Bridging the Gaps Between Patients and Primary Care in China: A Nationwide Representative Survey

Abstract

PURPOSE China introduced a national policy of developing primary care in 2009, establishing 8,669 community health centers (CHCs) by 2014 that employed more than 300,000 staff. These facilities have been underused, however, because of public mistrust of physicians and overreliance on specialist care. METHODSWe selected a stratified random sample of CHCs throughout China based on geographic distribution and urban-suburban ratios between September and December 2015. Two questionnaires, 1 for lead clinicians and 1 for primary care practitioners (PCPs), asked about the demographics of the clinic and its clinical and educational activities. Responses were obtained from 158 lead clinicians in CHCs and 3,580 PCPs (response rates of 84% and 86%, respectively). RESULTSCHCs employed a median of 8 physicians and 13 nurses, but only onehalf of physicians were registered as PCPs, and few nurses had training specifically for primary care. Although virtually all clinics were equipped with stethoscopes (98%) and sphygmomanometers (97%), only 43% had ophthalmoscopes and 64% had facilities for gynecologic examination. Clinical care was selectively skewed toward certain chronic diseases. Physicians saw a median of 12.5 patients per day. Multivariate analysis showed that more patients were seen daily by physicians in CHCs organized by private hospitals and those having pharmacists and nurses.CONCLUSIONS Our survey confirms China's success in establishing a large, mostly young primary care workforce and providing ongoing professional training. Facilities are basic, however, with few clinics providing the comprehensive primary care required for a wide range of common physical and mental conditions. Use of CHCs by patients remains low. INTRODUCTIONT he importance of a strong primary care system providing first contact access, an emphasis on prevention, and person-focused comprehensive care with continuity and coordination is widely accepted. [1][2][3][4][5] The World Health Report and World Health Organization (WHO) have highlighted additional key components underlying primary health care, including an emphasis on universal coverage, 6,7 communityoriented perspectives, and governance supported by national health policies. Nonetheless, many countries have yet to develop effective and robust primary care since the Alma Ata Declaration in 1978 calling for increased national and international commitment to primary care. 8 Primary care today is often still characterized by inadequately resourced facilities; lack of appropriate training; inequalities in delivery of care, itself variable in quality; and fragmented care, which may be unsafe and often has little focus on prevention. 6 In China, these problems have been compounded by a deterioration in physician-patient relationships resulting from economic and health systems reforms. 9 Since the economic reforms in the late 1980s involving fiscal decentralization, commercialization of medical services, and underfunding of the public health care sector, community health workers 238hav...

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