School of Public Health, Shanghai Jiaotong University School of Medicine, 227 Chongqing South RD, Shanghai, 200025, China.
Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China.
BMC Fam Pract. 2020 Aug 27;21(1):178. doi: 10.1186/s12875-020-01250-6.
Following World Health Organization's initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions.
Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience.
A total of 2404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß = 1.57, P < 0.001) compared with those from urban CHCs.
That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).
为响应世界卫生组织（WHO）推动初级保健发展的倡议，中国自 2009 年新医改以来推出了强有力的政策，包括家庭医生签约服务，以确保每个家庭都能在社区卫生服务中心（CHC）签约一位合格的医生。我们使用约翰霍普金斯大学设计的初级保健评估工具（PCAT）来评估签约居民所经历的初级保健质量，并比较不同社会经济区域的情况。
采用多阶段抽样方法，从上海市的城市、郊区和农村地区各随机选择 4 个 CHC。使用方差分析和多元分析评估 CHC 位置与初级保健体验质量之间的关系。
共有 2404 名 CHC 用户完成了我们的调查。除了协调（信息系统）领域外，郊区 CHC 的用户在所有其他领域都报告了更好的初级保健体验，其次是农村 CHC 的用户。在控制了协变量后，郊区 CHC 的用户更有可能报告更高的总 PCAT 得分（β=1.57，P<0.001），而不是城市 CHC 的用户。
签约居民报告郊区 CHC 的初级保健体验优于城市 CHC 的情况表明，CHC 在相对医疗资源不足的地区具有独特的价值。特别是，城市 CHC 可以进一步加强初级保健的第一接触（利用率）、第一接触（可及性）、协调（转诊系统）、全面性（可获得性）和社区导向方面的表现。然而，所有 CHC 都可以改善协调（信息系统）。
