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Objective:To survey the current health status, and awareness and participation rate of cardiac rehabilitation in patients with coronary heart disease of Beijing Yuetan community.Methods:From June to December 2020, a purposeful sampling method was used to select 983 patients with coronary heart disease under standardized management at Yuetan Community Health Service Center and its 8 community health service stations in Xicheng District of Beijing, and a health questionnaire survey was conducted. The questionnaire included the general condition of the patient, the type of coronary heart disease, the comorbidities, the current secondary preventive medication and disease control, the exercise method and the patient′s awareness and participation rate of cardiac rehabilitation.Results:Among 983 participants, 541 (55.0%) were male, 578 (58.8%) were aged 65-<75 years; 591 (60.1%) were overweight or obese (BMI≥24.0 kg/m 2) (60.1%). The top three complications were hypertension (790 cases, 80.4%), dyslipidemia (646 cases, 65.7%) and diabetes (451 cases, 45.9%). The control rate of blood pressure, blood sugar and blood lipids in patients after percutaneous coronary intervention and coronary artery bypass grafting was the lowest. There were 733 (74.6%) regular exercisers; while only 8 cases, 4 cases, and 6 cases received professional exercise risk assessment, professional exercise ability evaluation, and professional exercise guidance evaluation, respectively; and only 8 cases received cardiac rehabilitation. Most participants (88.9%, 867/975) responded that they “never heard of” cardiac rehabilitation. Conclusions:Community patients with coronary heart disease mostly have comorbidities such as hypertension, dyslipidemia and diabetes. The control rate of blood lipids and blood sugar needs to be improved. Patients with coronary heart disease have a low awareness and participation rate of cardiac rehabilitation. It is recommended that community doctors should promote cardiac rehabilitation and the community cardiac rehabilitation team should be constructed.
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Objective:To investigate the status quo of anticoagulant therapy for patients with non-valvular atrial fibrillation (NVAF) in Beijing community health centers and to analyze the affecting factors.Methods:From September to December 2020, 164 patients with NVAF in five community health service centers in Xicheng District of Beijing were selected for a face-to-face questionnaire survey. The questionnaire included basic information of patients, complications, CHA 2DS 2-VASc score, HAS-BLED score and oral anticoagulant therapy, et al. SPSS 23.0 software was used to analyze the status of anticoagulant therapy in patients with different risk stratification of stroke, and chi-square was used to analyze the factors affecting anticoagulant therapy in high-risk patients with stroke. Results:In 161 NVAF patients with indication, 86 received anticoagulation therapy (53.4%), and the utilization rates of rivaroxaban, dabigatran and warfarin were 64.0% (55/86), 26.7% (23/86) and 9.3% (8/86), respectively. In 140 patients (85.4%, 140/164) at high risk of stroke (CHA 2DS 2-VASc score ≥2 points in males or ≥3 points in females), 30.0% (42/140) had never received anticoagulant therapy, and 29.3% (41/140) was treated with antiplatelet therapy, 17.1% (24/140) did not use any antithrombotic medication. Univariate analysis showed that gender, age, symptoms at first diagnosis and complications were not significantly associated with the application of anticoagulant therapy in NVAF patients at high-risk of stoke ( P>0.05). The qualitative study showed that the reasons for not receiving anticoagulant therapy were spontaneous cardioversion or recovery of sinus rhythm after ablation (15 cases), adverse drug reactions (7 cases), self-withdrawal of drugs (10 cases), concern about bleeding (3 cases) and so on. Conclusion:A large proportion of NVAF patients in the community are at high risk of stroke, while the overall rate of anticoagulant treatment is relatively low. Clinician in the community should actively initiate anticoagulant therapy for patients with AF and strengthen the continuous management and compliance management of anticoagulant therapy.
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Objective:To investigate the knowledge status and health education needs of patients with atrial fibrillation in the community.Methods:From September to December 2020, 277 patients with atrial fibrillation from 5 community health service centers in Xicheng District of Beijing were selected using typical sampling method for online questionnaire survey. The questionnaire mainly contained basic information of patients, the knowledge of atrial fibrillation and the health education needs. Factors affecting patients′ knowledge level and health education needs were analyzed.Results:The overall awareness rate of disease-related knowledge in 277 patients with atrial fibrillation was 67.1% (1 860/2 770), and in aspects of antithrombotic effect of aspirin [12.3% (34/277)], the benefits and risks of anticoagulation therapy [52.7% (146/277)] and atrial fibrillation discontinuation [55.2% (153/277)], the awareness rates were relatively low. Compared with patients in the age group of 66-79 years and ≥80 years old, those aged ≤65 years had higher awareness rates in knowledge of purpose of anticoagulantion therapy [89.7% (70/78)] and adverse reactions of anticoagulation drugs [89.7% (70/78)] (χ2=6.72, 8.77; P<0.05), but the awareness rate of the benefits and harms of anticoagulation therapy [43.6% (34/78)] was lower (χ2=6.11, P<0.05). The top three health education needs of patients were the impact of atrial fibrillation on the body (3.66±1.77), the method of treating atrial fibrillation (3.65±1.13) and the prognosis with different treatments (3.62±1.15). Further analysis showed that in patients with disease duration ≤5 years, the education needs for the purpose of anticoagulation therapy (3.60±1.17), exercise methods (3.62±1.12), dietary taboos (3.63±1.16), and how to communicate with family and friends(3.33±1.29) were higher than those with a disease duration of more than 5 years ( t=2.03, 2.88, 2.05, 2.07; P<0.05). Doctors [98.6% (273/277)], nurses [40.8% (113/277)] and health education lectures [36.8% (102/277)] were the main sources for patients to acquire knowledge about atrial fibrillation. Most patients had the strongest motivation to obtain health education at the time of disease diagnosis [70.0% (194/277)]. Conclusions:There is insufficient understanding of the disease in patients with atrial fibrillation in the community, and the needs for patients to get health education are high. It is necessary to pay more attention to the early health education in patients with younger age and shorter course of disease.
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Objective:To investigate the feasibility of contracted nursing services for disabled persons.Methods:A qualitative study on the feasibility of contracted nursing services for disabled persons was conducted from August 2020 to October 2020 with the phenomenological method. Community nurses were selected with the purpose of sampling method from Yuetan and Baizhifang Community Health Service Centers in Beijing Xicheng District for semi-constructed interviews, and 12 community nurses were finally interviewed according to the principle of information saturation. The research team took field notes, audio recordings and transcriptions of the interviews, coded to refine the themes, and fed back with the respondents to confirm the accuracy of the themes.Results:All the interviewed nurses thought that the contents of basic medical and public health required by the Guidance manual of contracted services of family doctors for disabled persons (the manual) including basic documentation, appointments, pre-diagnosis and post-diagnosis services, home care, rehabilitation nursing guidance, referral services and extended nursing services for the disabled and their families could be completed. All interviewees said that the manual had a guiding role in contracted services for disabled persons. Eight interviewed nurses believed that the manual involved referral services and rehabilitation care, but the technical guidance content did not meet the actual work needs and it should be supplemented and improved; 9 interviewees pointed out that there was a lack of communication with various types of disabled people in service practice, especially for those with vision, hearing, mental disabilities and disabled children; 7 interviewees said that it the free home care for the disabled was not sustainable. Conclusion:The contracted nursing services for disabled persons are feasible and the manual has a guiding role for the practice,and some contents need to be added in the manual to further improve service capacity for disabled people.
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Objective:To investigate the status quo of communication between contracted family doctor team and the disabled.Methods:Using convenience sampling, family doctor team members of 80 community health centers (CHCs) in Beijing were selected to participate in a questionnaire survey from April to June 2022. The questionnaire included the basic information of team members, the choice of communication methods and targets, the acquisition of communication knowledge and skills and so on.Results:A total of 365 team members participated in the survey. The most common type of disability was physical disability (78.08%,285/365). All participants met communication obstacles with disabled people in contracted health service, and hearing and speech disabilities were the most common (70.14%, 256/365). Only 13.42% (49/365) chose to directly communicate with the disabled themselves; 84.93% (310/365) used "increase the volume and slow down" method when communicating with the disabled, and 38.63% (141/365) chose "write and convey multiple messages at the same time". Most of participants (84.38%, 308/365) indicated the need for professional training in communication with persons with disabilities.Conclusion:There are communication obstacles between family doctor team members and the disabled during contracted services. More relevant professional training are urgently needed for contracted family doctor team to improve the abilities to communicate with the disabled.
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China launched the nationwide resident standardized training (residential training) project since 2013 and has trained a large number of general practitioners. The primary health care institutions and general practitioners have played an important role during the prevention and control of COVID-19 epidemic, which not only presented the remarkable effect of residential training project, but provided new ideas for the further training program of general practitioners. It is proposed in this paper that we should adjust the training and assessment priorities in the following aspects: highlight the characteristics of general practice in the future training, so as to train general practitioners with more comprehensive ability, such as strengthening the ability to deal with public health emergencies, strengthening the consciousness and capability of scientific research, and increasing the proportion of humanistic quality training; At the same time, we should enhance career attractiveness of general practitioners to keep the excellent general residents stay for their career;All mentioned above will further improve the overall quality of general practitioners, and enable them to better deal with public health emergencies.
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During the COVID-19 epidemic period, general practitioners have been actively participating in screening and triage, referrals, follow-up, education and other activities related to disease prevention and control at the grass-roots level. However, there are still some problems: such as unclear of the role of general practitioners in an epidemic setting, inadequate ability to respond to public health emergencies and lack of knowledge of infectious diseases. To meet the challenge of COVID-19 pandemic, with the reference of Accreditation Council for Graduate Medical Education (ACGME) six core clinical competencies we suggest to improve the standardized general practice residency training in following aspects: to attach importance to infectious disease rotation, to increase the stomatology and nutrition course learning, to strengthen teaching in general practice service model, preventive medicine and medical humanities, to enhance the ability for dealing with public health emergencies, the evidence-based medicine and scientific research ability and doctor-patient communication ability.
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The current status of primary health institutions and personnels in China were analyzed based on the data from China Health and Family Planning Statistics Yearbook 2016 and China Health Statistics Summary 2018. By the end of 2017, there were 253 000 general practitioners in China, accounting for 7.46% of all practicing physicians or assistant physicians in the country(339 000). In 2017, the number of general practice residents was 8 517, accounting for 11.92% of all residents(71 430), which was 1.70% lower than that in 2016(8 664). The registered nurses in primary health care institutions were not sufficient, even the proportion of nursing to medical staff did not reach 1∶1 in primary settings. The distribution of primary health care institutions was not balanced. In the township hospitals and village clinics the number of practicing physicians or assistant physicians was far from meeting the requirement of the service. In view of the current problems, the social resources would be applied to promote the development of primary health care institutions and to improve the primary medical services in multiple ways such as personnel training, hardware construction, network construction and financial support, etc.
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The current status of primary health institutions and personnels in China were analyzed based on the data from China Health and Family Planning Statistics Yearbook 2016 and China Health Statistics Summary 2018. By the end of 2017, there were 253 000 general practitioners in China, accounting for 7.46% of all practicing physicians or assistant physicians in the country(339 000). In 2017, the number of general practice residents was 8 517, accounting for 11.92% of all residents(71 430), which was 1.70% lower than that in 2016 (8 664) . The registered nurses in primary health care institutions were not sufficient, even the proportion of nursing to medical staff did not reach 1 ∶ 1 in primary settings. The distribution of primary health care institutions was not balanced. In the township hospitals and village clinics the number of practicing physicians or assistant physicians was far from meeting the requirement of the service. In view of the current problems, the social resources would be applied to promote the development of primary health care institutions and to improve the primary medical services in multiple ways such as personnel training, hardware construction, network construction and financial support, etc.
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The current status of primary health institutions and personnels in China were analyzed based on the data from China Health and Family Planning Statistics Yearbook 2016 and China Health Statistics Summary 2018. By the end of 2017, there were 253 000 general practitioners in China, accounting for 7.46% of all practicing physicians or assistant physicians in the country(339 000). In 2017, the number of general practice residents was 8 517, accounting for 11.92% of all residents(71 430), which was 1.70% lower than that in 2016(8 664). The registered nurses in primary health care institutions were not sufficient, even the proportion of nursing to medical staff did not reach 1∶1 in primary settings. The distribution of primary health care institutions was not balanced. In the township hospitals and village clinics the number of practicing physicians or assistant physicians was far from meeting the requirement of the service. In view of the current problems, the social resources would be applied to promote the development of primary health care institutions and to improve the primary medical services in multiple ways such as personnel training, hardware construction, network construction and financial support, etc.
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Objective:To survey the mental health status and related factors of residents in a Beijing community during Coronavirus diease 2019 (COVID-19) epidemic period.Methods:A total of 765 residents aged ≥18 year from Beijing Yuetan subdistric, including 238 males and 527 females, were enrolled in our study on March 2020. The knowledge and attitude to COVID-19 were surveyed with online questionnaire and the mental health status was assessed with Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) . The influencing factors of mental status were analyzed.Results:The awareness rate of transmission routes, the prevention and control measures of the COVID-19 was 92.94% (711/765) and 97.25% (744/765) . The rates of anxiety and depression were 35.29% (270/765) and 31.50% (241/765); the severe anxiety (GAD-7>14) rate was 6.01% (46/765), and the severe depression rate (PHQ-9>19) was 1.43% (11/765), There was significant difference in depression rate among different age groups (χ 2=0.338, P<0.05). Conclusion:Under the threaten of COVID-19, the incidence of mental disorder among residents in the community has increased, indicating more attention should be paid to psychological heath during the COVID-19 epidemic period.
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Objective:To develop a guiding manual of family doctor contracting service for the disabled with Delphi method.Methods:From November 2017 to July 2018, a research group was formed and a survey on the status of family doctor service for disables was conducted in Beijing and other places. After the preliminary outline was formulated, 15 experts from the fields of general practice and rehabilitation for the disabled were invited and 4 rounds of expert consultation were conducted, finally the Guiding Manual of Family Doctor Contracting Service for the Disabled was developed. Results:The authority coefficient of experts was 0.870, and 13, 13, 15 and 15 questionnaires were collected from 15 experts in 4 rounds of consultation, respectively. The W value of Kendall harmony coefficient of the fourth round of expert consultation was 0.394 (χ 2=319.501, P<0.01) and accuracy was 0.234 (χ 2=189.189, P<0.01). After adding and deleting terms by the suggestion and scores of experts, the final draft of the manual is formed, including 5 first-level terms, 15 second-level terms, 18 third-level terms and 17 fourth-level terms. Conclusion:The Guiding Manual of Family Doctor Contracting Service for the Disabled has been developed with Delphi method. Its reliability, validity and practicability need to been further studied.
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During September to October 2016 a cross-section survey on job satisfaction of general practitioners (GPs) was conducted among 619 GPs who were randomly selected from 15 community health service centers/stations in Xicheng District of Beijing. The questionnaire used in the survey included items related to the satisfaction for salary, working environment, performance, equipment, performance assessment, professional promotion, training and respect degree; as well as the aspects that need to be improved. The overall satisfaction rate was 80.0% (495/619). The satisfaction of salary was the lowest (43.5%, 269/619), while the satisfaction of training was the highest (94.3%, 584/619). 93.2% (577/619) and 80.0% (495/619) of the participants felt that they were respected by the patients. The most desired aspects need to be improved were to increase personal income (95.6%, 592/619) and work ability (44.3%, 274/619). The survey indicates that attention should be paid to increase the income of primary care GPs in the future heathcare reform.
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Objective:To investigate the mental health status and psychological intervention needs in community health service staff during the outbreak of COVID-19.Methods:From February 28 to March 2, 2020, a total of 554 questionnaires on the mental health status and psychological intervention needs were collected from community health service staff in Beijing, Zhejiang, Hebei and Shanghai. The mental health was assessed by physical symptoms and GAD-7. The status and effectiveness of psychological intervention was analyzed.Results:The survey found that 19.7% (109/554) of community health service staff needed psychological support. Most psychological supports were received from colleagues′ encouragement (59.6%, 330/554) and internet mental health knowledge (41.2%, 228/554); in contrast, less from group intervention (5.8%, 32/554) and one-on-one counseling (5.6%, 31/554). Higher proportion of staff with anxiety symptoms and physical symptoms needed psychological support than that without symptoms (χ 2=53.41, 71.47), and a higher proportion of responders thought that the existing psychological intervention was not helpful (χ 2=26.89, 17.79), the difference is statistically significant ( P<0.05). Conclusion:It is necessary to strengthen the mental health assessment of community health service staff and give effective psychological intervention according to their needs during the outbreak of COVID-19.
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Objective To survey the status of aspirin application asautiplatelet therapy for secondary prevention of coronary artery disease (CAD) in Beijing communities.Methods A cross-sectional survey on status of aspirin use was conducted among 60 communities in Beijing from September 2014 to January 2015.Items of survey included the duration of aspirin application,aspirin dosage,application time,reasons for interruption and reasons for non-application.Results Total 61 000 questionnaires were delivered and 56 969 valid ones were retrieved with a recovery of 93.39%.The aspirin application rate was 78.22% (15 105/19 311)among patients with diagnosed CAD,while that was 81.42% (1 319/1 620) among patients with self-reported CAD (x2=9.06,P<0.01).There was no effect of early cardiovascular disease family history on aspirin application among patients with diagnosed CAD (P =0.77).Among the patients with diagnosed CAD,the reasons of no aspirin application were:rejection with unknown reasons,worry about stomach side effects,clopidogrel application,not suitable subjectsand other antiplatelet drugs application.Conclusions The proportion of aspirin application is relatively high among coronary artery disease patients in Beijing communities.The results of survey provide the direction of patient education in the future.
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Acute coronary syndrome (ACS) is a serious type of coronary disease with high morbidity and mortality rates,being one of leading causes of death in both developed and developing countries.Studies abroad have shown that,the cardiac rehabilitation in community hospitals carried out by general practitioners with the guidance of cardiac specialists and the establishment of a continuous,longterm exercise rehabilitation and drug therapy can effectively reduce the mortality of ACS patients.In order to complete the health care chain from prevention,treatment to rehabilitation for ACS patients in China,it is imperative for community hospitals to provide cardiac rehabilitation service.
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Objective To survey on the satisfaction with community health service among residents in Beijing Yutan subdistrict and its influencing factors.Methods From February 2017 to April 2017,a questionnaire survey was carried out among 829 residents over 15 years old in Beijing Yuetan community.The overall satisfaction with the community health service was surveyed,and its correlations with sex,age,educational level,occupation,medical insurance type,family per capita income,and chronic diseases of residents were analyzed.Results The satisfaction rates with various items of community health services were all above 75%,except that of drug types and facilities.The satisfaction with nursing service,service attitude,communication,equipment,convenience,waiting time and institutional environment was correlated with the age of the residents (x2 =14.913、16.144、13.966、14.279、15.208、23.590、13.746,P < 0.05),but not correlated with the educational level of residents (P > 0.05).There were significant differences in satisfaction with nursing service,convenience,waiting time and institutional environment among residents with different occupations (x2 =7.379,14.837,9.471,14.837,P < 0.05);there was significant difference in satisfaction with drug types among the residents with different payment methods (x2 =11.405,P < 0.05),and there was significant difference in the satisfaction with image accuracyandthe facilities among residents with different family income (x2 =9.808,10.117,P < 0.05).The satisfaction degree with medical care,nursing service,communication,image accuracy,equipment,andwaiting time was significantly different among residents with different chronic diseases (x2 =4.387,5.285,9.908,11.622,3.903,6.285,P < 0.05).Conclusion The overall satisfaction with the community health service among Yuetan residents is high;however,more attention should be paid to the health management for women and elderly patients and patients with chronic disease and low income.
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Patients aged ≥65 years with dementia diagnosed by neurological specialists were selected in Yuetan community from March 2016 to December 2016.The basic information of patients was collected from the health and medical records;the needs for community care were obtained through a questionnaire survey.Total 91 elderly patients with dementia was included in the study,among whom 15 (16.5%) were found by community institutions,18 (19.9%) patients got medication from the community health institutions.The survey showed that the numbers of participants who agreed that the community health service could provide treatment,drug prescription,referral service,condition assessment,regular follow-up,professional guidance for caregivers,door-to-door service and counseling services for patients and their relatives were 29 (31.8%),18 (19.9%),33 (36.3%),19 (20.9%),23 (25.3%),24 (26.4%),49 (53.8%) and 29 (31.9%),respectively.Results showed that 53.8% (49/91) dementia patients or their family members wanted to receive instruction of drug use in community health service,17.6% (16/91) wanted to know about the professional care skill as caregivers.Currently the services for dementia patients in health service centers and stations of Yuetan community are less sufficient,which cannot meet the needs of dementia patients and their family members.
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Objective To investigate the awareness of osteoporosis and to evaluate the effect of related health education among Beijing community residents.Methods Total 1 000 patients,who visited in 4 community health service centers in Beijing from June to December 2011,were selected as study participants.The questionnaire survey on the awareness of osteoporosis was conducted in all participants,and the items of questionnaire included the risk factors,symptoms,prevalence of osteoporosis,the recommended daily calcium intake and risk of falls.Five hundred participants in 2 health service centers were designated as intervention group and 500 in another health service centers as control group.In intervention group the health education of osteoporosis was conducted every 2 to 3 months and the outpatient follow-up was provided every 2 months;the contents of health education included the clinical manifestation,prevention and control of osteoporosis,and the preveution of fall.In control group only the general outpatient consultation and referral were provided.The second questionnaire survey was conducted 2 years after intervention,the results were compared with baseline and the intervention effect was evaluated.Results Before intervention,58.0% (580/1 000) participants had exercise,43.1% (431/1 000) participants took calcium supplement and vitamin D,and 12.1% (121/1 000)took medication following doctor's advance.The rates of fall prevention and administration of calcium vitamin D in intervention group before intervention [27.8% (139/500) and 38.7% (194/500)] were lower than those in control group [33.8% (308/500) and 47.5% (237/500)].After two-years of intervention the adoption rate of health behavior in intervention group was improved markedly,the highest one was diet control [increased by 38.4% (192/500)] and the lowest one was medication [increased by 17.3% (87/500)].Compared to control group the diet control rate in intervention group was significantly higher [74.0% (370/500) vs.23.6% (108/457),x2 =261.887,P=0.000].In addition,unhealthy behaviors were also reduced:55.0% participants reduced caffeine consumption and 72.2% participants reduced sodium intake in intervention group.Conclusion The awareness of osteoporosis among Beijing community residents is not satisfactory,but intervention focusing on osteoporosis prevention education is effective to change their behavior.
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Objective To evaluate the efficacy of community management of asymptomatic hyperuricemic patients.Methods Two hundred and six patients with asymptomatic hyperuricemia in Yuetan community of Beijing were randomly and equally divided into study group and control group.Patients in study group received 12-month standardized management, while those in control group were given conventional management.After 12 months of intervention, the clinical data and related information were analyzed and the effect of intervention was evaluated by questionnaire survey.Results After 12-month intervention, the rates of unhealthy lifestyle in intervention group were significantly lower, and the exercise time was significantly more than those in control group [drinking:frequently 8.7%(9/103)vs.11.7%(12/103),seldom 83.5% (86/103) vs.68.9% (71/103),χ2=7.005, P=0.030;eating animal offal: seldom 88.4%(91/103) vs.76.7%(79/103),frequently 1.9%(2/103) vs.8.7%(9/103),χ2=6.302, P=0.043;eating seafood: seldom 74.8%(77/103) vs.52.4%(54/103),frequently 4.8%(5/103) vs.16.5%(17/103),χ2=12.867, P=0.002;eating thickened gravy: seldom 78.6%(81/103)vs.53.4%(55/103),frequently 2.9%(3/103) vs.13.6%(14/103),χ2=16.334, P=0.000;exercise time: seldom 17.5%(18/103)vs.24.3%(25/103),1-3 h 26.2%(27/103) vs.38.8%(40/103),4-6 h 32.0% (33/103) vs.20.4%(21/103), ≥7 h 24.3%(25/103) vs.16.5%(17/103),χ2=7.852, P=0.049].The blood uric [(403±54) vs.(474±71) μmol/L], cholesterol [(4.6±0.8) vs.(4.9±1.0)mmol/L], triglyceride[(1.65± 0.54) vs.(1.86±0.86) mmol/L] and systolic pressure [(128±10) vs.(131±14) mmHg(1 mmHg=0.133 kPa)] in intervention group significantly lower than those in control group (t=7.984,P=0.000;t=2.803,P=0.006;t=2.130,P=0.034;t=2.059,P=0.041).The awareness rate of hyperuricemia-related knowledge in intervention group was significantly higher than that in control group [85.1% (964/1 133) vs.45.5%(516/1 133), χ2=390.959,P=0.000].Conclusion Standardized community management is effective for patients with asymptomatic hyperuricemia.