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

Abstract

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.

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

“…The reason for this may be the characteristics of hospitals, such as high patient volume and long waiting times, making it more inconvenient for patients with limited ability to perform their daily living activities to visit hospitals. In contrast, primary healthcare institutions typically have shorter waiting times, and patients who have an existing relationship with a family doctor can receive medical services at home, greatly facilitating the daily visits to patients with poor self‐care abilities [ 12 ].…”

Walking in their shoes: How primary‐care experiences of adults aged 50+ reveal the benefits of e‐learning intervention for general practitioners

“…In this study, we use a range of measures aimed to reflect patient health status (number of diseases, self‐rated health, health problems limiting daily activities) and healthcare use (hospital services use and number of GP visits last year, continuity of appointments with given GP) to control possible confounding effects on the outcome variables. The results indicate that these are important factors related to the patient's post‐intervention experience and complement earlier findings showing how continuous care increases satisfaction and decreases costs and hospitalization rates (Bazemore et al, 2018; Jin et al, 2021). However, we cannot interpret the collected data any further, because health‐related variables here concern only the second wave of participants.…”

Primary Health Institutions and Service Quality in China: Implications for Health Policy

“…(2) health-related information, which included having been diagnosed with various diseases and a self-perceived health score; and (3) perceptions of the quality of primary healthcare service, which were evaluated by an internationally recognized assessment tool called the Primary Care Assessment Tool-Adult Edition(PCAT-AE) [19,[21][22][23][24][25]. The PCAT-AE was designed to assess people's perception of primary healthcare service quality, and it is an internationally recognized assessment tool that can be compared among countries.…”