Chest Radiography: General Practitioners’ Compliance with Recommendations

Introduction: Chest radiography is the most frequently prescribed imaging test in general practice in France. We aimed to assess the extent to which general practitioners follow the recommendations of the French National Authority for Health in prescribing chest radiography. Methodology: We conducted a retrospective analysis study, in two radiology centers belonging to the same group in Saint-Omer and Aire-sur-la-Lys, of requests for chest radiography sent by general practitioners over the winter period between December 22, 2013, and March 21, 2014, for patients aged over 18 years. Results: One hundred and seventy-seven requests for chest X-rays were analyzed, 71.75% of which complied with recommendations. The most frequent reason was the search for bronchopulmonary infection, accounting for 70.08% of prescriptions, followed by 11.2% for requests to rule out pulmonary neoplasia, whereas the latter reason did not comply with recommendations. Chest X-rays contributed to a positive diagnosis in 28.81% of cases. The positive diagnosis was given by 36.22% of the recommended chest X-rays, versus 10% for those not recommended. Conclusion: In most cases, general practitioners follow HAS recommendations for prescribing chest X-rays. Non-recommended chest X-rays do not appear to make a major contribution to diagnosis or patient management, confirming the value of following the recommendations of the French National Authority for Health.

The quality of older adults'involvement in clinical communication with general practitioners:evidence from rural towns in Australia

Objective:A study was conducted about the putative links of older rural Australians'health knowledge and preparation with their quality of involvement in patient-general practitioner(GP)communication during health intake visits.Methods:It was a cross-sectional study between January 2021 and April 2022.The 32-item quality of involvement in communication scale was designed and incorporated into the SurveyGizmo software.This online survey was administered by sending an email request to the Renmark Rotary Club,which actively promoted this study across five rural towns in South Australia.121 participants completed the surveys.Mean-sum scores were calculated based on the questionnaire responses to evaluate outcomes,specifically initiation of information,active participation,and emotional expression.We employed different methods including t-tests,ANOVA,and leaner regressions to analyse data.Results:The demographic profile of participants characterised by a female predominance(58.7%,71/121),a majority falling within the 65-<70 age bracket(47.1%,57/121),and a high level of educational attainment(58.7%had completed high school or higher,71/121).Additionally,35%of the participants predominantly spoke a language other than English at home.Regarding the initiation of information with GPs,the mean sum-score was(20.5+3.7),indicating a marginally above-average level of engagement.Contrarily,the active participation was suboptimal,as suggested by a mean sum score of(35.9±6.3).Furthermore,the emotional expression was relatively low,with a mean score of(13.9±1.8).Substantial variations were discerned in the quality of patient-GP communication,contingent upon factors such as educational background,language spoken at home,health literacy,and preparatory measures for clinical visits.Participants who predominantly spoke a language other than English at home demonstrated significantly lower levels of information initiation with their GPs(P<0.o01).Higher educational attainment was positively correlated with increased active participation(P<0.001).Enhanced health literacy and thorough visit preparation were significantly associated with increased levels of active participation(P<0.001).Conclusion:Meaningful engagement through recognition,empowerment,and support(health literacy programs)for older rural adults is suggested for improving their quality of involvement in communication with GPs.

Knowledge about the Management of Anti-Epileptic Drug Treatment among General Practitioners in Brazzaville, Congo

Background: Epilepsy is a chronic brain disorder. It often leads to disabilities and handicaps. In Africa, epilepsy is almost exclusively treated by general practitioners (GPs) because of a shortage of epilepsy specialists. It is therefore important to know the level of knowledge about epilepsy among GPs in order to improve their skills. Objectives: To assess the level of knowledge about the management of anti-epileptic drug treatment among GPs in Brazzaville;to investigate the relationship between demographic factors and GPs’ knowledge. Methods: This was a cross-sectional analytical study. It was conducted from 20 July to 1 September 2021. It focused on GPs working in public hospitals and private care centers in Brazzaville. Information on treatment aspects was collected through a standardized 11-item questionnaire. Results: Among the 137 participants, there were 84 (61.3%) men and 53 (38.7%) women. Of these participants, 36 (26.3%) were trained in Congo versus 101 (73.7%) in other countries. Only 21 (15.3%) GPs had good knowledge about the management of anti-epileptic drug treatment. The overall average knowledge score among GPs was low (31.4%). No significant associations were found between low and good levels of knowledge and gender (OR = 1.03;95% CI = 0.40 - 2.68;p = 1.000), age groups (OR 0.05), training country (OR = 0.62;95% CI = 0.19 - 1.98;p = 0.591), practice hospital (OR = 0.40;95% CI = 0.05 - 3.20;p = 0.695) and duration of professional experience (OR 0.05). Conclusion: The study population has insufficient knowledge about the management of anti-epileptic drug treatment. Demographic factors have no impact on GPs’ knowledge. Epilepsy education programs are needed to improve GPs’ knowledge and skills.

Management of erectile dysfunction: barriers faced by general practitioners

Aim: To explore the barriers faced by general practitioners (GPs) in the management of patients with erectile dysfunction (ED). Methods: This was a qualitative analysis of focus group discussions and in-depth inter views involving 28 Malaysian GPs. Results: GPs' perception of ED being not a serious condition was a major determinant of their prescribing practice. Doctor's age (younger), gender (female), short consultation time and lack of experience were cited as barriers. The GPs' prescribing habits were heavily influenced by the feedback from the first few patients under treatment, the uncertainty of etiology of ED without proper assessment and the profit margin with bulk purchase. Other barriers include Patients' coexisting medical conditions, older age, lower socio-economic status, unrealistic expectations and inappropriate use of the anti-impoteneet drugs. Cardiovascular side effects and cost were two most important drug barriers. Conclusion: The factors influencing the management of ED among the general practitioners were multiple and complex. An adequate understanding of how these factors (doctors, patients and drugs) interact can assist in the formulation and implementation of strategies that encourage GPs to identify and manage ED patients.

Knowledge of General Practitioners in Cotonou about Systemic Lupus Erythematosus

Introduction: Patients with Systemic Lupus Erythematosus (SLE) are seen late in specialized medical consultation in Benin. The objective of this work was to assess general practitioners’ knowledge in Cotonou about SLE. Materials and Methods: This work was a cross-sectional study that was led in the city of Cotonou from July 1 to September 30, 2017. In the study population, we have general practitioners who practice in the city. Data collection was set in response to a self-questionnaire. Result: The survey involved 209 general practitioners. The average age was 27.5 years with a minimum of 22 and a maximum of 34. Most of them practiced in private clinics. Besides, 17 doctors (8.1%) reported that they never heard of lupus. Among the 192 remaining, only one had an average knowledge of lupus, while the others had insufficient knowledge. Conclusion: From this study, we got that SLE is still little known by the general practitioner. Increasing the knowledge of general practitioners’ knowledge of lupus is compulsory to improve the screening rate.

Knowledge Attitude and Practice of Viral Hepatitis B and C Screening by General Practitioners in Brazzaville

The involvement of general practitioners in the early detection of viral hepatitis B and C must be paramount. The objectives of this work were to assess GPs’ knowledge, attitude and practice with regard to screening for viral hepatitis B and C. We carried out a cross-sectional analytical study among GPs recruited by simple random sampling from the list of GPs in the city of Brazzaville. The judgement criteria were knowledge and practice of screening for viral hepatitis B and C, assessed according to a Likert scale divided into 3 categories: very good, good and bad. One hundred and twenty-one general practitioners were included, including 48 women and 73 men, with a sex ratio of 1.52;the average age was 33 years;52.89% of them worked in the private sector with an average period of activity of 4 years. The majority of the doctors had a good knowledge (69.42%) and a bad practice (56.20%) of screening for viral hepatitis B and C. The duration of activity was the factor linked to knowledge of viral hepatitis B and C (p = 0.006) while age was the factor linked to the practice of screening for viral hepatitis B and C (p = 0.0366). In conclusion, in Brazzaville, general practitioners’ knowledge of screening for viral hepatitis B and C is good in general, but the practices are poor and require targeted in-service training.

Role of general practitioners in prevention and treatment of hepatitis B in China

BACKGROUND： Hepatitis B virus（HBV） infection may impose an economic burden to patients or their families. The prevention and control of HBV could effectively reduce the burden. However, the management of HBV-related patients has not been well controlled in China. With the development of general practitioner（GP） system in this country, GPs may greatly improve the management of the patients with HBV infection. However, the role of GPs in controlling HBV infection has been rarely studied.DATA SOURCES： A literature search of PubMed, CNKI,Wanfang data and VIP was performed with the following key words： ＂general practitioner＂, ＂family physician＂, ＂community management＂, ＂community health care workers＂, ＂family practice＂, ＂hepatitis B virus＂, ＂HBV＂, ＂HBV vaccination＂, ＂HBV prevention＂, ＂HBV management＂, ＂HBV treatment＂, ＂antiviral therapy＂ and ＂chronic hepatitis B（CHB）＂. The information about the GPs-involved prevention, diagnosis and treatment of CHB was reviewed.RESULTS： The reports on the role of GPs in the prevention,diagnosis and treatment of HBV infection are few. But the experiences from Western countries demonstrated that GPs could play a significant role in the management of patients withCHB. The importance of GPs is obvious although there are some difficulties in China. GPs and health officials at different levels should work together in the management of patients with CHB.CONCLUSIONS： The involvement of GPs in the management of patients with HBV infection is effective in China. But GPs＇ knowledge and skills for the control of HBV infection have to be improved currently. GPs＇ involvement will enforce the management of CHB in China in the near future.

Analysis of the Role of General Practitioners Services in Rural Areas during the COVID-19 Epidemic

Since the outbreak of the COVID-19,various regions of China have been rapidly deployed under the leadership of the Central Committee of the Party to actively prevent and control the COVID-19.The rural areas of my country have weak links to the prevention and management of public health emergencies.Problems include lack of medical and health resources and farmers’low awareness of epidemic prevention.Situations that correspond to the prevention and management of the COVID-19 are more serious.As the patient’s first contact and“gatekeeper”in the fight against the epidemic,the general practitioner is responsible for the“first visit-subsequent ongoing intervention”.This article is about the prevention and control of the COVID-19 epidemics and epidemic prevention in terms of dissemination of knowledge,informed crowd control,joint prevention and control,and standardized management of people.This is a summary of the efforts of general practitioners.Quarantine at home,interactive referrals to medical consortiums,special care for contracted families.The function during the management period aims to analyze the role played by general practitioners during the epidemic and to provide new ideas for the prevention and management of the epidemic.Provide more targeted general practitioner-style services in rural areas to promote the implementation and improvement of health and poverty alleviation.The health level of the rural population provides a theoretical standard.

Application of BOPPPS + Mind Maps to Improve Clinical Competence of General Practitioner Residents: Taking Cough as an Example

Objective:To analyze the importance of general practitioner residents using the combined teaching method(BOPPPS+mind maps).Methods:From September 2023 to August 2024,a study was conducted with 6 control group participants receiving traditional teaching and 6 observation group participants receiving the combined teaching method(BOPPPS+mind maps).The study analyzed various indicators between the two groups(including mind map scores and assessment results).Results:Compared with the control group,the assessment scores of the observation group were significantly higher(P<0.05).Conclusion:The application of the combined teaching method(BOPPPS+mind maps)by general practitioner residents can significantly improve their comprehensive abilities.

Number, distribution, and predicted needed number of general practitioners in China

Family Medicine and Community Health 2018;6(3):154–159154 www.fmch-journal.org DOI 10.15212/FMCH.2018.0120.2018 Family Medicine and Community Health.Creative Commons Attribution-NonCommercial 4.0 International License CHINA FOCUS CHINA FOCUS Number,distribution,and predicted needed number of general practitioners in China*Baoling Wu1,Hanxiang Gong1,Zhenni Luo1 Abstract Objective:We aimed to investigate the number and distribution of general practitioners(GPs)in China,and to predict the number of GPs needed in the future.Methods:From China Health Statistics Yearbook 2014,China Health Statistics Yearbook 2016 and China Statistical Yearbook 2016,we obtained the number of GPs and the populations in China and each of its regions from 2012 to 2015.IBM SPSS Statistics version 22.0 was used to conduct descriptive statistical analysis.Grey model GM(1,1)and the manpower-to-population ratio method were used to predict the number of GPs needed in China from 2016 to 2020.Results:The total number of GPs in China was 109,794 in 2012,145,511 in 2013,172,597 in 2014,and 188,649 in 2015.The number increased by 78,855 from 2012 to 2015,and the average annual growth rate was 19.77%.By the end of 2015,of the GPs in all of China and in eastern,central,and western China,those who had achieved a GP qualification certificate following training accounted for 63.76%(120,285/188,649),60.06%(62,474/104,015),65.20%(29,565/45,344),and 71.89%(28,246/39,290),respectively,of the total.The number of GPs per 10,000 population in all of China and in eastern,central,and western China was 1.37,1.83,1.05,and 1.06,respectively,and the number of GPs needed for all of China and the eastern,central,and western parts would be 86,275,9787,40,764,and 34,976,respectively,calculated on the basis of the standard of two GPs per 10,000 population.Grey model GM(1,1)predicted that,in accordance with the natural growth trend of GPs,the number of GPs in China would be 220,314 in 2016,253,728 in 2017,293,101 in 2018,339,928 in 2019,and 396,228 in 2020.Moreover,the number of GPs in China in 2020 would be 277,000–415,500 if the calculated number of GPs to the population ratio is based on the standard of two to three GPs per 10,000 population.Conclusion:In recent years,although the number of GPs has increased rapidly,GPs are still greatly needed in all of China and in eastern,central,and western China.Moreover,the distribution of GPs is not balanced,and the number of qualified GPs is far from enough.Therefore,team building for GPs should be strengthened,and the training system for GPs should be improved.

The next step of community health construction: Traininggeneral practitioners and implementing health management

This article discusses the concept of health management and stresses that community health manage-ment should be the starting point of community health service,necessitating a paradigm shift from observing the treatment-oriented medical model to observing the pre-vention-and-health management-based medical model.Community health construction has entered a new phase,one which highlights the need to train general practitioners in practice-based life cycle health management.In addition,general practitioners should assume the mission of implementing community health management.

Effects of a general practitioner cooperative co-located with an emergency department on patient throughput

BACKGROUND:In 2013 a General Practitioner Cooperative(GPC) was introduced at the Emergency Department(ED) of our hospital.One of the aims of this co-located GPC was to improve throughput of the remaining patients at the ED.To determine the change in patient flow,we assessed the number of self-referrals,redirection of self-referrals to the GPC and back to the ED,as well as ward and ICU admission rates and length of stay of the remaining ED population.METHODS:We conducted a four months' pre-post comparison before and after the implementation of a co-located GPC with an urban ED in the Netherlands.RESULTS:More than half of our ED patients were self-referrals.At triage,54.5%of these selfreferrals were redirected to the GPC.After assessment at the GPC,8.5%of them were referred back to the ED.The number of patients treated at the ED declined with 20.3%after the introduction of the GPC.In the remaining ED population,there was a significant increase of highly urgent patients(P<0.001),regular admissions(P<0.001),and ICU admissions(P<0.001).Despite the decline of the number of patients at the ED,the total length of stay of patients treated at the ED increased from 14 682 hours in the two months' control period to 14 962 hours in the two months' intervention period,a total increase of 270 hours in two months(P<0.001).CONCLUSION:Introduction of a GPC led to efficient redirection of self-referrals but failed to improve throughput of the remaining patients at the ED.

上海市全科医生供需整合预测模型构建及响应策略模拟

目的构建上海全科医生供需整合的预测模型,进行政策的情景模拟,为解决上海全科医生供需失衡问题提供建议与策略。方法基于供给和需求的预测结果,计算上海全科医生的供需缺口,对增加供给和合理引导需求后全科医生的供需情况进行情景分析。结果根据供需整合预测结果,扩大全科规范化培训招生规模后,当需求参数保持不变时,2030年上海全科医生供需差值将达到578人,每万常住人口的全科医生供需差值将达到0.2人;扩大全科规范化培训招生规模后,当需求参数基于既往趋势变化时,2030年上海全科医生供需差值将达到2929人,每万常住人口的全科医生供需差值为1.1人。上海全科医生供需面临的风险主要为供不应求,通过增加全科医生的培养数量与扩大区域外招聘规模,可以缓解部分供需缺口;高龄化、首诊在社区等人口与政策的变化会增加全科医生的需求,从而扩大供需缺口。结论基于供需整合视角进行全科医生数量预测能够为更加系统、前瞻性地解决供需失衡问题提供综合、有力的证据支持。供需整合的系统动力学模型可以为模拟响应策略提供技术支持,其预测结果可以为上海全科医生的规划提供决策参考。

Assessment of Knowledge, Attitudes and Practices (KAP) on Rheumatic Heart Disease among Senior Medical Students in Cameroon

Background: Rheumatic heart disease (RHD) is the commonest cause of valvular heart disease in low and middle-income countries (LMICs). The low cardiologist to patient ratio leaves a big challenge of RHD prevention and management to general practitioners in Cameroon. This makes it important to assess the aptitude of senior medical students who are doctors-to-be on RHD. This could thus give a base on which to increase awareness and decrease the burden of the disease. Therefore, we sort to evaluate the knowledge, attitudes, and practices (KAP) of senior medical students on rheumatic heart disease. General objective: To determine the level of knowledge, attitudes on rheumatic heart disease, and assess practices towards RHD and its prevention. Methodology: A cross-sectional study was conducted in four medical schools in Cameroon for a period of 3 months (from January 1st to April 1st, 2019). The senior medical students were recruited using a structured self-administered questionnaire and electronic forms. Data were entered into an excel spreadsheet and analysed with IBM SPSS version 25.0 for windows. The knowledge level was divided into tertiles (poor, moderate and good) while the attitudes and practices were divided into poor or good. Association to KAP was evaluated and Statistical significance was set at P < 0.05. Results: In total, 509 senior medical students (6th and 7th year) were recruited. The mean age was 24.6 (SD ± 1.7) with 53.2% of students in the 19 to 24 years-old range. There were more females (51.7%) and level 6 students (50.1%). Most of the students had moderate knowledge (58.2%), with good attitudes and practices on rheumatic heart disease and its prevention. One-quarter of the students had good knowledge, attitudes, and practices on rheumatic heart disease. Lecture on RHD, history of sore throat and study in faculty of health science (FHS) was associated with good knowledge, attitudes, and practices on RHD. Conclusion: Despite having most of the senior medical students (6th and 7th years) in Cameroon with moderate to good knowledge of RHD, only a third has an above-average knowledge. There is a modest knowledge of RHD that could be used as an important foundation upon which to build RHD educational programs to expand awareness and understanding. Every 1 in 4 senior medical students have good knowledge, attitude and practice on RHD.

心理契约对基层全科医师工作绩效的影响机制:离职倾向的中介调节作用

目的 分析心理契约对基层全科医师工作绩效的影响机制,探析离职倾向在其中的中介调节作用,为基层全科医师队伍建设提供依据。方法 采用问卷调查对南京市浦口区基层医疗卫生机构的全科医师进行调研,收集其社会人口学信息,测量其心理契约、工作绩效和离职倾向水平,拟合多重线性回归模型分析作用机制和中介调节效应,验证本研究的4个研究假设。结果 基层全科医师心理契约对工作绩效存在正向促进作用(b=0.554,P<0.001)。纳入离职倾向后,心理契约和队伍稳定性对于工作绩效均存在正向促进作用(b=0.285、0.357,P<0.001)。纳入心理契约和离职倾向的交互项后,交互项的偏回归系数差异具有统计学意义(b=-0.013,P=0.006),说明低离职倾向抑制了心理契约提升工作绩效的正向作用。结论 应重视基层全科医师内在情感(即心理契约)的激励作用,采用多举措降低离职意愿,提升职业认同,避免发生“出工不出力”现象,促进工作绩效提升和基层全科医师队伍稳定。

上海市全科医生供给预测模型构建及应用

目的系统分析全科医生供给的影响因素,构建系统动力学模型,预测上海全科医生的供给数量,为上海全科医生的发展规划提供决策支撑。方法在人力资源生命周期理论和供给理论的指导下,通过查阅文献资料和专家咨询分析全科医生供给的影响因素,选取指标构建上海全科医生供给预测模型,并进行仿真预测。结果假设按照现有的培训和招聘规模,2030年上海全科医生的供给总量将达到13515人,每万常住人口的全科医生供给数将达到5.5人。结论对全科医生的供给预测应综合考虑各发展阶段全科医(学)生流入、流出的影响。基于系统动力学的供给预测模型能够为全科医生数量规划提供技术支持。应定期监测全科医生供给的影响因素,前瞻性地做好供给预测。

上海市全科医生需求预测模型构建及应用

目的系统分析影响全科医生需求的因素,构建系统动力学模型,预测上海全科医生的需求数量,为上海全科医生的发展规划提供决策支撑。方法基于“卫生服务需要-卫生服务需求-卫生服务利用-全科医生需求”的逻辑框架,通过专家咨询、文献资料、统计资料收集指标数据,运用系统动力学方法构建模型并进行仿真预测。结果根据构建的系统动力学模型,对2018—2030年上海全科医生的需求情况分别按照平稳趋势、变化趋势进行预测。当模型参数保持不变时,2030年上海全科医生需求总量将达到14093人,每万常住人口的全科医生需求数将达到5.7人。当模型参数按照既往趋势变化时,2030年上海全科医生需求总量将达到16444人,每万常住人口的全科医生需求数将达到6.6人。结论预测全科医生的需求应综合考虑卫生服务需要、需求与利用等诸多因素。基于系统动力学的需求预测模型能够为全科医生数量规划提供技术支持。上海应重视不断增长的全科医生需求,做到定期动态监测、预测预警。

Discussion on the model of community management of chronic diseases in cold areas

Because of the overbearing low temperature,cold areas increase the morbidity and mortality of chronic non-communicable diseases(chronic diseases)in exposed populations.With the growth of the aging population and the superposition of lifestyle risk factors,the number of people with chronic diseases in cold areas is climbing,and the family and social burdens are rising.These health-threatening circumstances in the cold areas render the general practitioners to face serious challenges and difficulties in the community management of chronic diseases.This paper summarizes the current situation of chronic disease management in cold areas and explores the relevant management models so as to provide a useful reference for regional health construction,graded diagnosis and treatment,and prevention and control of chronic diseases in China.

Motivations and Training Needs of General Practitioner Preceptors

Background：General practitioner （GP） preceptors play an important role in the cultivation of GPs.Many problems exist in the training of GP preceptors.This study aimed to explore the willingness and training needs of GP preceptors and compare the differences between preceptors from general practice and other specialties.Methods：A total of 375 questionnaire forms were sent to 375 GP preceptors from 11 different provinces,and 344 completed forms were returned.The main outcome included general information,teaching motivations,and training needs of GP preceptors.Results：The study showed that about 89.2% of GP preceptors were willing to be teachers.The majority of respondents strongly agreed that the motivation for becoming a GP supervisor was to learn from teaching.The most important capability they should master was clinical teaching （92.2%）,followed by lecture （83.1%） and doctor-patient communication （83.1%）.The top three preferred methods of GP preceptors training were case discussion （78.8%）,workshop （57.6%）,and classroom teaching （56.4%）.The domains in which most GP preceptors wanted to acquire knowledge and skill were mental health （59.3%）,rehabilitation （47.1%）,pediatrics （41.0%）,and obstetrics （37.5%）.No significant differences were found in the willingness to train GPs （x2 =3.34,P 〉 0.05） and whether they would become or continue to become a GP supervisor after the training （x2 =l.106,P 〉 0.05）.Conclusions：Although most preceptors were under on-the-job training,they were glad to train GPs.To be qualified,preceptors should be trained according to the actual needs of GP preceptors.

Exploration and practice of general practitioner responsibility system in an urban community of Shanghai

Objective:The Minhang district of Shanghai was selected as the subject and its public health management model was investigated.Methods:Minhang became a pilot location for the implementation of the general practitioner responsibility system(GPRS)in 2011.Since then,the management model of public health services in the district has gradually merged with the GPRS through a series of actions:the adjustment of organizations and the coordination mechanism in community public health services,the integration of basic public health services and clinic practice,the establishment of an informationized Internet service platform,comprehensive budgeting management of public health service programs,and performance assessment management of health workers.Results:By the end of 2014,the number of residents who had a contractual relationship with a general practitioner(GP)in Minhang had reached 1.4367 million and all of them had family health records.Compared with 2010,both the rate of maternal management and the rate of children management stayed at high level(≥96%),the rate of hypertension management increased(40.73%vs.28.70%),the rate of blood pressure control increased(82.13%vs.77.51%),the incidence of diabetes decreased(21.93%vs.37.85%),the rate of effective control of blood glucose for dia-betic patients increased(82.43%vs.62.77%),and the rate of child health management increased(99.79%vs.91.54%).Conclusion:The GPRS has helped to create a better community health environment.How-ever,the development of this system is limited by several factors,including the following:the shortage of GPs,most GPs do not have good public health service skills and a correct public health concept,unclear division of different services,and imperfect department coordination.