Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong, China.
Int J Environ Res Public Health. 2022 Oct 4;19(19):12701. doi: 10.3390/ijerph191912701.
Providing access to a range of basic health services, community-based primary health care (CB-PHC) plays a vital role in achieving the goal of health for all. Driven by a strong political commitment, China's CB-PHC progress in the past decade has been swift and impressive. However, a well-functioning delivery system for care has yet to be established. This systematic mapping review synthesizes selected evidence on barriers to CB-PHC delivery in urban China and draws lessons for policy development. We performed searches on five electronic databases: CINAHL, MEDLINE, Scopus, Web of Science, and China National Knowledge Infrastructure, and included studies published between 2012 and 2021. The Downs and Black and Critical Appraisal Skills Program checklists were used to assess the quality of eligible papers. We conducted our searches and syntheses following the framework set out in the Primary Health Care Performance Initiative (PHCPI). We synthesized the results of the included studies using a thematic narrative approach and reported according to PRISMA guidelines. Six salient barriers arose from our syntheses of 67 papers: lack of comprehensive health insurance schemes, lack of public awareness, superficial care relationships, gaps in communication, staff shortages and poor training, and second-rate equipment. These barriers are grouped into three subdomains following the PHCPI framework: access, people-centered care, and organization and management. A host of negative impacts of these barriers on community-based health care were also identified. It was not possible to determine clear causes of these barriers from the contributing evidence because of the lack of conceptual frameworks and research methods constraints. Non-eastern regions of China and access-related barriers require further exploration. It follows that, at the national level, the problems are likely more severe than the research suggests.
提供一系列基本卫生服务的社区基层医疗保健（CB-PHC）在实现全民健康目标方面发挥着至关重要的作用。在中国，基层医疗保健在过去十年中取得了迅速而令人印象深刻的进展，这是基于强烈的政治承诺。然而，一个运作良好的医疗保健提供系统尚未建立。本系统综述综合了中国城市中 CB-PHC 提供的障碍的选定证据，并为政策制定提供了经验教训。我们在五个电子数据库中进行了搜索：CINAHL、MEDLINE、Scopus、Web of Science 和中国国家知识基础设施，并包括 2012 年至 2021 年期间发表的研究。使用 Downs 和 Black 和关键评估技能计划清单评估合格论文的质量。我们根据初级卫生保健绩效倡议（PHCPI）中规定的框架进行了搜索和综合。我们使用主题叙述方法对纳入研究的结果进行综合，并根据 PRISMA 指南进行报告。从纳入的 67 篇论文中综合得出了 6 个突出的障碍：缺乏综合医疗保险计划、公众意识缺乏、肤浅的护理关系、沟通差距、人员短缺和培训不足以及设备二流。这些障碍根据 PHCPI 框架分为三个子域：获得、以人为中心的护理以及组织和管理。还确定了这些障碍对社区卫生保健的许多负面影响。由于缺乏概念框架和研究方法的限制，无法从相关证据中确定这些障碍的明确原因。中国非东部地区和与获得相关的障碍需要进一步探索。因此，在国家层面上，问题可能比研究表明的更为严重。
