Capability in noncommunicable diseases management among village doctors in China

Objective To examine village doctors′ performance in management of hypertension and diabetes – two major noncommunicable diseases (NCDs) patients covered by national primary public health service.

Methods We first selected all village clinics under the administration of 3 township hospitals in one county in each of 8 provinces/autonomous regions in eastern, central, and western China; then we conducted a face-to-face questionnaire survey among village clinic doctors engaged in management on NCDs patients covered by national primary public health service in September 2015 to collect information on the doctors′ demographics, professional performance, trainings, and difficulty in and satisfaction to their work. SAS 9.4 software was used in statistical analysis.

Results Of the 266 village doctors surveyed, 78.71% were part-timers. The median for the reported number of NCDs patients under the management of one village doctor was 189 and the median for number of NCDs patients which could be effectively managed by one village doctor was 100 based on the reporting of the village doctors surveyed. Of all the village doctors, 75.71% considered themselves being overloaded in the management work and all reported participations in trainings on hypertension and diabetes management. Main difficulties in NCDs patients management indicated by the village doctors were the lack of medicine supplied by grassroots clinics to meet the requirements of patients (reported by 43.94% of the doctors) and the patients′ poor compliance (38.64%). Low satisfaction to salary, performance assessment and career prospect were reported by the village doctors. Multivariate logistic regression analysis revealed that being a part-timer and being subject to administrative punishment were risk factors for overall satisfaction to working on NCDs patients management among the village doctors, with the odds ratios (95% confidence interval) of 0.409 (0.169 – 0.988) and 0.198 (0.088 – 0.449).

Conclusion The village doctors′ management on NCDs patients is supported with professional training but hindered by overload work, poor compliance of patients, and lack of medicine supplied by grassroots clinics. Targeted measures are needed to promote the village doctors′ management on patients with NCDs.