医疗保健机构类型与初级保健质量：对中国广东省患者特征与经历的研究
Types of health care facilities and the quality of primary care: a study of characteristics and experiences of Chinese patients in Guangdong Province, China.
作者信息
Hu Ruwei, Liao Yu, Du Zhicheng, Hao Yuantao, Liang Hailun, Shi Leiyu
机构信息
School of Public Health of Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou, China.
Johns Hopkins Primary Care Policy Center, Baltimore, 624 N. Broadway, Baltimore, Maryland, 21205, USA.
出版信息
BMC Health Serv Res. 2016 Aug 2;16(a):335. doi: 10.1186/s12913-016-1604-2.
BACKGROUND
In China, most people tend to use hospitals rather than health centers for their primary care generally due to the perception that quality of care provided in the hospital setting is superior to that provided at the health centers. No studies have been conducted in China to compare the quality of primary care provided at different health care settings. The purpose of this study is to compare the quality of primary care provided in different types of health care facilities in China.
METHODS
A cross-sectional survey with patients was conducted in Guangdong province of China, using the validated Chinese Primary Care Assessment Tool (PCAT). ANOVA was performed to compare the overall and 10 domains of primary care quality for patients in tertiary, secondary, and primary health care settings. Multivariate analyses were used to assess the association between types of facility and quality of primary care attributes while controlling for sociodemographic and health care characteristics.
RESULTS
The final number of respondents was 864 including 161 from county hospitals, 190 from rural community health centers (CHCs), 164 from tertiary hospitals, 80 from secondary hospitals, and 269 from urban CHCs. Type of health care facilities was significantly associated with total PCAT score and domain scores. CHC was associated with higher total PCAT score and scores for first contact-access, ongoing care, comprehensiveness-services available, and community orientation than secondary and/or tertiary hospitals, after controlling for patients' demographic and health characteristics. Higher PCAT score was associated with greater satisfaction with primary care received. CHC patients were more likely to report satisfactory experiences compared to patients from secondary and tertiary facilities.
CONCLUSIONS
The study demonstrated that CHCs provided better quality primary care when compared with secondary and tertiary health care facilities, justifying CHCs as a model of primary care delivery.
背景
在中国，大多数人通常倾向于选择医院而非健康中心进行初级保健，这主要是因为他们认为医院提供的医疗服务质量优于健康中心。中国尚未开展研究来比较不同医疗环境下提供的初级保健质量。本研究的目的是比较中国不同类型医疗设施中提供的初级保健质量。
方法
在中国广东省对患者进行了一项横断面调查，使用经过验证的中国初级保健评估工具（PCAT）。进行方差分析以比较三级、二级和初级医疗环境中患者的初级保健质量总体情况及10个领域。在控制社会人口统计学和医疗保健特征的同时，使用多变量分析来评估设施类型与初级保健属性质量之间的关联。
结果
最终受访者数量为864人，其中161人来自县级医院，190人来自农村社区卫生中心（CHC），164人来自三级医院，80人来自二级医院，269人来自城市CHC。医疗保健设施类型与PCAT总分及各领域得分显著相关。在控制患者的人口统计学和健康特征后，与二级和/或三级医院相比，CHC的PCAT总分以及首次接触 - 可及性、持续护理、综合服务可及性和社区导向等领域的得分更高。PCAT得分越高，对所接受的初级保健的满意度越高。与二级和三级设施的患者相比，CHC的患者更有可能报告满意的体验。
结论
该研究表明，与二级和三级医疗保健设施相比，CHC提供了质量更好的初级保健，证明CHC可作为初级保健提供的一种模式。
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