School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan, Hubei Province, 430071, People's Republic of China.
Department of Family Medicine, McGill University, Hayes Pavilion, Suite 4764, 3830 Avenue Lacombe, Montreal, Quebec, H3T 1M5, Canada.
Int J Equity Health. 2017 Oct 3;16(1):176. doi: 10.1186/s12939-017-0672-1.
In rural China, patients have free choice of health facilities for outpatient services. Comparison studies exploring the attributes of different health facilities can help identify optimal primary care service models. Using a representative sample of Chinese provinces, this study aimed to compare patients' rating of three primary care service models used by rural residents (public clinics, public hospitals and private clinics) on a range of health care attributes related to responsiveness.
This was a secondary analysis using the household survey data from World Health Organization (WHO) Study on global AGEing and adult health (SAGE). Using a multistage cluster sampling strategy, eight provinces were selected and finally 3435 overall respondents reporting they had visited public clinics, public hospitals or private clinics during the last year, were included in our analysis. Five items were used to measure patient perceived quality in five domains including prompt attention, communication and autonomy, dignity and confidentiality. ANOVA and Turkey's post hoc tests were used to conduct comparative analysis of five domains. Separate multivariate linear regression models were estimated to examine the association of primary care service models with each domain after controlling for patient characteristics.
The distribution of last health facilities visited was: 29.5% public clinics; 31.2% public hospitals and; 39.3% private clinics. Public clinics perform best in all five domains: prompt attention (4.15), dignity (4.17), communication (4.07), autonomy (4.05) and confidentiality (4.02). Public hospitals perform better than private clinics in dignity (4.03 vs 3.94), communication (3.97 vs 3.82), autonomy (3.92 vs 3.74) and confidentiality (3.94 vs 3.73), but equivalently in prompt attention (3.92 vs 3.93). Rural residents who are older, wealthier, and with higher self-rated health status have significantly higher patient perceived quality of care in all domains.
Rural public clinics, which share many characteristics with the optimal primary care delivery model, should be strongly strengthened to respond to patients' needs. Better doctor-patient interaction training would improve respect, confidentiality, autonomy and, most importantly, health care quality for rural patients.
在中国农村，患者可以自由选择门诊服务的医疗机构。比较研究探索不同医疗机构的属性可以帮助确定最佳的基层医疗服务模式。本研究使用中国各省的代表性样本，旨在比较农村居民使用的三种基层医疗服务模式（诊所、医院和私人诊所）在一系列与响应性相关的医疗保健属性方面的患者评分。
这是对世界卫生组织（WHO）全球老龄化和成人健康研究（SAGE）的家庭调查数据的二次分析。使用多阶段聚类抽样策略，选择了 8 个省份，最终有 3435 名总体受访者报告在过去一年中曾到诊所、医院或私人诊所就诊，包括在我们的分析中。使用五个项目来衡量五个领域的患者感知质量，包括及时关注、沟通和自主权、尊严和保密性。使用方差分析和 Turkey 事后检验进行五个领域的比较分析。在控制患者特征后，分别使用多个多元线性回归模型来检验基层医疗服务模式与每个领域的关联。
最后就诊的医疗机构分布为：诊所 29.5%；医院 31.2%；私人诊所 39.3%。诊所所有五个领域的表现最好：及时关注（4.15）、尊严（4.17）、沟通（4.07）、自主权（4.05）和保密性（4.02）。医院在尊严（4.03 比 3.94）、沟通（3.97 比 3.82）、自主权（3.92 比 3.74）和保密性（3.94 比 3.73）方面的表现优于私人诊所，但在及时关注方面（3.92 比 3.93）的表现相同。年龄较大、较富裕、自评健康状况较好的农村居民在所有领域的患者感知护理质量都显著较高。
与最佳基层医疗服务提供模式有许多共同特征的农村诊所应得到大力加强，以满足患者的需求。更好的医患互动培训将提高农村患者的尊重、保密性、自主权，最重要的是提高医疗质量。
