Association between doctor-patient familiarity and patient-centred care during general practitioner's consultations: a direct observational study in Chinese primary care practice

GP's GP, general practitioner's health and willingness to contract family doctors in China: a national cross-sectional study

OBJECTIVES

General practitioners are trained to care for patients with a high level of responsibility and professional competency. However, there are few reports on the physical and mental health status of general practitioners (GPs) in China, particularly regarding help seeking and self-treatment. The primary aims of this study were to explore GPs' expectations of their own family doctors and their reflection on role positioning, and to explore the objective factors that hinder the system of family doctors.

STUDY DESIGN

Cross-sectional study.

METHODS

We conducted an online survey of Chinese GPs. Descriptive statistics were used to summarize the findings.

RESULTS

More than half of the participants (57.20%) reported that their health was normal over the past year. A total of 420 participants (23.35%) reported having chronic diseases. For sleep duration, 1205 participants (66.98%) reported sleeping 6-8 h per day; 473 participants (26.29%) reported chronic insomnia. Two hundred thirty-one participants (12.84%) had possible depression. A total of 595 (33.07%) participants reported that they had contracted a fixed family doctor. In terms of preventing themselves from contracting for a family doctor, the following factors were identified: lack of sufficient time (54.81%), could solve obstacles themselves (50.97%), and embarrassment (24.24%). The proportion of the contract group (12.44%) taking personal relationship as a consideration was higher than that of the non-contract group (7.64%) (χ2 = 10.934 P = 0.01). Most participants (79.90%) in the non-signed group reported never having seen a family doctor. In terms of obstacles, more than half of the signed group thought that they could solve obstacles themselves, while the non-signed group (39.20%) was less confident in the ability of family doctors than the signed group (29.75%) (χ2 = 15.436, P < 0.01).

CONCLUSIONS

GPs work under great pressure and lack of self-care awareness, resulting in an increased prevalence of health conditions. Most GPs did not have a regular family doctor. Having a family doctor with a fixed contract is more conducive to the scientific management of their health and provides a reasonable solution to health problems. The main factors hindering GPs from choosing a family doctor were time consumption, abilities to solve obstacles themselves, and trust in the abilities of GPs. Therefore, simplifying the process of family doctor visits, Changing the GPs' medical cognition, and strengthening the policy of GP training would be conducive to promoting a family doctor system that enhances hierarchical diagnosis and treatment. International collaboration could integrate GP health support into global healthcare system.

The relationship between psychological capital, patient's contempt, and professional identity among general practitioners during COVID-19 in Chongqing, China

General practitioners are crucial in the primary healthcare system as well as for epidemic prevention and control. However, few researchers have examined their professional identity. This study investigated the current status of the professional identity of general practitioners in Chongqing, China and explored the effects of psychological capital and patient's contempt on their professional identity. From December 2021 to January 2022, randomized cluster sampling was used to conduct a cross-sectional online self-assessment questionnaire survey among general practitioners in Chongqing. In total, 2,180 general practitioners working for more than one year were selected. General practitioners' sense of professional identity, mental health, and sense of patients' disrespect were measured using the Professional Identity Scale, Psychological Capital Questionnaire, and Patient's Contempt Questionnaire. Sociodemographic characteristics were also collected. A multiple linear regression model was used to analyze the association between professional identity, psychological capital, and patient's contempt. The average score for professional identity among general practitioners was 53.59 (SD = 6.42). The scores for self-efficacy, hope, resilience, and optimism (subscales of psychological capital) were 26.87 (SD = 5.70), 26.47 (SD = 5.74), 26.97 (SD = 5.55), and 26.86 (SD = 5.59), respectively. The score for perceived contempt was 34.19 (SD = 7.59). An average monthly income greater than CNY 8,000 (β = 1.018, p < 0.001), work tenure of more than 15 years (β = 0.440, p = 0.001), hope (β = 0.249, p < 0.001) and a higher optimism score (β = 0.333, p < 0.001) were positively correlated with professional identity. Having a bachelor's degree and above (β = -0.720, p = 0.014), an administrative role (β = -1.456, p < 0.001), self-efficacy (β = -0.122, p < 0.001), and higher patient's contempt (β = -0.103, p < 0.001) were negatively associated with professional identity. General practitioners in Chongqing demonstrated high professional identity and a strong psychological status during the COVID-19 pandemic. Psychological capital and patient's contempt were associated with professional identity. To improve general practitioners' professional identity, stakeholders should promote practitioners' mental health and physician-patient relationships in China.

Process quality of type 2 diabetes mellitus care and association with patient perceived attributes of family doctor service in urban general practices, Beijing, China

Background

Family doctor service (FDS) is a scheme oriented to improving the access and continuity of primary care in China. Type 2 diabetes mellitus (T2DM) management is a core component of FDS. However, evidence on the quality of T2DM care is lacking and the potential association between FDS attributes and T2DM care is largely unknown. This study attempted to assess the process quality of T2DM care in general practice and explore the association between patient perceived FDS attributes and process quality of T2DM care.

Methods

Total 400 patients were recruited from 5 community health service centers in two urban districts in Beijing. Questionnaire survey and extraction of data from electronic health record (EHR) were conducted to collect patient characteristics, patient perceived FDS attributes (accessibility, continuity and team-based care) and process quality indicators (monitoring and health counseling indicators). Chi-square test and a two-level generalized linear mixed model (GLMM) were used to explore the association between FDS attributes and process quality.

Results

The utilization rate of all the 12 indicators in monitoring, 6 indicators in health counseling and all the 18 process indicators, was 12.8%, 23.8% and 6.0% respectively. Over half of the patients (56.8%) perceived all the 3 FDS attributes. There were statistically significant associations between accessibility of care and lipid (p = 0.008), electrocardiogram (p = 0.016), retinopathy (p = 0.037) and peripheral neuropathy (p = 0.006) monitoring and each of the 6 health counseling indicators (all the p values < 0.05). Regular follow up (p = 0.039), plasma blood glucose (p = 0.020), blood pressure (p = 0.026), body mass index (p = 0.044) and foot (p = 0.005) monitoring as well as each of the 6 health counseling indicators (all the p values < 0.05) were more likely to be received by patients when continuity of care was ensured. Patients who were managed by a GP team had higher utilization rate of glycosylated hemoglobin monitoring (p = 0.026) and each of the 6 health counseling indicators (all the p values < 0.05). When the patients perceived one more FDS attribute, the indicators they received significantly increased by 1.50 (coefficient = 1.50, p < 0.001). Patients between the age of 65 and 74 years received 1.15 more indicators than those under 65 (coefficient = 1.15, p = 0.003). Patients with more than ten years duration of T2DM received 0.74 more indicators (coefficient = 0.74, p = 0.028). Patients taking both insulin and oral medicine received 0.97 more indicators than those taking oral medication only (coefficient = 0.97, p = 0.027). Patients who were managed by GPs with on-job training experience received 1.19 more indicators (coefficient = 1.19, p = 0.040). Among the patients who had completed junior high school or below, having better self-report health status (≥ 60) received 2.40 less indicators (coefficient = -2.40, p = 0.004).

Conclusions

Improvement of key monitoring and health counseling indicators might be needed in T2DM care in general practice in Beijing, China. Policies for improving process quality of T2DM care should be considered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01838-0.