Objective:This scoping review aims to evaluate the factors influencing the service capacity of primary health care (PHC) institutions and to identify strategies for their development. Methods:We conducted a scoping review based on Arksey and O'Malley's framework and systematically searched PubMed, Web of Science, and SCOPUS for studies published from January 2014 to December 2024. Eligible research addressing PHC capacity-building interventions across diverse health systems was synthesized thematically. Results:This scoping review synthesized evidence from 76 publications (2014-2024) addressing PHC competency enhancement, comprising original research articles (63.2%, n = 48) and systematic/scoping reviews (36.8%, n = 28). Key challenges identified included workforce shortages, inequitable resource allocation, fragmented policy frameworks, limited integration of health information technologies, and persistent inequities in service delivery. Strategies to strengthen PHC capacity centered on workforce development, technology-enabled innovation, equitable service models, and interdisciplinary collaboration. Conclusion:Strengthening PHC capacity requires integrated approaches, including localized workforce training, technological adoption, optimized equity in service provision, and enhanced interdisciplinary cooperation. These approaches provide context-sensitive and equity-oriented pathways for building sustainable PHC systems-particularly in resource-constrained settings-supporting progress toward Universal Health Coverage and reducing global health disparities. Systematic review registration:Registration DOI: 10.17605/OSF.IO/MDR73.

BACKGROUND:Multimorbidity has emerged as a growing global health concern. Within its heterogeneous patterns, the cardiometabolic cluster is notably among the most common. Assessing the risk of such multimorbidity from a general practice perspective has become a priority in primary care. This study aimed to develop a comprehensive risk assessment model for the multimorbidity of diabetes, hypertension, and coronary heart disease among older adults in the community, utilizing large-scale data from Shanghai, China. METHODS:Retrospective data spanning 2017 to 2019 were collected from 40,261 residents across 47 community health centers. These data comprised residents' health records, health examination results, hospital information system (HIS) records, imaging databases, and lifestyle information. The XGBoost machine learning algorithm was utilized to construct a comprehensive risk assessment model for the multimorbidity of diabetes, hypertension, and coronary heart disease. Model performance was evaluated using the area under the receiver operating characteristic curve, accuracy, precision, recall, and the F1 Score. RESULTS:The dataset was split into training (80%) and testing (20%) sets. A total of 46 features were incorporated into the final comprehensive risk assessment model for the multimorbidity of diabetes, hypertension, and coronary heart disease. The optimal XGBoost model achieved a micro-average AUC of 0.822, a macro-average AUC of 0.795, and a weighted-average AUC of 0.784. These parameters demonstrate the high superiority of the constructed model. CONCLUSIONS:The XGBoost-based risk assessment model for the multimorbidity of diabetes, hypertension, and coronary heart disease, integrated clinical and public health data from community residents. It identifies multidimensional predictors across four dimensions, underscoring its practical value in supporting integrated risk assessment and informing targeted health management strategies for individuals with multimorbidity. CLINICAL TRIAL NUMBER:Not applicable.

Background General Practice Residency Training(GPRT) is one of the core links to consolidate the primary healthcare system and cultivate "gatekeepers" for residents' health. Primary healthcare puts forward higher requirements for the post competency of general practitioners(GPs). Mature training models are difficult to adapt to China due to the shortage of teachers, characteristics of primary healthcare and differences in patients' needs, and there is a lack of relevant local research in China. Therefore, it is urgent to construct a GPRT teaching program suitable for the primary care context of Shanghai. Objective To address the core pain points of "unstructured teaching resources" and "disconnection from community practice" in the GPRT in China, this study aimed to construct a community training program for GPRT based on the TPKCEE model, adapted to the primary care context of Shanghai, and to conduct a preliminary evaluation of its quality and feasibility. Methods In March 2025, a localized literature search was conducted to integrate policies and guidelines, such as "Healthy China 2030," with practical experience. A teaching program comprising six modules—Thinking (T), Problem (P), Key points (K), Case (C), Experiment (E), and Expansion (E)—was constructed, alongside a community implementation pathway developed based on the Structure-Process-Outcome (SPO) framework. Subsequently, a quality evaluation questionnaire was designed based on a modified AGREE-II framework. From July to August 2025, 15 senior general practice teaching experts were invited to participate in an anonymous consultation. Results The valid response rate of the expert consultation was 100%. The overall quality score for the teaching program was 6.13±0.64, and the score for the supporting cases was 6.09±0.74. The coefficient of variation (CV) for all indicators was < 0.25. In terms of promotion willingness, 46.7% (7/15) of experts said they were "willing to use it directly", 53.3% (8/15) said they were "willing to use it after modification", and no experts refused to use it. Delphi statistical indicators showed that the average authority coefficient (Cr) of experts was 0.88. Based on expert feedback, the research team completed five core revisions, including refining student grouping standards, emphasizing referral indications, and deepening the connotation of ideological education. Conclusion The community GPRT teaching program based on the TPKCEE model constructed in this study has good content validity and applicability in primary care. It provides a comprehensive and feasible operational tool to resolve the issue of insufficient integration between GPRT and the demand of the primary care system, possessing significant value for pilot trials and promotion in community teaching bases.

Primary health care (PHC) is central to achieving universal health coverage, yet longitudinal assessments of residents’ experiences—especially regarding urban–suburban disparities—remain scarce. This study aims to examine changes in PHC service experiences among Shanghai residents between 2023 and 2024, identify urban–suburban differences, and explore key influencing factors. A two-wave cross-sectional survey was conducted at 248 community health centers in Shanghai from May to June in 2023 and 2024. The Chinese version of the Primary Care Assessment Tool–Adult Short Version (PCAT-AS) was used. Propensity score matching ensured comparability between survey waves. Descriptive statistics, hypothesis testing, and multiple linear regression were employed to assess temporal changes, regional disparities, and associated predictors. Residents reported significantly improved PHC experiences in 2024 across all domains (P < 0.001), with the largest gains in service comprehensiveness (+ 0.23) and referral coordination (+ 0.18). Urban residents consistently reported better experiences in continuity, service delivery, and cultural competence, while suburban residents rated higher in first-contact accessibility and service availability. Improvements from 2023 to 2024 were most notable in first-contact accessibility (Δ = +0.11) and comprehensiveness (Δ = +0.10), though domains such as family-centeredness and cultural competence showed limited progress (Δ = +0.01). Multivariate analyses identified residential location, chronic disease burden, psychological distress, and self-rated health as significant predictors of overall PCAT scores. Suburban residence was associated with lower scores (B = − 1.59, P < 0.001), while comorbidities (B = 1.94, P < 0.001) and psychological distress (B = 2.06, P < 0.001) were linked to higher scores. This study demonstrates that while overall perceptions of PHC services among permanent residents in Shanghai improved significantly compared to the previous year—particularly in terms of service comprehensiveness and referral coordination—urban–suburban disparities persist. Specifically, urban residents reported more favorable experiences in first-contact utilization, continuity of care, and cultural competence, whereas suburban residents expressed better perceptions of first-contact accessibility and service availability. Notably, the urban–suburban gaps in first-contact accessibility and service comprehensiveness narrowed between 2023 and 2024, suggesting a positive trajectory toward greater equity in basic health service delivery. Multivariate regression analysis further indicated that residential location, chronic disease burden, psychological distress, and self-rated health status were significant determinants of residents’ PHC experiences. Based on these findings, we recommend the implementation of more targeted interventions focusing on enhancing continuity of care and strengthening integrated management for both mental health and chronic conditions. Special attention should be given to addressing structural disparities between urban and suburban areas and to meeting the health service needs of priority populations, in order to continuously advance both equity and quality in PHC delivery.

Background Integrated specialist–generalist outpatient care has been introduced in Chinese community health service centres to strengthen chronic disease management. However, whether this model improves patient-reported primary care experience remains unclear. This study compared primary care experiences between patients attending integrated specialist–generalist clinics and general outpatient clinics in Shanghai. Methods A multistage cross-sectional survey was conducted from June to October 2024 among patients with chronic diseases who attended community health service centres in Shanghai where integrated specialist–generalist care models had been implemented. Participants were recruited from either integrated specialist–generalist clinics for specific chronic diseases or general outpatient clinics. Patient-reported primary care experience was assessed using the Primary Care Assessment Tool–Adult Short version. Analysis of variance was used to compare characteristics and primary care experience scores between groups. Multivariable linear regression was performed to identify factors associated with the total primary care experience score. Results A total of 581 valid questionnaires were included in the analysis. Compared with patients attending general outpatient clinics, those attending integrated specialist–generalist clinics reported significantly higher scores across all primary care experience domains and a higher total Primary Care Assessment Tool–Adult Short version score. In multivariable linear regression analysis, attending an integrated specialist–generalist clinic was positively associated with the total primary care experience score after adjustment for patient characteristics and health-related factors ( β = 0.195, P < 0.001 ). Other factors independently associated with higher total scores included age ≥ 71 years ( β = 0.179, P < 0.001 ), awareness of the harms associated with chronic diseases ( β = 0.166, P < 0.001 ), and receiving disease-related health education from attending physicians or family doctors ( β = 0.181, P < 0.001 ). Conclusions Integrated specialist–generalist outpatient care was associated with better patient-reported primary care experiences among patients with chronic diseases. These findings suggest that this care model may be more conducive to chronic disease management in community health service centres. Further efforts are needed to strengthen care coordination, particularly referral processes, and to enhance community-oriented service delivery.

General practitioners (GPs) in primary care—particularly in low- and middle-income countries (LMICs)—frequently encounter meaningful clinical problems but lack the methodological training to formalize them into research questions. This paper reports a five-stage, AI-assisted approach that embeds established frameworks—including the JBI Population–Concept–Context framework, scoping review methodology, and evidence-based questioning paradigms—into nine standardized AI prompts, guiding GPs through: practice observation and value assessment; information extraction and evidence-based transformation; literature search and knowledge summarization; research question prototype construction; and methodology selection and feasibility assessment. Built on human-AI collaboration with human primacy, the approach requires no prior methodological training. It was piloted through the Shanghai General Practice Research Network (SGPRN) and is most applicable in low evidence-density primary care settings.

Background The clinical reasoning of general practitioners is the key to providing quality medical services to patients, but it is not suitable for traditional methods to evaluate this ability because it is an abstract ability that cannot be directly observed. Objective This paper aims to improve the efficiency of general practitioners' clinical reasoning training and enrich the evaluation of medical education by optimizing the evaluation method of curriculum teaching. Methods From September to December 2022, 38 master's degree students of the Medical School of Tongji University were divided into the in-service group (16) and residential training group (22). The course consists of three modules, namely core, case and result, and adopts blended teaching method to carry out teaching. The content of quantitative evaluation is different kinds of rating scale, while the content of subjective evaluation comes from multi-source feedback. Results The final course scores for the core and case modules were statistically significant for both groups (P<0.05), but the first course scores were not (P>0.05). The quantitative evaluation scores of the whole class and the two groups of students in the first and last courses of the above two modules were compared, and there was statistical significance (P<0.001). Subjective evaluation can be divided into positive evaluation and improvement evaluation. The positive evaluation of the courses on consultation skills, physical examination, auxiliary examination, health management, and chronic disease management is relatively low, while the improvement evaluation is relatively high; the positive evaluation of the courses on doctor-patient communication, SOAP, multiple diseases coexirelatively high, while the improvement evaluation is relatively low. Conclusion Programmatic assessment can enrich the evaluation system of general clinical reasoning, promote students' construction of general clinical reasoning in order, and also found that "flipped classroom" is a form of procedural evaluation.

Despite the widely acknowledged importance of primary care, there remains a significant gap in its comprehensive evaluation in China, particularly from the dual perspectives of institutional performance and patient experience. We utilized two internationally recognized tools, the Primary Care Assessment Tool (PCAT) for measuring primary care quality from the perspective of patients and The Patient-Centred Medical Home (PCMH, emphasizing providing comprehensive, accessible, and high-quality healthcare services, addressing the evolving needs of patients while enhancing the efficiency and effectiveness of primary care systems) for assessing an organization’s primary care achievement, to evaluate whether institutional achievement in primary care correlates with better patient experiences in community healthcare centers (CHCs) in Shanghai, China. Nine CHCs were randomly selected using a multi-stage sampling method, followed by a random selection of patients. The PCMH tool was used for CHCs, while the PCAT was administered to patients. Multivariate logistic regressions were used to analyze the association between the PCMH status of the CHCs and the quality of primary care experienced by patients. A total of 1,782 patients and 9 CHC administrators completed the PCAT and PCMH tools, respectively. Generally, higher PCAT scores were associated with higher PCMH scores. Compared with patients from Level 1 PCMH CHCs, those from Level 2 and Level 3 CHCs reported significantly better experiences in ongoing care (Level 2: OR = 4.57, P < 0.001; Level 3: OR = 4.54, P < 0.001), family-centeredness (Level 2: OR = 3.39, P < 0.001), and cultural competence (Level 2: OR = 4.27, P < 0.001; Level 3: OR = 2.83, P = 0.03). The study validated PCMH as a robust framework for assessing primary care performance. Furthermore, it identified specific areas where CHCs can enhance the patient experience, particularly in the domains of Coordination (Information Systems), Care Coordination, and Care Transitions. These findings underscored the need for targeted interventions to strengthen these aspects of primary care delivery, ultimately improving patient outcomes and satisfaction.

In the context of China’s health reforms aimed at strengthening primary care through the Family Doctor Contract Service Program, effectively measuring its functional features is paramount. This study seeks to translate, adapt, and validate the Person-Centered Primary Care Measure (PCPCM) for primary care patients enrolled in family doctor contract services in mainland China. Following the guidelines by Sousa and Rojjanasrirat, we translated and adapted the PCPCM into Simplified Chinese and evaluated its psychometric properties. A total of 583 patients enrolled in family doctor contract services from 10 primary care facilities in Shanghai, China, participated in the study. We assessed the structural validity, internal consistency, stability reliability, and criterion validity of the PCPCM-Simplified Chinese version in accordance with the practical guidelines developed by the Core Outcome Measures in Effectiveness Trials (COMET) initiative and the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) initiative. The study led to the development of the PCPCM-Simplified Chinese version tailored for patients receiving family doctor contract services (PCPCM-SC-FDCS), specifically designed to address the needs of populations most closely aligned with the concept of “primary care patients” in mainland China. Initial pilot testing prompted refinements to enhance clarity and applicability, particularly for Item 5 (Relationship). Analyses of the refined PCPCM-SC-FDCS, based on a three-point Likert scale, revealed that structural validity, internal consistency, and criterion validity all met the criteria for good measurement properties outlined in the relevant guidelines. However, for test-retest reliability, the intraclass correlation coefficient (ICC) between the first and second surveys was 0.58, which fell short of the recommended threshold of ≥ 0.70. The PCPCM-SC-FDCS demonstrates satisfactory reliability and strong feasibility as a tool for evaluating the functional features of primary care among Family Doctor Contract Service Program patients in mainland China. Although further testing and refinement are necessary, this instrument offers a feasible and straightforward approach to evaluating service quality, supporting family doctor teams in enhancing primary care delivery.

Background While research in multiple countries confirms that primary care functional features significantly improve patient health, China's primary care system differs markedly due to unique structural and contextual factors. This study aims to measure and explore the functional features experienced by patients received family doctor contract service in the past year, evaluating the impacts and pathways of these primary care features on health outcomes. Methods We employed a mixed-methods explanatory sequential design. In the quantitative phase, we randomly selected 2118 residents from 12 primary care institutions. The intensity of functional features was assessed using the Person-Centered Primary Care Measure (PCPCM), and their association with levels of EuroQol Visual Analogue Scale (EQ VAS) was evaluated through multilevel modelling. In the qualitative phase, a qualitative description approach was used, conducting 24 focus groups with a total of 85 patients to gather in-depth information about their experiences with functional features and perceived health impacts. Finally, the quantitative and qualitative data were integrated using meta-synthesis and joint display methods to validate, interpret, and expand the results. Results The average PCPCM score was 3.65, with subdomain scores ranging from 3.39 to 3.83. Qualitative findings confirmed the quantitative results regarding the intensity and manifestation of features like accessibility, coordination, and relationship-building. However, discrepancies were noted in features such as comprehensiveness, integration, and family and community context. Additionally, two new functional features, 'being appreciated' and 'being cared for,' were identified. The quantitative results also showed that higher PCPCM scores were positively associated with EQ VAS levels (odds ratio (OR) = 1.18; 95% confidence interval (CI) = 1.03-1.35, P < 0.001). Furthermore, qualitative results revealed six key pathways supporting the beneficial effects of local primary care functional features on health maintenance and improvement. Conclusions This study demonstrates high functional scores for Shanghai's family doctor services and highlights a positive association between primary care functionality and population health. These features and their health benefits are deeply shaped by the local social and health care context. This confirms the progress of Shanghai's primary care development and underscores the need for further exploration of primary care functional features across China, along with the development of tools tailored to local conditions to better measure and improve primary care quality and health outcomes.

Globally, primary care (PC) features like accessibility, continuity, and coordination enhance health outcomes. In China, 940,000 public facilities delivered 4.266 billion PC visits in 2022 (50.68% of total visits), focusing on chronic disease management and public health. Unlike Western gatekeeper models, China’s PC lacks this structure, influencing its characteristics and effectiveness. This review synthesises China’s PC functional features and their relationship with health service outcomes since 2009, combining quantitative and qualitative evidence. Using the JBI mixed-methods framework, we will search PubMed, Embase, Web of Science, Google Scholar, CNKI, and Wanfang Data for studies (quantitative, qualitative, mixed-methods). Two reviewers will screen and assess quality with JBI tools (>50% threshold). A convergent segregated approach integrates quantitative data (feature strength, associations with outcomes) with qualitative insights (stakeholder views on features and effects). This review may shed light on the functional features of China’s primary care system and their relationship with health service outcomes. The synthesized evidence could inform clinical practice, health service delivery, and health policy regarding the health service process of primary care in China, while also identifying areas for future research.

The prevalence of mental disorders is gradually increasing in China. As the Chinese government fully implements the tiered diagnosis and treatment system, community health service centers will take on an increased role in the diagnosis and treatment of mental disorders. However, Chinese general practitioners currently have limited expertise in mental health. The health administration is still exploring which areas should be the focus of training for general practitioners in their capability to handle mental disorders. To understand the types and characteristics of mental disorders, which can provide direction and evidence for improving the diagnosis and treatment capabilities of mental disorders in community mental health services in China. The data of outpatient visits of all community health service centers in Shanghai were extracted from the outpatient and emergency information system platform of primary care institutions during 2014 to 2020. All of the diagnoses of mental disorders were classified and counted according to the ICD-10 code. Mental disorders were analyzed by the specific types, gender, age group and regions. From 2014 to 2022, the proportion of patients with mental disorders in community health. Service centers in Shanghai has been increasing year by year, from 0.8

Background: Practice-Based Research Networks (PBRNs) enable collaborative primary care research. In China, since 2023, healthcare reforms emphasizing community-based primary care have spurred PBRN development. However, the research environment and incentives for primary care practitioners (PCPs) to belong to these networks remain under-explored. Objective: This study investigates the research environment and support needed by PCPs in the Shanghai General Practice Research Network (SGPRN) to maximize PBRN development in China. Methods: This study employed a mixed-methods explanatory sequential design. The quantitative component involved an online survey of 145 PCPs from the SGPRN, selected through purposive sampling, who expressed interest in research activities. The survey collected data on their background, research capabilities, research environment, and preferred incentives for participating in PBRN-organized research. Descriptive statistical analysis and the Kano Model were used to analyze and categorize the data. The qualitative component involved one focus group discussion and 21 semi-structured interviews with 24 PCPs from the survey sample, selected to validate and complement the quantitative findings. Interview data were analyzed iteratively using a qualitative descriptive approach. Quantitative and qualitative data were integrated through joint display and meta-synthesis. Results: Most PCPs (85 %) reported a supportive research environment, with 69 % integrating research with clinical practice. However, only 43 % had sufficient research time, and 50 % access to collaborators. Qualitative findings revealed limited professional support and fragmented time as key barriers. Incentives required included opportunities to acquire research skills, leading personally relevant studies, securing primary authorship, and accessing shared data, all contingent on transparent collaboration and trust. All these preferences aligned with institutional performance-driven policies. Conclusion: The SGPRN research environment is currently neutral to slightly favorable, strongly driven by performance-oriented policies. PCPs participate in PBRN research primarily to enhance their research expertise and achieve publication-driven career advancement. Despite these motivations, China’s PBRNs need to draw on international strategies, enhancing research training, fostering collaborative platforms, and prioritizing practice-oriented, high-quality research to improve patient care, while aligning with local general practitioners’ professional aspirations for advancing the discipline and clinical practice, to reconcile and overcome the limitations of output-focused, impractical research policies.

Background Basic medical service is the primary manifestation of primary care within China's healthcare system. Since the 2009 healthcare reform, the theory of primary care functional features has been introduced to China. Chinese researchers have since employed international instruments and developed localized tools to evaluate the process quality of these services across diverse regions and populations. This mixed-methods systematic review aims to synthesize qualitative and quantitative evidence regarding the conceptual connotations, intensity levels, and relationships with health service outcomes of different functional features in China's primary care services. Methods Following the JBI mixed-methods systematic review framework, we searched six databases (PubMed, Embase, Web of Science, Google Scholar, CNKI, and Wanfang) for qualitative, quantitative, and mixed-methods studies published between January 2009 and March 2025. Two reviewers screened literature using Rayyan and assessed methodological quality using JBI tools. Utilizing a convergent segregated approach, we synthesized the qualitative and quantitative findings separately, and subsequently integrated them to explain the pathways and mechanisms underlying the associations between functional features and health service outcomes. Results The review included 60 studies (52 quantitative studies, 4 qualitative studies, and 3 mixed-methods studies). The functional features of China’s primary care services can be broadly categorized into six core dimensions: First Contact, Accessibility, Comprehensiveness, Continuity, Coordination, and Patient Empowerment. Their local conceptual connotations have undergone significant reconfiguration compared to the original theoretical constructs. Overall, the intensity level of these features is medium-to-high. Stronger measurement levels are positively associated with multiple critical health service outcomes, including improved patient health status, enhanced patient experience, lower healthcare costs, preference for primary care first-contact, and reduced general hospital utilization. Furthermore, clear mechanistic pathways influencing key outcomes were identified for the first five features. Conclusion This review validates the real-world value of sustained investment by the Chinese government and society in primary healthcare reform. It supports the strategic enhancement of these functional features to maximize their capacity to improve health outcomes. Finally, it highlights the imperative for future research to employ broader, deeper, and more precise methodologies to capture the evolving nature of primary care in China.

Background With the aging of the population, chronic diseases have become a significant public health challenge. Enhancing health literacy among individuals with chronic diseases can foster a proactive approach to health management, leading to improved health outcomes. Objective This study aims to examine the current status of health literacy and its influencing factors among patients with chronic diseases in Shanghai, with the goal of providing theoretical support for future health promotion strategies and chronic disease management programs. Methods From February to May 2023, a multi-stage stratified random sampling method was employed. Based on the resident population size and the number of community health service centers in each administrative district of Shanghai, 1 to 4 community health service centers were randomly selected from 16 districts, totaling 28 centers. A questionnaire survey was administered to chronic disease patients visiting these centers. A general information questionnaire was used to collect demographic and clinical data, and a health literacy scale was applied to assess the health literacy levels of the respondents. Results Of the 768 chronic disease patients surveyed, 13 questionnaires with incomplete data were excluded, resulting in a final sample of 755 patients, with an effective response rate of 98.3%. Among the respondents, 435 (57.62%) exhibited good health literacy. In terms of specific dimensions, 664 patients (87.95%) demonstrated the ability to obtain information, 618 (81.85%) expressed willingness to provide economic support, 559 (74.04%) showed communication and interaction skills, and 646 (85.56%) were willing to improve their health. Binary logistic regression analysis revealed that female gender (OR=1.549, 95%CI=1.148-2.091) and family doctor contracting (OR=1.634, 95%CI=1.162-2.299) were significant influencing factors for health literacy among chronic disease patients (P<0.05). Furthermore, the proportion of patients with stable disease control in the past year was significantly higher among those with adequate health literacy compared to those without (P<0.05) . Conclusion The overall health literacy of chronic disease patients in Shanghai requires improvement. Gender and contracting with a family doctor are key factors influencing health literacy levels. Targeted interventions are recommended to expand the coverage and enhance the quality of family doctor services, thereby improving health literacy. These findings provide valuable insights for promoting proactive health management in chronic disease care.

Objective: This systematic review aims to summarize narratives related to the context, delivery models, and healthcare outcomes associated with Community-Oriented Primary Care (COPC) services provided by Cuban primary care practitioners to local community residents. Introduction: "Community orientation" is a core feature of primary health care that enhances population health and a vital skill for general practitioners. COPC integrates primary health care and community medicine in a coordinated practice to improve population health. Cuba stands out globally, particularly among low- and middle-income countries, for its primary health care system and has achieved outstanding population health outcomes through this approach. However, systematic evidence summarizing the context, delivery models, and healthcare outcomes of COPC in Cuba remains lacking. Inclusion and Exclusion Criteria: Included documents must: (1) focus on Cuban primary care practitioners and teams delivering community-oriented primary care services, along with local residents receiving and participating in these services; (2) explicitly address COPC services, including their context, delivery models, and healthcare outcomes; (3) be set in the Cuban community or primary care context; (4) consist of published or unpublished narratives within grey literature; (5) be in Spanish or English; and (6) be published on or after January 1, 1990. Excluded literature: (1) does not explicitly mention COPC services provided by Cuban practitioners, their context, or healthcare outcomes; (2) only addresses context beyond local health administration and community influence (e.g., U.S. economic embargo); (3) only involves events outside the Cuban primary care context (e.g., international medical missions); (4) is not a narrative (e.g., quantitative or qualitative studies). Methods: We will search narrative literature published between January 1, 1990, and July 31, 2024, in Spanish or English across four academic databases: PubMed, Web of Science, Google Scholar, and Embase, and grey literature from the World Health Organization (WHO), the World Organization of Family Doctors (WONCA), including its Latin American branches, and the Cuban Ministry of Public Health websites. The review protocol is developed using JBI SUMARI. Qualified researchers will screen literature using Rayyan and JBI SUMARI, assess methodological quality, and extract data with JBI SUMARI tools. Data will be synthesized via the meta-aggregation method in JBI SUMARI. Systematic Review Registration Number: This study is registered with PROSPERO, registration number is: CRD420251018485. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Dementia has been regarded as a priority in public health for healthy ageing. Mild cognitive impairment (MCI) detection and management is one of the strategies to confront the challenge of increasing burden of dementia. However, MCI is not well recognized or managed in primary care. This study aimed to assess system barriers relating to MCI detection and management in the community. A mixed-methods study was undertaken over the period from October 2020 to October 2022. First, a focus group study (n = 124) in Shanghai explored the experiences of general practitioners (GPs), people with MCI and their informal caregivers, and community health managers using thematic analysis. This was followed by 2 rounds of national Delphi surveys among 22 eligible experts to solicit their consensus on the system conditions needed for community detection and management of MCI. A questionnaire survey based on the Delphi consultations was conducted with GPs (n = 1253) recruited from 56 community health centres (CHCs) in Shanghai to quantify their knowledge, attitudes, and practice (KAP) toward community detection and management of MCI and perceived system barriers. The results were mapped and triangulated in line with the chronic care model (CCM) and the health system building blocks articulated by the World Health Organization. Potential system barriers were identified from eight themes: (i) lack of self-management skills and enablement; (ii) lack of family support; (iii) lack of community support; (iv) unprepared healthcare system; (v) health service delivery deterrence; (vi) inadequate clinical decision support; (vii) lack of case management; and (viii) misaligned clinical information systems. The primary care system in Shanghai is not adequately equipped to handle the task of detecting and managing MCI. Both intrinsic and extrinsic obstacles impede the successful conversion of MCI knowledge into desired actions. A systems approach is needed to confront the challenge of MCI detection and management in China.

Objective In recent years, many primary healthcare institutions in China have implemented integrated general–specialist care models within community settings. This study aimed to examine patients’ objective experiences and evaluations of two types of community-based healthcare services—integrated general–specialist clinics for specific chronic diseases and general outpatient clinics. By comparing these evaluations, the study sought to identify the strengths and weaknesses of current service quality and to provide empirical evidence for improving community healthcare capacity and patient experiences. Methods From June to October 2024, a multistage sampling method was used to recruit patients with chronic diseases who received care either from integrated general–specialist clinics or general outpatient clinics in community health service centres implementing the integrated care model. Data were collected using the Primary Care Assessment Tool–Adult Short version (PCAT-AS) to assess patients’ evaluations of primary care services. Analysis of variance (ANOVA) was used to compare clinical characteristics between groups, and multiple linear regression analysis was conducted to identify factors influencing patients’ evaluations of primary healthcare services. Results A total of 581 valid questionnaires were collected. Patients attending integrated general–specialist clinics reported significantly higher scores across all dimensions and in the total PCAT-AS score compared with those attending general outpatient clinics. Multiple regression analysis indicated that attending an integrated general–specialist clinic (β = 0.195, P < 0.001), being aged ≥ 71 years (β = 0.179, P < 0.001), awareness of the harms of chronic diseases (β = 0.166, P < 0.001), and receiving health education on related diseases from attending or family physicians (β = 0.181, P < 0.001) were significantly associated with higher total PCAT-AS scores. Conclusions Integrated general–specialist care within community health service centres play an increasingly important role in safeguarding patient health and promoting the rational allocation of healthcare resources. Community centres offering such integrated services provide patients with chronic diseases a better primary care experience. However, further improvements are needed in care coordination (referral processes) and community orientation.

At present,the collaboration of general practice and speciality has been applied to the diagnosis,treatment and management of various chronic diseases in the community based on the technical support of disease diagnosis and treatment and the implementation of hierarchical diagnosis and treatment.Based on the patient-centered,systematic and holistic thinking characteristics of general practice,the general practice team of Yangpu Hospital Affiliated to Tongji University explored and practiced a more comprehensive,in-depth and effective collaboration model of general practice and speciality around the multi-dimensional construction of'six ones'.The construction of'six ones'was based on the collaboration of general practice and speciality between general hospitals and community health service centers.Taking osteoarthritis(OA),a common chronic disease in the community,as an example,its contents and characteristics were as follows.(1)Establishment of a multidisciplinary team:the established team could rely on the basis of the three-dimensional integrated health care system of the general hospitals,to give play to the liaison and coordination role of general practice department in general hospitals,refine and coordinate the multidisciplinary division of labor;(2)Improvement of a set of diagnosis and treatment processes:improve a set of hierarchical diagnosis and treatment process for diseases based on scientific evidence,and evaluate the effectiveness of the diagnosis and treatment process,so that it could help to improve patients'symptoms and quality of life;(3)Development of an APP:the developed APP could cover multiple functions such as hierarchical diagnosis and management of OA patients,doctor-patient communication,popularization of science,appointment registration,and could record the complete diagnosis and treatment data in the exclusive information platform;(4)Designing a set of publicity and promotion programs:Publicize the program in multiple scenarios such as disease diagnosis and treatment,health examination and consultation in general hospitals and communities through a variety of forms of text,pictures and videos;(5)Establishment of a case database:establish a specific disease database for OA patients,continuously follow up patients and implement hierarchical management of the collected data,so as to provide more cases with general characteristics;(6)Construction of a set of curricula:the curriculum is built around OA specialties,including"bone pain as an undifferentiated disease in general practice"and"chronic disease management of OA",the course is conducted in the form of problem-oriented learning,outpatient consultation and teaching round demonstration,which was for multi-level training of undergraduate,graduate and continuing education.Taking the'six ones'construction of OA management in the community as an example,the practice of the collaboration of general practice and speciality for the management of chronic disease based on the thinking of general practice suggests the potential of comprehensive,in-depth cooperation and mutual promotion between the two sides in multiple dimensions of medicine,teaching and research,as well as the effectiveness of optimizing and integrating the team,technology and information support related to hierarchical disease management for promoting the physical and mental health of patients.

Primary healthcare institution undertakes a significant responsibility in medical and health provision.As the medical industry has undergone continuous development,which is evident in the obvious improvement of facilities and medical treatment environment of community health service institutions,and the effectively upgraded health information systems,the public's demand for specialized medical treatment in community health service institutions is becoming increasingly prominent.This article discusses the significance of developing specialized medical technology in community,the connotation of general-specialized combination,as well as the implementation strategies and methods.The article points out that the construction and development of specialized diagnosis and treatment technology in community health service centers can enhance the ability of community general practitioners to practice,improve the level of primary medical care technology,upgrade the level of community health services and meet the public's demand for specialized diagnosis and treatment.The goal of general-specialty integration can be achieved either by developing specialized diagnostic and treatment techniques on the basis of general practice,or by collaborating with higher-level hospitals to introduce a series of specialized techniques.In terms of specific implementation strategies,it is necessary to find appropriate specialized technologies according to the local needs,develop advanced technologies,carry out scientific research around specialized diseases,and build technical resources by opening specialized outpatient clinics,allocating medical conditions,etc.,and cultivate community talents along with the four construction work,so as to implement the development strategy of the all-specialized combination of community diagnosis and treatment technologies in the four-plus-one way.