From the JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, P.R. China, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK, School of Public Health, Guangzhou Medical University, Guangzhou 510182, P.R. China and Bauhinia Foundation Research Centre, Hong Kong From the JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, P.R. China, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK, School of Public Health, Guangzhou Medical University, Guangzhou 510182, P.R. China and Bauhinia Foundation Research Centre, Hong Kong From the JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, P.R. China, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK, School of Public Health, Guangzhou Medical University, Guangzhou 510182, P.R. China and Bauhinia Foundation Research Centre, Hong Kong.
From the JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, P.R. China, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK, School of Public Health, Guangzhou Medical University, Guangzhou 510182, P.R. China and Bauhinia Foundation Research Centre, Hong Kong
QJM. 2015 Jul;108(7):549-60. doi: 10.1093/qjmed/hcu248. Epub 2014 Dec 17.
China has been undergoing a health-care reform, and community health centres (CHCs) are being established as primary care provider across urban areas.
To evaluate primary care attributes in CHCs by measuring patients' experiences.
Cross-sectional surveys of 3360 adult service users with multistage cluster sampling.
We developed a short assessment tool consisting of 33 items derived from the short version of the original Primary Care Assessment Tool-Adult Edition (PCAT-AE). The reliability and validity of the instrument were evaluated. Score distributions were assessed using descriptive statistics with 95% confidence interval (CI). The overall PCAT scores were categorized into three quantile groups (lower score, medium score and optimal score). Ordinal logistic regression analysis was performed to explore patient characteristics associated with optimal score after controlling for demographic, socio-economic, health conditions and health-care utilization characteristics.
One-third (33.4%, 95% CI: 31.0-35.9%) of subjects had optimal overall PCAT scores, while the majority (83.4%) reported medium-to-lower score in the community orientation scale. Patients' characteristics with respect to health-care utilization had major effects on PCAT scores. Subjects with the presence of social medical insurance had higher odds of having greater experience in most primary care attributes and tended to report optimal primary care experience (aOR 2.30, 95% CI: 1.92-2.75) compared with those without social medical insurance.
Equitable primary care is yet to be strengthened with regard to the community orientation attribute, and particularly among patients without social medical insurance, as they tend to have inferior experiences in the primary care sector.
中国一直在进行医疗改革，社区卫生服务中心（CHC）作为城市地区的初级保健提供者正在建立。
通过测量患者的体验来评估 CHC 的初级保健属性。
采用多阶段聚类抽样对 3360 名成年服务使用者进行横断面调查。
我们开发了一个由 33 个项目组成的简短评估工具，这些项目源自原始初级保健评估工具-成人版（PCAT-AE）的简短版本。评估了该工具的可靠性和有效性。使用描述性统计和 95%置信区间（CI）评估分数分布。总体 PCAT 分数分为三个分位数组（较低分数、中等分数和最佳分数）。进行有序逻辑回归分析，以在控制人口统计学、社会经济、健康状况和卫生保健利用特征后，探索与最佳分数相关的患者特征。
三分之一（33.4%，95%CI：31.0-35.9%）的受试者具有最佳的总体 PCAT 评分，而大多数（83.4%）的社区定向量表评分中等偏低。与卫生保健利用相关的患者特征对 PCAT 评分有重大影响。有社会医疗保险的患者在大多数初级保健属性方面具有更高的体验机会，并且倾向于报告最佳的初级保健体验（优势比 2.30，95%CI：1.92-2.75），而没有社会医疗保险的患者则不然。
在社区定向属性方面，公平的初级保健仍有待加强，特别是在没有社会医疗保险的患者中，因为他们在初级保健部门的体验较差。
