School of Health Management, Guangzhou Medical University, Guangzhou 511436, China.
Health Policy and Management, School of Public Health, John Hopkins University, Baltimore, MD 21205, USA.
Int J Environ Res Public Health. 2020 Jul 7;17(13):4898. doi: 10.3390/ijerph17134898.
A series of reforms were implemented to improve the quality of primary care services in China. This study aims to assess patients' perceived quality of primary healthcare between rural and urban community health centers in Guangdong.
A cross-sectional survey was conducted from July to December 2015 in Guangdong. We surveyed 1010 respondents who visited either community health centers/stations (CHCs/CHSs) in urban areas or township health centers/rural health stations (THCs/RHSs) in rural areas. A validated Chinese version of the Primary Care Assessment Tool-Adult Short Version (PCAT-AS), representing ten primary care domains, was used to collect information on patients' primary care experiences. A -test was used for comparison on domain scores and total scores between patients from CHCs/CHSs and THCs/RHSs. An analysis of covariance was employed to compare the adjusted PCAT domain scores and total scores. Multilevel models were used to explore factors associated with PCAT total scores.
Overall, patients reported a lower level of experience of community orientation and family centeredness compared to other primary care domains. Patients from THCs/RHSs settings in the rural area reported better primary care experience in four domains, including first contact, accessibility, ongoing care, and community orientation. Higher education background and those with a chronic disease were associated with better primary care experience, after controlling for confounding factors. Patients who preferred primary care institutions when getting sick or used health services more frequently reported better primary care experiences.
Continued efforts are needed to strengthen primary care performances, particularly in a community orientation and family centeredness. Primary care delivery in CHCs/CHSs settings should be improved in four domains, including first contact, accessibility, ongoing care, and community orientation.
中国实施了一系列改革措施，以提高基层医疗服务质量。本研究旨在评估广东城乡社区卫生服务中心患者对基层医疗保健的感知质量。
2015 年 7 月至 12 月在广东进行了一项横断面调查。我们调查了 1010 名受访者，他们分别来自城市地区的社区卫生服务中心/站（CHCs/CHSs）或农村地区的乡镇卫生院/农村卫生站（THCs/RHSs）。使用经过验证的中文版初级保健评估工具-成人简短版（PCAT-AS）收集患者初级保健体验信息，该工具代表十个初级保健领域。采用 t 检验比较 CHCs/CHSs 和 THCs/RHSs 患者在各领域得分和总分上的差异。采用协方差分析比较调整后的 PCAT 领域得分和总分。采用多水平模型探讨与 PCAT 总分相关的因素。
总体而言，患者对社区定向和以家庭为中心的体验水平较低，而对其他初级保健领域的体验水平较高。来自农村地区 THCs/RHSs 的患者在四个领域的初级保健体验较好，包括首诊、可及性、持续护理和社区定向。在控制混杂因素后，较高的教育背景和患有慢性病的患者具有更好的初级保健体验。当生病时更喜欢基层医疗机构和经常使用卫生服务的患者报告具有更好的初级保健体验。
需要继续努力加强基层医疗服务的绩效，特别是在社区定向和以家庭为中心方面。应在四个领域（包括首诊、可及性、持续护理和社区定向）改进 CHCs/CHSs 中的初级保健服务提供。
