scholarly journals Multimorbid Patient Experiences With Primary Care at Community Health Centers in Shanghai, China

2021 ◽  
Vol 9 ◽  
Author(s):  
Hua Jin ◽  
Zhaoxin Wang ◽  
Leiyu Shi ◽  
Chen Chen ◽  
Yongyan Huo ◽  
...  
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Community Health Centers ◽  
Patient Experiences ◽  
Health Centers ◽  
Quality Of Primary Care ◽  
Family Centeredness ◽  
Ongoing Care ◽  
First Contact

Objective: Primary care in China is facing mounting challenges with multimorbidity as the aging population grows. Knowing how patients experience primary care may highlight the deficiencies of the care system and guide health system reform. The purpose of this study was to compare the quality of primary care experienced by patients with and without multimorbidity at community health centers (CHCs) in Shanghai, China and to examine the factors influencing these experiences.Methods: A cross-sectional survey was conducted from August to December 2019 using the validated Chinese Primary Care Assessment Tool-Adult Edition (PCAT-AE). ANOVA was performed to compare the overall and domain-specific quality of primary care for patients with and without multimorbidity. Multivariate linear regressions were used to assess the factors associated with primary care quality while controlling for patients' sociodemographic and healthcare characteristics.Results: From 2,404 completed questionnaires, patients with multimorbidity reported higher PCAT scores in the domains of first contact-utilization (3.54 ± 0.55 vs. 3.48 ± 0.56, P < 0.01), accessibility (2.93 ± 0.49 vs. 2.86 ± 0.47, P < 0.001), and ongoing care (3.20 ± 0.39 vs. 3.14 ± 0.43, P < 0.001), while reporting lower scores in coordination (information system) (2.72 ± 0.41 vs. 2.79 ± 0.35, P < 0.001) and family-centeredness (3.23 ± 0.63 vs. 3.30 ± 0.64, P < 0.01). Multimorbidity (ß = 0.355, P < 0.01), education level (ß = 0.826, P < 0.01), district (suburb: ß = 1.475, P < 0.001), and self-perceived good health status (ß = 0.337, P < 0.05) were associated with better patient experiences in primary care. Patients between the age 61 and 70 (ß = −0.623, P < 0.001; >70 years: ß = −0.573, P < 0.01), with a monthly household income ≥6,000 RMB (ß = −1.385, P < 0.001) and with more than 20 outpatient visits the previous year (ß = −1.883, P < 0.001) reported lower total PCAT scores.Conclusion: The findings of our study suggest that CHCs in China have contributed to better primary care experiences for patients with multimorbidity in certain quality domains, including first contact-utilization, accessibility, and ongoing care. However, there is still room for improvement in care coordination and family-centeredness.

scholarly journals Comparison of Patients’ Perceived Quality of Primary Care Between Urban and Rural Community Health Centers in Guangdong, China

2020 ◽  
Author(s):  
aiyun chen ◽  
Shanshan Feng ◽  
liang Zhang ◽  
leiyu Shi
Keyword(s):  
Primary Care ◽  
Community Health Centers ◽  
Health Centers ◽  
Care Experience ◽  
Community Orientation ◽  
Quality Of Primary Care ◽  
Family Centeredness ◽  
Ongoing Care ◽  
First Contact

Abstract Background: A series of reforms were implemented to improve the quality of primary care services in China. This study aims to assess patients' perceived quality of primary health care between rural and urban community health centers in Guangdong.Methods: A cross-sectional survey was conducted from July to December 2015 in Guangdong. We surveyed 1010 respondents who visited either CHCs/CHSs in urban areas or THCs/RHSs in rural areas via face-to-face interviews. A validated Chinese version of Primary Care Assessment Tool-Adult Short Version (PCAT-AS), representing 10 primary care domains, was used to collect information on patients’ primary care experiences. T-test was used for comparison on domain scores and total scores between patients from CHCs/CHSs and THCs/RHSs. Analysis of covariance was employed to compare the adjusted PCAT domain scores and total scores. Multilevel models were used to explore factors associated with PCAT total scores. Results: Overall, patients reported a lower level of experience of community orientation and family centeredness compared to other primary care domains. Patients from THCs/RHSs settings in the rural area reported better primary care experience in four domains, including first contact, accessibility, ongoing care, and community orientation. Higher education background, and those with a chronic disease were associated with better primary care experience, after controlling for confounding factors. Patients who preferred primary care institutions when getting sick or used health services more frequently reported better primary care experience.Conclusion: Continued efforts are needed to strengthen primary care performance, particularly in community orientation and family centeredness. Primary care delivery in CHCs/CHSs settings should be improved in four domains including first contact, accessibility, ongoing care, and community orientation.

scholarly journals Comparison of Patients’ Perceived Quality of Primary Care Between Urban and Rural Community Health Centers in Guangdong, China

2020 ◽  
Vol 17 (13) ◽  
pp. 4898
Author(s):  
Aiyun Chen ◽  
Shanshan Feng ◽  
Liang Zhang ◽  
Leiyu Shi
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Community Health Centers ◽  
Health Centers ◽  
Care Experience ◽  
Community Orientation ◽  
Quality Of Primary Care ◽  
Family Centeredness ◽  
First Contact

Background: A series of reforms were implemented to improve the quality of primary care services in China. This study aims to assess patients’ perceived quality of primary healthcare between rural and urban community health centers in Guangdong. Methods: A cross-sectional survey was conducted from July to December 2015 in Guangdong. We surveyed 1010 respondents who visited either community health centers/stations (CHCs/CHSs) in urban areas or township health centers/rural health stations (THCs/RHSs) in rural areas. A validated Chinese version of the Primary Care Assessment Tool-Adult Short Version (PCAT-AS), representing ten primary care domains, was used to collect information on patients’ primary care experiences. A t-test was used for comparison on domain scores and total scores between patients from CHCs/CHSs and THCs/RHSs. An analysis of covariance was employed to compare the adjusted PCAT domain scores and total scores. Multilevel models were used to explore factors associated with PCAT total scores. Results: Overall, patients reported a lower level of experience of community orientation and family centeredness compared to other primary care domains. Patients from THCs/RHSs settings in the rural area reported better primary care experience in four domains, including first contact, accessibility, ongoing care, and community orientation. Higher education background and those with a chronic disease were associated with better primary care experience, after controlling for confounding factors. Patients who preferred primary care institutions when getting sick or used health services more frequently reported better primary care experiences. Conclusion: Continued efforts are needed to strengthen primary care performances, particularly in a community orientation and family centeredness. Primary care delivery in CHCs/CHSs settings should be improved in four domains, including first contact, accessibility, ongoing care, and community orientation.

scholarly journals Effect of family doctor contract services on patient perceived quality of primary care in southern China

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Shanshan Feng ◽  
Aiyun Cheng ◽  
Zhenni Luo ◽  
Yao Xiao ◽  
Luwen Zhang
Keyword(s):  
Primary Care ◽  
Linear Regression ◽  
Service Utilization ◽  
Family Doctor ◽  
Perceived Quality ◽  
Community Orientation ◽  
Quality Of Primary Care ◽  
Family Centeredness ◽  
First Contact

Abstract Background Family doctor contract service is an important service item in China’s primary care reform. This research was designed to evaluate the impact of the provision of family doctor contract services on the patient-perceived quality of primary care, and therefore give evidence-based policy suggestions. Methods This cross-sectional study of family doctor contract service policy was conducted in three pilot cities in the Pearl River Delta, South China, using a multistage stratified sampling method. The validated Primary Care Assessment Tool-Adult Edition (PCAT-AS) was used to measure the quality of primary care services. PCAT-AS assesses each of the unique characteristics of primary care including first contact, continuity, comprehensiveness, coordination, family-centeredness, community orientation, culture orientation. Data was collected through face-to-face interviews held from July to November, 2015. Covariate analysis and multivariate Linear Regression were adopted to explore the effect of contract on the quality of primary care by controlling for the socio-demographic status and health care service utilization factors. Results A total of 828 valid questionnaires were collected. Among the interviewees, 453 patients signed the contract (54.7%) and 375 did not (45.3%). Multivariate linear regression showed that contracted patients reported higher scores in dimensions of PCAT total score (β = − 8.98, P < 0.000), first contact-utilization(β = − 0.71,P < 0.001), first contact-accessibility(β = − 1.49, P < 0.001), continuity (β = 1.27, P < 0.001), coordination (referral) (β = − 1.42, P < 0.001), comprehensiveness (utilization) (β = − 1.70, P < 0.001), comprehensiveness (provision) (β = − 0.99, P < 0.001),family-centeredness(β = − 0.52, P < 0.01), community orientation(β = − 1.78, P < 0.001), than un- contracted after controlling socio-demographic and service utilization factors. There were no statistically significant differences in the dimensions of coordination (information system) (β = − 0.25, P = 0.137) and culture orientation (β = − 0.264, P = 0.056) between the two both groups. Conclusions This study demonstrates that the pilot implementation of family doctor contract services has significantly improved patients’ perceived primary care quality in the pilot cities, and could help solve the quality problem of primary care. It needs further promotion across the province.

scholarly journals The Quality of Primary Care in Community Health Centers: Comparison among Urban, Suburban and Rural Users in Shanghai, China

2020 ◽  
Author(s):  
Jianwei Shi ◽  
Hua Jin ◽  
Leiyu Shi ◽  
Chen Chen ◽  
Xuhua Ge ◽  
...  
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Family Doctor ◽  
Care Quality ◽  
World Health ◽  
Care Experience ◽  
Quality Of Primary Care ◽  
Care Assessment ◽  
First Contact

Abstract Objective: Following World Health Organization’s initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions.Methods: Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience.Findings: A total of 2,404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß=1.57, P<0.001) compared with those from urban CHCs.Conclusion: That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).

scholarly journals The Quality of Primary Care Performance in Private Sector Facilities in Nairobi, Kenya: A Cross-Sectional Descriptive Survey

2021 ◽  
Author(s):  
Gulnaz Mohamoud ◽  
Robert Mash
Keyword(s):  
Primary Care ◽  
Poor Performance ◽  
Cross Sectional ◽  
Community Orientation ◽  
Quality Of Primary Care ◽  
Overall Performance ◽  
Ongoing Care ◽  
First Contact ◽  
Care Performance

Abstract BackgroundIntegrated health services with an emphasis on primary care are needed for effective primary health care and achievement of universal health coverage. The key elements of high quality primary care are first-contact access, continuity, comprehensiveness, coordination, and person-centredness. In Kenya, there is little information on these key elements and such information is needed to improve service delivery. This study aimed to evaluate the quality of primary care performance in a group of private sector clinics in Nairobi, Kenya.Methods A cross-sectional descriptive study adapted the Primary Care Assessment Tool for the Kenyan context and surveyed 412 systematically sampled primary care users, from 13 PC clinics. Data was analysed to measure 11 domains of primary care performance and two aggregated primary care scores using the Statistical Package for Social Sciences.Results Mean primary care score was 2.64 (SD=0.23) and the mean expanded primary care score was 2.68 (SD=0.19), implying poor overall performance. The domains of first contact-utilisation, coordination (information system), family-centredness and cultural competence had mean scores of >3.0 (acceptable to good performance). The domains of first contact (access), coordination, comprehensiveness (provided and available), ongoing care and community-orientation had mean scores of < 3.0 (poor performance). Older respondents (p=0.05) and those with higher affiliation to the clinics (p=0.01) were more likely to rate primary care as acceptable to good.Conclusion These primary care clinics in Nairobi had a poor overall performance. There was a report of acceptable-to-good performance in first-contact utilisation, the information systems, family centredness and cultural competence. However, patients rated first-contact access, ongoing care, coordination of care, comprehensiveness of services, community orientation and availability of a complete primary health care team, as poor. Performance could be improved by deploying family physicians, increasing the scope of practice to become more comprehensive, improving access after-hours and marketing the use of the clinics to the practice population.

scholarly journals The Quality of Primary Care in Community Health Centers: Comparison among Urban, Suburban and Rural Users in Shanghai, China

2020 ◽  
Author(s):  
Jianwei Shi ◽  
Hua Jin ◽  
Leiyu Shi ◽  
Chen Chen ◽  
Xuhua Ge ◽  
...  
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Family Doctor ◽  
Care Quality ◽  
World Health ◽  
Care Experience ◽  
Quality Of Primary Care ◽  
Care Assessment ◽  
First Contact

Abstract Objective: Following World Health Organization’s initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions.Methods: Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience.Findings: A total of 2,404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß=1.57, P<0.001) compared with those from urban CHCs.Conclusion: That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).

scholarly journals The Quality of Primary Care in Community Health Centers: Comparison among Urban, Suburban and Rural Users in Shanghai, China

2020 ◽  
Author(s):  
Jianwei Shi ◽  
Hua Jin ◽  
Leiyu Shi ◽  
Chen Chen ◽  
Xuhua Ge ◽  
...  
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Family Doctor ◽  
Care Quality ◽  
World Health ◽  
Care Experience ◽  
Quality Of Primary Care ◽  
Care Assessment ◽  
First Contact

Abstract Objective: Following World Health Organization’s initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions.Methods: Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience.Findings: A total of 2,404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß=1.57, P<0.001) compared with those from urban CHCs.Conclusion: That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs should strengthen first contact (utilization), first contact (accessibility) and coordination (referral system) aspects of primary care performance. However, all CHCs should improve coordination (information system).

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