Department of Health Administration, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China.
Int J Environ Res Public Health. 2021 Dec 24;19(1):157. doi: 10.3390/ijerph19010157.
Family practice contract services, an important primary-care reform policy for improving primary healthcare quality in China, incorporate patients with multiple chronic conditions into the priority coverage groups and focus on their management. This study aims to explore the family practice contract services' effectiveness in improving the quality of primary care experienced by this population. A cross-sectional study using a three-stage sampling was conducted from January to March 2019 in Guangdong, China. A multivariable linear regression, including interaction terms, was applied to examine the associations between the contract services and primary care quality among people with different chronic conditions. The process quality of primary care was measured in six dimensions using the validated assessment survey of primary care (ASPC) scale. People with contract services scored higher in terms of quality of primary care than those without contract services. Contract services moderated the association between chronic condition status and primary care quality. Significantly positive interactions were observed in the patient-centred care dimension and negative interactions were reflected in the accessibility dimension. Our findings suggest that family practice contract services play a crucial role in improving patient-perceived primary care quality and provide emerging evidence that patients with multimorbidity tend to benefit more from the services, especially in patient-centred care.
家庭医生签约服务是中国提高基层医疗质量的一项重要的基层医疗改革政策，将患有多种慢性病的患者纳入优先保障群体，并重点关注他们的管理。本研究旨在探讨家庭医生签约服务在提高这部分人群所体验到的基层医疗质量方面的效果。2019 年 1 月至 3 月，在中国广东采用三阶段抽样进行了一项横断面研究。应用包含交互项的多变量线性回归分析，检验了签约服务与不同慢性病患者的基层医疗质量之间的关联。使用经过验证的基层医疗评估调查（ASPC）量表，从六个维度衡量基层医疗的过程质量。有签约服务的人群在基层医疗质量方面的得分高于没有签约服务的人群。签约服务调节了慢性病状况与基层医疗质量之间的关联。在以患者为中心的护理维度上观察到显著的正交互作用，而在可及性维度上则反映出负交互作用。我们的研究结果表明，家庭医生签约服务在改善患者感知的基层医疗质量方面发挥着关键作用，并提供了新的证据表明，患有多种慢性病的患者往往从服务中获益更多，尤其是在以患者为中心的护理方面。
