Usual source of care and experiences with primary care among community health service centre patients in Changchun, China: A cross‐sectional survey

Abstract

Under China's healthcare reforms, community health service centres (CHCs) have been established as the preferred primary care providers. Even with this change, there is still little attention paid to patients' usual source of care (USC) from CHCs in Northeastern China. The main purposes of this study were to explore the determinants of usual source of community health service and to examine the association between usual source of community health service and patients' experiences with primary care. A cross-sectional survey with 515 adult patients at CHCs in Jilin Province, China, was conducted between July 2016 and November 2016. The patients' experiences with primary care were assessed with the Primary Care Assessment Tool (PCAT). Patients with self-perceived poor health status (odds ratio = 1.984, 95% confidence interval = 1.145-3.437) and chronic disease (odds ratio = 2.207, 95% confidence interval = 1.203-4.051) were more likely to have a usual source of community health service than patients with selfperceived good health status or without chronic disease. Patients scored the highest on comprehensiveness of services available (Mean = 2.87) and the lowest on community orientation (Mean = 1.83) in all domains of the PCAT, with values ranging from 1 to 4. A multiple linear regression analysis revealed that patients with a usual source of community health service had significantly higher overall scores than those without (B = 0.205, p < .001). This study demonstrated the important role of CHCs in providing affordable health services for patients with chronic disease or poor health status. Moreover, patients who chose a CHC as a USC had better experiences with primary care compared with patients who did not choose a CHC as a USC. However, community-oriented services need to be improved, and efforts to improve patients' experiences should include policies that incentivise patients to adopt a CHC as their USC.

The trend in primary health care preference in China: a cohort study of 12,508 residents from 2012 to 2018

“…With respect to the determinants of PHC preference, we found that residents with poor health status or chronic disease were less likely to choose the PHC services in China. This finding is inconsistent with the study of patients' experience with PHC in Changchun in China, indicating that patients with poor health status or chronic disease were more likely to choose PHC [2]. The possible explanations for this finding might be that it was caused by the differences in study sample.…”

“…During the past decade of healthcare reform, China has made great efforts to improve the Primary Health Care (PHC) system [1], especially to strengthen the construction of PHC delivery system. In China, the PHC institutions consist of community healthcare centers/stations in urban areas, township hospitals, and village clinics in rural areas [2]. They provide general disease diagnosis, treatment services, and essential public health services [3,4].…”

“…Previous studies about PHC preference mainly concentrated on the determinants of choosing PHC services and limited in research data. For example, characteristics of care provider, service mode, cost or cost-sharing policy, individuals' characteristics, and their experiences with PHC were the key factors impacting the preference for PHC [2,[8][9][10][11]. The provision and utilization of PHC in China varied from region to region due to large differences in socioeconomic factors and health policies [12,13].…”

“…The provision and utilization of PHC in China varied from region to region due to large differences in socioeconomic factors and health policies [12,13]. Most of the studies about PHC preference in China were based on cross-sectional surveys in limited geographic areas [2,10,14]. Thus, they cannot be extrapolated to the general population in China [11].…”

Horizontal Integration and Financing Reform of Rural Primary Care in China: A Model for Low-Resource and Remote Settings

“…As well as improving drug accessibility for poor patients and lowering their treatment financial burden, the government’s centralized drug procurement should be further expanded; a reasonable range of medications, more technologies, and innovative medicines should be added to meet the people’s demand for high quality [ 46 ]. Moreover, simply adding more health workers will not suffice, as a strong foundation for trusting relationships within the workforce needs to be strengthened, supported by high-quality training, strong and effective supervision, and appropriate compensation [ 47 ]. To achieve this, team-based approaches could be considered a promising way to scale quality, patient-centered primary care services; inclusive of family doctors and community health workers being actively engaged with patients and their families in healthcare delivery [ 48 ].…”