China Alliance for Respiratory Disease Prevention and Control at the Primary Care Level: Bridging with IPCRG to Build a Comprehensive Respiratory Disease Prevention, Diagnosis, and Treatment System in Chinese Primary Healthcare Institutions

To address key issues in the prevention and control of respiratory diseases in China, effectively improve the level of prevention and control of respiratory diseases at the primary care level, and promote the development of the system and capacity for preventing and controlling respiratory diseases at the primary care level, the Chinese Thoracic Society of the Chinese Medical Association initiated the establishment of the China Primary Care Respiratory Disease Prevention and Control Alliance (hereinafter referred to as the Primary Care Respiratory Alliance) in 2015.

The alliance is a member organization of the International Primary Care Respiratory Group (IPCRG). It actively participates in international activities to stay abreast of the latest global trends in respiratory diseases and is committed to building a comprehensive primary care system for the prevention and treatment of respiratory diseases in China. Currently, the alliance covers 28 provinces, municipalities, and autonomous regions across China, encompassing nearly 7,600 secondary hospitals and approximately 30,000 community health centers and township health centers.

The Chairman of the Primary Care Respiratory Alliance is Academician Wang Chen, and the Executive Chairman is Professor Chi Chunhua. Academician Wang Chen serves as Vice President of the Chinese Academy of Engineering, President of the Chinese Academy of Medical Sciences and Peking Union Medical College, and is a renowned expert in respiratory medicine and critical care medicine. He has published more than 200 papers in internationally authoritative journals and participated in the compilation of over 10 medical textbooks, including the nationally planned textbooks Internal Medicine and Critical Care Medicine.

From November 1 to 3, the Primary Care Respiratory Alliance held its annual academic forum in Xi’an, themed “Promoting Standardized Diagnosis and Treatment of Respiratory Diseases at the Primary Care Level under New Conditions.” This marked the fourth consecutive China Primary Care Respiratory Disease Prevention and Control Academic Forum organized by the Alliance since its establishment. The forum invited leading domestic and international experts in respiratory medicine and general practice to deliver academic presentations and engage in interactive discussions on policies, strategies, current status, and future trends in primary care respiratory disease management. Nearly 2,000 participants attended, including primary care physicians specializing in respiratory medicine, general practice, and pediatrics, as well as other relevant stakeholders from more than 30 provinces, municipalities, and autonomous regions across China.

At the 4th China Primary Care Respiratory Disease Prevention and Control Academic Forum, VCBeat (WeChat ID: vcbeat) learned that the Primary Care Respiratory Alliance has carried out dozens of activities and projects related to the prevention and control of respiratory diseases at the primary care level across China in recent years, and has compiled a summary of the alliance’s major events.

Among the nearly ten major initiatives launched by the Primary Care Respiratory Alliance in 2019, the Primary Care Respiratory Standardization Project stood out as one of its core endeavors. To implement the national “Healthy China 2030” action plan and respond to the National Health Commission’s requirements for further enhancing primary healthcare capabilities, the Chinese Association of Chest Physicians (under the Chinese Medical Doctor Association), the Chinese Thoracic Society (under the Chinese Medical Association), the General Practitioners Branch of the Chinese Medical Doctor Association, and the General Practice Branch of the Chinese Medical Association jointly initiated the “Project on Standardized Prevention, Diagnosis, and Treatment Systems and Capacity Building for Respiratory Diseases in Primary Healthcare Institutions.”

This project was developed in reference to international frameworks for the prevention and control of respiratory diseases at the primary care level. It convened a multidisciplinary panel of experts, including specialists in general practice, pulmonology, and representative community physicians, to discuss and evaluate outstanding primary healthcare institutions. The Primary Care Respiratory Disease Standardization Project was officially launched in Beijing on August 26, 2018. In its initial phase, 167 primary healthcare institutions from 12 provinces and municipalities participated in the evaluation. A total of 54 expert groups specializing in respiratory medicine and general practice were formed to conduct the assessments. Ultimately, 85 institutions were designated as “Outstanding,” 76 as “Compliant,” and 5 as “Incubation” sites. The project has received high recognition and strong support from the Department of Primary Healthcare under the National Health Commission.

In March and June 2019, the Primary Care Respiratory Standardization Project launched the second round of evaluation activities in Tianjin and Shanghai, respectively. To date, three rounds of evaluations have been conducted, with the results shown in the figure below.

2019 Review Results of the Primary Care Respiratory Standardization Project

As the project progresses, an increasing number of primary healthcare institutions are participating. Currently, there are more than 50,000 such institutions. To improve evaluation efficiency, the National Primary Care Respiratory Alliance plans to establish a national data information platform for primary healthcare, with technical support provided by Zechuang Tiancheng, a medical big data company. In the future, the Primary Care Respiratory Standardization Project will adopt a combined approach of online assessment and on-site verification, covering all 31 provinces, municipalities, and autonomous regions across China. The plan is to evaluate 1,000 primary healthcare institutions in 2019 and achieve 100% coverage of community health centers nationwide within three years.

“Zhi Xiang Respiratory Care” is a knowledge and skills competition on the prevention and treatment of respiratory diseases, designed for primary care physicians. It aims to help these physicians master the fundamental theoretical knowledge and diagnostic and therapeutic techniques for respiratory diseases, thereby comprehensively enhancing their capacity in the prevention and management of such conditions.

The competition encompassed multiple dimensions, including disease-specific knowledge, professional skills, and case analysis. During the 2018 event, “Zhi Xiang Hu Xi” (Respiratory Knowledge Sharing) conducted 120 training sessions, achieving remarkable participation with over 10,000 primary care physicians trained in person and more than 20,000 observing online. Ultimately, the competition awarded individual first, second, and third prizes to six winners, and team first, second, and third prizes to six winning teams.

In addition to “Zhi Xiang Hu Xi” (Knowledgeable Breathing), the Primary Care Respiratory Alliance launched the “Chenxi Initiative” (Dawn Plan) in 2019. This initiative aims to strengthen talent development, technical capabilities, and disciplinary construction in respiratory medicine at county-level and primary care hospitals through personnel training and paired assistance programs. It also fosters exchange and collaboration between physicians at county-level hospitals and those at tertiary Grade A hospitals with robust medical and technical resources, thereby enhancing the medical technical standards and service capacity of county-level hospitals.

The “Morning Light Initiative” was officially launched in Beijing on April 27, 2019. From May to October of the same year, it conducted 15 standardized training sessions on the prevention and control of respiratory diseases at the primary care level, while concurrently holding the preliminary and semi-final rounds of a case competition.

In November 2018, the Primary Care Respiratory Alliance established the “Young Physicians Elite Group of the Chinese Primary Care Respiratory Disease Prevention and Treatment Alliance.” Composed of pioneering professionals from the front lines of primary care respiratory disease prevention and treatment, recommended by primary care alliances across 24 provinces, municipalities, and autonomous regions nationwide, the group undertakes academic tasks assigned by the Primary Care Alliance. The inaugural cohort trained 119 outstanding young and middle-aged physicians.

Sun Yingjie, Director of the Primary Care Respiratory Alliance, stated, “These outstanding young and middle-aged physicians constitute a reserve force and teaching faculty for the cause of respiratory disease prevention and control at the primary care level. We will regularly organize members of the Elite Group to participate in multi-level academic exchanges, scientific research training, and other related activities, providing support and assistance for the professional growth and development of our broader membership.”

In addition to providing strong support for talent development, the Primary Care Respiratory Alliance has actively organized nationwide touring lectures on the prevention and treatment of respiratory diseases in primary care settings, thereby strengthening the role of primary care in respiratory disease prevention and enhancing the diagnostic and therapeutic capabilities of primary care physicians. Since August 2018, the “Strengthening Primary Care, Walking Together” national touring campaign for the prevention and treatment of respiratory diseases in primary care has conducted 60 offline training sessions, with nearly 6,000 participations by primary care respiratory physicians.

In terms of discipline development, the Primary Care Respiratory Alliance participated in and formulated clinical practice guidelines for respiratory diseases in 2018. Commissioned by the National Health Commission and the Chinese Medical Association, Academician Wang Chen, Chairman of the Primary Care Respiratory Alliance, and Professor Chi Chunhua, Executive Chairman, served as co-chairs of the guideline development working group. Focusing on eight diseases, one symptom, and one technique, they collaborated with respiratory specialists and general practitioners to jointly develop the relevant guidelines.

In 2018, the guideline development group completed the formulation of three volumes of primary care guidelines for common respiratory diseases. In 2019, there was a significant increase in quantity, with a cumulative total of seven volumes of primary care guidelines for common respiratory diseases developed and published, including the "Primary Care Diagnosis and Treatment Guidelines for Cough" and the "Primary Care Diagnosis and Treatment Guidelines for Pulmonary Tuberculosis."

In terms of collaboration with the International Primary Care Respiratory Group (IPCRG), in May this year, Executive Chair Chi Chunhua led a delegation representing the Chinese Alliance for Prevention and Control of Respiratory Diseases in Primary Care to attend the IPCRG 2019 Scientific Conference held in Romania. Members of the delegation delivered academic presentations and speeches at the conference.

Meanwhile, the Primary Care Respiratory Alliance and the International Primary Care Respiratory Group (IPCRG) jointly established the “IPCRG Researcher Academy: China Clinical Research Training Camp” program. Drawing on advanced international approaches and experience in clinical research training, the program receives support in research and training platforms from institutions such as the National Clinical Research Center for Respiratory Diseases, IPCRG, and China-Japan Friendship Hospital, as well as from MedCoffee, a leading domestic clinical research learning platform. Primarily targeting healthcare professionals committed to clinical research in secondary and tertiary hospitals and primary care institutions, the program facilitates research projects and international exchanges, cultivates young and middle-aged experts in respiratory clinical research in China, and enhances their clinical research capabilities.

The training for Phase 1 of Stage 1 of this project was successfully completed in Xi’an from November 1 to 3. The second and third phases, along with subsequent related training programs, will be rolled out sequentially in 2020.

At an international conference in Romania, the Chinese Primary Care Respiratory Alliance and the IPCRG jointly agreed that the “5th Chinese Primary Care Respiratory Disease Prevention and Treatment Academic Forum & International Primary Care Respiratory Alliance Conference IPCRG2020-China” will be held in Beijing, China, from October 23 to 25, 2020. We sincerely welcome colleagues to actively participate in this international academic event on primary care respiratory health.