# Effectiveness of family doctor contract services for chronic diseases management in China: a mixed-methods systematic review

## TL;DR

This review evaluates how well family doctor contract services in China help manage chronic diseases and identifies factors that influence their effectiveness.

## Contribution

The study provides the first systematic evaluation of the effectiveness of family doctor contract services for chronic disease management in China.

## Key findings

- 77% of studies reported positive effects on blood pressure, glucose control, health knowledge, and quality of life.
- Factors like policy support and team building were linked to FDCS effectiveness, while challenges include inadequate resources and low public awareness.
- Most quantitative studies had moderate bias, and long-term effects of FDCS remain unreported.

## Abstract

The world is facing increasing challenges related to the rising burden of chronic diseases as the population ages. The family doctor contract service (FDCS) has been shown to play a vital role in managing chronic diseases in China. However, a systematic evaluation of its effectiveness is lacking. This systematic review explores the effectiveness of the FDCS in the management of chronic diseases and discusses the barriers and facilitators that affect their effectiveness in China.

PubMed, Embase, Web of Science, CNKI and WanFang were searched for relevant studies, which were synthesised following their review using mixed methods. Articles on the effectiveness, barriers, and facilitators of FDCS that were published before 13 September 2024 were retrieved. We excluded studies that did not report the effectiveness of FDCS in managing chronic diseases and those that reported the barriers and facilitators of FDCS contraction. We report our review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

We identified 7486 titles, retrieved 315 full-text articles and included 64 articles in the final analysis. The review found that 77% (n = 49) of the included studies reported positive effects of FDCS on blood pressure control, glucose control, health knowledge, and quality of life (QoL). The findings of the studies on medical expenses (n = 6) and quality of primary care (n = 4) were inconsistent. The following factors associated with the effectiveness of FDCS were identified from four qualitative and three mixed-methods studies; policy support, team building, and the needs of the residents. However, these studies also highlighted the need for improvements in FDCS related areas, including inadequate human resources and professional capabilities, imperfect economic incentive mechanisms, non-standard service implementation and management, low public participation and awareness, and inadequate technical support and resource guarantee. While 71.9% of the quantitative studies had moderate risks of bias, their quality was unsatisfactory.

FDCS is effective for managing chronic disease. However, long-term effects have not been reported in previous studies. Further studies are required to identify the service cascade and maximise the effectiveness of FDCS. Efforts should also be made to address the challenges associated with FDCS in human resources, incentive systems, resource integration, and policy promotion to facilitate sustainable development in China.

The review was registered in PROSPERO (registration no. CRD42024587272).

The online version contains supplementary material available at 10.1186/s12875-025-03009-3.