ArticleThe Lancet regional health. Western Pacific2020
The competence of village clinicians in the diagnosis and treatment of heart disease in rural China: A nationally representative assessment.
Article in The Lancet regional health. Western Pacific, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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18 citing papers in PubMed, 25 citations in OpenAlex.
- Management capacity for stable coronary heart disease in Shanghai community medical institutions: a cross-sectional study.BMC health services research · 2025Article
- Comparison of the clinicians' and experts' assessments of rehabilitation service needs for patients in the middle of China.Scientific reports · 2025Article
- Impact of the hierarchical medical system on the perceived quality of primary care in China: a quasi-experimental study.Global health research and policy · 2025Article
- Primary Healthcare Physicians' Insufficient Knowledge Is Associated with Antibiotic Overprescribing for Acute Upper Respiratory Tract Infections in China: A Cross-Sectional Study.Antibiotics (Basel, Switzerland) · 2024Article
- Primary care quality and provider disparities in China: a standardized-patient-based study.The Lancet regional health. Western Pacific · 2024Article
- The impact of provider-patient communication skills on primary healthcare quality and patient satisfaction in rural China: insights from a standardized patient study.BMC health services research · 2024Article
- Correlates and consequences of atrial fibrillation in a prospective study of 25 000 participants in the China Kadoorie Biobank.European heart journal open · 2024Article
- Quality of primary health care for chronic diseases in low-resource settings: Evidence from a comprehensive study in rural China.PloS one · 2024Article
- Article
- Are informal healthcare providers knowledgeable in tuberculosis care? A cross-sectional survey using vignettes in West Bengal, India.International health · 2023Article
- Structural Determinants of Child Health in Rural China: The Challenge of Creating Health Equity.International journal of environmental research and public health · 2022Review
- Are Rural Primary Care Providers Able to Competently Manage Common Illnesses? A Cross-Sectional Study in Rural Sichuan, Western China.Healthcare (Basel, Switzerland) · 2022Article
- Provider competence in hypertension management and challenges of the rural primary healthcare system in Sichuan province, China: a study based on standardized clinical vignettes.BMC health services research · 2022Article
- The Role of Village Doctors in Residents' Uptake of Eye Screening: Evidence from Ageing Residents in Rural China.Healthcare (Basel, Switzerland) · 2022Article
- Explaining the declining utilization of village clinics in rural China over time: A decomposition approach.Social science & medicine (1982) · 2022Article
- The know-do gap in quality of health for chronic non-communicable diseases in rural China.Frontiers in public health · 2022Article
- Measurements of quality of village-level care and patients' healthcare-seeking behaviors in rural China.BMC public health · 2021Article
- Primary care providers are, fundamentally, risk managers - And this is a challenge for health policy.The Lancet regional health. Western Pacific · 2020Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWhile strengthening primary care quality is key to China's health system reforms, evidence to guide this work has been limited, particularly for rural areas. This study provides the first nationally-representative assessment of village doctors' competence in diagnosing and managing presumptive heart disease.
methodsA cross-sectional study of village clinics was conducted across five provinces. We presented standardized clinical vignettes to evaluate clinicians' competence in diagnosing and managing unstable angina. Enumerators accompanying mock patients documented the interaction, including questions, physical examinations, diagnoses, and management options provided by the doctor. We measured diagnostic process competence as adherence to "recommended" questions and examinations based on national clinical practice guidelines, diagnostic competence according to whether clinicians provided a correct diagnosis, and management as correct medication and/or referral. Management was assessed twice: following clinicians' own diagnoses determined through questioning and examinations, and after enumerators provided doctors with the correct diagnosis.
findingsClinicians completed 26% (95% CI 24% to 28%) of recommended diagnostic questions and examinations; 20% (14% to 27%) arrived at a correct diagnosis. Rates of correct management were 43% (35% to 51%) following clinicians' own diagnosis and 51% (43% to 59%) after being given the correct diagnosis. When given the correct diagnosis and only asked to provide treatment, clinicians prescribed 82% fewer potentially harmful medications than in treatments based on their own (potentially incorrect) diagnosis.
interpretationThe ability of village doctors to diagnose a textbook case of unstable angina is limited. Deficits in diagnostic competence led to low rates of correct management.
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