Zhang Weiwei, Ung Carolina Oi Lam, Lin Guohua, Liu Jie, Li Wenjun, Hu Hao, Xi Xiaoyu
The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China.
State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.
Front Public Health. 2020 Aug 18;8:414. doi: 10.3389/fpubh.2020.00414. eCollection 2020.
Primary health care (PHC) is a key component of the health care system in many countries. In China, however, PHC institutions are less preferred by patients, leading to the underuse of PHC services. Factors affecting patients' preferences for PHC institutions in China remain unreported in the current literature, which was first explored in this study. A qualitative interview study was conducted in Nanjing, Jiangsu Province of China. A semi-structured interview guide was applied to ask patients' opinions regarding the PHC institutions in China. Qualitative data analysis was conducted using the thematic framework approach. A total of 142 participants were interviewed. Three themes and their sub-themes emerged from the study: (1) attributes of PHC services, including accessibility of primary healthcare services, consultation time, drug cost, continuity of care, referral system, opening hours, waiting time, and drug accessibility; (2) attributes of PHC doctors' workforce, including doctors' attitude, competence, and accessibility; (3) attributes of PHC facility infrastructure, including basic facilities, diagnostic facilities and department settings. It was identified that some attributes of PHC services had positive impacts on participants' preferences for PHC institutions, while the same attributes of PHC doctors were the opposite. There are three major factors that contribute to patients' preferences for PHC institutions in China. Policy interventions to improve doctors' workforce and facility infrastructure of PHC institutions are needed to promote patients' preferences for PHC.
初级卫生保健（PHC）是许多国家卫生保健系统的关键组成部分。然而，在中国，患者不太倾向于选择初级卫生保健机构，导致初级卫生保健服务利用不足。目前的文献中尚未报道影响中国患者对初级卫生保健机构偏好的因素，本研究首次对此进行了探讨。在中国江苏省南京市进行了一项定性访谈研究。采用半结构化访谈指南询问患者对中国初级卫生保健机构的看法。使用主题框架方法进行定性数据分析。共采访了142名参与者。研究得出了三个主题及其子主题：（1）初级卫生保健服务的属性，包括基本医疗服务的可及性、咨询时间、药品费用、连续护理、转诊系统、开放时间、等待时间和药品可及性；（2）初级卫生保健医生队伍的属性，包括医生的态度、能力和可及性；（3）初级卫生保健机构基础设施的属性，包括基本设施、诊断设施和科室设置。研究发现，初级卫生保健服务的一些属性对参与者对初级卫生保健机构的偏好有积极影响，而初级卫生保健医生的相同属性则相反。有三个主要因素影响中国患者对初级卫生保健机构的偏好。需要采取政策干预措施来改善初级卫生保健机构的医生队伍和设施基础设施，以提高患者对初级卫生保健的偏好。
