Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Rd, 250012, Jinan, Shandong, China.
NHC Key Lab of Health Economics and Policy Research, Shandong University, 250012, Jinan, China.
BMC Public Health. 2024 Feb 12;24(1):449. doi: 10.1186/s12889-024-17910-6.
This study aims to describe the preference for primary healthcare (PHC) and investigate associated factors among homebound residents in both rural and urban areas of China. It provides valuable insights to facilitate the rational allocation of healthcare resources and promote the utilization of PHC.
In this nationally representative cross-sectional study, we utilized the most recent data (2020) from the China Family Panel Studies (CFPS). Participants were recruited from 25 provincial-level administrative regions in both rural and urban areas of China. Homebound patients were asked to provide details about their individual characteristics, variables related to family caregiving, and preferences for PHC. Multivariable logistic models were used to analyze potential factors associated with preference for PHC. Estimates of association were reported as odds ratios (OR) and their 95% confidence intervals (CI).
The study found that 58.43% of rural patients reported a preference for PHC, while 42.78% of urban patients favored PHC. Compared to rural participants who did not received inpatient care in the past year, those who received inpatient care in the past year had 67% lower odds of choosing PHC (OR:0.33, 95% CI:0.19-0.59); Compared to rural participants who did not received family caregiving when ill, those who received family caregiving when ill had 59% lower odds of choosing PHC (OR: 0.41, 95% CI:0.21-0.77). Correspondingly, Compared to urban participants who did not received inpatient care in the past year, those who had received inpatient care in the past year had 75% lower odds of choosing PHC (OR: 0.25, 95% CI: 0.10-0.56); Compared to urban participants who did not received family caregiving when ill, those who received family caregiving when ill had 73% lower odds of choosing PHC (OR: 0.27, 95% CI: 0.11-0.63); Compared to urban participants who with agricultural Hukou, those with Non-agricultural Hukou had 61% lower odds of choosing PHC (OR: 0.39, 95% CI:0.18-0.83); Compared to urban participants living in the eastern part of mainland China, those living in the central part of China had 188% higher odds of choosing PHC (OR: 2.88, 95% CI: 1.14-7.29).
Policymakers should focus on tailoring PHC to vulnerable populations and prioritizing family-based public health strategies for enhancing homebound patients' perceptions of PHC. Furthermore, further study is needed on whether the Hukou registration system affects the barriers that homebound patients experience in choosing healthcare providers.
本研究旨在描述中国城乡居家居民对基层医疗保健（PHC）的偏好，并探讨相关影响因素。研究结果有助于合理配置医疗资源，促进基层医疗保健的利用。
本研究采用全国代表性的横断面研究设计，利用中国家庭追踪调查（CFPS）2020 年最新数据。参与者来自中国城乡 25 个省级行政区。研究要求居家患者详细说明其个人特征、家庭照护相关变量以及对 PHC 的偏好。采用多变量逻辑回归模型分析与 PHC 偏好相关的潜在因素。关联估计以优势比（OR）及其 95%置信区间（CI）表示。
研究发现，58.43%的农村患者表示偏好 PHC，而 42.78%的城市患者倾向于 PHC。与过去一年未住院的农村患者相比，过去一年住院的农村患者选择 PHC 的可能性降低 67%（OR：0.33，95%CI：0.19-0.59）；与过去一年未接受家庭照护的农村患者相比，过去一年接受家庭照护的农村患者选择 PHC 的可能性降低 59%（OR：0.41，95%CI：0.21-0.77）。相应地，与过去一年未住院的城市患者相比，过去一年住院的城市患者选择 PHC 的可能性降低 75%（OR：0.25，95%CI：0.10-0.56）；与过去一年未接受家庭照护的城市患者相比，过去一年接受家庭照护的城市患者选择 PHC 的可能性降低 73%（OR：0.27，95%CI：0.11-0.63）；与拥有农业户口的城市患者相比，拥有非农业户口的城市患者选择 PHC 的可能性降低 61%（OR：0.39，95%CI：0.18-0.83）；与居住在中国东部地区的城市患者相比，居住在中国中部地区的城市患者选择 PHC 的可能性增加 188%（OR：2.88，95%CI：1.14-7.29）。
决策者应关注为弱势群体定制 PHC，并优先考虑以家庭为基础的公共卫生策略，以增强居家患者对 PHC 的认知。此外，还需要进一步研究户籍登记制度是否会影响居家患者在选择医疗服务提供者时面临的障碍。
