Background:China has become an aged society so that the health status of older population is gaining increasing concern by the researchers overall. Depression especially attracted attention because it impairs the quality of life on one hand and imposes a significant economic burden on both society and families on the other hand. The early detection of depression and comprehensively understanding of factors influencing its prevalence, therefore is crucial. However, currently available research findings lack of consistency. Moreover, much solid evidence from systematic review is insufficient in China.
Objective:To understand the prevalence of depression and its influencing factors among the Chinese older population from 2018 to 2022, providing suggestions on preventing depression among the older population and promoting healthy aging.
Methods:A systematic review was conducted on available published papers on depression of Chinese older population in January 2023, searching multiple online databases including PubMed, EmBase, Web of Science, CNKI, Wanfang Data, and VIP, covering the period from 2018 to 2022. Two independent reviewers selected the papers, assessed the quality of the studies using the cross-sectional study quality assessment criteria recommended by the Agency for Healthcare Research and Quality(AHRQ), then extracted data needed. Meta-analysis was performed using Stata 15.0.
Results:A total of 23 papers were included, covering older population of 75,599, with 13,815 among them identified as depressed. The AHRQ quality assessment scores ranged from 5 to 7. Meta-analysis results indicated that the prevalence of depression among the Chinese older population was 20.6 % [95 % CI (16.6 %, 24.8 %)]. Significant risk factors include gender (female) [OR = 1.46, 95 % CI (1.30, 1.64)], older age [OR = 1.48, 95 % CI (1.13, 1.94)], lower educational level [OR = 1.52, 95 % CI (1.32, 1.75)], absence of a spouse [OR = 1.60, 95 % CI (1.35, 1.91)], rural residency [OR = 1.38, 95 % CI (1.14, 1.66)], having chronic disease [OR = 2.75, 95 % CI (2.07, 3.66)], comorbidities [two: OR = 1.84, 95 % CI (1.07, 3.14); three or more: OR = 3.86, 95 % CI (2.89, 5.15)], poor self-rated health [OR = 3.47, 95 % CI (1.14, 10.53)], insomnia [OR = 2.62, 95 % CI (1.88, 3.66)], living alone [OR = 1.86, 95 % CI (1.56, 2.21)], lack of exercise [OR = 1.88, 95 % CI (1.60, 2.20)], and requiring full or partial assistance for daily living [OR = 2.96, 95 % CI (1.12, 7.85)], all of which were statistically significant (P<0.05). Protective factors included alcohol consumption [OR = 0.67, 95 % CI (0.50, 0.88)] and having friends [OR = 0.52, 95 % CI (0.38, 0.71)].
Conclusion:The prevalence of depression among the older population in China is high. Those female, of older age, with a lower level of education, without a spouse, living in rural areas, with chronic diseases and comorbidities, self-rated poor health, suffering from insomnia, living alone, lack of physical exercise, and requiring full or partial assistance for daily living, are more likely to suffer from depression.
Background: Implementing effective, rational support and comprehensive services for patients with advanced cancer undergoing chemotherapy is a significant challenge in community health services. According to recent data, the mortality rate from malignant tumors in Shanghai residents now ranks second only to cardiovascular and cerebrovascular diseases. Attention toward patients with advanced cancer undergoing chemotherapy is gradually increasing. This study aims to understand the primary care demands of such patients and the factors influencing these demands.
Objective: To investigate the demand and influencing factors for community health services during chemotherapy for patients with advanced cancer in Shanghai and to develop community interventions and services tailored to these patients' demands.
Methods: Patients with advanced cancer undergoing chemotherapy who regularly visited or were hospitalized at Shanghai Ninth People's Hospital, Wusong Hospital and Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine from December 2021 to March 2022 were selected as the study subjects. Based on government specifications, previous research findings from surveys on questionnaires and interviews, the final version of the "Community Health Services Demand Questionnaire for Patients with Advanced Cancer in Shanghai" was developed. It includes three demand dimensions (psychological, medical care, social support) and 38 demand items. The contents cover general information such as demographic and sociological information(educational level, marital status, source of medical expenses, disposable monthly household income, patient group participation), and tumor diagnosis(type and time of diagnosis, pain score, comorbidities), along with items on psychological demand (6 items), medical care demand (24 items), and social support demand (8 items). A 3-point scale was employed: 1 for unnecessary, 2 for necessary, and 3 for very necessary. Demand levels were ranked according to the average score of each item. Logistic regression analyses were used to identify the influencing factors of community health service demand among these patients.
Results: The demand dimensions, ranked from highest to lowest, were psychological demand (2.31 points), medical care demand (2.27 points), and social support demand (2.18 points). The top five demands were “preparation for pathological tests such as routine blood, liver and kidney functions before chemotherapy” (2.48 points), “education on chemotherapy knowledge” (2.48 points), “care for peripherally inserted central catheter(PICC) catheterization during chemotherapy” (2.45 points), “management of myelosuppression after chemotherapy” (2.43 points) and "providing updated information on treatment, examination and rehabilitation” (2.42 points), primarily focusing on the medical care demand dimension. Logistic regression analysis showed that educational level and disposable monthly household income significantly influenced psychological demand, while age and source of medical expenses influenced medical care demand, and age and patient group participation affected social support demand (P < 0.05).
Conclusion: Patients with advanced cancer undergoing chemotherapy have specific demands for community health services across psychological, medical care, and social support dimensions, influenced by factors such as age, educational level, and household income. This study offers recommendations for community health centers to develop relevant medical services. Future initiatives could introduce new service items in high demand and monitor the effectiveness of community interventions, such as psychological and medical care support for these patients, to improve their quality of life.
Background: Allergic rhinitis (AR) is a highly prevalent chronic non-communicable disease. The research on the understanding and treatment of AR in China is mainly conducted by otorhinolaryngology specialists, but rarely by general practitioners (GPs). And recommendations on the diagnosis and treatment of AR in primary care are also insufficient.
Objective: To explore the knowledge of AR and diagnosis and treatment capacities related to AR in GPs.
Methods: By using simple random sampling, 432 GPs from 21 community health centers of Chaoyang District of Beijing were chosen between August and September 2020. The survey questionnaire was developed based on the Guidelines for the Diagnosis and Treatment of Allergic Rhinitis (Tianjin, 2015) (China 2015 AR Guidelines) and Allergic Rhinitis and Its Impact on Asthma (ARIA) Guidelines:2010 Revision, and its 2016 annual revision following expert consultation and a pre-survey. The questionnaire encompassed basic information, understanding to AR, diagnostic and therapeutic behaviors, training, and support needs regarding AR of GPs.
Results: There were 383 out of 432 total distributed questionnaires returned, with a response rate of 88.7 %. Only 0.8 % (3/383) of the GPs correctly responded to all of the questions on typical AR symptoms, diagnosis, treatment principle, first-line drug categories, and regimens suggested by guidelines. 32.4 % (124/383) of the GPs reported that they knew Guidelines for AR, including China 2015 AR Guidelines and ARIA Guidelines, their sources of knowledge were from online continuing education platform, such as www.haoyisheng.com, www.dxy.cn and social media such as WeChat. When treating each patient with a respiratory disease, the percentage of GPs differentiating AR from other conditions, providing recommendations on environmental control, suggesting nasal rinsing, recommending other treatments instead of immunotherapy, and referring the patient to the specialty department without any treatment, was 59.8 % (229/383), 37.1 % (142/383), 17.8 % (68/383), 49.4 % (189/383), and 13.1 % (50/383), respectively. In terms of pharmacological treatment, 17.5 % (67/383) of GPs reported their facilities offered all four categories of first-line AR medications. As for AR-related training, 75.7 % (366/383) of the GPs reported not having taken any AR-related training in 2019;and 91.7 % (266/290) needed the training. And 95.6 % (290/383) of the GPs reported AR should be treated standardized in the community. The Logistic regression analysis revealed that when encountering patients with respiratory symptoms, GPs with a master's degree or higher〔OR (95 %CI) =2.790 (1.057, 7.366) 〕and a good understanding of AR-related health knowledge〔OR (95 %CI) =3.537 (2.015, 6.209) 〕were more likely to distinguish AR from other illnesses, GPs with a good understanding of AR-related health knowledge〔OR (95 %CI) =4.397 (0.534, 1.576) 〕were more likely to offer patients guidance on environmental control behaviors, GPs who were familiar with nasal irrigation procedures〔OR (95 %CI) =6.592 (3.038, 14.306) 〕were more likely to recommend nasal irrigation, and GPs knowing about immunotherapy〔OR (95 %CI) =1.881 (1.087, 3.254) 〕, accurately answering questions on the principles of treatment〔OR (95 %CI) =128.330 (16.628, 990.402) 〕or their facilities providing some/all laboratory testing services〔OR (95 %CI) =2.210 (1.299, 3.760) 〕were prone to recommend immunotherapy.
Conclusion: Despite insufficient knowledge of AR expertise and guidelines, and unsatisfied practice, GPs in Chaoyang District demonstrated proactive attitude towards continuing education and carrying out standardized AR treatment in primary care. As good understanding of AR-related knowledge and guidelines can promote quality of practice, relevant training for GPs should be strengthened, and AR-related guidelines applicable to primary care should be developed, which can provide support for the best practice of AR treatment in primary care.
Background: The long-standing dilemma of difficulties in the improvement of primary care in China has led to county-level medical alliances reforms in various regions throughout the country.
Objective: To analyze the combination of pathways that contribute to improving the service capabilities of county-level medical alliances, providing a reference for the improvement and promotion of county-level medical alliances.
Methods: CNKI and Wanfang Data Knowledge Service Platform were searched by using "county-level medical alliance" "county health care unit" as keywords from 2020-01-01 to 2022- 11-26 to obtain 662 related papers, a total of 9 papers and 11 cases were selected in the analysis. Based on literature review and policy analysis, variables including scale of planning and implementation, close organizational structure, collaborative management system, information platform integration, regional resources sharing, medical insurance payment reform, and incentive mechanism design were identified as outcome variables. The fuzzy set qualitative comparative analysis was used to identify multiple realization pathways for the service capability improvement of county-level medical alliances.
Results: Four combinations of pathways were found to improve the service capability of county-level medical alliances. Pathway S1:planning and implementation scale * close organizational structure * collaborative management system * regional resources sharing * medical insurance payment reform * incentive mechanism design. Pathway S2:close organizational structure * collaborative management system * information platform integration * regional resources sharing * medical insurance payment reform * incentive mechanism design. Pathway S3:smaller scale of planning and implementation * close organizational structure * collaborative management system * non-integrated information platform * non-sharing of regional resources * medical insurance payment reform * incentive mechanism design. Pathway S4:smaller scale of planning and implementation * close organizational structure * collaborative management system * non-integrated information platform * regional resource sharing * medical insurance payment reform * no incentive mechanism design.
Conclusion: The improvement of service capability of county-level medical alliances needs to focus on close organizational structure, establish management system focusing on the collaboration of departments and member institutions, and promote medical insurance payment reform such as global budget management system of medical insurance funds and diagnosis related groups(DRGs).
Background: Diabetes self-management is an important measure to reduce the adverse impact of the disease and improve the outcome in patients with diabetes. Existing diabetes self-management studies mainly focus on the evaluation of short-term intervention effects, but rarely report the long-term effects.
Objective: To evaluate the short- and long-term effects of self-management group activities on comprehensive glycemic control in patients with type 2 diabetes in the community.
Methods: In 2014, 500 adults with type 2 diabetes were recruited from Fangshan District, Beijing, and were randomly divided into a control group(n = 241) and an intervention group(n = 259). Both groups received routine diabetes follow-up services. The intervention group also received a three-month self-management group activities. We conducted four surveys at different times(at baseline, three months, two years and five years post-intervention) to collect patient demographics, disease condition, comprehensive glycemic control indicators〔body mass index(BMI), blood pressure, fasting plasma glucose(FPG), glycated hemoglobin(HbA1c), high-density lipoprotein cholesterol(HDL-C), triacylglycerol(TG), low-density lipoprotein cholesterol(LDL-C)〕. Generalized estimating equations were used to analyze the main effect of the self-management activities and the interaction effect of the activities with post-intervention time.
Results: After adjusting for potential confounders, the main effects of the self-management activities on BMI, systolic blood pressure, diastolic blood pressure, FPG, HbA1c, HDL-C, TG an LDL-C were not statistically significant(P > 0.05). The main effects of post-intervention time on various indicators were statistically significant(P < 0.05). Specifically, BMI, systolic blood pressure, diastolic blood pressure, FPG, HbA1c, HDL-C and LDL-C increased, and TG decreased in the patients after intervention. We found the self-management activities and the post-intervention time had an interaction effect on BMI〔β(95 %CI)=-0.33(-0.62, -0.05)〕, FPG〔β(95 %CI)=-1.03(-1.71, -0.35)〕, and TG〔β(95 %CI)=-0.54(-0.93, -0.14)〕: the BMI of the intervention group was 0.31 kg/m2 lower than that of the control group at baseline, but was 0.64 kg/m2 lower than that of the control group at three months post-intervention; the FPG of the intervention group was 0.19 mmol/L higher than that of the control group at baseline, but was 0.84 mmol/L lower than that of the control group at two years post-intervention; the TG of the intervention group was 0.03 mmol/L higher than that of the control group at baseline, but was 0.51 mmol/L lower than that of the control group at five years post-intervention.
Conclusion: Self-management group activities have a short-term effect on controlling BMI, and may have a long-term effect on controlling FPG and TG in patients with type 2 diabetes.
Background: Research on family doctor contract services has predominantly focused on residents, with limited attention to the general practitioners (GPs) regarding the current situation of family doctor team contracting.
Objective: This study aims to assess the current status of family doctor contract services in primary health care facilities in Guangdong Province from the GPs' perspective and to identify factors influencing the number of people contracting with family doctor teams.
Methods: A multi-stage stratified cluster sampling method was used to select GPs from primary health care facilities in Guangdong Province from July 5 to July 31, 2021. A self-developed survey questionnaire was used to collect data. The number of people contracted with family doctor teams under different characteristics of GPs and their teams was compared, and a two-level Logistic regression model was developed using R 4.2.2 software to determine the factors that influence whether enrollment numbers in family doctor teams exceed 2,000.
Results: A total of 3,252 valid responses were collected from family doctor teams with a contracting count above 100. In 2020, the median number of contracts per family doctor team, as reported by GPs, was 1,400(IQR = 2,499). Comparisons of the number of people contracted with family doctor teams among GPs of different genders, ages, educational levels, managerial positions, employment forms, years of professional experience, working facilities, practicing regions, training received, and annual income showed statistically significant differences (P < 0.05). Variables including the number of team members, the population under jurisdiction, the intention for specialist doctors within the health group to join the team, the availability of hospital beds, and guidance from higher-level hospitals also exhibited significant variations (P < 0.05). Zero model fitting results highlighted that the distribution of contracted individuals was regionally clustered among the practicing regions of GPs (P < 0.05). The comprehensive analysis using a two-level Logistic regression model revealed several key findings: GPs holding a college diploma [OR (95 %CI) = 2.79 (1.84, 3.74)] or a vocational school/high school certificate [OR (95 %CI) = 2.83 (1.80, 3.86)] were more likely to manage teams with over 2,000 contracted individuals, compared to those with a master's degree or higher. GPs in managerial positions were less likely [OR (95 %CI) = 0.66 (0.33, 0.99)] to oversee teams exceeding 2,000 contracted individuals, in contrast to those without any managerial role. Formal employment status was associated with a higher likelihood [OR (95 %CI) = 2.02 (1.53, 2.51)] of managing larger numbers of contracted individuals compared to temporary employment. Team size showed a positive correlation with contracting capacity; teams with 4-6 members [OR (95 %CI) = 1.31 (1.05, 1.57)], 7-10 members [OR (95 %CI) = 2.06 (1.75, 2.37)], 11-19 members [OR (95 %CI) = 3.67 (3.31, 4.03)], and ≥20 members [OR (95 %CI) = 3.46 (2.74, 4.18)] were increasingly likely to surpass 2,000 contracted individuals. Teams managing larger populations—2,001-9,999 [OR (95 %CI) = 2.37 (2.12, 2.62)], 10,000-29,999 [OR (95 %CI) = 2.92 (2.65, 3.19)], and ≥30,000 [OR (95 %CI) = 2.86 (2.55, 3.17)]—were more likely to exceed 2,000 contracts compared to those managing ≤2,000 people. The absence of hospital bed resources within a team was positively associated [OR (95 %CI) = 1.38 (1.14, 1.62)] with surpassing the 2,000 contracted individuals threshold.
Conclusion: The study findings suggest that a larger family doctor team size and larger population size of jurisdiction positively impact the capacity for contracting with family doctor teams. GPs with higher educational levels, managerial roles, and access to hospital bed resources possess a more profound understanding and control over family doctor contract service policies, leading to optimized management of contracted individuals. Compared to their temporarily employed counterparts, formally employed GPs within family doctor teams are more likely to engage in contracting activities.
Background: Outpatient medical care payment play a pivotal role in the reform of medical insurance payment methods. With ongoing reforms in China, a variety of payment strategies, including capitation and the ambulatory patient groups (APG) point method, are being progressively implemented.
Objective: This study aims to identify appropriate capitation calculation methods for chronic diseases in Beijing and to provide recommendations for implementing capitation payments reforms in the city.
Methods: We focused on four prevalent chronic diseases—hypertension, diabetes, coronary heart disease, and stroke—and analyzed basic medical data and public health funding in Beijing's districts C and H as case studies. This research was aimed at developing a capitation calculation method tailored to these locales, determining payment standards for major chronic diseases in primary care clinics, and thus supporting the advancement of capitation reform for outpatient chronic diseases.
Results: Using medical insurance data and public health funding data from 2017 to 2019, a top-down allocation was employed to determine the capitation payment standards in district H: 4,693.11 Yuan for hypertension, 6,597.70 Yuan for diabetes, 5,644.46 Yuan for coronary heart disease, and 6,437.78 Yuan for stroke. A bottom-up costing approach was used in district C, resulting in payment standards of 4,884.18 Yuan for hypertension, 5,960.63 Yuan for diabetes, 3,733.93 Yuan for coronary heart disease, and 3,886.66 Yuan for stroke.
Conclusion: The outpatient costs associated with different chronic disease populations vary considerably. In view of maintaining equity in medical insurance and the fairness of capitation fees, it is imperative to apply risk adjustments to the benchmark capitation fee. Personalized services should be tailored to the diverse types and severities of chronic diseases. It is also crucial to provide customized basic medical and public health services to various chronic disease patients as part of the capitation payment reform for outpatient services. Additionally, enhancing the capabilities of community health services in managing chronic diseases, improving contracting percentages, and establishing effective incentive and evaluation mechanisms for general practitioners are essential for equitable distribution of surplus from capitation payments.
Background The competency of graduates of rural bonded general practice education program has attracted widespread attention. Strengthening continuing professional development is an important measure to enhance the competency of general practitioners (GPs) who graduated from the bonded medical program.
Objective To understand the current status, challenges, and needs of continuing professional development for doctors who graduated from the bonded medical program in Guizhou Province, and to inform the improvement of the continuing professional development.
Methods Between November and December 2021, a combination of purposive sampling and snowball sampling was used to select 42 GPs who graduated from the bonded medical program from 39 township health centers across nine cities (prefectures) in Guizhou Province as research subjects. Semi-structured interviews were conducted, and the results were analyzed using a procedural grounded theory method.
Results Through three-level coding, a total of 145 concepts, 23 categories, and 5 main categories were ultimately organized, leading to one storyline: the continuing professional development of the GPs is influenced by multiple factors. The actual conditions pose the main obstacles, while capability and quality act as external drivers, policies and systems provide crucial safeguards, and inherent needs serve as internal motivators. Improving training process management is identified as the key element.
Conclusion The willingness of the rural GPs in Guizhou Province to undergo training needs to be strengthened. The quality of continuing professional development, the relevance of training content to their needs, and the level of attention from primary care facilities require improvement. There should be enhanced support for continuing professional development and the development of an information platform. Developing suitable education content and training formats for GPs who graduated from bonded medical program is essential to enhance the quality and effectiveness of continuing professional development.
Background: With population aging, the prevalence of dementia is rising annually, alongside a rise in multimorbidity. However, comprehensive surveys on the prevalence of dementia in older population in Hunan Province are limited, and the comorbid relationships between diseases remain unclear.
Objective: To comprehensively understand the prevalence of dementia among older people aged 65 years and above in Hunan Province and analyze its comorbidity relationships with 11 common chronic diseases.
Methods: From April to May 2021, using stratified multistage sampling, residents aged 65 years and above were randomly surveyed across 30 districts/counties, 60 streets/townships, and 180 community/village committees in Hunan Province. Dementia diagnosis was conducted by neurologists or psychiatrists using the Community Screening Interview for Dementia (CSI-D) or the 8-item dementia questionnaire (AD8), along with the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Additionally, the prevalence of hypertension, cerebrovascular disease, ischemic heart disease, rheumatoid arthritis, intervertebral disc disease, diabetes, gastroenteritis, chronic obstructive pulmonary disease, cholecystitis cholelithiasis, peptic ulcer, and cancer was investigated.
Results: Out of the 5,979 individuals sampled, 5,616 completed the survey, with 785 cases (13.98 %) identified with dementia. Comparisons of dementia prevalence among different regions, genders, ages, smoking histories, and chronic disease conditions showed statistically significant differences (P < 0.05). A total of 5,606 sets of chronic disease prevalence data were collected, with hypertension [2,205 (39.33 %)], intervertebral disc disease [553 (9.86 %)], diabetes [526 (9.38 %)], cerebrovascular disease [492 (8.78 %)], and ischemic heart disease [467 (8.33 %)] being the most common. In the dementia group, the most prevalent conditions were hypertension [325 (41.40 %)], cerebrovascular disease [111 (14.14 %)], ischemic heart disease [91 (11.59 %)], rheumatoid arthritis [89 (11.33 %)], and intervertebral disc disease [81 (10.31 %)]. The prevalence rates of dementia among groups with varying numbers of chronic diseases ranged from 11.46 % to 18.26 %, increasing with the number of conditions. Significant differences in dementia prevalence were found in individuals with gastroenteritis, rheumatoid arthritis, cerebrovascular disease, chronic obstructive pulmonary disease, and ischemic heart disease (P < 0.05). Binary logistic regression analysis showed that living in rural areas [OR = 2.048, 95 %CI (1.655, 2.536)], being female [OR = 1.388, 95 %CI (1.163, 1.655)], advanced age [OR = 1.348, 95 %CI (1.270, 1.431)], and suffering from chronic diseases [OR = 1.195, 95 %CI (1.101, 1.297)] were risk factors for dementia in residents aged ≥ 65 (P < 0.05). Regarding medication adherence, 12.79 % (99/774) dementia patients reported difficulties, 6.59 % (51/774) needed assistance, and 2.97 % (23/774) were unable to manage independently.
Conclusion: The prevalence of dementia among residents aged ≥ 65 in Hunan Province is influenced by the number of chronic diseases and varies with different conditions. The self-care abilities and family care burdens of dementia patients with comorbidities should attract widespread attention from all of the society. These findings aim to provide recommendations for the development of prevention and control policies for dementia and related comorbidities in Hunan Province.
Background: The development plan of traditional Chinese medicine (TCM) has been integrated into the national development strategy, with a focus on significantly enhancing the TCM service capabilities of primary care facilities. However, researches on the disease spectrum of TCM diagnosis and treatment in community health centers is lacking.
Objective: To understand the TCM diagnosis and treatment capabilities of Shenzhen's community health centers by analyzing the disease spectrum of TCM diagnosis and treatment among outpatients signed with family doctors at these centers.
Methods: From May to June 2022, records of family doctor-signed residents who visited the outpatient departments of community health centers in 10 districts of Shenzhen from January 1, 2021, to June 30, 2021, and incurred diagnosis and treatment costs were extracted from the “Hangchuang Community Health Service Center Business System,” a unified information platform of the Shenzhen Health Commission. Records for which TCM was the purpose for the visit, which had corresponding diagnosis and treatment costs, as well as a primary diagnosis coded according to the “Classification and codes of diseases and patterns of traditional Chinese medicine” (TCD) were included in the study (n=385,138). The disease spectrum was analyzed based on the TCD, mainly involving specialty category, sub-specialty system classification and TCM term of disease and pattern.
Results: Among the 385,138 records included, there were 170,077 male visits (44.16 %) with an average age of 37.5 ± 8.2 years; and 215,061 female visits (55.84 %), with an average age of 36.7 ± 9.4 years. The disease spectrum covered all seven specialty categories of TCD: internal medicine (219,445, 56.98 %), pediatrics (79,201, 20.56 %), otorhinolaryngology (47,965, 12.45 %), gynecology (30,620, 7.95 %), surgery (5,797, 1.51 %), orthopedics (1,407, 0.37 %), and ophthalmology (703, 0.18 %). The spectrum covered all sub-specialty system classifications under the seven specialty categories except for tumor diseases, cancer diseases in each specialty category, and certain eye disease classes such as diseases of the canthus, diseases of the cornea, pupil diseases, and traumatic eye diseases. In each specialty category, several diseases accounted for ≥90.00 % of the total diagnostic and treatment volume for that specialty category. The top five system diseases were respiratory system diseases (208,701, 54.19 %), musculoskeletal system diseases (73,369, 19.05 %), gynecological system diseases (30,620, 7.95 %), cardiovascular and cerebrovascular system diseases (27,539, 7.15 %), and digestive system diseases (19,162, 4.98 %). Patients under 15 and those aged 15 to 24 primarily had diseases related to the respiratory system and digestive systems. As age increased, the number of patients with paralysis, dizziness, headache, insomnia, and fatigue gradually increased; before the age of 45, the leading disease was the common cold, and after 45, it was muscle and joint pain caused by paralysis.
Conclusion: The TCM diagnosis and treatment disease spectrum at Shenzhen's community health centers is broad but concentrated and singular, predominantly involving internal medicine. The disease spectrum is mainly concentrated in five major systems: respiratory, musculoskeletal, gynecological, cardiovascular and cerebrovascular, and digestive systems. There is a need to further enhance and expand the TCM diagnosis and treatment capabilities of community health centers to better meet the diverse health needs of residents.