Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-06-08 Cooperative journals: 《中国全科医学》
Abstract： Background With the aging and longer survival of the population，comorbid chronic diseases is increasingly common. The variety and complexity of diseases poses challenges to the health management of the elderly.There is a relative lack of multimorbidity pattern researches in China，whichare necessary issues for research. Objective To investigate the patterns of coexistence of common multiple chronic conditions among the elderly in China，in order to help policymakers， researchers，and clinicians better understand the current status of multimorbidity among Chinese elderly. Methods Data on the demographic characteristics and health status of 14 chronic diseases were extracted from the respondents aged 60 years and above in the China Health and Retirement Longitudinal Study（CHARLS）2018，association rules，cluster analysis，principal component analysis，latent class analysis were used to explore the multimorbidity patterns of Chinese elderly，and the results of different methods were compared. Results The data from a total of 10 800 respondents were eventually included，there were differences among the patterns obtained by four methods.However，the consistent multimorbidity patterns were identified：（i） hypertension，diabetes or elevated blood glucose，dyslipidemia；（ii）chronic lung disease and asthma；（iii）arthritis or rheumatism，stomach diseases or digestive diseases；（iv）stroke，memory-related diseases. Conclusion The consistent patterns obtained by different methods contain chronic diseases with significant relationships of etiologies.The reasons of differences in results are complex etiologic relationships and different method principles.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-05-05 Cooperative journals: 《中国全科医学》
Abstract： Background The long-term and stable development of the general practitioner workforce is crucial to the implementation of policies related to contracted family doctor services，the continuous promotion of construction of the hierarchical diagnosis and treatment system，and the realization of national strategic goals for achieving “big health”. Whether a general practitioner continues to work in general practice depends primarily on his confidence in the profession. Exploring the perceptions toward general practice as a career among general medical graduates finishing the standardized general residency training program（SGRTP），can provide a reference for the improvement of training content and relevant policy formulation.However，there are few relevant studies. Objective To explore the perceptions toward general practice career among non-targeted admission general medical graduates completing the SGRTP，offering insights into how to better retain general practice talents. Methods In August 2021，stratified cluster random sampling was used to select non-targeted admission general medical graduates who had been admitted to the SGRTP in 10 standardized general residency training bases in Henan Province during 2014 to 2017，and completed the SGRTP as of the survey date. They attended a self-administered survey conducted through an online platform named Wenjuanxing（http://www.wjx.cn），using a questionnaire developed by our research group for understanding their general information，standardized training information，current work situation and perceptions toward a career in general practice. Results Three hundred and twenty-six cases attended the survey，and 271（83.1%） of them who handed in responsive questionnaires were finally included，among whom 77（28.4%） went into the career of general practice after the completion of SGRTP. Compared with their counterparts who did not work in general practice following the completion of training，the trainees who worked in general practice rated the disciplinary position of general medicine and the social position of general practitioners higher（P<0.05）. Moreover，the percentage of them〔80.6%（62/77）〕 intending to work in general practice in their whole life was higher（P<0.05）. The score for disciplinary position of general medicine rated by the trainees varied by age and whether or not being the only child of the family（P<0.05）. The score for social position of general practitioners rated by the trainees varied by maternal education level（P<0.05）. The score for the career prospect of general practitioners rated by the trainees varied by age（P<0.05）. Age，education level，marital status，maternal occupation，and current work unit were associated with the differences in scores for intending to be a general practitioner in the whole life given by the trainees（P<0.05）.The top three factors limiting the development of general medicine according to the trainees were “inadequate supporting policies”（150 cases，55.4%），“low salary for general practitioners”（146 cases，53.9%），and “poor equipment in primary care”（137 cases，50.6%）. The rates of trainees choosing restrictors of the development of general medicine did not vary by whether or not working in general practice following the completion of SGRTP（P>0.05）. The top three advantages of primary care institutions were “better health guidance for residents”（213 cases，78.6%），“optimal allocation of medical resources，relieving pressure on major hospitals and avoiding waste of resources”（165 cases，60.9%），and “solving the problem of'seeing a doctor is difficult and expensive' among the masses”（162 cases，59.8%）. The rates of trainees choosing the options of advantages of primary care institutions did not vary by whether or not working in general practice following the completion of SGRTP（P>0.05）.The top three disadvantages of primary care institutions according to the trainees were “low salary for general practitioners”（212 cases，78.2%），“poor hardware and equipment”（181 cases，66.8%），and“inadequate social security mechanism”（111 cases，41.0%）. The rate of trainees choosing “inadequate social security mechanism” or “great concern in educational issues for children due to backward development in remote rural areas” varied by whether or not working in general practice following the completion of SGRTP（P<0.05），but the rate of choosing each of the other options of disadvantages of primary care institutions did not（P>0.05）. Conclusion Age，education level，marital status，mother's education level and occupation，whether or not being the only child in the family，and current work unit were associated with the perceptions toward general practice career in non-targeted admission general medical graduates completing the SGRTP. The supporting policies and salary system are main factors affecting the development of general medicine and primary care institutions，and priority should be given to the allocation of hardware and equipment and the education guarantee for children of general practitioners.
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