel trend test and the placebo test were used to test the robustness to illustrate the necessity of policy implementation. Second, combined with customer value theory, this paper used a logistic regression model to study the impact of customer value perception on grassroots medical care.ResultsThe implementation of the GDT can indeed improve the rate of primary care (p = 0.028), but the impact is relatively small (0.042). From the perspective of value perception hierarchy, emotional value perception (p < 0.05) is the key factor that affects the behavior of grassroots medical treatment at this stage.ConclusionThis paper fills the gaps in existing research, including empirical research on the grassroots medical treatment behavior of the masses under GDT and the impact of value perception on grassroots medical behavior. Furthermore, the recommendations are made for primary care institutions based on the results of the analysis, which promote the advancement of primary care services in China.

Objective: Traditional Chinese medicine (TCM) injection is widely used, but its adverse drug reaction (ADR) may be a serious public health concern in primary medical institutions. This research will explore the safety of TCM injections and provide clinical recommendations at the primary medical institutions. Method: ADR data were collected by the Henan Adverse Drug Reaction Monitoring Center from 2016 to 2020 were analized Descriptive statistics, chi-square analysis, binary logistic regression, and Mantel-haenszel hierarchical analysis were used to identify the risk factors associated with the rational use of TCM injections in primary medical institutions. Results: A total of 30,839 cases were collected in this study, 4905 cases (15.90%) were SADRs. Patients using TCM injections in primary medical institutions were more likely to cause SADRs (OR = 1.149, 95% CI: 1.061–1.245). Aged over 60 years (OR = 1.105, 95% CI: 1.007–1.212), non-essential drugs (OR = 1.292, 95% CI: 1.173–1.424), autumn (OR = 1.194, 95% CI: 1.075–1.326) and TCM injections with safflower (OR = 1.402, 95% CI: 1.152–1.706), danshen (OR = 1.456, 95% CI: 1.068–1.984) and medication reasons with chemotherapy (OR = 2.523, 95% CI: 1.182–5.386) and hypertension (OR = 1.495, 95% CI: 1.001–2.233) were more likely to suffer SADR in primary medical institutions. Conclusion: In general, the number of reported cases of TCM injection was declining over time, but the proportion of SADRs in primary medical institutions increased. In the future, it is necessary to continue to restrict TCM injections at the macro policy level, and vigorously promote the varieties in the essential drug list. At the micro level, it is necessary to intervene in specific populations, specific diseases and specific drugs, first start with them, step by step, and effectively prevent SADR occurrences in primary medical institutions. [ABSTRACT FROM AUTHOR]

BackgroundThe Chinese hierarchical treatment system expects patients to first visit primary medical institutions (PMIs), and patients' willingness determined their utilization of primary health care. The aim of this study was to explore the factors associated with patients' willingness to make their first visit to PMIs.MethodsWe employed multistage stratified sampling and convenience sampling to administer questionnaires to 1,507 patients in Beijing, Qinghai, and Fujian. Patients' willingness of first visit in PMIs was analyzed using Chi-square test and binary logistic regression.ResultsOf the 1,507 participants in the survey, 55.1% were willing to make their first visit in PMIs. Fewer patients in Beijing (17.6%) are willing to make their first visit in PMIs than those in Qinghai (71.9%) and Fujian provinces (72.0%). Binary logistic regression analysis revealed that higher recognition of the community first visit policy and higher satisfaction with the medical technology of PMIs are associated with patients' willingness of first visit in PMIs.ConclusionsDue to differences in local economic conditions, medical resources, and policy formulation, there are differences among provinces in patients' willingness of first visit in PMIs. To increase patients' rate of visits in PMIs, it is important to improve service capacity and quality of PMIs and change residents' attitudes for PMIs.

Objective: Traditional Chinese medicine (TCM) injection is widely used, but its adverse drug reaction (ADR) may be a serious public health concern in primary medical institutions. This research will explore the safety of TCM injections and provide clinical recommendations at the primary medical institutions.Method: ADR data were collected by the Henan Adverse Drug Reaction Monitoring Center from 2016 to 2020 were analized Descriptive statistics, chi-square analysis, binary logistic regression, and Mantel-haenszel hierarchical analysis were used to identify the risk factors associated with the rational use of TCM injections in primary medical institutions.Results: A total of 30,839 cases were collected in this study, 4905 cases (15.90%) were SADRs. Patients using TCM injections in primary medical institutions were more likely to cause SADRs (OR = 1.149, 95% CI: 1.061–1.245). Aged over 60 years (OR = 1.105, 95% CI: 1.007–1.212), non-essential drugs (OR = 1.292, 95% CI: 1.173–1.424), autumn (OR = 1.194, 95% CI: 1.075–1.326) and TCM injections with safflower (OR = 1.402, 95% CI: 1.152–1.706), danshen (OR = 1.456, 95% CI: 1.068–1.984) and medication reasons with chemotherapy (OR = 2.523, 95% CI: 1.182–5.386) and hypertension (OR = 1.495, 95% CI: 1.001–2.233) were more likely to suffer SADR in primary medical institutions.Conclusion: In general, the number of reported cases of TCM injection was declining over time, but the proportion of SADRs in primary medical institutions increased. In the future, it is necessary to continue to restrict TCM injections at the macro policy level, and vigorously promote the varieties in the essential drug list. At the micro level, it is necessary to intervene in specific populations, specific diseases and specific drugs, first start with them, step by step, and effectively prevent SADR occurrences in primary medical institutions.

Background: The implementation of family doctor contract service is a pivotal measure to enhance primary medical services and execute the hierarchical diagnosis and treatment system. Achieving service coordination among various institutions is both a fundamental objective and a central element of contract services., Objective: The study aims to assess residents' evaluations and determining factors related to the coordination of health services within primary medical institutions across different regions of Shandong Province. The findings intend to serve as a reference for enhancing the coordination services offered by these institutions., Methods: The study employed a multi-stage stratified random sampling method to select three prefecture-level cities in Shandong Province with different economic levels. Within each city, three counties (districts) were randomly sampled using the same method. Within each county (district), three community health service centers and township health centers implementing family doctor contract services were selected randomly. Face-to-face questionnaire surveys were conducted with contracted residents using the coordination dimension of the revised Primary Care Assessment Tools Scale (PCAT) developed by the research team. Data analysis was conducted using such methods as one-way analysis of variance and multiple linear regression., Results: The sample included 3,859 contracted residents. The coordination dimension score of primary medical institutions averaged 3.41 ± 0.18, with the referral service sub-dimension scoring 3.60 ± 0.58 and the information system sub-dimension scoring 3.34 ± 0.65. The overall score of the referral service sub-dimension surpassed that of the information system sub-dimension. Regression results indicated that the city's economic status, the type of contracted institutions, gender, education, marital status, income, occupation, health status, and endowment insurance payment status significantly influenced the coordinated service score of primary medical institutions ( p  < 0.05)., Conclusion: The coordination of primary medical institutions in Shandong Province warrants further optimization. Continued efforts should focus on refining the referral system, expediting information infrastructure development, enhancing the service standards of primary medical institutions, and fostering resident trust. These measures aim to advance the implementation of the hierarchical diagnosis and treatment and two-way referral system., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Xu, Xu, Jiang, Peng, Wu, Lang, Zhou, Ma, Chen, Yin and Yu.)

Primary medical institutions are the forefront of the diagnosis and treatment of osteoporosis. In order to solve the problems of diagnosis, treatment, and management in the process of prevention and treatment of osteoporosis in primary medical institutions, experts have compiled expert consensus on diagnosis and treatment of osteoporosis in primary medical institutions (2021) to provide reference for clinical diagnosis and treatment of osteoporosis in primary medical institutions organized by the Expert Consensus Committee on Diagnosis and Treatment of Osteoporosis in Primary Medical Institutions of China Health Promotion Foundation. The consensus indicates that osteoporosis is a systemic bone disease characterized by low bone mass, damage of bone microstructure, increase of bone fragility and easy fracture, which can be divided into primary and secondary . It is recommended that primary medical institutions conduct preliminary screening using high risk factors of osteoporosis and simple screening tools. The diagnosis of osteoporosis includes high-risk population, clinical diagnosis, and differential diagnosis. The treatment of osteoporosis includes lifestyle adjustment, basic treatment, oral and external treatment of traditional Chinese medicine, integrated traditional Chinese and Western medicine, exercise, fracture treatment, and efficacy judgment. The management of primary osteoporosis can start from population screening, data filing, hierarchical diagnosis and treatment, two-way referral, standardized treatment, and regular follow-up. [ABSTRACT FROM AUTHOR]

Objectives: Based on the background of the implementation of graded diagnosis and treatment policy (GDT) in China, this paper studied the service optimization of primary medical institutions from the perspective of the primary medical treatment rate., Methods: First, the difference-in-difference (DID) empirical strategy is used to analyze the impact of the implementation of the GDT on the improvement of the primary medical attendance rate, and the parallel trend test and the placebo test were used to test the robustness to illustrate the necessity of policy implementation. Second, combined with customer value theory, this paper used a logistic regression model to study the impact of customer value perception on grassroots medical care., Results: The implementation of the GDT can indeed improve the rate of primary care ( p = 0.028), but the impact is relatively small (0.042). From the perspective of value perception hierarchy, emotional value perception ( p < 0.05) is the key factor that affects the behavior of grassroots medical treatment at this stage., Conclusion: This paper fills the gaps in existing research, including empirical research on the grassroots medical treatment behavior of the masses under GDT and the impact of value perception on grassroots medical behavior. Furthermore, the recommendations are made for primary care institutions based on the results of the analysis, which promote the advancement of primary care services in China., Competing Interests: Author WT was employed by company Zhejiang Geely Holding Group Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Tao, Chen and Gan.)

Background: The Chinese hierarchical treatment system expects patients to first visit primary medical institutions (PMIs), and patients' willingness determined their utilization of primary health care. The aim of this study was to explore the factors associated with patients' willingness to make their first visit to PMIs., Methods: We employed multistage stratified sampling and convenience sampling to administer questionnaires to 1,507 patients in Beijing, Qinghai, and Fujian. Patients' willingness of first visit in PMIs was analyzed using Chi-square test and binary logistic regression., Results: Of the 1,507 participants in the survey, 55.1% were willing to make their first visit in PMIs. Fewer patients in Beijing (17.6%) are willing to make their first visit in PMIs than those in Qinghai (71.9%) and Fujian provinces (72.0%). Binary logistic regression analysis revealed that higher recognition of the community first visit policy and higher satisfaction with the medical technology of PMIs are associated with patients' willingness of first visit in PMIs., Conclusions: Due to differences in local economic conditions, medical resources, and policy formulation, there are differences among provinces in patients' willingness of first visit in PMIs. To increase patients' rate of visits in PMIs, it is important to improve service capacity and quality of PMIs and change residents' attitudes for PMIs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Li, Zhao, Zhang, Yang and Yang.)

The construction of county and district medical community is an important measure for high-quality medical resources to "double sink and improve". In this study, we have initially constructed a medical equipment quality control system for members of the regional medical community. The current situation of lack of professional medical equipment management personnel and quality control equipment in primary medical institutions has been alleviated, the quality control level of medical equipment in primary medical institutions has been improved, and a new management model for quality control of primary medical equipment has been explored.

The weak primary healthcare system in China brings challenges to the national strategy of primary medical institutions providing general health needs for patients with non-communicable diseases (NCDs). It is necessary to explore the potential discrepancies in health status for patients with NCDs if they go to primary medical institutions rather than high-level hospitals. Data was obtained from Surveillance of Health-seeking Behavior in Hubei Province. Respondents were investigated six times to collect information on health service utilization and health-related quality of life (HRQoL). Ninety-two hypertension patients who went to medical institutions of the same level were included. HRQoL was measured by the Chinese version of EQ-5D-3L. A multilevel growth curve model was applied to analyze whether provider level could influence HRQoL. The utility score and visual analogue scale (VAS) of patients varied insignificantly over six months ( p > 0.05). A growth curve model showed that comorbidity was the only factor significantly influencing utility score ( p = 0.019). Time and comorbidity were the only influencing factors of VAS ( p < 0.05). Our findings indicated that the level of healthcare provider had no significant impact on the health status of patients with NCDs. As such, this study concludes that the primary healthcare system in China is qualified to be the health gatekeeper for NCDs patients.