The BPHS project is a significant step towards combining prevention and treatment at the grassroots level and is the first line of defense for the health of urban and rural citizens. The primary objective of this study was to examine trends in the utilization of BPHS projects in Guangzhou from 2017 to 2021 and determine discrepancies in these trends between the urban and rural areas of Guangzhou. The results of this study showed that the utilization rate of the BPHS, in general, has improved significantly. However, there is still a disparity in the use of the BPHS by urban and rural residents.
Health records contain important information such as residents' personal information, past medical history, drug allergies, family history, and genetic history, which are critical to the realization of integrated health services. A comprehensive health record enables doctors to quickly assess an individual's health status and implement targeted health promotion programs [22]. With the improvement of the national target value, the management rate of the three indices in the health record management service is rising. According to this study, the rates of paper and electronic health record creation in Guangzhou are nearly identical. Guangzhou City has encouraged the adoption of electronic health records since 2017, and by 2018 electronic records completely replaced paper health records. Although the coverage of paper and electronic health record creation was lower in urban areas than in rural areas, the coverage of paper health record usage was higher in urban areas than in rural areas. Information technology utilization in rural areas lags behind that in urban areas, which is not beneficial to the flow of information relevant to residents' health records within the health system; therefore, it is recommended that the health sector should further improve information technology utilization in rural areas to improve the flow of information, which is consistent with the findings of Wang [23].
Guangzhou City has strongly promoted the idea that "everyone is the first person responsible for their health," which emphasizes the importance of health education, and standardizes health checkups and disease screening. Studies have shown that health literacy is negatively correlated with healthcare spending. Improving health education for people with low health literacy can help improve the health status of this population and reduce healthcare costs [24]. In the prevention and control of the COVID-19 pandemic, WeChat, microblogs, public numbers, and television should be actively used to take full advantage of new communication methods to improve public health knowledge during the special circumstances. To further improve the utilization of health education-related indicators, it is recommended that rural primary health service institutions further strengthen training programs on the work standards of the BPHS project to achieve an accurate and detailed implementation of the BPHS. It is advisable to carry out a needs assessment before developing health education programs to meet the health needs of residents [25].
Vaccination not only saves the lives of millions of children and adults each year, but also improves physical development, educational outcomes, and equity in the distribution of health benefits for children, and has significant benefits to society as a whole [26, 27]. Since the beginning of the BPHS in 2009, through effective vaccination and reporting of infectious diseases, the occurrence and prevalence of major infectious diseases have been prevented [28]. The BPHS program contains eight vaccines from the national immunization project. Following 2017, vaccination rates for all types of vaccines exhibited an upward trend and the annual childhood vaccination establishment rate in Guangzhou City was 100.00 percent from 2018 until the COVID-19 outbreak in 2021. Although the vaccination rates for all types of vaccinations were lower in rural areas than those in urban areas, they exceed 99.60 percent in all regions. According to the data analysis, Guangzhou achieved complete and consistent immunization coverage.
In the city of Guangzhou, the rate of newborn follow-up visits increased from 2017 to 2021; however, the utilization rate of health management services for children was lower in 2021 than that in 2017. This may be related to children being restricted from leaving the house by parents during the COVID-19 outbreak to prevent their exposure to the possible spread of infections in crowded places. The rate of newborn visits was lower in the city than in rural areas with a significantly higher rate of newborn visits in rural areas compared to urban areas in 2018. This study found that rural areas had a low birth rate in 2018, with the number of live births at 104,752. Regarding maternal health management services, relevant indicators showed an increasing trend in Guangzhou. By region, the early pregnancy registration rate and the percentage of postpartum and follow-up visits were higher in urban areas than in rural areas, probably because most primary healthcare institutions are well-equipped, operate in a standardized manner, and can meet the needs of pregnant women in urban areas. In contrast, rural primary care facilities are poorly equipped, and doctors are less specialized. In terms of health management services for older adults, based on the trend observed in Guangzhou, the utilization rate of health management services for older adults is increasing. However, over the past five years, this rate has not reached national target values. Moreover, this may be related to the large population of older adults and the insufficient number of relevant staff. In the seventh national census in 2021, there were 1,460,333 people aged 65 or above in Guangzhou, accounting for 7.82% of the population, and Guangzhou officially had an aging population. Moreover, this is likely due to the city's experience with a COVID-19 outbreak on May 21, 2021. A large workforce was involved in the prevention and control of new outbreaks at the grassroots level, which to some extent hindered the delivery of basic public health services and the reduction of manpower in the BPHS. The utilization rate of health management services for older adults was much lower in urban areas compared to rural areas, which may be related to the fact that in recent years, rural areas have placed more importance on health management for older adults, implemented performance allocation, and relied on street, town, and neighborhood committees to carry out health management for older adults. However, medical resources in rural areas are relatively scarce, and residents are more likely to visit primary medical and health institutions for physical examinations. Urban residents are better off, and some older people choose to go to public hospitals rather than accepting the services provided by primary health care institutions. Furthermore, Guangzhou City released data on the older adult population in 2020, which indicated that Guangzhou was in a mild aging stage overall from 2016–2020. The degree of aging was divided among districts, with urban areas having moderately aging societies. As a result, there are more urban areas than rural areas with health management services for older adults.
Regarding health management for patients with chronic diseases, the China Cardiovascular Report points out that hypertension and diabetes are risk factors for cardiovascular disease, and that standardized management of patients with hypertension and type 2 diabetes is an important way to reduce the incidence of cardiovascular disease and patient mortality. In Guangzhou, there were no changes in the percentage of diabetic patients receiving standardized management from 2017 to 2021, while the rest of the indicators showed an increasing trend. Standardized management of hypertension and type 2 diabetes, is an important way to reduce the incidence of cardiovascular disease and patient mortality. The rates of standardized management of hypertension, type 2 diabetes, and blood glucose control in the managed population were all higher in urban areas compared to rural areas. In contrast, blood pressure control rates in the managed population were lower in urban areas compared to rural areas. Shi et al. [29] surveyed the health literacy status of Beijing residents in 2015, and the results showed that urban residents had higher health literacy regarding chronic disease prevention and control than rural residents (33.8% vs. 27.3%). It has been suggested that people with low health literacy cannot access and use health information or engage in health behaviors and are more likely to have poor health outcomes [30]. Therefore, it is recommended that chronic disease health education for key rural populations be strengthened to improve health literacy for chronic disease prevention and control, reduce the incidence of chronic diseases, and improve self-management in rural populations. The rate of standardized management of patients with severe mental disorders is higher in urban areas than in rural areas. It may be that the large population in rural areas leads to a higher detection rate, and the large number of patients makes management difficult. Mental illnesses are relatively complex diseases. Therefore, it is important to manage them in a standardized manner. Therefore, we recommend the establishment of a comprehensive management model by the government, combining the efforts of multiple departments to implement follow-up and medical examinations of patients, and improve the rate of standardized management, thus effectively controlling the condition of key service groups [31]. Regarding TB patient management, the utilization rate of health management services for TB patients was lower in urban areas than in rural areas. This may be related to the increasing incidence of TB in recent years and the difficulty of managing TB patients due to high population mobility in urban areas.
The BPHS was included in the TCM Health Management Service in 2013. According to a survey, only 8.19 percent of Guangdong inhabitants were aware of TCM health management [32]. Health management using TCM among children aged 0–36 months and TCM health management for older adults are two indicators of TCM health management services. Indicators related to TCM health management showed an increasing trend; however, the completion rates of all relevant indicators were low. Therefore, it is recommended to expand the publicity of TCM management and raise the awareness of the relevant service population. Various publicity methods are used to promote TCM preventive and healthcare knowledge. The service objectives of TCM health management are similar to those for the health management of older adults and children and vaccination programs. Therefore, it is recommended to combine the implementation of TCM health management for children aged 0–36 months with child health management and vaccination programs and to combine the implementation of TCM health management for older adults with health management of older adults to rationalize the mode, frequency, and timing of services to implement the coverage of TCM health management.
In terms of infectious disease reporting and handling, from 2017 to 2021, the annual reporting rate of infectious diseases was 100.00%, whereas the timely reporting rate of infectious diseases and the reporting rate of information related to public health emergencies were both over 99.90%. By region, there were no differences between the urban and rural areas in the three relevant metrics. The state performs standardized management of infectious diseases through the Law of the People's Republic of China on the Prevention and Treatment of Infectious Diseases, and the China Disease Surveillance Information Report Management System. In addition, the municipal government prioritizes infectious disease prevention and control, and all districts have established a comprehensive reporting and management system for infectious diseases. The municipal government has also actively promoted the management of infectious diseases. Regarding health and family planning supervision and co-management, in Guangzhou, the reporting rate of health and family planning supervision and co-management information reached 100.00% annually from 2017 to 2021. The management of infectious diseases, as well as the supervision and management of health and family planning in Guangzhou are already relatively well established and standardized. Therefore, these two types of services are recommended to be removed from the BPHS.
The limitation of this study was the use of an administrative database as the main source of data, which may have led to the authenticity of the study data.