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López García A, Barber Pérez P. [Systematic review of the primary care quality assessment instruments used in the last 10 years]. Aten Primaria 2024; 56:103046. [PMID: 39018797 PMCID: PMC11305259 DOI: 10.1016/j.aprim.2024.103046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVE There are numerous instruments in the scientific literature for the evaluation of the quality of Primary Care (PC) and to know which of them are the most used and in which countries provides more information to make a well-founded decision. The aim is to determine which, between 2013 and 2023, have been the instruments used to assess the international quality of PC, its evolution and geographical distribution. DESIGN Systematic review. DATA SOURCES PubMed and Embase. From March to December 2023. INCLUSION CRITERIA 1) Validation studies of specific assessment instruments to measure the quality of PC and/or the satisfaction of patients, providers or managers. 2) carried out in the field of PC and 3) published between 1/01/2013 and 01/02/2023. 83 full-text articles were included. DATA EXTRACTION From each publication, an instrument used to evaluate the quality of the PC, attributes of the PC it evaluates, recipient of the evaluation, user, provider or manager, year, and country. RESULTS Fifteen PC assessment instruments were found. The most widely used is the Primary Care Assessing Tool (PCAT), with wide geographical distribution, versions in several languages, is more limited in Europe, except in Spain, and is mostly used in the Primary Care Assessing Tool (PCAT). CONCLUSIONS The PCAT, due to its cultural adaptability, availability in several languages, its ability to evaluate the fundamental principles of PC enunciated by the World Health Organization and to contemplate the perspectives of all health agents, is a complete, versatile, and consistent questionnaire for the evaluation of the quality of PC.
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Affiliation(s)
- Alberto López García
- Facultad de Ciencias Económicas, Campus de Tafira, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España.
| | - Patricia Barber Pérez
- Profesora titular de universidad, Departamento de Métodos Cuantitativos, Facultad de Ciencias Económicas, Campus de Tafira, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
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Clapp MA, Ray A, Liang P, James KE, Ganguli I, Cohen JL. Postpartum Primary Care Engagement Using Default Scheduling and Tailored Messaging: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2422500. [PMID: 39012630 PMCID: PMC11252898 DOI: 10.1001/jamanetworkopen.2024.22500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/02/2024] [Indexed: 07/17/2024] Open
Abstract
Importance More than 30% of pregnant people have at least 1 chronic medical condition, and nearly 20% develop gestational diabetes or pregnancy-related hypertension, increasing the risk of future chronic disease. While these individuals are often monitored closely during pregnancy, they face major barriers when transitioning to primary care following delivery, due in part to a lack of health care support for this transition. Objective To evaluate the impact of an intervention designed to improve postpartum primary care engagement by reducing patient administrative burden and information gaps. Design, Setting, and Participants An individual-level randomized clinical trial was conducted from November 3, 2022, to October 11, 2023, at 1 hospital-based and 5 community-based outpatient obstetric clinics affiliated with a large academic medical center. Participants included English- and Spanish-speaking pregnant or recently postpartum adults with obesity, anxiety, depression, diabetes, chronic hypertension, gestational diabetes, or pregnancy-related hypertension and a primary care practitioner (PCP) listed in their electronic health record. Intervention A behavioral economics-informed intervention bundle, including default scheduling of postpartum PCP appointments and tailored messages. Main Outcome and Measures Completion of a PCP visit for routine or chronic condition care within 4 months of delivery was the primary outcome, ascertained directly by reviewing the patient's electronic health record approximately 5 months after their estimated due date. Intention-to-treat analysis was conducted. Results A total of 360 patients were randomized (control, 176; intervention, 184). Individuals had a mean (SD) age of 34.1 (4.9) years and median gestational age of 36.3 (IQR, 34.0-38.6) weeks at enrollment. The distribution of self-reported race and ethnicity was 6.8% Asian, 7.4% Black, 68.6% White, and 15.0% multiple races or other. Most participants (75.4%) had anxiety or depression, 16.1% had a chronic or pregnancy-related hypertensive disorder, 19.5% had preexisting or gestational diabetes, and 40.8% had a prepregnancy body mass index of 30 or greater. Medicaid was the primary payer for 21.2% of patients. Primary care practitioner visit completion within 4 months occurred in 22.0% (95% CI, 6.4%-28.8%) of individuals in the control group and 40.0% (95% CI, 33.1%-47.4%) in the intervention group. In regression models accounting for randomization strata, the intervention increased PCP visit completion by 18.7 percentage points (95% CI, 9.1-28.2 percentage points). Intervention participants also had fewer postpartum readmissions (1.7% vs 5.8%) and increased receipt of the following services by a PCP: blood pressure screening (42.8% vs 28.3%), weight assessment (42.8% vs 27.7%), and depression screening (32.8% vs 16.8%). Conclusions and Relevance The findings of this randomized clinical trial suggest that the current lack of support for postpartum transitions to primary care is a missed opportunity to improve recently pregnant individual's short- and long-term health. Reducing patient administrative burdens may represent relatively low-resource, high-impact approaches to improving postpartum health and well-being. Trial Registration ClinicalTrials.gov Identifier: NCT05543265.
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Affiliation(s)
- Mark A. Clapp
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Alaka Ray
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Pichliya Liang
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston
| | - Kaitlyn E. James
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Ishani Ganguli
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Jessica L. Cohen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Clapp MA, Ray A, Liang P, James KE, Ganguli I, Cohen J. Increasing Postpartum Primary Care Engagement through Default Scheduling and Tailored Messaging : A Randomized Clinical Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.21.24301585. [PMID: 38633772 PMCID: PMC11023680 DOI: 10.1101/2024.01.21.24301585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Importance Over 30% of pregnant people have at least one chronic medical condition, and nearly 20% develop gestational diabetes or pregnancy-related hypertension, increasing the risk of future chronic disease. While these individuals are often monitored closely during pregnancy, they face significant barriers when transitioning to primary care following delivery, due in part to a lack of health care support for this transition. Objective To evaluate the impact of an intervention designed to improve postpartum primary care engagement by reducing patient administrative burden and information gaps. Design Individual-level randomized controlled trial conducted from November 3, 2022 to October 11, 2023. Setting One hospital-based and five community-based outpatient obstetric clinics affiliated with a large academic medical center. Participants Participants included English- and Spanish-speaking pregnant or recently postpartum adults with obesity, anxiety, depression, diabetes mellitus, chronic hypertension, gestational diabetes, or pregnancy-related hypertension, and a primary care practitioner (PCP) listed in their electronic health record (EHR). Intervention A behavioral economics-informed intervention bundle, including default scheduling of postpartum PCP appointments and tailored messages. Main Outcome Completion of a PCP visit for routine or chronic condition care within 4 months of delivery. Results 360 patients were randomized (Control: N=176, Intervention: N=184). Individuals had mean (SD) age 34.1 (4.9) years and median gestational age of 36.3 weeks (interquartile range (IQR) 34.0-38.6 weeks) at enrollment. The distribution of self-reported races was 7.4% Asian, 6.8% Black, 15.0% multiple races or "Other," and 68.6% White. Most (75.8%) participants had anxiety or depression, 15.9% had a chronic or pregnancy-related hypertensive disorder, 19.8% had pre-existing or gestational diabetes, and 40.4% had a pre-pregnancy BMI ≥30 kg/m2. Medicaid was the primary payer for 21.9% of patients. PCP visit completion within 4 months occurred in 22.0% in the control group and 40.0% in the intervention group. In regression models accounting for randomization strata, the intervention increased PCP visit completion by 18.7 percentage points (95%CI 10.7-29.1). Intervention participants also had fewer postpartum readmissions (1.7 vs. 5.8%) and increased receipt of the following services by a PCP: blood pressure screening (42.8 vs. 28.3%), weight assessment (42.8 vs. 27.7%), and depression screening (32.8 vs. 16.8%). Conclusions and Relevance In this randomized trial of pregnant individuals with or at risk for chronic health conditions, default PCP visit scheduling, tailored messages, and reminders substantially improved postpartum primary care engagement. The current lack of support for postpartum transitions to primary care is a missed opportunity to improve recently pregnant individual's short- and long-term health. Reducing patient administrative burdens may represent relatively low-resource, high-impact approaches to improving postpartum health and wellbeing. Trial Registration NCT05543265.
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Affiliation(s)
- Mark A Clapp
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Alaka Ray
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Kaitlyn E James
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ishani Ganguli
- Harvard Medical School, Boston, MA
- Brigham & Women's Hospital, Boston MA
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Kang HK, Sung NJ. Correlation between Usual Source of Care and Medication Adherence in Patients with Hypertension. Korean J Fam Med 2024; 45:82-88. [PMID: 38008710 DOI: 10.4082/kjfm.23.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/13/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Maintaining a usual source of care (USC), which is crucial for primary healthcare, encompasses initial contact, comprehensive services, coordinated care, and ongoing support. However, limited research exists on the relationship between USC and medication adherence in patients with hypertension. This study aimed to investigate the association between USC and medication adherence among patients with hypertension. METHODS Data from the 2nd Korea Health Panel Survey 2020 were analyzed. The final sample consisted of 3,318 participants aged 19 years or older diagnosed with hypertension. USC was categorized into three groups: no USC, place only (without a regular doctor), and regular doctor. Medication adherence was assessed using detailed items (dose, frequency, time, no stop) and a 4-point Likert scale. A logistic regression analysis was conducted with control for relevant variables. RESULTS Compared to the no USC group, the regular doctor group had significantly higher odds ratios (ORs) for overall perfect/high medication adherence rates: 1.70 (95% confidence interval [CI], 1.42-2.03) and 1.59 (95% CI, 1.14-2.20). Similar results were observed for each adherence item, including prefect dose (OR, 2.14; 95% CI, 1.73- 2.63), frequency (OR, 1.87; 95% CI, 1.53-2.28), time (OR, 1.72; 95% CI, 1.43-2.07), and no stop (OR, 1.56; 95% CI, 1.09-2.23)/high frequency (OR, 2.47; 95% CI, 1.21-5.01), time (OR, 2.30; 95% CI, 1.19-4.44). However, the place only group showed no significant differences in medication adherence except for perfect adherence to dose (OR, 1.35; 95% CI, 1.06-1.71). CONCLUSION These findings provide evidence supporting the need for healthcare policies that encourage having a regular doctor in South Korea, which has a healthcare system with limited primary care.
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Affiliation(s)
- Han-Kil Kang
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Nak-Jin Sung
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
- Department of Family Medicine, Dongguk University College of Medicine, Goyang, Korea
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Shin JW, Choi BR. Effect of patient-related factors on hospitalization service satisfaction and recommendation intention of medical institutions in Korea. BMC Health Serv Res 2023; 23:716. [PMID: 37391768 DOI: 10.1186/s12913-023-09754-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 06/26/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE This study examined the factors that influence the 'Overall Satisfaction' and 'Intention to Recommend' of medical institutions used using the Korea Medical Service Experience Survey (2019-2021). DATA SOURCES This study used the data of Medical Service Experience Survey in Korea. The data collected for data analysis were from 2019 to 2021 (Medical service period: 2018.07.01. ~ 2021.06.30). STUDY DESIGN The 2019 Medical Service Experience Survey was conducted from July 8 to September 20, 2019, and a total of 12,507 people (Medical service period: 2018.07.01. ~ 2019.06.30) were collected. The 2020 survey was conducted from July 13 to October 9, 2020, and a total of 12,133 people (Medical service period: 2019.07.01 ~ 2020.06.30.) were collected. The 2021 survey was conducted from July 19 to September 17, 2021), and a total of 13,547 people were collected (Medical service period: 2020.07.01. ~ 2021.06.30). Overall satisfaction and recommendation intentions for medical institutions consist of a Likert 5-point scale. At this time, the Top-box rating model used in the United States was applied. DATA COLLECTIONS/EXTRACTION METHODS In this study, only those who used inpatient services (15 years of age or older) were included because they spent a long time in a medical institution and had an intensive experience, and a total of 1,105 subjects were included in the analysis. PRINCIPAL FINDINGS Self-rated health and the type of bed influenced overall satisfaction with medical institutions. In addition, the type of economic activity, living area, self-rated health, the type of bed, and the type of nursing service affected the intention to recommend. And it was confirmed that overall satisfaction with medical institutions and intention to recommend them were higher in the 2021 survey than in 2019. CONCLUSIONS These results suggest that government policy on resources and systems is important. Through the case of Korea, it was found that the policy of reducing multi-person beds and expansion of integrated nursing service had a significant impact on patients' experience of using medical institutions and improving the quality of care.
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Affiliation(s)
- Jeong Woo Shin
- Korea Institute for Health and Social Affairs, 370 Sicheong-Daero, Sejong, South Korea
| | - Bo Ram Choi
- Department of Health Administration, Hanyang Cyber University, 220 Wangsimni-Ro, Seongdong-Gu, Seoul, South Korea.
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Huo Y, Kang X, Zhong C, Shi L, Liu R, Hu R. The quality of migrant patients' primary healthcare experiences and patient-centered medical home achievement by community health centers: results from the China greater bay area study. Int J Equity Health 2023; 22:114. [PMID: 37287015 DOI: 10.1186/s12939-023-01929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND In China, Community Health Centers (CHCs) provide primary healthcare (PHC); however, few studies have examined the quality of PHC services experienced by migrant patients. We examined the potential association between the quality of migrant patients' PHC experiences and the achievement of Patient-Centered Medical Home by CHCs in China. METHODS Between August 2019 and September 2021, 482 migrant patients were recruited from ten CHCs in China's Greater Bay Area. We evaluated CHC service quality using the National Committee for Quality Assurance Patient-Centered Medical Home (NCQA-PCMH) questionnaire. We additionally assessed the quality of migrant patients' PHC experiences using the Primary Care Assessment Tools (PCAT). General linear models (GLM) were used to examine the association between the quality of migrant patients' PHC experiences and the achievement of PCMH by CHCs, adjusting for covariates. RESULTS The recruited CHCs performed poorly on PCMH1, Patient-Centered Access (7.2 ± 2.0), and PCMH2, Team-Based Care (7.4 ± 2.5). Similarly, migrant patients assigned low scores to PCAT dimension C-First-contact care-which assesses access (2.98 ± 0.03), and D-Ongoing care (2.89 ± 0.03). On the other hand, higher-quality CHCs were significantly associated with higher total and dimensional PCAT scores, except for dimensions B and J. For example, the total PCAT score increased by 0.11 (95% CI: 0.07-0.16) with each increase of CHC PCMH level. We additionally identified associations between older migrant patients (> 60 years) and total PCAT and dimension scores, except for dimension E. For instance, the average PCAT score for dimension C among older migrant patients increased by 0.42 (95% CI: 0.27-0.57) with each increase of CHC PCMH level. Among younger migrant patients, this dimension only increased by 0.09 (95% CI: 0.03-0.16). CONCLUSION Migrant patients treated at higher-quality CHCs reported better PHC experiences. All observed associations were stronger for older migrants. Our results may inform future healthcare quality improvement studies that focus on the PHC service needs of migrant patients.
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Affiliation(s)
- Yongjun Huo
- Department of Health Management, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
| | - Xun Kang
- The Third People's Hospital of Foshan, Foshan Mental Health Center, Foshan, Guangdong, China
| | - Chenyang Zhong
- Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
| | - Leiyu Shi
- John Hopkins School of Public Health, Baltimore, MD, USA
| | - Ruqing Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China.
| | - Ruwei Hu
- Department of Health Management, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China.
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Kasenda S, Meland E, Hetlevik Ø, Mildestvedt T, Dullie L. Factors associated with self-rated health in primary care in the South-Western health zone of Malawi. BMC PRIMARY CARE 2022; 23:88. [PMID: 35439944 PMCID: PMC9016970 DOI: 10.1186/s12875-022-01686-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
Background Self-rated health (SRH) is a single-item measure of current health, which is often used in community surveys and has been associated with various objective health outcomes. The prevalence and factors associated with SRH in Sub-Saharan Africa remain largely unknown. This study sought to investigate: (1) the prevalence of poor SRH, (2) possible associations between SRH, and socio-demographic and clinical parameters, and (3) associations between SRH and the patients’ assessment of the quality of primary care. Methods A cross-sectional study was conducted in 12 primary care facilities in Blantyre, Neno, and Thyolo districts of Malawi among 962 participants who sought care in these facilities. An interviewer-administered questionnaire containing the Malawian primary care assessment tool, and questions on socio-demographic characteristics and self-rated health was used for data collection. Descriptive statistics were used to determine the distribution of variables of interest and binary logistic regression was used to determine factors associated with poor SRH. Results Poor SRH was associated with female sex, increasing age, decreasing education, frequent health care attendance, and with reported disability. Patients content with the service provided and who reported higher scores of relational continuity from their health care providers reported better SRH as compared with others. Conclusion This study reports findings from a context where SRH is scarcely examined. The prevalence of poor SRH in Malawi is in line with findings from clinical populations in other countries. The associations between poor SRH and socio-demographic factors are also known from other populations. SRH might be improved by emphasizing continuity of care in primary care services.
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Mohamoud G, Mash R. The quality of primary care performance in private sector facilities in Nairobi, Kenya: a cross-sectional descriptive survey. BMC PRIMARY CARE 2022; 23:120. [PMID: 35585488 PMCID: PMC9114290 DOI: 10.1186/s12875-022-01700-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/06/2022] [Indexed: 12/03/2022]
Abstract
Background Integrated health services with an emphasis on primary care are needed for effective primary health care and achievement of universal health coverage. The key elements of high quality primary care are first-contact access, continuity, comprehensiveness, coordination, and person-centredness. In Kenya, there is paucity of information on the performance of these key elements and such information is needed to improve service delivery. Therefore, the study aimed to evaluate the quality of primary care performance in private sector facilities in Nairobi, Kenya. Methods A cross-sectional descriptive study using an adapted Primary Care Assessment Tool for the Kenyan context and surveyed 412 systematically sampled primary care users, from 13 PC clinics. Data were analysed to measure 11 domains of primary care performance and two aggregated primary care scores using the Statistical Package for Social Sciences. Results Mean primary care score was 2.64 (SD=0.23) and the mean expanded primary care score was 2.68 (SD=0.19), implying an overall low performance. The domains of first contact-utilisation, coordination (information system), family-centredness and cultural competence had mean scores of >3.0 (acceptable to good performance). The domains of first contact-access, coordination, comprehensiveness (provided and available), ongoing care and community-orientation had mean scores of < 3.0 (poor performance). Older respondents (p=0.05) and those with higher affiliation to the clinics (p=0.01) were more likely to rate primary care as acceptable to good. Conclusion These primary care clinics in Nairobi showed gaps in performance. Performance was rated as acceptable-to-good for first-contact utilisation, the information systems, family-centredness and cultural competence. However, patients rated low performance related to first-contact access, ongoing care, coordination of care, comprehensiveness of services, community orientation and availability of a complete primary health care team. Performance could be improved by deploying family physicians, increasing the scope of practice to become more comprehensive, incentivising use of these PC clinics rather than the tertiary hospital, improving access after-hours and marketing the use of the clinics to the practice population.
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Kasenda S, Meland E, Hetlevik Ø, Mildestvedt T, Dullie L. Factors associated with self-rated health in primary care in the South-Western health zone of Malawi. BMC PRIMARY CARE 2022; 23:88. [PMID: 35439944 PMCID: PMC9016970 DOI: 10.1186/s12875-022-01686-y#citeas] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Self-rated health (SRH) is a single-item measure of current health, which is often used in community surveys and has been associated with various objective health outcomes. The prevalence and factors associated with SRH in Sub-Saharan Africa remain largely unknown. This study sought to investigate: (1) the prevalence of poor SRH, (2) possible associations between SRH, and socio-demographic and clinical parameters, and (3) associations between SRH and the patients' assessment of the quality of primary care. METHODS A cross-sectional study was conducted in 12 primary care facilities in Blantyre, Neno, and Thyolo districts of Malawi among 962 participants who sought care in these facilities. An interviewer-administered questionnaire containing the Malawian primary care assessment tool, and questions on socio-demographic characteristics and self-rated health was used for data collection. Descriptive statistics were used to determine the distribution of variables of interest and binary logistic regression was used to determine factors associated with poor SRH. RESULTS Poor SRH was associated with female sex, increasing age, decreasing education, frequent health care attendance, and with reported disability. Patients content with the service provided and who reported higher scores of relational continuity from their health care providers reported better SRH as compared with others. CONCLUSION This study reports findings from a context where SRH is scarcely examined. The prevalence of poor SRH in Malawi is in line with findings from clinical populations in other countries. The associations between poor SRH and socio-demographic factors are also known from other populations. SRH might be improved by emphasizing continuity of care in primary care services.
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Affiliation(s)
- Stephen Kasenda
- grid.512477.2Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Eivind Meland
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Øystein Hetlevik
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Thomas Mildestvedt
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Luckson Dullie
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway ,Partners in health, Neno, Malawi
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Jin H, Wang Z, Shi L, Chen C, Huo Y, Huang W, Zhang Y, Lu Y, Ge X, Shi J, Yu D. Multimorbid Patient Experiences With Primary Care at Community Health Centers in Shanghai, China. Front Public Health 2021; 9:606188. [PMID: 34169053 PMCID: PMC8218628 DOI: 10.3389/fpubh.2021.606188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/11/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: Primary care in China is facing mounting challenges with multimorbidity as the aging population grows. Knowing how patients experience primary care may highlight the deficiencies of the care system and guide health system reform. The purpose of this study was to compare the quality of primary care experienced by patients with and without multimorbidity at community health centers (CHCs) in Shanghai, China and to examine the factors influencing these experiences. Methods: A cross-sectional survey was conducted from August to December 2019 using the validated Chinese Primary Care Assessment Tool-Adult Edition (PCAT-AE). ANOVA was performed to compare the overall and domain-specific quality of primary care for patients with and without multimorbidity. Multivariate linear regressions were used to assess the factors associated with primary care quality while controlling for patients' sociodemographic and healthcare characteristics. Results: From 2,404 completed questionnaires, patients with multimorbidity reported higher PCAT scores in the domains of first contact-utilization (3.54 ± 0.55 vs. 3.48 ± 0.56, P < 0.01), accessibility (2.93 ± 0.49 vs. 2.86 ± 0.47, P < 0.001), and ongoing care (3.20 ± 0.39 vs. 3.14 ± 0.43, P < 0.001), while reporting lower scores in coordination (information system) (2.72 ± 0.41 vs. 2.79 ± 0.35, P < 0.001) and family-centeredness (3.23 ± 0.63 vs. 3.30 ± 0.64, P < 0.01). Multimorbidity (ß = 0.355, P < 0.01), education level (ß = 0.826, P < 0.01), district (suburb: ß = 1.475, P < 0.001), and self-perceived good health status (ß = 0.337, P < 0.05) were associated with better patient experiences in primary care. Patients between the age 61 and 70 (ß = −0.623, P < 0.001; >70 years: ß = −0.573, P < 0.01), with a monthly household income ≥6,000 RMB (ß = −1.385, P < 0.001) and with more than 20 outpatient visits the previous year (ß = −1.883, P < 0.001) reported lower total PCAT scores. Conclusion: The findings of our study suggest that CHCs in China have contributed to better primary care experiences for patients with multimorbidity in certain quality domains, including first contact-utilization, accessibility, and ongoing care. However, there is still room for improvement in care coordination and family-centeredness.
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Affiliation(s)
- Hua Jin
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Zhaoxin Wang
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China.,School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Leiyu Shi
- Department of Health Policy and Management, Primary Care Policy Center, Johns Hopkins University, Baltimore, MD, United States
| | - Chen Chen
- Shanghai Jing'an District Jiangning Road Community Health Service Center, Shanghai, China
| | - Yongyan Huo
- Shanghai Jiading District Anting Town Huangdu Community Health Service Center, Shanghai, China
| | - Wuquan Huang
- Shanghai Jiading District Jiading Town Community Health Service Center, Shanghai, China
| | - Yi Zhang
- Shanghai Xuhui District Fenglin Community Health Service Center, Shanghai, China
| | - Yuan Lu
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Xuhua Ge
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Jianwei Shi
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China.,School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dehua Yu
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China
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Shi J, Jin H, Shi L, Chen C, Ge X, Lu Y, Zhang H, Wang Z, Yu D. The quality of primary care in community health centers: comparison among urban, suburban and rural users in Shanghai, China. BMC FAMILY PRACTICE 2020; 21:178. [PMID: 32854623 PMCID: PMC7453522 DOI: 10.1186/s12875-020-01250-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Following World Health Organization's initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions. METHODS Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience. FINDINGS A total of 2404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß = 1.57, P < 0.001) compared with those from urban CHCs. CONCLUSION That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).
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Affiliation(s)
- Jianwei Shi
- School of Public Health, Shanghai Jiaotong University School of Medicine, 227 Chongqing South RD, Shanghai, 200025, China.,Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China
| | - Hua Jin
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China.,Academic Department of General Practice, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China
| | - Leiyu Shi
- Department of Health Policy and Management, Primary Care Policy Center, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Chen Chen
- Shanghai Jing 'an District Jiangning Road Community Health Service Center, Shanghai, 200041, China
| | - Xuhua Ge
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China.,Academic Department of General Practice, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China
| | - Yuan Lu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China.,Academic Department of General Practice, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China
| | - Hanzhi Zhang
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China.,Academic Department of General Practice, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiaotong University School of Medicine, 227 Chongqing South RD, Shanghai, 200025, China. .,Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China. .,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China.
| | - Dehua Yu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China. .,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China. .,Academic Department of General Practice, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China.
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12
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Guanais F, Doubova SV, Leslie HH, Perez-Cuevas R, García-Elorrio E, Kruk ME. Patient-centered primary care and self-rated health in 6 Latin American and Caribbean countries: Analysis of a public opinion cross-sectional survey. PLoS Med 2018; 15:e1002673. [PMID: 30300422 PMCID: PMC6177127 DOI: 10.1371/journal.pmed.1002673] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/12/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the substantial attention to primary care (PC), few studies have addressed the relationship between patients' experience with PC and their health status in low-and middle-income countries. This study aimed to (1) test the association between overall patient-centered PC experience (OPCE) and self-rated health (SRH) and (2) identify specific features of patient-centered PC associated with better SRH (i.e., excellent or very good SRH) in 6 Latin American and Caribbean countries. METHODS AND FINDINGS We conducted a secondary analysis of a 2013 public opinion cross-sectional survey on perceptions and experiences with healthcare systems in Brazil, Colombia, El Salvador, Jamaica, Mexico, and Panama; the data were nationally representative for urban populations. We analyzed 9 features of patient-centered PC. We calculated OPCE score as the arithmetic mean of the PC features. OPCE score ranged from 0 to 1, where 0 meant that the participant did not have any of the 9 patient-centered PC experiences, while 1 meant that he/she reported having all these experiences. After testing for interaction on the additive scale, we analyzed countries pooled for aim 1, with an interaction term for Mexico, and each country separately for aim 2. We used multiple Poisson regression models double-weighted by survey and inverse probability weights to deal with the survey design and missing data. The study included 6,100 participants. The percentage of participants with excellent or very good SRH ranged from 29.5% in Mexico to 52.4% in Jamaica. OPCE was associated with reporting excellent or very good SRH in all countries: adjusting for socio-demographic and health covariates, patients with an OPCE score of 1 in Brazil, Colombia, El Salvador, Jamaica, and Panama were more likely to report excellent or very good SRH than those with a score of 0 (adjusted prevalence ratio [aPR] 1.61, 95% CI 1.37-1.90, p < 0.001); in Mexico, this association was even stronger (aPR 4.27, 95% CI 2.34-7.81, p < 0.001). The specific features of patient-centered PC associated with better SRH differed by country. The perception that PC providers solve most health problems was associated with excellent or very good SRH in Colombia (aPR 1.38, 95% CI 1.01-1.91, p = 0.046) and Jamaica (aPR 1.21, 95% CI 1.02-1.43, p = 0.030). Having a provider who knows relevant medical history was positively associated with better SRH in Mexico (aPR 1.47, 95% CI 1.03-2.12, p = 0.036) but was negatively associated with better SRH in Brazil (aPR 0.71, 95% CI 0.56-0.89, p = 0.003). Finally, easy contact with PC facility (Mexico: aPR 1.35, 95% CI 1.04-1.74, p = 0.023), coordination of care (Mexico: aPR 1.53, 95% CI 1.19-1.98, p = 0.001), and opportunity to ask questions (Brazil: aPR 1.42, 95% CI 1.11-1.83, p = 0.006) were each associated with better SRH. The main study limitation consists in the analysis being of cross-sectional data, which does not allow making causal inferences or identifying the direction of the association between the variables. CONCLUSIONS Overall, a higher OPCE score was associated with better SRH in these 6 Latin American and Caribbean countries; associations between specific characteristics of patient-centered PC and SRH differed by country. The findings underscore the importance of high-quality, patient-centered PC as a path to improved population health.
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Affiliation(s)
- Frederico Guanais
- Social Protection and Health Division, Inter-American Development Bank, Lima, Peru
| | - Svetlana V. Doubova
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Mexico City, Mexico
- * E-mail:
| | - Hannah H. Leslie
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ricardo Perez-Cuevas
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Margaret E. Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Zhong C, Kuang L, Li L, Liang Y, Mei J, Li L. Equity in patient experiences of primary care in community health centers using primary care assessment tool: a comparison of rural-to-urban migrants and urban locals in Guangdong, China. Int J Equity Health 2018; 17:51. [PMID: 29703206 PMCID: PMC5921537 DOI: 10.1186/s12939-018-0758-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/10/2018] [Indexed: 12/11/2022] Open
Abstract
Background The equity of rural-to-urban migrants’ health care utilization is already on China’s agenda. The Chinese government has been embarking on efforts to improve the financial and geographical accessibility of health care for migrants by strengthening primary care services and providing universal coverage. Patient experiences are equally vital to migrants’ health care utilization. To our knowledge, no studies have focused on equity in the patient experiences between migrants and locals. Based on a patient survey from Guangdong, China, which has a large number of rural-to-urban migrants, our study assessed the equity in the primary care patient experiences between rural-to-urban migrants and urban locals in the same health insurance context, since different forms of insurance can affect the patient experiences of primary care. Methods We stratified our samples by different insurance types into three layers. We assessed primary care patient experiences using a validated Chinese version of the Primary Care Assessment Tool (PCAT), including eight primary care attributes. A ‘PCAT total score’ was calculated. Data were collected through face-to-face and one-on-one surveys in 2014. Propensity score matching (PSM) was used for each layer to generate comparable samples between rural-to-urban migrants and urban locals. Based on the matched dataset, a t-test was employed to compare the primary care patient experiences of the two groups. Results Using PSM, 220 patients in the rural-to-urban migrants group were matched to 220 patients in the urban locals group. After the matching, the observed confounding variables were balanced, and the PCAT scores were almost equal between the two groups. The only slight differences existed in the Urban Employee Basic Medical Insurance layer and in the without basic medical insurance coverage layer. Conclusions Equity in the primary care patient experiences between rural-to-urban migrants and urban locals seems to have been achieved to some extent. However, there is room for improvement in the equity of coordination of care and comprehensiveness. Policy makers should consider strengthening these two dimensions by integrating the health care system. More attention should be focused on helping migrants break down language and cultural barriers and improving the patient-physician communication process. Electronic supplementary material The online version of this article (10.1186/s12939-018-0758-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chenwen Zhong
- Department of Health Administration, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Li Kuang
- Department of Health Administration, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Lina Li
- Department of Health Administration, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yuan Liang
- Department of Health Administration, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jie Mei
- Department of Health Administration, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Li Li
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, 44106, USA
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Self-Rated Health and Its Determinants in Female Population in Iran: A Community-Based Study. HEALTH SCOPE 2018. [DOI: 10.5812/jhealthscope.68258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lee JY, Eun SJ, Kim HJ, Jo MW. Finding the Primary Care Providers in the Specialist-Dominant Primary Care Setting of Korea: A Cluster Analysis. PLoS One 2016; 11:e0161937. [PMID: 27560181 PMCID: PMC4999290 DOI: 10.1371/journal.pone.0161937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 08/15/2016] [Indexed: 01/12/2023] Open
Abstract
Objective This study aimed to identify private clinics that have a potential to perform the role of primary care providers (PCPs) in a primary care setting in Korea where private specialists are dominant. Methods The 2013 National Patient Sample claim data of Health Insurance Review and Assessment Service in Korea was used. Two-step cluster analysis was performed using characteristics of private clinics, and patient and utilization characteristics of 27,797 private clinics. External validation of clusters was performed by assessing the association among clusters and outcomes of care provided by private clinics. Stability of clusters was cross-validated using discriminant analysis. Results The result classified more than a half of private clinics into a potential PCP cluster. These were private clinics with specialties considered to be those of primary care physicians and were more likely to be located in non-metropolitan areas than specialized PCPs were. Compared to specialized PCPs, they had a higher percentage of pediatric and geriatric patients, patients with greater disease severity, a higher percentage of patients with complex comorbidities or with simple or minor disease groups, a higher number of patients and visits, and the same or higher quality of primary care. The most important factor in explaining variations between PCP clusters was the number of simple or minor disease groups per patient. Conclusion This study identified potential PCPs and suggested the identifying criteria for PCPs. It will provide useful information for formulation of a primary care strengthening policy to policy makers in Korea as well as other countries with similar specialist-dominant primary care settings.
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Affiliation(s)
- Jin Yong Lee
- Public Health Medical Service, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea
- * E-mail:
| | - Hyun Joo Kim
- Department of Nursing Science, Shinsung University, Dangjin, Chungnam, Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
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Bresick GF, Sayed AR, Le Grange C, Bhagwan S, Manga N, Hellenberg D. Western Cape Primary Care Assessment Tool (PCAT) study: Measuring primary care organisation and performance in the Western Cape Province, South Africa (2013). Afr J Prim Health Care Fam Med 2016; 8:e1-e12. [PMID: 27247157 PMCID: PMC4913443 DOI: 10.4102/phcfm.v8i1.1057] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/25/2016] [Accepted: 12/12/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Major health sector reform and the need for baseline measures of performance to determine impact. AIM Baseline audit of primary healthcare (PHC) performance. SETTING Cape Town and Cape Winelands (rural) PHC facilities (PCFs) in Western Cape Province, South Africa. METHOD The South African cross-culturally validated ZA PCAT to audit PHC performance on 11 subdomains associated with improved health and reduced costs. Adult PCF users systematically sampled. All full-time doctors and nurse practitioners in PCFs sampled and all PCF managers in sub-districts sampled invited into the study. RESULTS Data from 1432 users, 100 clinicians and 64 managers from 13 PCFs in 10 sub-districts analysed (figures show stakeholder percentages scoring subdomain performance 'acceptable to good'). 11.5% users scored access 'acceptable to good'; community orientation and comprehensive services provided 20.8% and 39.9%, respectively. Total PHC score for users 50.2%; for managers and practitioners 82.8% and 88.0%, respectively. Among practitioners access was lowest (33.3%); PHC team (98.0%) and comprehensive services available (100.0%) highest. Among managers, access (13.5%) and family centredness (45.6%) are lowest; PHC team (85.9%) and comprehensive services available (90.6%) highest. Managers scored access, family centredness and cultural competence significantly lower than practitioners. Users scored comprehensive services available, comprehensive services provided and community orientation significantly lower than practitioners and managers. CONCLUSION Gaps between users' experience and providers' assessments of PHC performance are identified. Features that need strengthening and alignment with best practice, provincial and national, and health policies are highlighted with implications for practitioner and manager training, health policy, and research.
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Affiliation(s)
- Graham F Bresick
- Division of Family Medicine School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, South Africa.
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Wang W, Shi L, Yin A, Mao Z, Maitland E, Nicholas S, Liu X. Contribution of primary care to health: an individual level analysis from Tibet, China. Int J Equity Health 2015; 14:107. [PMID: 26616447 PMCID: PMC4663737 DOI: 10.1186/s12939-015-0255-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/22/2015] [Indexed: 11/10/2022] Open
Abstract
Introduction There have been significant improvements in health outcomes in Tibet, health disparities between Tibet and the rest of China has been greatly reduced. This paper tests whether there was a positive association between good primary care and better health outcomes in Tibet. Method A validated Tibetan version of the Primary Care Assessment Tool (PCAT-T) was used to collect data on 1386 patients aged over 18 years old accessing primary care. Self-rated health (SRH) was employed to measure health outcomes. A multiple binary logistic regression model was used to explore the association between primary care quality and self-rated health status after controlling for socio-demographic and lifestyle variables. Results This study found that primary care quality had a significant positive association with self-rated health status. Among the nine domains of PCAT-T, family centeredness domain had the highest Odds Ratio (OR = 1.013) with SRH. Patients located in rural area, with higher education levels, without depression, and less frequent drinking were more likely to self-rate as “good health” compared with the reference group. Conclusions In Tibet, higher quality primary care was associated with better self-rated health status. Primary care should be much strengthened in future health system reform in Tibet.
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Affiliation(s)
- Wenhua Wang
- School of Public Health, Wuhan University, 115 Donghu Road, Wuhan, 430071, Hubei Province, P. R. China. .,Center for Health Management and Policy, Shandong University, 44 Wenhuaxilu, Jinan, 250012, Shandong Province, P. R. China.
| | - Leiyu Shi
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Primary Care Policy Center, 624 North Broadway, Baltimore, MD, 21205, USA.
| | - Aitian Yin
- Center for Health Management and Policy, Shandong University, 44 Wenhuaxilu, Jinan, 250012, Shandong Province, P. R. China.
| | - Zongfu Mao
- School of Public Health, Wuhan University, 115 Donghu Road, Wuhan, 430071, Hubei Province, P. R. China.
| | - Elizabeth Maitland
- School of Management, Australian School of Business, University of New South Wales, Sydney, 2052, NSW, Australia.
| | - Stephen Nicholas
- School of Management, Tianjin Normal University, West Bin Shui Avenue, Tianjin, 300074, P. R. China. .,School of International Business, Beijing Foreign Studies University, 19 North Xisanhuan Avenue, Haidian, Beijing, 100089, P. R. China. .,Guangdong Research Institute for International Strategies, Guangdong University of Foreign Studies, 2 Baiyun North Avenue, Baiyun, Guangzhou, 510420, Guangdong, P. R. China. .,University of Newcastle, Newcastle, 2308, NSW, Australia.
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, P. R. China.
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Kim YI, Hong JY, Kim K, Goh E, Sung NJ. Primary care research in South Korea: its importance and enhancing strategies for enhancement. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2013. [DOI: 10.5124/jkma.2013.56.10.899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yu-Il Kim
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jee Young Hong
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Kyoungwoo Kim
- Department of Family Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Eurah Goh
- Department of Family Medicine, Kangwon National University Postgraduate College of Medicine, Chuncheon, Korea
| | - Nak-Jin Sung
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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