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

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.

Patients’ trust and associated factors among primary care institutions in China: a cross-sectional study

“…Chinese residents, especially those with poor health status, have very few trust in competences of primary care providers; thus, they would seek health-care resources directly from hospitals once they get sick. Individuals with family doctor contracts have better access to and spend more time with preferred general physicians, which improve their perceived primary care quality and benefits in satisfaction and trust in PCIs [ 54 ]. The signing coverage rate in China of family doctor’s contract is still very low after the FDCS was launched in 2016.…”

Facilitate Signing with the Family Doctor: A Study of the Practice in Shanghai, China

“…10,11 The residents were encouraged to use family doctor services, such as priority referral appointments, convenient medications, targeted health management, medical insurance management and other supporting services, in order to gradually establish a hierarchical medical system and to fully realize the gatekeeper role of family doctors. [12][13][14] Due to the lack of qualitative systematic summaries and quantitative evaluations in the existing studies, this study aimed to summarize the experience of the promotion of the scheme of signings with family doctors in Shanghai and to evaluate its effectiveness. When regarding the promotion of family doctor services in China, Shanghai is far ahead of other cities in China; however, the circumstances commonly involve the idea that patients can freely choose the type of primary care and specialist without strict restrictions.…”

Effect of Family Practice Contract Services on the Perceived Quality of Primary Care among Patients with Multimorbidity: A Cross-Sectional Study in Guangdong, China

“…Previous studies have reported that the family practice contract services’ policy can improve the process quality experience of patients [ 39 , 40 ], but it is not clear whether this policy has an equivalent effect on perceived care quality among patients with multiple chronic diseases, with a single chronic disease and with no chronic diseases and whether patients with multiple chronic diseases can benefit to a greater extent than those among the other two groups.…”