Supporting and retaining competent primary care workforce in low-resource settings:lessons learned from a prospective cohort study  

作　　者：Mingyue Li Haoqing Tang Huixian Zheng Yiran Tian Xiaoran Cheng Haozhe Cheng Xiaotian Zhang Dan Hu Xiaoyun Liu 

机构地区：[1]School of Public Health,Peking University,Beijing,China [2]China Center for Health Development Studies,Peking University,Beijing,China [3]School of Health Policy and Management,Nanjing Medical University,Nanjing,Jiangsu,China

出　　处：《Family Medicine and Community Health》2023年第4期13-35,共23页家庭医学与社区卫生（英文）

基　　金：This study involves human participants and was approved by Institutional Review Board of Peking University Health Science Center(PU IRB)(IRB00001052-15027).

摘　　要：Objective Assess whether local health facilities can adequately support the performance of general practitioners(GPs)trained by China’s national compulsory services programme(CSP).Design Prospective cohort study.Setting Health facilities in middle and western rural areas in China,2015–2022.Participants Cohorts of CSP graduates from 2015 to 2019 in four major medical universities.Main outcomes Job performance measured by a 12-item Job Performance Scale;productivity measured by outpatient volume per day;turnover measured by ever changing jobs within the past year.Results 91.2%,92.0%and 90.5%GPs working in township health centres reported inadequate medication,equipment and external assistance from higher level hospitals,while CSP graduates working in secondary or tertiary hospitals reported a lower rate of less than 60%.The top three tests reported as lacking were blood gases(67.7%),microbiology(61.6%)and cancer biomarkers(49.7%);the top three lacked procedures were CT scan(64.8%),MRI scan(58.1%)and ambulatory BP monitoring(55.8%);and the top three lacked drugs were drugs for cardiovascular diseases(23.3%),systematic hormonal preparations(17.7%)and traditional Chinese medicines(13.0%).Multivariable analysis showed that facility support was positively associated with job performance—adequate medication increased job performance by 2.2 points(95%CI 0.7to 3.8),and adequate external assistance increased job performance by 3.3 points(95%CI 1.8to 4.8).Facility support was also positively associated with productivity—adequate medication increased outpatients seen per day by 20%(95%CI 0.1to 0.3),and adequate equipment increased outpatients seen per day by 12%(95%CI 0.0to 0.2).Facility support did not have significant impact on turnover,but GPs who changed jobs in the past year were 1.9–2.3 times more likely to report adequate facility support.Conclusion GPs in township health centres experienced a high prevalence of shortage in facility support.The identification of a positive association between facility support

关 键 词：retaining ADEQUATE FACILITY 

分 类 号：R192[医药卫生—卫生事业管理]