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

Liao, Jingyi; Zhou, Mengping; Zhong, Chenwen; Liang, Cuiying; Hu, Nan; Kuang, Li

doi:10.3390/ijerph19010157

Cited by 3 publications

(2 citation statements)

References 54 publications

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“…The second layer of the decision tree consisted of age and whether the patient had an existing relationship with a family doctor, indicating that both were important factors influencing a patient's choice of healthcare institutions. Our results thus showed that the older the patient with comorbidities, the more likely they tended to prefer primary healthcare institutions for medical treatment, consistent with the findings of many related studies [ 13 , 14 ]. Patients in older age experience a decline in physical function, and as the number of illnesses increases, the frequency of various minor physical discomforts also increases, leading to an increased number of medical visits.…”

Section: Discussionsupporting

confidence: 91%

Choices of medical institutions and associated factors in older patients with multimorbidity in stabilization period in China: A study based on logistic regression and decision tree model

Wang,

Zhang

2023

Health Care Science

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BackgroundAs China's population ages, its disease spectrum is changing, and the coexistence of multiple chronic diseases has become the norm with respect to the health status of its elderly population. However, the health institution choices of older patients with multimorbidity in stabilization period remains underresearched. This study investigate the factors influencing the choices of older patients with multimorbidity to provide references for the rational allocation of healthcare resources.MethodsA multistage, stratified, whole‐group random‐sampling method was used to select eligible older patients from September to December of 2022 who attended the Community Health Service Center of Guangdong Province. We adopted a self‐designed questionnaire to collect patients' general, disease‐related, social‐support information, their intention to choose a healthcare provider. A binary logistic regression and decision tree model based on the Chi‐squared automatic interaction detector algorithm were implemented to analyze the associated factors involved.ResultsA total of 998 patients in stabilization period were included in the study, of which 593 (59.42%) chose hospital and 405 (40.58%) chose primary care. Our binary logistic regression results revealed that age, sex, individual average annual income, educational level, self‐reported health status, activities of daily living, alcohol consumption, family doctor contracting, and family supervision of medication or exercise were the principal factors influencing the choice of medical institutions for older patients with multimorbidity (p < 0.05). The decision‐tree model reflected three levels and 11 nodes, and we screened a total of four influencing factors: activities of daily living, age, a family doctor contract, and patient sex. The data showed that the logistic regression model possessed an accuracy of 72.9% and that the decision tree model exhibited an accuracy of 68.7%. Prediction using the binary logistic regression was thus statistically superior to the categorical decision‐tree model based on the Chi‐squared automatic interaction detector algorithm (Z = 3.238, p = 0.001).ConclusionMore than half of older patients with multimorbidity in stabilization period chose hospitals for healthcare. Efforts should be made to improve the quality of healthcare services and increase the medical contracting rate and recognition of family doctors so as to attract older patients with multimorbidity to primary medical institutions.

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Section: Discussionsupporting

confidence: 91%

Choices of medical institutions and associated factors in older patients with multimorbidity in stabilization period in China: A study based on logistic regression and decision tree model

Wang,

Zhang

2023

Health Care Science

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“…First, regarding health service utilisation, a large body of literature has focused on the reform process of health service systems, influencing factors of health service utilisation inequity, and the connection between MCCs and health service utilisation, cost and mortality 13 26–28. Second, in terms of vertical equity in health service utilisation, few studies have longitudinally measured and summarised health service demand and utilisation equity among MCCs patients, mostly using cross-sectional data or an overview of the influencing factors and severity of MCCs 4 29 30. Third, in terms of horizontal equity in health service utilisation, abundant research has considered objective differences, such as gender and age, while placing greater emphasis on the inequity stemming from controllable socioeconomic factors.…”

Section: Introductionmentioning

confidence: 99%

Equity in health service utilisation among middle-aged and elderly people with multiple chronic conditions in China: evidence from longitudinal data of 2011–2018 CHARLS

Zhang,

Su,

et al. 2023

BMJ Open

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ObjectivesEquity in health service utilisation is a central objective for health systems. Middle-aged and elderly patients with multiple chronic conditions (MCCs) are particularly vulnerable to healthcare inequity. This study aimed to update the information on the trends in the incidence and equity of outpatient health service utilisation (OHSU) and inpatient health service utilisation (IHSU) for middle-aged and elderly MCCs patients in China, identify socioeconomic determinants that may contribute to inequity, and suggest optimisation strategies to mitigate this disparity.MethodsPanel data obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS) were used to determine the trends in OHSU and IHSU. The inequity in OHSU and IHSU was measured by the Concentration Index (CI) and Horizontal Inequity Index (HI), which is a valid measure of health service utilisation equity. The decomposition model of the CI was set up to explore the contribution of various determinants of overall equity.ResultsThe annual rate of OHSU gradually decreased from 29.32% in 2011 to 27.27% in 2018. The HI remained positive and decreased from 0.0803 in 2011 to 0.0662 in 2018, indicating the existence of pro-rich inequity. The annual rate of IHSU gradually increased from 13.31% in 2011 to 19.89% in 2018. The HI remained positive and showed a declining trend from 0.2363 in 2011 to 0.0574 in 2018, evidencing pro-rich inequity; however, a trend towards the easing of inequity was observed.ConclusionsPro-rich inequity was present in both OHSU and IHSU among middle-aged and elderly MCCs patients in China. Economic status, area, education and age were the main contributors to pro-rich inequity. Concerted efforts are needed to allocate resources for mitigating health service utilisation inequity in middle-aged and elderly people with MCCs.

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Association between Continuity of Primary Care and Chronic Conditions among Patients in Guangdong Province, China

Chowdhury¹,

Zhou²,

Kuang³

et al. 2023

TOPHJ

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Background: One important aspect of primary care is the association between continuity with primary care providers (PCPs) and chronic conditions among patients. However, there is a lack of literature to specifically address these issues in countries with large populations, such as China. Objective: The goal of this study is to examine the effect of chronic conditions on the continuity of primary care among patients from a cross-sectional survey conducted in Guangdong province, China. Methods: Multiple logistic regression was used to estimate the effect of chronic conditions on continuity. Effect modification by residency status (migrants vs. locals) on the relationship between the number of chronic conditions and continuity was also assessed. The intermediate effect of the existing contract between patients and PCPs was also evaluated for examining the relationship between chronic conditions and continuity of primary care. Results: Participants with chronic conditions had 2.32 (95% CI: 1.78 - 3.04) times the odds to continue with their PCPs for one year or more. Compared to those without any chronic condition, individuals with one chronic condition had 2.03 (95% CI: 1.49 - 2.75) times, and more than one chronic condition had 3.00 (95% CI: 2.01 - 4.49) times the odds to continue with their PCPs. The residency status of the participants did not modify the effect of the number of chronic conditions on the continuity of primary care. The contract between patients and their PCPs was found to be an intermediate factor for the relationship between chronic conditions and continuity. Conclusion: To strengthen the connection between patients with chronic conditions, PCPs may reinforce the relationship between providers and patients, thus ultimately benefitting the patients. The results of this study can serve as a reference for policymakers.

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

Cited by 3 publications

References 54 publications

Choices of medical institutions and associated factors in older patients with multimorbidity in stabilization period in China: A study based on logistic regression and decision tree model

Choices of medical institutions and associated factors in older patients with multimorbidity in stabilization period in China: A study based on logistic regression and decision tree model

Equity in health service utilisation among middle-aged and elderly people with multiple chronic conditions in China: evidence from longitudinal data of 2011–2018 CHARLS

Association between Continuity of Primary Care and Chronic Conditions among Patients in Guangdong Province, China

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