scholarly journals The effects of gatekeeping on the quality of primary care in Guangdong Province, China: a cross-sectional study using primary care assessment tool-adult edition

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Cuiying Liang ◽  
Jie Mei ◽  
Yuan Liang ◽  
Ruwei Hu ◽  
Li Li ◽  
...  
BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e021317 ◽  
Author(s):  
Lina Li ◽  
Chenwen Zhong ◽  
Jie Mei ◽  
Yuan Liang ◽  
Li Li ◽  
...  

ObjectiveCurrent healthcare reform in China has an overall goal of strengthening primary care and establishing a family practice system based on contract services. The objective of this study was to determine whether contracting a general practitioner (GP) could improve quality of primary care.DesignA cross-sectional study using two-stage sampling conducted from June to September 2014. Propensity score matching (PSM) was employed to control for confounding between patients with and without contracted GP.SettingThree community health centres in Guangzhou, China.Participants698 patients aged 18–89 years.Main outcome measuresThe quality of primary care was measured using a validated Chinese version of primary care assessment tool (PCAT). Eight domains are included (first contact utilisation, accessibility, continuity, comprehensiveness, coordination, family-centredness, community orientation and cultural competence from patient’s perceptions).ResultsA total of 692 effective samples were included for data analysis. After PSM, 94 pairs of patients were matched between the patients with and without contracted GPs. The total PCAT score, continuity (3.12 vs 2.68, p<0.01), comprehensiveness (2.31 vs 2.04, p<0.01) and family-centredness (2.11 vs 1.79, p<0.01) were higher in patients who contracted GPs than those did not. However, the domains of first contact utilisation (2.74 vs 2.87, p=0.14) and coordination (1.76 vs 1.93, p<0.05) were lower among patients contracted with GPs than in those who did not.ConclusionOur findings demonstrated that patients who had a contracted GP tend to experience higher quality of primary care. Our study provided evidence for health policies aiming to promote the implementation of family practice contract services. Our results also highlight further emphases on the features of primary care, first contact services and coordination services in particular.


Author(s):  
Nguyen Thi Hoa ◽  
Anselme Derese ◽  
Jeffrey F. Markuns ◽  
Nguyen Minha Tam ◽  
Wim Peersman

Abstract Aim: To adapt the provider version of the Primary Care Assessment Tool (PCAT) for Vietnam and determine its internal consistency and validity. Background: There is a growing need to measure and explore the impact of various characteristics of health care systems on the quality of primary care. It would provide the best evidence for policy makers if these evaluations come from both the demand and supply sides of the health care sector. Comparatively more researchers have studied primary care quality from the consumer perspective than from the provider’s perspective. This study aims at the latter. Method: Our study translated and adapted the PCAT provider version (PCAT PE) into a Vietnamese version, after which a cross-sectional survey was conducted to examine the feasibility, internal consistency and validity of the Vietnamese PCAT provider version (VN PCAT PE). All general doctors working at 152 commune health centres in Thua Thien Hue province had been selected to participate in the survey. Findings: The VN PCAT PE is an instrument for evaluation of primary care in Vietnam with 116 items comprising six scales representing four core primary care domains, and three additional scales representing three derivative domains. From the translation and cultural adaptation stage, two items were combined, two items were removed and one item was added. Six other items were excluded due to problems in item-total correlations. All items have a low non-response or ‘don’t know/don’t remember’ response rate, and there were no floor or ceiling effects. All scales had a Cronbach’s alpha above 0.80, except for the Coordination scale, which still was above the minimum level of 0.70. Conclusion: The VN PCAT PE demonstrates adequate internal consistency and validity to be used as an effective tool for measuring the quality of primary care in Vietnam from the provider perspective.


2017 ◽  
Vol 25 ◽  
pp. e14442
Author(s):  
Inês Leoneza ◽  
Elisabete Pimenta Araújo Paz ◽  
Raphael Mendonça Guimarães ◽  
Adelson Antonio Castro

Objetivo: analisar o grau de orientação oferecida por unidades primárias em relação ao atributo acesso de primeiro contato na perspectiva de usuários hipertensos. Método: estudo transversal de avaliação com uso do Primary Care Assessment Tool-Brasil. Os dados foram coletados com 373 hipertensos maiores de 20 anos, no município de Macaé, Brasil. Resultados: verificou-se a predominância das seguintes características individuais: 49% tinham entre 40 a 59 anos; 74% pertenciam ao gênero feminino; 38,1% apresentaram ensino fundamental incompleto; 59,5% tinham renda de até 2 salários mínimos. Obteve-se escore de 7,65 para acesso de primeiro contato, superior à média de 6,6 do escore padrão, e um escore de 2,40 para acessibilidade. Conclusão: os resultados apontam utilização satisfatória das unidades no que refere ao acesso de primeiro contato e insatisfatória quanto à acessibilidade aos serviços, o que mostra necessidade de investimentos na reorganização do processo de atendimento às demandas e prioridades dos usuários.ABSTRACTObjective: to analyze the degree of orientation offered by primary units in relation to the attribute first contact access from the perspective of hypertensive users. Methods: cross-sectional study using Primary Care Assessment Tool-Brazil. Data were collected with 373 hypertensive patients over 20 years of age, in the city of Macaé, Brazil. Results: the predominance of the following individual characteristics was verified: 49% were between 40 and 59 years old; 74% were female; 38.1% had incomplete elementary education; 59.5% had income of up to 2 minimum wages (about US$548.00). A score of 7.65 was obtained for first contact access, superior to the mean of 6.6 of the standard score, and a score of 2.40 for accessibility. Conclusion: the results indicate a satisfactory use of the units in relation to first contact access and unsatisfactory related to accessibility to services, which shows the need for investments in the reorganization of the process of meeting the demands and priorities of users.RESUMENObjetivo: analizar el grado de orientación ofrecida por unidades primarias en relación al atributo acceso de primer contacto en la perspectiva de usuarios hipertensos. Método: estudio transversal de evaluación con uso de Primary Care Assessment Tool-Brasil. Los datos fueron recolectados con 373 hipertensos mayores de 20 años, en el municipio de Macaé, Brasil. Resultados: se verificó la predominancia de las siguientes características individuales: el 49% tenía entre 40 a 59 años; el 74% pertenecía al género femenino; 38,1% presentaron enseñanza fundamental incompleta; el 59,5% tenía ingresos de hasta 2 salarios mínimos (alrededor de US$ 548.00). Se obtuvo una puntuación de 7,65 para acceso de primer contacto, superior a la media de 6,6 de la puntuación estándar, y una puntuación de 2,40 para accesibilidad. Conclusión: los resultados apuntan utilización satisfactoria de las unidades en lo que se refiere al acceso de primer contacto e insatisfactorio en cuanto a la accesibilidad a los servicios, lo que muestra necesidad de inversiones en la reorganización del proceso de atención a las demandas y prioridades de los usuarios. DOI: http://dx.doi.org/10.12957/reuerj.2017.14442


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