{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T15:02:52Z","timestamp":1774969372259,"version":"3.50.1"},"reference-count":45,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T00:00:00Z","timestamp":1699228800000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001547","name":"China Medical Board","doi-asserted-by":"crossref","award":["CMB 18-294"],"award-info":[{"award-number":["CMB 18-294"]}],"id":[{"id":"10.13039\/100001547","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Fam Med Com Health"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Assess whether local health facilities can adequately support the performance of general practitioners (GPs) trained by China\u2019s national compulsory services programme (CSP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Health facilities in middle and western rural areas in China, 2015\u20132022.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Cohorts of CSP graduates from 2015 to 2019 in four major medical universities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcomes<\/jats:title><jats:p>Job performance measured by a 12-item Job Performance Scale; productivity measured by outpatient volume per day; turnover measured by ever changing jobs within the past year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>91.2%, 92.0% and 90.5% GPs working in township health centres reported inadequate medication, equipment and external assistance from higher level hospitals, while CSP graduates working in secondary or tertiary hospitals reported a lower rate of less than 60%. The top three tests reported as lacking were blood gases (67.7%), microbiology (61.6%) and cancer biomarkers (49.7%); the top three lacked procedures were CT scan (64.8%), MRI scan (58.1%) and ambulatory BP monitoring (55.8%); and the top three lacked drugs were drugs for cardiovascular diseases (23.3%), systematic hormonal preparations (17.7%) and traditional Chinese medicines (13.0%). Multivariable analysis showed that facility support was positively associated with job performance\u2014adequate medication increased job performance by 2.2 points (95% CI 0.7\u2009to 3.8), and adequate external assistance increased job performance by 3.3 points (95% CI 1.8\u2009to 4.8). Facility support was also positively associated with productivity\u2014adequate medication increased outpatients seen per day by 20% (95% CI 0.1\u2009to 0.3), and adequate equipment increased outpatients seen per day by 12% (95% CI 0.0\u2009to 0.2). Facility support did not have significant impact on turnover, but GPs who changed jobs in the past year were 1.9\u20132.3 times more likely to report adequate facility support.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>GPs in township health centres experienced a high prevalence of shortage in facility support. The identification of a positive association between facility support and performance and productivity has implications for future research and resources deployment in primary healthcare.<\/jats:p><\/jats:sec>","DOI":"10.1136\/fmch-2023-002421","type":"journal-article","created":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T16:16:19Z","timestamp":1699287379000},"page":"e002421","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Supporting and retaining competent primary care workforce in low-resource settings: lessons learned from a prospective cohort study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8417-5665","authenticated-orcid":false,"given":"Mingyue","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haoqing","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huixian","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiran","family":"Tian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoran","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haozhe","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaotian","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,11,6]]},"reference":[{"key":"2023110608151126000_11.4.e002421.1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.19.234138"},{"key":"2023110608151126000_11.4.e002421.2","unstructured":"World Health Organization . 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