Department of Health Management, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China.
Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China.
BMJ Open. 2022 Mar 25;12(3):e055166. doi: 10.1136/bmjopen-2021-055166.
Patients' experiences are important part of health services quality research, but it's still unclear whether patients' experiences are influenced by resident status. This study aimed to evaluate the association between resident status and patients' primary care experiences with the focus on migrants vs local residents.
A cross-sectional study using multistage cluster random sampling was conducted from September to November 2019. The data were analysed using general linear models.
Six community health centres in Guangzhou, China.
1568 patients aged 20 years or older.
Patients' primary care experiences were assessed using the Primary Care Assessment Tool. The 10 domains included in Primary Care Assessment Tool (PCAT) refers to first contact-utilisation, first contact-access, ongoing care, coordination (referral), coordination (information), comprehensiveness (services available), comprehensiveness (services provided), family-centredness, community orientation and cultural competence from patient's perspective.
1568 questionnaires were analysed. After adjusting for age, sex, education, annual family income, self-perceived health status, chronic condition, annual medical expenditure and medical insurance, the PCAT total scores of the migrants were significantly lower than those of local residents (β=-0.128; 95% CI -0.218 to -0.037). Migrants had significantly lower scores than local residents in first contact utilisation (β=-0.245; 95% CI -0.341 to -0.148), ongoing care (β=-0.175; 95% CI -0.292 to -0.059), family-centredness (β=-0.112; 95% CI -0.225 to 0.001), community orientation (β=-0.176; 95% CI -0.286 to -0.066) and cultural competence (β=-0.270; 95% CI -0.383 to -0.156), respectively.
Primary care experiences of migrants were significantly worse off than those of local residents, especially in terms of primary care utilisation, continuity and cultural competence. Given the wide disparity in primary care experiences between migrants and local residents, Chinese healthcare system reform should focus on improving quality of primary care services for migrants, overcoming language barriers and creating patient-centred primary care services.
患者体验是卫生服务质量研究的重要组成部分，但目前尚不清楚患者体验是否受到居民身份的影响。本研究旨在评估居民身份与患者初级保健体验之间的关系，重点关注移民与本地居民。
这是一项使用多阶段聚类随机抽样的横断面研究，于 2019 年 9 月至 11 月进行。使用一般线性模型分析数据。
中国广州的 6 家社区卫生中心。
年龄在 20 岁及以上的 1568 名患者。
使用初级保健评估工具评估患者的初级保健体验。初级保健评估工具（PCAT）包括的 10 个领域是从患者的角度评估的，包括首次接触利用、首次接触可及性、持续护理、协调（转诊）、协调（信息）、全面性（可提供的服务）、全面性（提供的服务）、以家庭为中心、社区导向和文化能力。
分析了 1568 份问卷。在调整年龄、性别、教育程度、家庭年收入、自我感知健康状况、慢性疾病、年医疗支出和医疗保险后，移民的 PCAT 总分明显低于本地居民（β=-0.128；95%置信区间 -0.218 至 -0.037）。移民在首次接触利用（β=-0.245；95%置信区间 -0.341 至 -0.148）、持续护理（β=-0.175；95%置信区间 -0.292 至 -0.059）、以家庭为中心（β=-0.112；95%置信区间 -0.225 至 0.001）、社区导向（β=-0.176；95%置信区间 -0.286 至 -0.066）和文化能力（β=-0.270；95%置信区间 -0.383 至 -0.156）方面的得分明显低于本地居民。
移民的初级保健体验明显差于本地居民，尤其是在初级保健的利用、连续性和文化能力方面。鉴于移民和本地居民在初级保健体验方面存在明显差异，中国医疗保健系统改革应侧重于改善移民的初级保健服务质量，克服语言障碍，创建以患者为中心的初级保健服务。
