Analysis of the difficulities in developing integrated general practice and specialty diagnosis and treatment techniques in Shanghai communities: a mixed-methods study
10.3760/cma.j.cn114798-20250312-00208
- VernacularTitle:基于混合研究方法的上海市社区全专结合诊疗技术存在的困难分析
- Author:
Aizhen GUO
1
;
Hongya LIU
;
Dehua YU
;
Hua JIN
Author Information
1. 同济大学附属杨浦医院全科医学科 上海市全科医学与社区卫生发展研究中心 同济大学医学院全科医学研究中心，上海 200090
- Publication Type:Journal Article
- Keywords:
Community health centers;
Integration of general practice and specialty;
Difficulties
- From:
Chinese Journal of General Practitioners
2025;24(7):793-800
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To understand the difficulties in the development of community-based integrated general and specialized medical care in Shanghai, and to provide a scientific basis for further proposing strategies to promote the development of integrated general and specialized medical care.Methods:A mixed-methods study was used in this study. In the first stage, a quantitative method was used. From August to December 2023, 30 community health centers (CHCs) were randomly selected from 239 CHCs in the city that provided integrated general specialist care. In each of these CHCs, a questionnaire was administered to a manager and a general practitioner involved in integrated care for specific diseases. The content of the questionnaire included general demographic information and questions related to the integration of general and specialized care, covering six aspects: community-specific disease diagnosis and treatment, examination items, drug configuration, patient sources, support from specialists, and referrals. In the second stage, a qualitative method was used. From January to February 2024, face-to-face semi-structured interviews were conducted with the managers and general practitioners of the CHCs who had completed the questionnaire survey in the previous stage, to further understand the reasons for the difficulties in integrating general and specialist care.Results:(1) Quantitative research: a total of 30 community health center managers and 30 general practitioners participated in the questionnaire survey. The survey found that the top four difficulties were: lack of technology for diagnosis and treatment of special diseases (49, 81.7%), shortage of clinical medical technical examination (36, 60.0%), and insufficient drug configuration (33, 55.0%) and few patients with special diseases in the community (33, 55.0%). (2) Qualitative research: 12 community health center managers and 10 general practitioners participated in the interviews. The interviews explained the difficulties identified in the research from different angles, such as "lack of support from higher-level medical institutions, lack of ancillary examinations and drugs, and a single form of cooperation between and lower-level medical institutions". At the same time, the interviewees mentioned the difficulty of "insufficient staff involved in community-based integrated care", which complemented the research.Conclusions:There are difficulties in many aspects of community-based comprehensive and specialized treatment, such as collaboration between hospitals and community health institutions, specialist and general practitioner resources, patient sources, specialized treatment-related examination items and drugs, which need to be solved in a variety of ways to further promote the development of community-based integration of general practice and specialty care.
