Objective:To understand the current status of health management cognition and healthcare behaviors of community residents in Shanghai, and to analyze their related influencing factors, in order to promote the optimization of proactive health-oriented health management strategies.Methods:This study was a cross-sectional survey. From February to May 2023, 1-4 community health service centers were randomly selected from each administrative district in Shanghai by stratified random sampling using the random number table method. Ultimately, 28 community health service centers were selected as research sites. The research team then used convenience sampling method to select at least 50 patients as research subjects from those visiting each selected center. A total of 1 436 community residents were included in this study in the form of on-site completion of questionnaire stars, and the study covered the residents′ level of health management cognition, chronic disease management, intention to seek medical care, physical examination behavior, and handling of abnormal values. Multiple regression analysis was used to assess the correlation between health management cognition and medical consultation behavior and their influencing factors.Results:The results of the health management awareness survey showed that 827 residents (57.6%) had a relatively high level of awareness. Among the 755 residents (52.6%) with chronic diseases, the proportion of self-assessed stable control was significantly higher in the high-cognition group (318 (76.0%)) than that in the low-cognition group (223 (66.2%)), and the difference was statistically significant ( χ2=9.01, P=0.003). Multiple regression analysis showed that females ( OR=1.293, 95% CI: 1.028-1.627),≤44 years old and 45-59 years old ( OR=2.328, 95% CI: 1.648-2.328; OR=1.351, 95% CI: 1.035-1.763), bachelor′s degree or above ( OR=1.784, 95% CI: 1.256-2.534), living in suburban area ( OR=1.577, 95% CI: 1.235-2.014), use of employee health insurance and resident health insurance ( OR=2.294, 95% CI: 1.629-3.232; OR=1.628, 95% CI: 1.149-2.306), suffering from a chronic disease ( OR=3.110, 95% CI: 1.918-5.042), and having a contracted family doctor ( OR=1.870, 95% CI: 1.431-2.442) were all positive correlation with health management perception(all P<0.05). In terms of health care behavior, 908 (63.2%) residents showed a high active intention to seek medical care, and 906 (63.1%) and 796 (55.4%) residents showed active participation in medical check-ups and timely handling of medical check-up abnormal values, respectively. Residents in the high awareness group were significantly better than those in the low awareness group in terms of intention to seek medical care ( χ2=33.26), mode of medical checkups ( χ2=110.71), frequency of medical checkups ( χ2=45.37), and the way of dealing with abnormal values after medical checkups ( χ2=93.14), with the difference being statistically significant(all P<0.05). The results of linear regression analysis of the factors influencing the medical behavior of community residents showed that age≤44 and 45-59 ( B=0.479, 0.167), high school and specialist versus bachelor′s degree and above ( B=0.465, 0.739), use of employee medical insurance and residents′ health insurance ( B=0.604, 0.420), the number of current chronic diseases 1 ( B=0.919) and contracted family doctor ( B=0.134) of community residents′ health care behaviors are better (all P<0.05). Conclusions:The level of community residents′ health management cognition needs to be improved, and high health management cognition can significantly promote proactive healthcare-seeking behavior. However, residents′ medical behavior is still influenced by multidimensional factors. Signing a contract with a family doctor is significantly associated with high cognition and quality healthcare behaviors.

Objective:To investigate the current status of the implementation of active health management in tumor care in community health service institutions in Shanghai.Methods:This cross-sectional study was conducted in July 2022. A questionnaire was designed based on tumor management practices according to active health principles was designed and distributed to all 247 community health service institutions in 16 administrative districts of Shanghai. Data were collected on tumor screening, establishment of health records for tumor patients, and follow-up practices.Results:Of the 247 questionnaires distributed, 239 were returned, with 228 valid responses (effective response rate: 92.3%). Of the 228 institutions, 72 (31.6%) were located in urban areas, 101 (44.3%) in suburban areas, and 55 (24.1%) in rural areas. Tumor screening was performed by 89.0% (203/228) of the institutions, mainly for colorectal, lung, liver, breast, and gastric cancers. Health records for tumor patients were established by 92.5% (211/228) of institutions. Follow-up of tumor patients was conducted by 99.1% (226/228) of institutions, with 29.6% (67/226) performing 1-2 annual follow-ups. Telephone follow-up was used by 99.1% (224/226) of institutions, while 42.5% (96/226) adjusted the frequency of follow-up based on patients′ Karnofsky Performance Status scores. Targeted health education for patients and families was provided by 84.6% (193/228) of institutions, including exercise guidance (78.8%, 152/193) and psychological support (76.2%, 147/193). No statistically significant differences were observed among urban, suburban, and rural institutions in tumor screening, health record establishment, follow-up frequency, assessment content, follow-up methods, and tumor health education and content (all P>0.05). Conclusions:The coverage of tumor screening in Shanghai′s community health service institutions remains incomplete, the quality of follow-up needs to be improved, and health education programs are not comprehensive. There were no regional differences in tumor screening, health record establishment, follow-up practices, or tumor health education among urban, suburban, and rural populations.

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.

Objective:To investigate the ability to diagnose, treat and manage kidney disease in Shanghai community health service centers.Methods:This was a cross-sectional survey. An online questionnaire survey was conducted in November 2023 among 248 Shanghai community health service centers and 2 140 general practitioners in Shanghai. The main topics of the institutional research were the kidney disease-related inspection items that medical institutions could carry out, the kidney disease diagnosis and treatment drugs, the kidney disease grass-roots management training, the opening of kidney disease clinics and the establishment of kidney disease standard diagnosis and treatment records. The main topics of the survey of general practitioners were general information, standardized diagnosis and management measures of kidney disease, knowledge based on the diagnosis and treatment guidelines of chronic kidney disease, and difficulties in standardized management of kidney disease.Results:Among the laboratory examination items in Shanghai community health service centers, the rates of routine urine (99.60%, 247 centers), renal function (95.16%, 236 centers) and urinary microalbumin (89.11%, 229 centers) were high. Among the imaging examinations, B-ultrasound of urinary system had the highest rate (92.34%, 229 centers). The preparation rate of kidney disease drugs varied widely among the centers, and the preparation rate of Chinese drugs such as Jinshuibao, nephritis Kangfu tablet and Shenshuaining was more than 90%. Sixty-six (26.61%) community health service centers had established kidney disease clinics. The overall accuracy rate of community general practitioners was 63.81% (13 656/21 400), of which the accuracy rate for diagnosis and screening method, referral indication and emergency dialysis indication was more than 85%, but the accuracy rate for drug treatment and careful medication was low at 28.93% (1 238/4 280) and 33.22% (711/2 140), respectively. There was a willingness for Community general practitioners to provide all aspects of life guidance for patients with kidney disease, but for patients with end-stage renal disease replacement therapy, there was a preference for this to be provided by the appropriate specialist.Conclusions:The community health service centers in Shanghai has already had the basic conditions for the management of kidney disease in terms of basic examination and testing equipment, drugs, etc. The community general practitioners have a certain knowledge of kidney disease, and the drug treatment needs to be strengthened.

Strengthening primary healthcare (PHC) capacity is a critical pathway in China′s ongoing healthcare system reform to build a robust healthcare network foundation. While China′s PHC capacity shows a trend of continuous improvement, a significant gap remains in achieving the goal of comprehensive diagnosis and treatment for common and frequently occurring diseases, as well as standardized management of chronic diseases. Based on a literature review and integrating relevant domestic and international research findings, this article defines the core connotation of PHC capacity, systematically analyzes its current status and main challenges, and proposes strategies for optimizing PHC capacity and directions for future development.

Objective:To investigate the application of blended team-based learning (BTBL) in improving the clinical reasoning ability of general practitioners from different sources.Methods:From September to December in 2021, 52 postgraduates of general practice in Tongji University School of Medicine were selected as subjects, and according to their study background and practice experience, they were divided into residency training group, community group, and specialist group. BTBL was adopted for all students in the course of clinical reasoning in general practice, and a 4-station objective structured clinical examination (OSCE) test was conducted before and after the course to evaluate teaching effectiveness from the aspects of medical history collection, physical examination, doctor-patient communication, and medical record writing. SPSS 22.0 was used to perform a statistical analysis of data. Continuous data were expressed as mean±standard deviation, and an analysis of variance or the Kruskal-Wallis test was used for comparison between groups; the paired samples t-test or the Wilcoxon signed rank sum test was used for comparison of normally distributed or non-normally distributed data within each group. Categorical data were expressed as frequency and percentage. Results:There was a significant change in the score of physical examination after the course in the community group (44.88±9.17 vs. 78.06±12.11, t=-12.49, P<0.001), the specialist group (45.85±8.18 vs. 68.65±13.10, t=-6.43, P<0.001), and the residency training group (42.38±15.30 vs. 76.44±16.46, t=-5.98, P<0.001). There was a significant change in the score of doctor-patient communication after the course in the community group (63.00±13.84 vs. 78.69±7.10, t/Z=-4.33, P<0.05) and the residency training group (60.00±15.50 vs. 70.88±6.44, t/Z=-2.12, P<0.05). There was also a significant change in the score of medical record writing after the course in the community group (60.19±17.96 vs. 79.69±14.25, t=-2.96, P<0.05), the specialist group (47.77±12.59 vs. 80.31±12.93, t=-6.26, P<0.05), and the residency training group (37.00±15.50 vs. 75.88±15.88, t=-7.25, P<0.05). The score of medical record writing before the course was 60.19±17.96 in the community group, 47.77±12.59 in the specialist group, and 37.00±15.50 in the residency training group, with a significant difference between the three groups ( χ2=13.04, P=0.001); after the course, the score of medical record writing was 78.69±7.10 in the community group, 63.46±19.40 in the specialist group, and 70.88±6.44 in the residency training group, with a significant difference between the three groups ( χ2=10.13, P=0.006). Conclusions:In the course of clinical reasoning in general practice, BTBL can improve teaching efficiency, save teaching resources, and play the role of promoting strengths and avoiding weaknesses.

Objective:To investigate the application of blended team-based learning (BTBL) in improving the clinical reasoning ability of general practitioners from different sources.Methods:From September to December in 2021, 52 postgraduates of general practice in Tongji University School of Medicine were selected as subjects, and according to their study background and practice experience, they were divided into residency training group, community group, and specialist group. BTBL was adopted for all students in the course of clinical reasoning in general practice, and a 4-station objective structured clinical examination (OSCE) test was conducted before and after the course to evaluate teaching effectiveness from the aspects of medical history collection, physical examination, doctor-patient communication, and medical record writing. SPSS 22.0 was used to perform a statistical analysis of data. Continuous data were expressed as mean±standard deviation, and an analysis of variance or the Kruskal-Wallis test was used for comparison between groups; the paired samples t-test or the Wilcoxon signed rank sum test was used for comparison of normally distributed or non-normally distributed data within each group. Categorical data were expressed as frequency and percentage. Results:There was a significant change in the score of physical examination after the course in the community group (44.88±9.17 vs. 78.06±12.11, t=-12.49, P<0.001), the specialist group (45.85±8.18 vs. 68.65±13.10, t=-6.43, P<0.001), and the residency training group (42.38±15.30 vs. 76.44±16.46, t=-5.98, P<0.001). There was a significant change in the score of doctor-patient communication after the course in the community group (63.00±13.84 vs. 78.69±7.10, t/Z=-4.33, P<0.05) and the residency training group (60.00±15.50 vs. 70.88±6.44, t/Z=-2.12, P<0.05). There was also a significant change in the score of medical record writing after the course in the community group (60.19±17.96 vs. 79.69±14.25, t=-2.96, P<0.05), the specialist group (47.77±12.59 vs. 80.31±12.93, t=-6.26, P<0.05), and the residency training group (37.00±15.50 vs. 75.88±15.88, t=-7.25, P<0.05). The score of medical record writing before the course was 60.19±17.96 in the community group, 47.77±12.59 in the specialist group, and 37.00±15.50 in the residency training group, with a significant difference between the three groups ( χ2=13.04, P=0.001); after the course, the score of medical record writing was 78.69±7.10 in the community group, 63.46±19.40 in the specialist group, and 70.88±6.44 in the residency training group, with a significant difference between the three groups ( χ2=10.13, P=0.006). Conclusions:In the course of clinical reasoning in general practice, BTBL can improve teaching efficiency, save teaching resources, and play the role of promoting strengths and avoiding weaknesses.

Objective:To understand the current status of health management cognition and healthcare behaviors of community residents in Shanghai, and to analyze their related influencing factors, in order to promote the optimization of proactive health-oriented health management strategies.Methods:This study was a cross-sectional survey. From February to May 2023, 1-4 community health service centers were randomly selected from each administrative district in Shanghai by stratified random sampling using the random number table method. Ultimately, 28 community health service centers were selected as research sites. The research team then used convenience sampling method to select at least 50 patients as research subjects from those visiting each selected center. A total of 1 436 community residents were included in this study in the form of on-site completion of questionnaire stars, and the study covered the residents′ level of health management cognition, chronic disease management, intention to seek medical care, physical examination behavior, and handling of abnormal values. Multiple regression analysis was used to assess the correlation between health management cognition and medical consultation behavior and their influencing factors.Results:The results of the health management awareness survey showed that 827 residents (57.6%) had a relatively high level of awareness. Among the 755 residents (52.6%) with chronic diseases, the proportion of self-assessed stable control was significantly higher in the high-cognition group (318 (76.0%)) than that in the low-cognition group (223 (66.2%)), and the difference was statistically significant ( χ2=9.01, P=0.003). Multiple regression analysis showed that females ( OR=1.293, 95% CI: 1.028-1.627),≤44 years old and 45-59 years old ( OR=2.328, 95% CI: 1.648-2.328; OR=1.351, 95% CI: 1.035-1.763), bachelor′s degree or above ( OR=1.784, 95% CI: 1.256-2.534), living in suburban area ( OR=1.577, 95% CI: 1.235-2.014), use of employee health insurance and resident health insurance ( OR=2.294, 95% CI: 1.629-3.232; OR=1.628, 95% CI: 1.149-2.306), suffering from a chronic disease ( OR=3.110, 95% CI: 1.918-5.042), and having a contracted family doctor ( OR=1.870, 95% CI: 1.431-2.442) were all positive correlation with health management perception(all P<0.05). In terms of health care behavior, 908 (63.2%) residents showed a high active intention to seek medical care, and 906 (63.1%) and 796 (55.4%) residents showed active participation in medical check-ups and timely handling of medical check-up abnormal values, respectively. Residents in the high awareness group were significantly better than those in the low awareness group in terms of intention to seek medical care ( χ2=33.26), mode of medical checkups ( χ2=110.71), frequency of medical checkups ( χ2=45.37), and the way of dealing with abnormal values after medical checkups ( χ2=93.14), with the difference being statistically significant(all P<0.05). The results of linear regression analysis of the factors influencing the medical behavior of community residents showed that age≤44 and 45-59 ( B=0.479, 0.167), high school and specialist versus bachelor′s degree and above ( B=0.465, 0.739), use of employee medical insurance and residents′ health insurance ( B=0.604, 0.420), the number of current chronic diseases 1 ( B=0.919) and contracted family doctor ( B=0.134) of community residents′ health care behaviors are better (all P<0.05). Conclusions:The level of community residents′ health management cognition needs to be improved, and high health management cognition can significantly promote proactive healthcare-seeking behavior. However, residents′ medical behavior is still influenced by multidimensional factors. Signing a contract with a family doctor is significantly associated with high cognition and quality healthcare behaviors.

Objective:To investigate the current status of the implementation of active health management in tumor care in community health service institutions in Shanghai.Methods:This cross-sectional study was conducted in July 2022. A questionnaire was designed based on tumor management practices according to active health principles was designed and distributed to all 247 community health service institutions in 16 administrative districts of Shanghai. Data were collected on tumor screening, establishment of health records for tumor patients, and follow-up practices.Results:Of the 247 questionnaires distributed, 239 were returned, with 228 valid responses (effective response rate: 92.3%). Of the 228 institutions, 72 (31.6%) were located in urban areas, 101 (44.3%) in suburban areas, and 55 (24.1%) in rural areas. Tumor screening was performed by 89.0% (203/228) of the institutions, mainly for colorectal, lung, liver, breast, and gastric cancers. Health records for tumor patients were established by 92.5% (211/228) of institutions. Follow-up of tumor patients was conducted by 99.1% (226/228) of institutions, with 29.6% (67/226) performing 1-2 annual follow-ups. Telephone follow-up was used by 99.1% (224/226) of institutions, while 42.5% (96/226) adjusted the frequency of follow-up based on patients′ Karnofsky Performance Status scores. Targeted health education for patients and families was provided by 84.6% (193/228) of institutions, including exercise guidance (78.8%, 152/193) and psychological support (76.2%, 147/193). No statistically significant differences were observed among urban, suburban, and rural institutions in tumor screening, health record establishment, follow-up frequency, assessment content, follow-up methods, and tumor health education and content (all P>0.05). Conclusions:The coverage of tumor screening in Shanghai′s community health service institutions remains incomplete, the quality of follow-up needs to be improved, and health education programs are not comprehensive. There were no regional differences in tumor screening, health record establishment, follow-up practices, or tumor health education among urban, suburban, and rural populations.

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.