Background: Medication therapy is a cornerstone for the primary and secondary prevention of cardiovascular diseases, yet values and preferences regarding medication use remain unclear.

Objective: To explore the values and preferences of medication use in patients for the primary and secondary prevention of cardiovascular diseases.

Methods: This study explanatory sequential mixed methods study recruited patients for primary or secondary prevention of cardiovascular diseases at West China Hospital of Sichuan University and Yulin Community Health Service Center from November 2021 to January 2022. The focus group interviews collected the understanding of the values and preferences related to medication use among the participants. After coding with MAXQDA 2020, the investigators sorted, analyzed, and extracted the themes using Colaizzi's seven-step analysis method. Following the findings from the qualitative study, a quantitative survey was conducted from November 2022 to February 2023 among a conveniently sampled group of participants in multidisciplinary departments before the quantitative analysis.

Results: The focus group interview included 21 participants, yielding four themes: (1) cognition and behavior towards medication; (2) barriers to medication use; (3) facilitators of medication use; and (4) needs for medical services. The quantitative survey collected 186 valid questionnaires (response rate: 93.5%), confirming common missed doses and medication stigma. Despite the heterogeneity in medication preferences, participants preferred fewer types of drugs and lower frequencies of medication and were averse to injectable formulations.

Conclusion: The study suggests the preference of the compound preparations to reduce the number of pills and the integrity of the therapeutic regimens and daily lives to reduce the burden of taking medications for people receiving cardiovascular prevention. Timely identification and intervention targeting the individual-level misconceptions and improper practices are critical to improve the adherence.

In 2023, the Consensus Reporting Items for Studies in Primary Care (CRISP) Working Group introduced a consensus checklist aimed at enhancing the quality, practicality, and dissemination of research reports in general practice and primary care. The editorial team of the Chinese General Practice and Chinese General Practice Journal translated the CRISP Checklist into Chinese and conducted a review of the current status of primary care research in China. The review identifies major problems in the field, including six common problems: “author-centered orientation,” “overemphasis on authority,” “uncritically adopting international experience,” “lack of rigor in reporting methodologies,” “inclusion of excessive and redundant information,” and “lack of transparency” Finally, the editorial team encourages authors, editors, and reviewers in China to adopt the CRISP Checklist to improve the quality of primary care research reports. Additionally, the review provides specific recommendations for applying the CRISP Checklist in various subfields, such as discipline development research, clinical research, health services research, health policy research, medical education research, and community epidemiological research.

Background: Traditional Chinese Medicine (TCM) has unique advantages in preventive services, particularly for chronic disease management and active aging. Primary care serves as a crucial platform for implementing and promoting preventive services of TCM. However, elderly individuals' using of these services remains suboptimal.

Objective: This study aims to explore the factors influencing elderly individuals' using of preventive services of TCM in primary care facilities based on Andersen model and dual model of Social Cognitive Theory (SCT), and to assess the importance of these factors by dominance analysis.

Methods: A multi-stage stratified cluster random sampling method was used to conduct face-to-face surveys with elderly individuals in 12 communities across six cities in Zhejiang and Guangxi provinces from July to September 2022. The survey collected data on participants' demographics, using of preventive services of TCM, and the influencing factors. A binary logistic regression model identified independent predictors of preventive services of TCM utilization, leading to the development of an optimal predictive model. These predictors were then grouped into four dimensions based on the dual model: predisposing factors, needs-based factors, enabling factors, and individual factors. Dominance analysis was used to evaluate the contribution of each dimension to the total variance in service utilization.

Results: Among 2,081 elderly participants, only 369 (17.7 %) used preventive services of TCM in the past year, with most utilizing the services 1-2 times annually. Combined analysis of the logistic regression and dominance analysis revealed that individual factors (cognitive status, self-control) were the most important predictors, followed by enabling factors (perceived service environment), predisposing factors (education level), and needs-based factors (self-reported chronic conditions, pain, or discomfort).

Conclusion: Individual factors lay a decisive role in the elderly's decision to use preventive services of TCM. Enhancing cognitive abilities and self-management skills, alongside improving the primary care environment for preventive services of TCM, may encourage broader adoption of these services among the elderly.

Background: The rising incidence of diabetes has led China to prioritize the management of type 2 diabetes within community health services. However, there remain gaps in standardized diabetes management in primary care facilities, particularly in terms of quality and capacity.

Objective: This study aims to evaluate the current status of diabetes management and provide a systematic quality assessment. Recommendations for improvement are proposed based on identified issues.

Methods: In May 2022, a survey was conducted involving 249 community health centers of Shanghai. A simple random sampling method was used to select 3,875 general practitioners(GPs), representing 50 % of the registered GPs at each center. Data were collected using a self-designed questionnaire.

Results: All community health centers of Shanghai were able to conduct HbA1c tests; however, screening for diabetic complications was insufficient, with only 16.9 % offering nerve conduction velocity tests. The availability of oral hypoglycemic agents was relatively comprehensive, but insulin options were limited, with only 7.6 % of centers had novel GLP-1 available. Furthermore, only 57.4 % of centers had diabetes specialty clinics. GPs demonstrated strong adherence to diabetes management guidelines but had significant knowledge gaps in medication use, with correct responses regarding oral hypoglycemic agents at 27.9 % and insulin at 29.0 %. GPs tended to transfer new patients with high blood glucose or confirmed diabetic nephropathy to higher-level hospitals.

Conclusion: The infrastructure, equipment, and medications for diabetes management in Shanghai's community health centers partially meet basic quality standards, but there are significant gaps in GPs' knowledge of diabetes medications. To improve diabetes management, efforts should focus on expanding complication screening, increasing the availability of novel hypoglycemic agents and insulin types, enhancing the development of diabetes specialty clinics, and providing GPs with further training to improve their diagnostic and treatment capabilities.

Background: With shifts in disease patterns and the implementation of tiered healthcare, general practitioners (GPs) play a vital role in disease diagnosis and management. The rapid advancement of medical knowledge and evolving health service demands necessitate continuing education for GPs to provide optimal clinical decision-making and disease management.

Objective: This study analyzes the development trends, training quality, and research quality of continuing medical education (CME) for GPs in China over the past decade (2013-2022).

Methods: In January 2023, eight databases (PubMed, Cochrane Library, Embase, CINAHL, ERIC, CNKI, Wanfang Data, and CBM) were searched for studies on CME for Chinese GPs, covering publications from January 2013 to December 2022. The Medical Education Research Study Quality Instrument (MERSQI) was used to systematically evaluate study quality.

Results: A total of 49 studies were analyzed, including 11 in English and 38 in Chinese. Training themes focused primarily on cardiovascular diseases (22.4 %), emergency care (6.1 %), and mental health (6.1 %). Most training was lecture-based (69.3 %), with only 6.1 % using skill-based formats and 4.0 % employing problem-based (PBL) or team-based (TBL) learning. Rigorous evaluation was lacking in most studies: 63.2 % (n = 31) used surveys to assess outcomes, with 19 lacking reliability and validity considerations. Study designs were predominantly single-group pre- and post-tests (53.1 %), with 26.5 % using randomized controls and only 4.1 % incorporating controlled pre- and post-test designs. Only 18.3 % (n = 9) reported ethical considerations; most studies (81.7 %) did not mention it. Assessment largely focused on knowledge and skill gains (85.7 %) with limited evaluation of behavioral changes (14.2 %) or benefits to patients and healthcare institutions (22.4 %).

Conclusion: Research on general practice CME in China over the past decade has been limited in scope but shows significant growth potential. Future CME efforts should broaden topic coverage, diversify instructional methods, use validated assessment tools, and prioritize training-induced behavioral changes and patient outcomes to improve the multidimensional quality of general practice education programs.

Background: High-quality primary health care (PHC) can reduce complications from chronic diseases by providing timely, effective, and continuous interventions, thereby preventing hospitalizations due to disease progression. However, there has been limited evidence on avoidable hospitalizations in rural areas of central and western China.

Objective: This study aims to localize the measurement of avoidable hospitalizations tailored to China's context and assess the quality and efficiency of PHC in rural areas of central and western China among patients with type 2 diabetes or hypertension.

Methods: Data from 61,450 hospitalizations related to hypertension and diabetes were extracted from the medical records of three county-level hospitals in two provinces between 2017 and 2021, using ICD-10 diagnostic codes. Two types of avoidable hospitalizations were defined: (type I) PHC preventable but not avoidable hospitalization; (type II) PHC preventable and avoidable hospitalization. A multilevel logistic regression model was used to identify the factors influencing avoidable hospitalizations.

Results: Between 2017 and 2021, 18.1 % of diabetes-related hospitalizations and 49.6 % of hypertension-related hospitalizations were preventable by PHC but not avoidable (type I). Meanwhile, 8.1 % of diabetes-related hospitalizations and 2.4 % of hypertension-related hospitalizations were preventable by PHC and avoidable (type II). Avoidable hospitalizations for these two chronic conditions at the three hospitals resulted in an estimated financial loss of approximately 2.37 million yuan per year. Factors influencing avoidable hospitalizations for diabetes included demographic characteristics and health status, while for hypertension, additional factors included medical insurance coverage and distance to the hospital.

Conclusion: The quality of PHC for chronic diseases in rural counties of central and western China remains suboptimal, with inefficiencies and significant resource waste. Strengthening PHC quality should be a key strategy for future chronic disease management in rural China.

Background: As China advances healthcare reforms, research output in general practice and primary care has rapidly expanded in recent years. However, the methodological quality of this literature remains unclear.

Objective: This study evaluates the methodological quality of representative quantitative studies, systematic reviews, and guidelines published by Chinese researchers in the field of general practice and primary care in 2021, with the aim of providing an overview of methodological standards in this field.

Methods: From a pool of 3,122 papers collected in the Primary Care and General Practice Research Paper Productivity Report in China in 2021, 449 representative studies were sampled. A team of 22 researchers specializing in public health and general practice, from various institutions, assessed the methodological quality of 320 papers (71.3 %) using six design-specific tools (for cross-sectional studies, cohort studies, pre- and post-intervention studies, randomized controlled trials, systematic reviews, and clinical guidelines). Researchers worked in pairs under the supervision of an expert in evidence-based methodology, and descriptive statistics were used to present quality assessment results.

Results: In 114 cross-sectional studies, common methodological issues were identified in “whether the source population was representative of the study's target population” (41.2 %), “whether the reliability and validity of the survey instrument could be conclusively demonstrated” (32.5 %), and “whether the survey is clinically meaningful” (26.3 %). Among 25 cohort studies, quality issues were more concentrated in the areas of “whether the cohort was adequately followed up” (44.0 %) and “whether the co-intervention was similar among groups” (56.0 %). Of the 34 pre and post-intervention studies, quality issues were mostly found in the areas of “whether the target outcome was measured multiple times before and after the intervention” (97.1 %), “whether the sample size was large enough to generate confidence in the study results” (82.4 %), and “whether the study participants were representative of the eligible population” (61.8 %). Of the 122 randomized controlled trials, quality concerns were mostly in the areas of “blinding of different stakeholders” (25.4 %-61.5 %), “adequate concealment of random allocation” (41.8 %), and “other risks of bias” (72.1 %). Among the 19 systematic reviews, quality issues were mostly found in the areas “is the source of funding for the included studies reported” (100.0 %), “were the methods of the review developed before the start of the review” (94.7 %), “was heterogeneity reasonably discussed and explained” (84.2 %), and “was the risk of bias of individual studies considered” (84.2 %). Finally, the quality of all six clinical guidelines/consensus was rated low.

Conclusion: Overall, methodological quality remains limited in recent Chinese research in general practice and primary care, especially in cross-sectional studies, pre- and post-intervention studies, randomized controlled trials, and clinical guidelines. This highlights an urgent need for comprehensive research training, a stronger emphasis on evidence-based reporting standards, and the development of pragmatic guidelines in this field.

Background: General practice, with its interdisciplinary nature, is well-suited to both qualitative and mixed-methods research. In recent years, the number of relevant academic publications in China has steadily increased, yet the overall quality has not been systematically assessed.

Objective: This study aims to evaluate the methodological quality of qualitative and mixed-methods studies published in the field of primary care and general practice in China.

Methods: From August 2022 to April 2023, four investigators analyzed and assessed the methodological quality of qualitative and mixed methods research published in the field of primary care and general practice in China in 2021 using the qualitative assessment tools of Critical Appraisal Skills Programme(CASP) and MixedMethodsAppraisal Tool(MMAT), respectively. The researchers worked in pairs, independently conducting data extraction and quality evaluation.

Results: A total of 35 qualitative research and 9 mixed methods research were included. Key issues in qualitative studies included: insufficient attention to ethical considerations (65.71 %, 23/35), lack of discussion on participant recruitment (94.29 %, 33/35), limited consideration of the researcher-participant relationship (82.86 %, 29/35), sample sizes of <20 participants in 42.86 % (15/35) of studies, and lack of data saturation discussion in 25.71 % (9/35). Major issues in mixed-methods studies included a lack of clarity in research design type (8/9 studies) and ineffective integration of qualitative and quantitative components to answer the research question (8/9 studies).

Conclusion: The methodological quality of such qualitative and mixed methods research in primary care and general practice published in 2021 in China is still partially limited, especially in the areas of ethics, reliability, and data saturation in qualitative studies and integration of methods in mixed-methods research. Improved training in research methodology and adherence to design and reporting standards are essential to enhance the quality of future research and the robustness of evidence generated for decision-making.