BackgroundChina adopted family doctor (FD) to help achieve “Healthy China 2030” through providing continuous, comprehensive, and life-cycle contract services. However, there is a disparity between actual and targeted FD use, as residents continue to visit specialists in large hospitals. The government implemented initiatives to improve residents’ willingness to sign up with and visit their FDs. Factors that influence contract behavior are therefore significant for frontier policy research.MethodsTwo survey waves were conducted in Shanghai (2013 and 2016). The first wave included 2754 people and the second 1995 people. Exploratory factor analysis was used to synthesize “satisfaction” as a predictor of contract behavior. Pearson’s chi-square, pooled and logistic regression models were used to estimate associations between influencing factors and contract behavior, and clarify variations in factors across the two waves.ResultsFour factors were extracted from 15 satisfaction items: “Treatment Environment,” “Medical Technology,” “Service Specification” and “Service Attitude”. Consistent with descriptive analysis, longitudinal analysis showed sociodemographic characteristics (age, education, marital status, and hukou) were significant predictors of contract behavior. The odds ratio of non-communicable diseases (NCD) patients for contract behavior was 2.218 times that of residents without NCD. Contract behavior was positively correlated with awareness of FD services (OR = 21.674, 95%CI = 15.043–31.229), satisfaction with Service Attitude (OR = 1.210, 95%CI = 1.009–1.451), and visit compliance (OR = 1.959, 95%CI = 1.564–2.452). Over time, the odds ratios of the married, Shanghai hukou, NCD, and awareness of FD services declined from 0.456, 1.795, 2.492, 28.690 to 0.443, 1.678, 1.910 and 14.031 respectively, while those of age, and visit compliance increased from 1.027, 1.521 to 1.041 and 2.305 respectively. In 2016, an education-contract gradient had formed (the higher the education level, the higher probability of signing with a FD), whereas high school education had the highest odds ratio (OR = 1.163,95%CI = 0.740–1.827) in 2013. Service Attitude was the only significant satisfaction-related predictor (OR = 1.358, 95%CI = 1.001–1.842) in 2016, compared with “Treatment Environment” (OR = 1.224, 95%CI = 1.001–1.496) and “Service Specification” in 2013(OR = 1.270, 95%CI = 1.040–1.552).ConclusionsExcept for the socio-demographic variables, NCD, awareness of FD services, satisfaction and visit compliance were significant predictors of contract behavior with FDs. The effect of visit compliance had increased over time while NCD and awareness of FD services were losing impact over time. Significant satisfaction factors had also changed from “Treatment Environment” and “Service Specification” to “Service Attitude”.

Summary Background Noncommunicable diseases (NCDs) are a major threat to population health worldwide. In Shanghai, China, a new pattern of NCD management—self‐management—has been developed in community health service centres (CHSCs). Objective To clarify how contracting with CHSC‐based family doctors (FDs) influences the engagement in and effectiveness of self‐management behaviour among NCD patients. Method We conducted two waves of a questionnaire survey (in 2013 and 2016) to collect data on patients with NCDs. Separate logistic regression models and longitudinal analysis were performed to examine the effect of contracting with an FD on NCD self‐management and the effectiveness of this self‐management. Results Nearly all contracted patients (80.79%) had implemented NCD self‐management, while only 55.57% of non‐contracted patients did so. The self‐management effectiveness rate was also higher among contracted patients than among non‐contracted ones (86.66% vs. 54.79%). In the population‐averaged models, contracted patients had 2.25 and 2.91 times greater odds of implementing self‐management and reporting that the self‐management was effective, respectively, after controlling for all related variables. Additionally, awareness of FD‐contracted services, satisfaction with CHSCs, and experiencing first contact at CHSCs had positive impacts on the implementation and effectiveness of self‐management. Conclusions FDs were important for ensuring that NCD patients engaged in self‐management behaviour, the most common form of which was focus group. Participation in NCD focus groups may be key for attaining the effects of self‐management, including improved health knowledge, greater health awareness, more frequent engagement in health behaviour, and, most importantly, greater practice of self‐monitoring. Self‐management might help to achieve greater NCD control.

Background Changning District of Shanghai pioneered in implementing Family Doctor and Medical Insurance Payment Coordination Reform. The survey aimed to assess the effect of the reform to provide a decision-making basis for ensuring the “gatekeeper” role of the family doctor. Methods A cross-sectional survey was conducted using a self-designed questionnaire in Changning District of Shanghai during January and February in 2014. Multi-stage random cluster was applied and 3040 residents were selected. Comparisons were made with statistically test between the contracted and non-contracted residents in four policy targeted dimensions, doctor-visiting behavior, health management and status, medical cost control and satisfaction. Results Compared with the non-contracted residents, the contracted residents (72.9%) presented a higher prevalence rate of chronic diseases (32.6%), a higher proportion (51.9%) in first-contact in the community health service center and a higher proportion to refer to specialists as well ( P < 0.001).The result showed that the average annual medical expense were significantly higher than non-contracted residents ( P < 0.001), however, the difference disappeared after age, medical insurance and other socio-demographic variables were controlled. In terms of self-management of non-communicable diseases and complication prevention, the blood pressure control rate and blood glucose control rate for the contracted group were also higher than the counterparts, reaching up to 85.6 and 72.7% respectively. Conclusion The preliminary analysis indicated that the contracted residents performed better in orderly doctor visiting behavior, health management behavior, health status and satisfaction. Follow up survey is necessary to further analyze the policy effect. Electronic supplementary material The online version of this article (10.1186/s12875-019-0949-0) contains supplementary material, which is available to authorized users.

Elevated autophagy is highly associated with cancer development and progression.Fruit extracts of several plants inhibit activity of autophagy-related protease ATG4B and autophagy activity in colorectal cancer cells. However, the effects of these plant extracts in oral cancer cells remain unclear. In this study, we found that the extracted Tribulus terrestris fruit (TT-(fr)) and Xanthium strumarium fruit had inhibitory effects on autophagy inhibition in both SAS and TW2.6 oral cancer cells. Moreover, the fruit extracts had differential effects on cell proliferation of oral cancer cells. In addition, the fruit extracts hampered cell migration and invasion of oral cancer cells, particularly in TT-(fr) extracts. Our results indicated that TT-(fr) extracts consistently inhibited autophagic flux, cell growth and metastatic characteristics of oral cancer cells, suggesting TT-(fr) might contain function ingredient to suppress oral cancer cells.