Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-04-03 Cooperative journals: 《中国全科医学》
Abstract： Background The difficulty of getting pediatric services still exists in China. It is a general trend that community health centers（CHCs） provide pediatric services. There are rare studies on the spectrum of pediatric illnesses in CHCs.
Objective To understand the current status of pediatric diagnosis and treatment in Shenzhen's CHCs by analyzing the spectrum of pediatric illnesses treated in clinics，and to analyze the gap between actual practical status with the training contents based on Spectrum of Diseases for Resident Rotation in Pediatric Medicine（hereinafter referred to as Pediatric Training Rules） specified in General Residency Training Rules in the Standardized Training Contents and Standards for Residents（2022 Edition）.
Methods Through checking the outpatient medical records in CHCs in Shenzhen's 10 districts during April to September 2021，pediatric care expenditure data of children〔including babies（<1 year old），toddlers（1-3 years old），preschoolers（4-6 years old），gradeschoolers（7-12 years old） and teens（13-18 years old） stratified by age〕 contracting family doctor services were collected. The actual spectrum of diseases and diagnosis and treatment behaviors were analyzed，and compared with the Pediatric Training Rules to assess the practical application of the contents required to be mastered in the Pediatric Training Rules.
Results A total of 961 605 children were included，among whom preschoolers accounted for the highest percentage（38.22%），followed by gradeschoolers（27.57%），toddlers（21.90%），teens（8.49%），and babies（3.82%）. The top five diseases in the spectrum and diagnosis and treatment behaviors were respiratory diseases，calcium and vitamin supplements，pediatric physical examination and health care，trauma and postoperative dressing change，and skin diseases，accounting for 67.92% of the total diagnostic and therapeutic workload. Younger age was associated with increased concentrated diagnosis and treatment behaviors. Physical examination and health care（27.60%，10 142/36 753），calcium and vitamin supplements（25.48%，9 364/36 753） were the main diagnosis and treatment behaviors in babies. Five diseases in the spectrum and diagnosis and treatment behaviors accounting for ≥ 80% of the total diagnostic and therapeutic workload in babies，while in teens，10 diseases in the spectrum and diagnosis and treatment behaviors accounting for ≥ 80% of the total diagnostic and therapeutic workload. Except for babies，respiratory diseases were the primary reason for seeking treatment in children of other age groups. The proportion of workload of trauma treatment and postoperative dressing change was the highest in teens. Except neonatal asphyxia，neonatal pneumonia，poliomyelitis，infantile tetany and viral myocarditis，the pediatric diseases encountered in these CHCs were covered by the disease spectrum required to be mastered in the Pediatric Training Rules，and the top five healthcare & treatments were respiratory disease treatment〔333 172 （34.65%）〕，pediatric physical examination and health care〔70 703（7.35%）〕，acute infectious diseases treatment〔20 893（2.17%）〕，infantile diarrhea〔13 622（1.42%）〕，and pediatric abdominal pain〔12 526（1.30%）〕. The amount of diagnosis and treatment workload for pediatric anemia，pediatric leukemia，rickets，infantile diabetes，malnutrition，neonatal jaundice，nephritis and nephrotic syndrome，infantile epilepsy，simple obesity，and infantile convulsion accounted for less than 1% of the total amount，among which pediatric anemia，pediatric leukemia，neonatal jaundice，nephritis and nephrotic syndrome，infantile epilepsy and simple obesity were mainly transferred for treatment or prescribed a laboratory test.
Conclusion In general，the CHCs provide a large number of pediatric diagnosis and treatment services，but the services for younger children are still insufficient. Pediatric Training Rules focus on internal diseases，and relevant trainings have some differences with the actual diagnosis and treatment services. The treatments for some diseases in the spectrum in the rules are too specialized，and the diseases are less frequently encountered in community settings，and such patients mainly are transferred for treatment or examined using a laboratory test. Therefore，the pediatric rotation in standardized general residency training should be planned as a whole since the disease spectrum includes many diseases rather than only internal diseases，and actions should be made to expand the training content，improve outpatient teaching，and strengthen the training for physicians to improve their abilities in diagnosis and treatment of young children.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-19 Cooperative journals: 《中国全科医学》
Abstract： Background The development of traditional Chinese medicine has become a vital strategy in our country, and to vigorously improve the service capacity of traditional Chinese medicine in primary health service centres is one of the important contents. At present, there are few studies on the disease spectrum of traditional Chinese medicine in community health service institutions. Objectives According to the "Classification and Code of Diseases and Syndrome of Traditional Chinese Medicine" (TCD), using the types, quantity, and characteristics of disease spectrum in outpatients’ diagnosis and treatments of traditional Chinese medicine from the residents contracted with family doctors in Community Health Centers (CHCs) in Shenzhen, to explore the diagnosis and treatment ability of traditional Chinese medicine in these CHSCs, so as to provide theoretical basis for promoting the development of grass-roots Chinese medicine in our country. Methods This study utilized the records of outpatient residents contracted with family doctors with medical expenses incurred in the CHSCs in 10 districts of Shenzhen from January 1, 2021 to June 30, 2021, Including gender, age, and disease diagnosis. Patients with diagnosis the treatment purposes of Chinese medicine, who generated matching diagnosis treatment costs and the first diagnosis being TCD-coded diagnosis, were selected to include in this study. Patients with multiple medical records and the same first diagnosis was classified according to the disease name in the same TCD case, mainly involving the category of the department, the classification of the specialist system, and the name of the disease in traditional Chinese medicine. Results A total of 385,138 cases of TCM diagnosis and treatment were included in this study. Among them, 170,077 (44.16%) were male, with an average age of 37.5±8.2 years; and 215,061 (55.84%) were female, with an average age of 36.7±9.4 years. The disease spectrum covers all of the 7 TCD categories, including: Internal medicine 56.98%, Pediatrics 20.56%, Otolaryngology 12.45%, Gynecology 7.95%, Surgery 1.51%, Orthopedics 0.37%, and Ophthalmology 0.18%. Apart from tumor diseases, cancer diseases, trauma diseases in Surgery and ophthalmology middle canthal disease, black eye disease, pupillary disease, traumatic eye disease in Ophthalmology, the disease spectrum covers all specialist system classifications under the 7 TCD categories. The disease spectrum is concentrated in several TCM disease categories in each specialist. Specifically, arthralgia, cold, cough, vertigo, insomnia, consumptive disease, diarrhea, and stomach ruffian account for 93.95% in Internal medicine; infant cold, infant cough, infant diarrhea, infant abdominal pain, infant vomiting account for 97.60% in Pediatrics; laryngeal paralysis, aphthous disease, milk moth disease, toothache, dental disease, rhinophyma, and Biyuan disease account for 98.71% of Otolaryngology; leucorrhoea, oligomenorrhea, and dysmenorrhea account for 94.40% of Gynecology; rash disease, eczema, breast addiction, and carbuncle disease account for 94.0% of Surgery; tendon disease and stiff neck disease account for 96.73% of Orthopedics; and the Tianxing red eye disease, storm fever, and needle eye disease account for 93.03% of Ophthalmology. The top 5 systems of the disease spectrum include, the respiratory system 54.19%, the musculoskeletal system 19.05%, the gynecological system 7.95%, the cardiovascular and cerebrovascular system 7.15%, and the digestive system 4.98%. Patients under 15 years and at 15-24 years mainly suffered from diseases related to the respiratory and digestive tracts. With the increase of age, paralysis, dizziness, headache, insomnia, fatigue, etc. gradually increased. Colds ranked the first for patients below 45 years, and the paralysis of muscle and joint pain ranked the first for those above 45 years. Conclusions In recent years, with the strengthening of grassroots and various favorable policies, the TCM diagnosis and treatment in Shenzhen CHSCs has a wide spectrum of diseases, but the types of diseases are relatively concentrated. It is necessary to strengthen the TCM diagnosis and treatment capabilities in CHSCs to better meet the residents’ health needs.
Hits
Hits
Downloads
Comment