Family medicine training in China: crisis and opportunity

Morikawa, Masahiro J.

doi:10.1136/fmch-2019-000283

Cited by 5 publications

(5 citation statements)

References 24 publications

(24 reference statements)

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“…To be more specific, there is a need to scale up the residency training model (5 + 3) and rapidly increase the number of general practitioners familiar with general medicine concepts, all of which can serve as a foundation for establishing a GP-PCIC multimorbidity prevention and control model. Secondly, on the basis of harmonizing national audit standards and training quality monitoring systems for general practitioner transfer training ( 47 , 48 ), specific capacity improvement training for specific chronic disease epidemic trends in specific regions should be provided to address the problem of general practitioners in the circulatory system. Thirdly, there is a need for additional training of general practitioners, with an emphasis on establishing and improving mechanisms for comprehensive disease prevention and control.…”

Section: Discussion and Policy Implicationsmentioning

confidence: 99%

Multimorbidity in Hospitalized Patients Admitted to General Practice Departments and Its Implications for the General Practice Healthcare System: A Four-Year Longitudinal Study in China

Zhou

Shi

Liu

et al. 2021

Front. Public Health

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Objective: China and many developing countries has placed high expectations on the general practice healthcare system in terms of lowering medical costs and improving the health status of the multimorbid population in recent years. However, the prevalence of multimorbidity among inpatients attending the general practice department of hospitals and its policy implications are largely unknown. The current study aimed to analyze the prevalence of comorbidities among inpatients attending the general practice department of the tertiary Grade-A Hospitals in China, and put forward evidence-based policy recommendations.Methods: Between December 2016 and November 2020, 351 registered general practitioners from 27 tertiary hospitals were selected, and their direct admissions were evaluated. The rate and composition ratio were used for descriptive analysis of the clinical and epidemiological characteristics of multimorbidity. A backward stepwise algorithm was used to explore independent variables. The absence of multicollinearity and plausible interactions among variables were tested to ensure the robustness of the logistic regression model. The pyramid diagram was used to show the link between gender and the involved human body system in multimorbidity.Results: Multimorbidity was present in 93.1% of the 64, 395 patients who were admitted directly. Multimorbidity was significantly more prevalent in patients aged 45–59 years (OR=3.018, 95% CI=1.945–4.683), 60–74 years (OR = 4.349, 95% CI = 2.574–7.349), ≥75 years (OR = 7.804, 95% CI = 3.665–16.616), and those with body mass index (BMI) ≥ 28 kg/m2 (OR = 3.770, 95% CI = 1.453–9.785). The circulatory system was found to be the most commonly involved human body system in multimorbidity, accounting for 79.2% (95% CI = 78.8–79.5%) of all cases. Significant gender inequity was further observed in the involved human body system in multimorbidity.Conclusion: Multimorbidity is likely common among the inpatients attending the general practice department of hospitals in China and many developing countries, with significant gender inequity in the involved human body systems. Effective countermeasures include establishing a GP-PCIC multimorbidity prevention and control model and enhancing the multimorbidity of elderly and obese patients at both the clinical and healthy lifestyle levels. The diagnosis and treatment capabilities of GPs on the circulatory, endocrine, metabolic, digestive, and respiratory systems should be prioritized.

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Section: Discussion and Policy Implicationsmentioning

confidence: 99%

Multimorbidity in Hospitalized Patients Admitted to General Practice Departments and Its Implications for the General Practice Healthcare System: A Four-Year Longitudinal Study in China

Zhou

Shi

Liu

et al. 2021

Front. Public Health

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“…Besides, at least eight textbooks related to FM had been published in China in 2007. Also, Morikawa (2020) indicated the case-based and problem-based learning methods with group discussions were preferable to lecture-heavy teachings in China. Justino et al (2016) showed that the techno-theoretical programs, such as weekly workshops in skills, weekend seminars and clinical reasoning workshops, covered 15% of FMR training programs in Brazil.…”

Section: Discussionmentioning

confidence: 99%

A compatible model of family medicine residency training in Iran

Khatami

Shariati

Motezarre

2021

HESWBL

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PurposeOne of the major challenges in practicing family medicine residents (FMRs) is the choice of an appropriate pattern in training health centers (THCs) to provide high-quality health services to patients. This study aimed to design an efficient residency training model in Iranian healthcare centers.Design/methodology/approachA four-phase qualitative study with the nominal group technique was carried out in 2018–2019. The required standards of THCs and superior educational practices were initially extracted from the review literature. After collecting and presenting the key findings to the experts' panel, the required training standards and the optimal strategic model to educate FMRs in THCs were prioritized by a nine-point rating system for the well-structured terms of indigenous resources.FindingsTwenty-two educational standards for FMRs in THCs were finalized after reviewing the literature and taking an opinion poll of experts. The highest assessment scores belonged to sufficient numbers of referrals for common health issues and the existence of satisfactory educational and recreational facilities in THCs. The problem-based (PBL), task-based (TBL) and context-based (CBL) learning models were better strategies than guided-discovery learning (GDL) and small group teaching (SGT) ones to train FMRs in THCs. Also, PBL and SGT models were rated as the best and worst advanced medical education methods to empower FMRs.Originality/valueDue to different resources available in THCs and training centers, different factors and infrastructures should be considered to meet the required standards in building the integrative training model for FMRs in THCs.

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“…PCPs in village clinics ordinarily have 3 years of medical education after high school [ 34 ]. They receive periodic in-service education that includes HTN management using CDC practice guidelines that address detection, management by both pharmacologic and nonpharmacologic means, and guidance on when to make referral to specialized care [ 35 ].…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of integrated care for older adults with depression and hypertension in rural China: A cluster randomized controlled trial

et al. 2022

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Background Effectiveness of integrated care management for common, comorbid physical and mental disorders has been insufficiently examined in low- and middle-income countries (LMICs). We tested hypotheses that older adults treated in rural Chinese primary care clinics with integrated care management of comorbid depression and hypertension (HTN) would show greater improvements in depression symptom severity and HTN control than those who received usual care. Methods and findings The study, registered with ClinicalTrials.gov as Identifier NCT01938963, was a cluster randomized controlled trial with 12-month follow-up conducted from January 1, 2014 through September 30, 2018, with analyses conducted in 2020 to 2021. Participants were residents of 218 rural villages located in 10 randomly selected townships of Zhejiang Province, China. Each village hosts 1 primary care clinic that serves all residents. Ten townships, each containing approximately 20 villages, were randomly selected to deliver either the Chinese Older Adult Collaborations in Health (COACH) intervention or enhanced care-as-usual (eCAU) to eligible village clinic patients. The COACH intervention consisted of algorithm-driven treatment of depression and HTN by village primary care doctors supported by village lay workers with telephone consultation from centrally located psychiatrists. Participants included clinic patients aged ≥60 years with a diagnosis of HTN and clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10). Of 2,899 eligible village residents, 2,365 (82%) agreed to participate. They had a mean age of 74.5 years, 67% were women, 55% had no schooling, 59% were married, and 20% lived alone. Observers, older adult participants, and their primary care providers (PCPs) were blinded to study hypotheses but not to group assignment. Primary outcomes were change in depression symptom severity as measured by the Hamilton Depression Rating Scale (HDRS) total score and the proportion with controlled HTN, defined as systolic blood pressure (BP) <130 mm Hg or diastolic BP <80 for participants with diabetes mellitus, coronary heart disease, or renal disease, and systolic BP <140 or diastolic BP <90 for all others. Analyses were conducted using generalized linear mixed effect models with intention to treat. Sixty-seven of 1,133 participants assigned to eCAU and 85 of 1,232 COACH participants were lost to follow-up over 12 months. Thirty-six participants died of natural causes, 22 in the COACH arm and 14 receiving eCAU. Forty COACH participants discontinued antidepressant medication due to side effects. Compared with participants who received eCAU, COACH participants showed greater reduction in depressive symptoms (Cohen’s d [±SD] = −1.43 [−1.71, −1.15]; p < 0.001) and greater likelihood of achieving HTN control (odds ratio [OR] [95% CI] = 18.24 [8.40, 39.63]; p < 0.001). Limitations of the study include the inability to mask research assessors and participants to which condition a village was assigned, and lack of information about participants’ adherence to recommendations for lifestyle and medication management of HTN and depression. Generalizability of the model to other regions of China or other LMICs may be limited. Conclusions The COACH model of integrated care management resulted in greater improvement in both depression symptom severity and HTN control among older adult residents of rural Chinese villages who had both conditions than did eCAU. Trial registration ClinicalTrials.gov Identifier NCT01938963 https://clinicaltrials.gov/ct2/show/NCT01938963.

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Family medicine training in China: crisis and opportunity

Cited by 5 publications

References 24 publications

Multimorbidity in Hospitalized Patients Admitted to General Practice Departments and Its Implications for the General Practice Healthcare System: A Four-Year Longitudinal Study in China

Multimorbidity in Hospitalized Patients Admitted to General Practice Departments and Its Implications for the General Practice Healthcare System: A Four-Year Longitudinal Study in China

A compatible model of family medicine residency training in Iran

Effectiveness of integrated care for older adults with depression and hypertension in rural China: A cluster randomized controlled trial

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