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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 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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Batista SRR, Sousa ALL, Nunes BP, Rodrigues RRD, Jardim PCBV. Regular source of primary care and health services utilisation among Brazilian elderly with mental-physical multimorbidity. BMC Geriatr 2024; 24:430. [PMID: 38750413 PMCID: PMC11094868 DOI: 10.1186/s12877-024-05048-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND In ageing populations, multimorbidity is a complex challenge to health systems, especially when the individuals have both mental and physical morbidities. Although a regular source of primary care (RSPC) is associated with better health outcomes, its relation with health service utilisation in elderly patients with mental-physical multimorbidity (MP-MM) is scarce. OBJECTIVE This study explored the relations among health service utilisation, presence of RSPC and MP-MM among elderly Brazilians. METHODS A national cross-sectional study performed with data from national representative samples from the Brazilian National Health Research (PNS, in Portuguese; Pesquisa Nacional de Saúde) carried out in 2013 with 11,177 elderly Brazilian people. MP-MM was defined as the presence of two or more morbidities, including at least one mental morbidity, and was evaluated using a list of 16 physical and mental morbidities. The RSPC was analysed by the presence of regular font of care in primary care and health service utilisation according to the demand for health services ≤ 15 days, medical consultation ≤ 12 months, and hospitalisation ≤ 1 year. Frequency description of variables and bivariate association were performed using Stata v.15.2 software. RESULTS The majority of individuals was female (56.4%), and their mean age was 69.8 years. The observed prevalence of MP-MM was 12.2%. Individuals with MP-MM had higher utilisation of health services when compared to those without MP-MM. RSPC was present at 36.5% and was higher in women (37.8% vs. 34.9%). There was a lower occurrence of hospitalisation ≤ 1 year among MP-MM individuals with RSPC and without a private plan of health. CONCLUSION Our findings demonstrate that RSPC can be an important component of care in elderly individuals with MP-MM because it was associated with lower occurrence of hospitalisation, mainly in those that have not a private plan of health. Longitudinal studies are necessary to confirm these findings.
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Affiliation(s)
- Sandro Rogério Rodrigues Batista
- Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil.
- Postgraduate Program in Medical Sciences, Faculty of Medicine, University of Brasília, Brasília, Brazil.
- Postgraduate Program in Public Health, Faculty of Health Sciences, University of Brasília, Brasília, Brazil.
| | - Ana Luiza Lima Sousa
- Faculty of Nursing, Federal University of Goiás, Goiânia, Brazil
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
| | | | - Rodolfo Rêgo Deusdará Rodrigues
- Postgraduate Program in Medical Sciences, Faculty of Medicine, University of Brasília, Brasília, Brazil
- Faculty of Medicine, University of Brasília, Brasília, Brazil
| | - Paulo Cesar Brandão Veiga Jardim
- Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
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Aoki T, Zukeran S, Matsushima M. The role of primary care attributes in preventing loss or change of usual source of care: a nationwide cohort study. Fam Pract 2024:cmae006. [PMID: 38382048 DOI: 10.1093/fampra/cmae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The existence of a stable usual source of care (USC) is fundamental to the provision of quality health care. However, no longitudinal studies have examined whether core primary care attributes influence the stability of USC status. OBJECTIVES We aimed to examine the association between primary care attributes (first contact, longitudinality, coordination, comprehensiveness, and community orientation) and the loss or change of USC. METHODS This nationwide cohort study was conducted during the coronavirus disease 2019 pandemic using a representative sample of the Japanese adult population aged 40-75 years. The primary outcome measures were loss of USC and voluntary change in USC during the 12-month follow-up period. Primary care attributes were evaluated in the baseline survey using the Japanese version of Primary Care Assessment Tool (JPCAT). RESULTS Data were analyzed for 725 participants who had a USC at baseline. Among them, 93 (12.8 %) lost their USC and 46 (6.3%) changed their USC during the follow-up period. Multivariable multinominal logistic regression analyses showed that the JPCAT total score was associated with decreased loss of USC and change in USC. Among the JPCAT domains, longitudinality, comprehensiveness (services available), and community orientation were associated with reductions in both USC loss and change. CONCLUSIONS Our study indicates that primary care attributes play an important role in preventing the loss or change of USC and contribute to the stability of USC status. These findings provide additional rationale for policymakers, healthcare providers, and managers to seek to strengthen core attributes of primary care.
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Affiliation(s)
- Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Sota Zukeran
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
- Department of General Medicine, Okinawa Chubu Hospital, 281 Miyazato, Uruma City, Okinawa, 904-2293, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Li B, Chen J. Barriers to community healthcare delivery in urban China: a nurse perspective. Int J Qual Stud Health Well-being 2023; 18:2220524. [PMID: 37300842 DOI: 10.1080/17482631.2023.2220524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE There is considerable research on China's community healthcare, but little examining its delivery from a nurse perspective. This article, set in the context of Shenzhen, elicits community nurses' views on barriers to healthcare delivery, providing an initial evidence framework to improve community nursing practice at organizational and policy levels. METHODS We used qualitative methods. Data from semi-structured interviews with 42 community nurses in Shenzhen underwent inductive content analysis. Consolidated criteria for reporting qualitative research were consulted to structure our reporting. RESULTS Our analysis suggests four elements discouraging community nurses in care delivery: lack of equipment, stressful work environments, staff incompetence, and patient distrust. Centralized means of procurement, management indifference to nurses' well-being, unsystematic training and reluctance to enter the community healthcare sector, and public prejudices against nursing contributed to these constraints, preventing community nurses from performing patient-centred care, devoting energy to caring, freeing themselves from heavy workloads, and building trust-based care relationships. CONCLUSIONS Delivery barriers devalued community health services systematically and undermined nurses' professional advancement and psychological well-being. Targeted management and policy inputs are necessary to reduce caring barriers and enhance the ability of community nursing to safeguard population health.
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Affiliation(s)
- Bo Li
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Juan Chen
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
- Mental Health Research Centre, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
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Le TK, Cha L, Gee G, Dean LT, Juon HS, Tseng W. Asian American Self-Reported Discrimination in Healthcare and Having a Usual Source of Care. J Racial Ethn Health Disparities 2023; 10:259-270. [PMID: 35018579 DOI: 10.1007/s40615-021-01216-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: 08/19/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Self-reported racial or ethnic discrimination in a healthcare setting has been linked to worse health outcomes and not having a usual source of care, but has been rarely examined among Asian ethnic subgroups. OBJECTIVE We examined the association between Asian ethnic subgroup and self-reported discrimination in a healthcare setting, and whether both factors were associated with not having a usual source of care. DESIGN Using the California Health Interview Survey (CHIS) 2015-2017, we used logistic regression models to assess associations among Asian ethnic subgroup, self-reported discrimination, and not having a usual source of care. Interactions between race and self-reported discrimination, foreign-born status, poverty level, and limited English proficiency were also analyzed. PARTICIPANTS Respondents represented adults age 18 + residing in California who identified as White, Black, Hispanic, American Indian/Alaska Native, Asian (including Chinese, Filipino, Japanese, Korean, Vietnamese, and Other Asian), and Other. MAIN MEASURES We examined two main outcomes: self-reported discrimination in a healthcare setting and having a usual source of care. KEY RESULTS There were 62,965 respondents. After survey weighting, Asians (OR 1.78, 95% CI 1.19-2.66) as an aggregate group were more likely to report discrimination than non-Hispanic Whites. When Asians were disaggregated, Japanese (3.12, 1.36-7.13) and Koreans (2.42, 1.11-5.29) were more likely to report discrimination than non-Hispanic Whites. Self-reported discrimination was marginally associated with not having a usual source of care (1.25, 0.99-1.57). Koreans were the only group associated with not having a usual source of care (2.10, 1.23-3.60). Foreign-born Chinese (ROR 7.42, 95% CI 1.7-32.32) and foreign-born Japanese (ROR 4.15, 95% CI 0.82-20.95) were more associated with self-reported discrimination than being independently foreign-born and Chinese or Japanese. CONCLUSIONS Differences in self-reported discrimination in a healthcare setting and not having a usual source of care were observed among Asian ethnic subgroups. Better understanding of these differences in their sociocultural contexts will guide interventions to ensure equitable access to healthcare.
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Affiliation(s)
- Thomas K Le
- School of Medicine, Johns Hopkins University, 733 N. Broadway, Suite 137 Miller Research Building, Baltimore, MD, 21205, USA.
| | - Leah Cha
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Gilbert Gee
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Lorraine T Dean
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hee-Soon Juon
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Winston Tseng
- Health Research for Action, Berkeley Public Health, University of California at Berkeley, Berkeley, CA, USA
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Lu J, Yang H, Shi L, Sheng X, Huo Y, Liu R, Hu R. Associations between Primary Healthcare Experiences and Glycemic Control Status in Patients with Diabetes: Results from the Greater Bay Area Study, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1120. [PMID: 36673874 PMCID: PMC9859184 DOI: 10.3390/ijerph20021120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/29/2022] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Primary healthcare (PHC) plays an important role in diabetes management; community health centers (CHCs) serve as the main providers of PHC. However, few studies have discussed the association between the service quality of PHC and the effects of diabetes management. In this study, we explored the associations between experiences of PHC in CHCs and glycemic control status in patients with diabetes mellitus. This study was conducted in six CHCs in the Greater Bay Area of China. In total, 418 patients with diabetes mellitus (44% males and 56% females) were recruited between August and October 2019. We evaluated their PHC experiences using the Primary Care Assessment Tool (PCAT) developed by Johns Hopkins and assessed their glycemic control status by measuring their fasting plasma glucose levels. Binary logistic regression analyses were conducted to assess the associations between the patients’ PHC experiences and glycemic control status, adjusting for covariates. The patients with good glycemic control had significantly higher total and dimensional PCAT scores compared with those with poor glycemic control (p < 0.05). Higher PCAT scores were significantly associated with a greater adjusted odds ratios (aORs) of good glycemic control for total and dimensional PCAT scores. For example, compared to those with poor glycemic control, the aORs for those with good glycemic control was 8.82 (95% CI = 4.38−17.76) per total PCAT score increasing. Especially, the aORs for those with good glycemic control were 3.92 (95% CI = 2.38−6.44) and 4.73 (95% CI = 2.73−8.20) per dimensional PCAT score of family-centeredness and community orientation increasing, respectively. Better PHC experiences were associated with better diabetes management. In particular, family-centered and community-oriented CHCs may help improve diabetes management in China and other low- and middle-income countries.
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Affiliation(s)
- Junfeng Lu
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Hui Yang
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
| | - Leiyu Shi
- John Hopkins School of Public Health, Baltimore, MD 21205, USA
| | - Xia Sheng
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yongjun Huo
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - 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 510080, China
| | - Ruwei Hu
- Department of Health Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
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Yang S, Zhou M, Liao J, Ding X, Hu N, Kuang L. Association between Primary Care Utilization and Emergency Room or Hospital Inpatient Services Utilization among the Middle-Aged and Elderly in a Self-Referral System: Evidence from the China Health and Retirement Longitudinal Study 2011-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912979. [PMID: 36232279 PMCID: PMC9564952 DOI: 10.3390/ijerph191912979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 05/09/2023]
Abstract
With rapid economic growth and aging, hospital inpatient and emergency services utilization has grown rapidly, and has emphasized an urgent requirement to adjust and optimize the structure of health service utilization. Studies have shown that primary care is an effective way to reduce inpatient and emergency room (ER) service utilization. This study aims to examine whether middle-aged and elderly individuals who selected primary care outpatient services in the last month had less ER and hospital inpatient service utilization than those who selected hospitals outpatient services via the self-referral system. Data were obtained from four waves of the nationally representative China Health and Retirement Longitudinal Study (CHARLS). We pooled respondents who had outpatient visits and were aged 45 years and above. We used logistic regressions to explore the association between types of outpatient and ER visits or hospitalization, and then used zero-truncated negative binomial regression to examine the impact of outpatient visit types on the number of hospitalizations and the length of hospitalization days. A trend test was used to explore the trend of outpatient visit types and the ER or hospital inpatient services utilization with the increase in outpatient visits. Among the 7544 respondents in CHARLS, those with primary care outpatient visits were less likely to have ER visits (adjusted OR = 0.141, 95% CI: 0.101-0.194), hospitalization (adjusted OR = 0.623, 95% CI: 0.546-0.711), and had fewer hospitalization days (adjusted IRR = 0.886, 95% CI: 0.81-0.969). The trend test showed that an increase in the number of total outpatient visits was associated with a lower hospitalizations (p = 0.006), but a higher odds of ER visits (p = 0.023). Our findings suggest that policy makers need to adopt systematic policies that focus on restructuring and balancing the structure of resources and service utilization in the three-tier healthcare system.
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Affiliation(s)
- Siman Yang
- Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Mengping Zhou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, 17177 Stockholm, Sweden
| | - Jingyi Liao
- Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Xinxin Ding
- Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Nan Hu
- Department of Biostatistics, FIU Robert Stempel College of Public Health and Social Work, Miami, FL 33199, USA
- Department of Family and Preventive Medicine and Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Correspondence: (N.H.); (L.K.)
| | - Li Kuang
- Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
- Correspondence: (N.H.); (L.K.)
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Li B, Chen J. Barriers to Community-Based Primary Health Care Delivery in Urban China: A Systematic Mapping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912701. [PMID: 36232001 PMCID: PMC9566097 DOI: 10.3390/ijerph191912701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/21/2022] [Accepted: 09/30/2022] [Indexed: 05/15/2023]
Abstract
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.
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Affiliation(s)
- Bo Li
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Correspondence:
| | - Juan Chen
- 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
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Wu J, Liu R, Shi L, Zheng L, He N, Hu R. Association between resident status and patients' experiences of primary care: a cross-sectional study in the Greater Bay Area, China. BMJ Open 2022; 12:e055166. [PMID: 35338060 PMCID: PMC8961107 DOI: 10.1136/bmjopen-2021-055166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES 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. DESIGN A cross-sectional study using multistage cluster random sampling was conducted from September to November 2019. The data were analysed using general linear models. SETTING Six community health centres in Guangzhou, China. PARTICIPANTS 1568 patients aged 20 years or older. MAIN OUTCOME MEASURES 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- JingLan Wu
- Department of Health Management, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
| | - RuQing Liu
- 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
| | - Leiyu Shi
- Department of Health Policy & Management, School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lingling Zheng
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ning He
- Department of Health Management, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
| | - Ruwei Hu
- Department of Health Management, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
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Wang W, van Wijngaarden J, Wang H, Buljac-Samardzic M, Yuan S, van de Klundert J. Factors Influencing the Implementation of Foreign Innovations in Organization and Management of Health Service Delivery in China: A Systematic Review. FRONTIERS IN HEALTH SERVICES 2021; 1:766677. [PMID: 36926484 PMCID: PMC10012679 DOI: 10.3389/frhs.2021.766677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022]
Abstract
Background: China has been encouraged to learn from international innovations in the organization and management of health service delivery to achieve the national health reform objectives. However, the success and effectiveness of implementing innovations is affected by the interactions of innovations with the Chinese context. Our aim is to synthesize evidence on factors influencing the implementation of non-Chinese innovations in organization and management of health service delivery in mainland China. Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched seven databases for peer-reviewed articles published between 2009 and 2020. Data were analyzed and combined to generate a list of factors influencing the implementation of foreign innovations in China. The factors were classified in the categories context, system, organization, innovation, users, resources, and implementation process. Results: The 110 studies meeting the inclusion criteria revealed 33 factors. Most supported by evidence is the factor integration in organizational policies, followed by the factors motivation & incentives and human resources. Some factors (e.g., governmental policies & regulations) were mentioned in multiple studies with little or no evidence. Conclusion: Evidence on factors influencing the implementation of foreign innovations in organization and management of health service delivery is scarce and of limited quality. Although many factors identified in this review have also been reported in reviews primarily considering Western literature, this review suggests that extrinsic motivation, financial incentives, governmental and organizational policies & regulations are more important while decentralization was found to be less important in China compare to Western countries. In addition, introducing innovations in rural China seems more challenging than in urban China, because of a lack of human resources and the more traditional rural culture.
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Affiliation(s)
- Wenxing Wang
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jeroen van Wijngaarden
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Hujie Wang
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Martina Buljac-Samardzic
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Shasha Yuan
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Joris van de Klundert
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Mohammad Bin Salman College of Business and Entrepreneurship, King Abdullah Economic City, Saudi Arabia
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Zhang L, Zhang Q, Li X, Shao W, Ma J, Zhang R, Zhou A, Li J. The effect of patient perceived involvement on patient loyalty in primary care: The mediating role of patient satisfaction and the moderating role of the family doctor contract service. Int J Health Plann Manage 2021; 37:734-754. [PMID: 34697826 DOI: 10.1002/hpm.3355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 08/06/2021] [Accepted: 10/04/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Chinese government has taken many incentives to promote the implementation of the family doctor (FD) contract service; however, whether primary health care providers establishing a strong relationship with patients that shapes their loyalty is still unknown. Under this circumstance, drawing the public attention to patient loyalty in primary care and clarifying the underlying mechanism of loyalty is imperative to the development of primary care. OBJECTIVE To analyse the effect of patient perceived involvement on patient loyalty in primary care, investigate the mediating role of patient satisfaction, and explore the moderating role of the FD contract service on the relationship between patient perceived involvement and patient loyalty. METHODS A cross-sectional questionnaire survey of patients in primary health facilities was conducted in Jilin province of China. Participants comprised 1334 patients selected via a multi-stage sampling method. RESULTS Patient perceived involvement not only had a direct positive impact on patient loyalty but also had an indirect effect on patient loyalty via patient satisfaction. Furthermore, for patients who contracted with FDs, patient perceived involvement had a higher direct effect and indirect effect on patient loyalty when compared with patients who did not contract with FDs. CONCLUSIONS Our findings suggest that health managers should encourage patients to participate in medical visits to improve patient satisfaction. Additionally, customised and tailored health services that meet individuals' specific needs and preferences should be designed and implemented to attract more patients to contract the FD contract service.
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Affiliation(s)
- Li Zhang
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Qian Zhang
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Xinru Li
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Weiya Shao
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Jingyu Ma
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Ruijie Zhang
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.,Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Angdi Zhou
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Jinghua Li
- School of Public Health, Jilin University, Changchun, Jilin Province, China
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12
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Matteoni TCG, Magno L, Luppi CG, Grangeiro A, Szwarcwald CL, Dourado I. Usual source of healthcare and use of sexual and reproductive health services by female sex workers in Brazil. CAD SAUDE PUBLICA 2021; 37:e00188120. [PMID: 34644757 DOI: 10.1590/0102-311x00188120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/29/2021] [Indexed: 11/22/2022] Open
Abstract
The fact of having a usual source of care can improve access to health services and preventive activities. The article aimed to estimate the proportion of factors associated with usual source of care among female sex workers. This was a socio-behavioral survey with 4,328 female sex workers, ≥ 18 years, in 12 Brazilian cities. Female sex workers were recruited by the respondent-driven sampling method (RDS). A descriptive profile was performed of the female sex workers who had usual source of care and the association was analyzed between usual source of care and indicators of access to HIV prevention and reproductive health. As effect measure, the study used adjusted odds ratio (OR) in a logistic regression model. The data were weighted by the RDS-II estimator. 71.5% of the female sex workers reported having a usual source of care, and of these, 54.3% cited primary healthcare (PHC) as their main usual source of care. Among female sex workers 18-24 years of age, there was an association between usual source of care and having a Pap smear test (OR = 2.27; 95%CI: 1.66-3.12), seven or more prenatal visits (OR = 2.56; 95%CI: 1.30-5.03), and the use of a contraceptive method (OR = 1.64; 95%CI: 1.09-2.46). Among female sex workers ≥ 25 years, there was an association between usual source of care and attending talks on sexually transmitted infections (STIs) (OR = 1.45; 95%CI: 1.12-1.89), prior knowledge of post-exposure prophylaxis (OR = 1.32; 95%CI: 1.02-1.71), and history of Pap smear test (OR = 1.92; 95%CI: 1.54-2.40). The study's results showed that female sex workers have PHC as their main usual source of care. usual source of care can also positively impact care and activities in reproductive health and prevention of HIV and STIs in this population group.
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Affiliation(s)
| | - Laio Magno
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil.,Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Brasil
| | - Carla Gianna Luppi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
| | | | - Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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13
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Zhang L, Li J, Ma T, Zhang R, Zhang Q. Usual source of care and experiences with primary care among community health service centre patients in Changchun, China: A cross-sectional survey. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1979-1988. [PMID: 32358993 DOI: 10.1111/hsc.13009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
Under China's healthcare reforms, community health service centres (CHCs) have been established as the preferred primary care providers. Even with this change, there is still little attention paid to patients' usual source of care (USC) from CHCs in Northeastern China. The main purposes of this study were to explore the determinants of usual source of community health service and to examine the association between usual source of community health service and patients' experiences with primary care. A cross-sectional survey with 515 adult patients at CHCs in Jilin Province, China, was conducted between July 2016 and November 2016. The patients' experiences with primary care were assessed with the Primary Care Assessment Tool (PCAT). Patients with self-perceived poor health status (odds ratio = 1.984, 95% confidence interval = 1.145-3.437) and chronic disease (odds ratio = 2.207, 95% confidence interval = 1.203-4.051) were more likely to have a usual source of community health service than patients with self-perceived good health status or without chronic disease. Patients scored the highest on comprehensiveness of services available (Mean = 2.87) and the lowest on community orientation (Mean = 1.83) in all domains of the PCAT, with values ranging from 1 to 4. A multiple linear regression analysis revealed that patients with a usual source of community health service had significantly higher overall scores than those without (B = 0.205, p < .001). This study demonstrated the important role of CHCs in providing affordable health services for patients with chronic disease or poor health status. Moreover, patients who chose a CHC as a USC had better experiences with primary care compared with patients who did not choose a CHC as a USC. However, community-oriented services need to be improved, and efforts to improve patients' experiences should include policies that incentivise patients to adopt a CHC as their USC.
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Affiliation(s)
- Li Zhang
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Jinghua Li
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Tianjiao Ma
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Ruijie Zhang
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Qian Zhang
- School of Public Health, Jilin University, Changchun, Jilin Province, China
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14
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Comparison of Patients' Perceived Quality of Primary Care Between Urban and Rural Community Health Centers in Guangdong, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134898. [PMID: 32646063 PMCID: PMC7369941 DOI: 10.3390/ijerph17134898] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 12/18/2022]
Abstract
Background: A series of reforms were implemented to improve the quality of primary care services in China. This study aims to assess patients’ perceived quality of primary healthcare between rural and urban community health centers in Guangdong. Methods: A cross-sectional survey was conducted from July to December 2015 in Guangdong. We surveyed 1010 respondents who visited either community health centers/stations (CHCs/CHSs) in urban areas or township health centers/rural health stations (THCs/RHSs) in rural areas. A validated Chinese version of the Primary Care Assessment Tool-Adult Short Version (PCAT-AS), representing ten primary care domains, was used to collect information on patients’ primary care experiences. A t-test was used for comparison on domain scores and total scores between patients from CHCs/CHSs and THCs/RHSs. An analysis of covariance was employed to compare the adjusted PCAT domain scores and total scores. Multilevel models were used to explore factors associated with PCAT total scores. Results: Overall, patients reported a lower level of experience of community orientation and family centeredness compared to other primary care domains. Patients from THCs/RHSs settings in the rural area reported better primary care experience in four domains, including first contact, accessibility, ongoing care, and community orientation. Higher education background and those with a chronic disease were associated with better primary care experience, after controlling for confounding factors. Patients who preferred primary care institutions when getting sick or used health services more frequently reported better primary care experiences. Conclusion: Continued efforts are needed to strengthen primary care performances, particularly in a community orientation and family centeredness. Primary care delivery in CHCs/CHSs settings should be improved in four domains, including first contact, accessibility, ongoing care, and community orientation.
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15
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Wu QL, Street RL. The Communicative Ecology of Chinese Patients' Experiences with Health Care. JOURNAL OF HEALTH COMMUNICATION 2020; 25:463-473. [PMID: 32716729 DOI: 10.1080/10810730.2020.1789245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Patient satisfaction and trust are important intermediate outcomes along pathways linking clinician-patient communication to improve well-being, but they are difficult to achieve in Chinese health care. Problematic physician-patient interactions, questionable health-care organizational practices, and media coverage of medical scandals may have contributed to this problem. Nevertheless, there isscant literature documenting reasons underlying dissatisfaction with Chinese health care. Using Street's ecological model of communication in medical encounters as a conceptual framework, this study explores how media and organizational factors affect Chinese patients' satisfaction and trust both directly and as mediated by the quality of patients' past communication experiences with clinicians. A survey was conducted among 257 Ob-gyn patients in a top-tier hospital in Sichuan, China. The results show that several organizational and media factors, along with patients' experiences with physician communication, predict patient satisfaction and trust. Perceptions of physician communication mediated some of the relationships between organizational and media factors with outcomes. Theoretical and practical implications are discussed, particularly with respect to improving health-care services in China.
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Affiliation(s)
- Qiwei L Wu
- Department of Communication, Texas A&M University , College Station, Texas, USA
| | - Richard L Street
- Department of Communication, Texas A&M University , College Station, Texas, USA
- Department of Medicine, Baylor College of Medicine , Houston, Texas, USA
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16
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Chávez GM, Viegas SMDF, Roquini GR, Santos TR. Acesso, acessibilidade e demanda na estratégia saúde da família. ESCOLA ANNA NERY 2020. [DOI: 10.1590/2177-9465-ean-2019-0331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo compreender demanda, acesso e acessibilidade perante as necessidades de saúde, sob a ótica de profissionais e usuários da Estratégia Saúde da Família (ESF). Método utilizou-se a Teoria Fundamentada nos Dados, ancorada no Interacionismo Simbólico, com 34 participantes, usuários e profissionais da ESF de município de grande porte. Resultados as demandas cotidianas na ESF e as limitações do acesso evidenciam as dificuldades enfrentadas pelas equipes pela baixa cobertura populacional, elevado número de pessoas cadastradas, baixa resolutividade, falta de profissionais, ineficácia da gestão e escassez de ações programadas. As concepções de acesso, acessibilidade e resolutividade são contextualizadas no acolhimento e humanização, na precisão de ampliar a cobertura populacional e o acesso, além de os usuários e profissionais expressarem seus sentimentos de frustração, angústia e insatisfação perante a baixa resolutividade e insuficiência de recursos. Conclusões e implicações para prática a ESF ainda trabalha a lógica da atenção curativa, cujas atividades são realizadas dentro do consultório, com recursos insuficientes, elevada demanda reprimida e muitos desafios. Apresenta subsídios para que os profissionais de saúde, usuários e gestores busquem, de forma colaborativa, estratégias de enfrentamento da elevada demanda espontânea e dificuldades de acesso.
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Stewart KA, Ristvedt S, Brown KM, Waters EA, Trinkaus K, McCray N, James AS. Giving Voice to Black Men: Guidance for Increasing the Likelihood of Having a Usual Source of Care. Am J Mens Health 2019; 13:1557988319856738. [PMID: 31170862 PMCID: PMC6557027 DOI: 10.1177/1557988319856738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Black men suffer inequalities in health and health-care outcomes relative to other racial/ethnic groups, requiring well-informed efforts for health promotion. Fewer Black men have a usual source of health care, which may be a contributor to these disparities. Increasing access to and the likelihood of a usual source of care among Black men are important to address health and health-care disparities. In this focus group study, we sought to better understand how Black men think about primary care and usual sources of care. A total of six focus groups were conducted with N = 25 men. Groups were a mix of men with and without a usual source of care. Several themes were identified through analysis of the data regarding factors that contribute to Black men going to the doctor. Themes identified in the data analysis included Lack of Health Insurance as a Barrier to Establishing Usual Source of Care; Family Promoting Health Care Use; Relationship With Doctor, Trust, and Empowerment; Age and Maturity in Health Promotion; and Positive Tone of Messaging. Future research should explore if similar findings are obtained among men in different regions of the United States or between Black men of different backgrounds. Taking a step beyond this research, specifically, future research can also examine the impact of particular health messages/messaging on Black men's health-care-seeking behaviors.
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Affiliation(s)
- Karyn A Stewart
- 1 Department of Sociology, DePaul University, Chicago, IL, USA
| | - Stephen Ristvedt
- 2 Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Katherine M Brown
- 3 Division of Public Health Sciences, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Erika A Waters
- 3 Division of Public Health Sciences, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Kathryn Trinkaus
- 4 Biostatistics Shared Resource, Siteman Cancer Center, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Natasan McCray
- 3 Division of Public Health Sciences, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Aimee S James
- 3 Division of Public Health Sciences, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
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Evaluating Primary Health Care Performance from User Perspective in China: Review of Survey Instruments and Implementation Issues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060926. [PMID: 30875833 PMCID: PMC6466226 DOI: 10.3390/ijerph16060926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 12/28/2022]
Abstract
This review aims to summarize the progress of patient evaluation studies focusing on primary health care (PHC) in China, specifically in relation to survey instruments and implementation issues. Eligible studies published in English or Chinese were obtained through online searches of PubMed and China National Knowledge Infrastructure. A descriptive reporting approach was used due to variations in the measurements and administration methods between studies. A total of 471 articles were identified and of these articles; of those 91 full-text articles were included in the final analysis. Most studies used author-developed measurements with five-point Likert response scales and many used the Chinese translations of validated tools from other countries. Most instruments assessed the physical environment, medical equipment, clinical competency and convenience aspects of PHC using a satisfaction rating instead of care experience reporting. Many studies did not report the sampling approach, patient recruitment procedures and survey administration modes. The patient exit survey was the most commonly used survey implementation method. The focus on the structural dimensions of PHC, inconsistent wording, categories of response options that use satisfaction rating, and unclear survey implementation processes are common problems in patient evaluation studies of PHC in China. Further studies are necessary to identify population preferences of PHC in China in order to move towards developing Chinese value-based patient experience measurements.
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19
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Sung NJ, Lee JH. Association between Types of Usual Source of Care and User Perception of Overall Health Care Service Quality in Korea. Korean J Fam Med 2018; 40:143-150. [PMID: 30419631 PMCID: PMC6536901 DOI: 10.4082/kjfm.17.0093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/12/2017] [Indexed: 11/17/2022] Open
Abstract
Background Patients’ perceptions of care tend to correlate with the quality of care provided. Different health care systems and service environments may show different associations between types of usual source of care (USC) and overall service quality assessment. We attempted to analyze this association as a benefit of having a USC. Methods This study used the 2012 Korea Health Panel data version 1.1 as representative national household survey data. The total number of subjects aged 18 years or more was 12,708. The number of subjects in the final analysis was 10,665. Multiple logistic regression analysis was used to assess the association between types of USC and overall health care service quality. The main outcome variable was users’ ratings of the quality of health care service. Results People having a usual doctor (n=1,796) were more likely to positively assess the quality of health care they received than those not having a USC (n=7,920; odds ratio [OR], 1.39; 95% confidence interval [CI], 1.20–1.60) or with those having only a place as a USC without a usual doctor (n=949; OR, 1.29; 95% CI, 1.05–1.58) after adjustment for demographic characteristics and health-related variables. Conclusion People having a usual doctor rated overall health care service quality as high, which might be due to benefits of primary care attributes related to usual doctors. Further studies are needed to elucidate the causal relationship. This finding implies that health policies encouraging people to have a usual doctor are needed in Korea.
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Affiliation(s)
- Nak-Jin Sung
- Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Jae-Ho Lee
- Department of Family Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Li L, Zhong C, Mei J, Liang Y, Li L, Kuang L. Effect of family practice contract services on the quality of primary care in Guangzhou, China: a cross-sectional study using PCAT-AE. BMJ Open 2018; 8:e021317. [PMID: 30420344 PMCID: PMC6252701 DOI: 10.1136/bmjopen-2017-021317] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Current healthcare reform in China has an overall goal of strengthening primary care and establishing a family practice system based on contract services. The objective of this study was to determine whether contracting a general practitioner (GP) could improve quality of primary care. DESIGN A cross-sectional study using two-stage sampling conducted from June to September 2014. Propensity score matching (PSM) was employed to control for confounding between patients with and without contracted GP. SETTING Three community health centres in Guangzhou, China. PARTICIPANTS 698 patients aged 18-89 years. MAIN OUTCOME MEASURES The quality of primary care was measured using a validated Chinese version of primary care assessment tool (PCAT). Eight domains are included (first contact utilisation, accessibility, continuity, comprehensiveness, coordination, family-centredness, community orientation and cultural competence from patient's perceptions). RESULTS A total of 692 effective samples were included for data analysis. After PSM, 94 pairs of patients were matched between the patients with and without contracted GPs. The total PCAT score, continuity (3.12 vs 2.68, p<0.01), comprehensiveness (2.31 vs 2.04, p<0.01) and family-centredness (2.11 vs 1.79, p<0.01) were higher in patients who contracted GPs than those did not. However, the domains of first contact utilisation (2.74 vs 2.87, p=0.14) and coordination (1.76 vs 1.93, p<0.05) were lower among patients contracted with GPs than in those who did not. CONCLUSION Our findings demonstrated that patients who had a contracted GP tend to experience higher quality of primary care. Our study provided evidence for health policies aiming to promote the implementation of family practice contract services. Our results also highlight further emphases on the features of primary care, first contact services and coordination services in particular.
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Affiliation(s)
- Lina Li
- Institute of Social Medicine and Health Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chenwen Zhong
- Institute of Social Medicine and Health Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jie Mei
- Institute of Social Medicine and Health Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuan Liang
- Institute of Social Medicine and Health Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Li
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio, USA
| | - Li Kuang
- Institute of Social Medicine and Health Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Kim KM, Jeon H, Lee JH. Having a Physician Rather than a Place as a Usual Source of Care Would Be Better - from 2012 Korea Health Panel Data. J Korean Med Sci 2017; 32:4-12. [PMID: 27914125 PMCID: PMC5143297 DOI: 10.3346/jkms.2017.32.1.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/10/2016] [Indexed: 12/05/2022] Open
Abstract
A usual source of care (USC) in primary care improves health care quality and can result in improved health. However, current research about the type of USC (place only vs. physician with a place) is insufficient as an evidence to support the value of primary care. We analyzed data from the 2012 Korea Health Panel survey of adults aged 18 years or older (n = 11,873) who reported whether having a USC or not to compare the effects by type of USC on medical care use and out-of-pocket costs. Descriptive analysis showed significant differences in the distributions of sociodemographic and health status factors except frequency of outpatient visit by type of USC. Adjusted odds ratios (ORs) of having a physician with a place compared to not having a USC were 4.05 for age 65 ≥ years (vs. < 35 years), 1.33 for females (vs. males), 0.63 for the fifth (highest) quintile (vs. the first) of household income, 1.62 for medical aid (vs. employee) health insurance, and 4.46 for having a chronic disease (vs. not). For those having a physician with a place (vs. only a place) as a USC, adjusted ORs of hospital admission and emergency room (ER) visit were 0.77 and 0.71 with out-of-pocket costs not significantly high. Those having a physician with a place (vs. only a place) as a USC included more patients with chronic diseases, but they had fewer hospital admissions and ER visits. When designing a plan for health care reform in Korea, promoting having a physician rather than a place as a USC would be a better policy.
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Affiliation(s)
- Kyeong Min Kim
- Department of Family Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyunsoo Jeon
- Department of Family Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jae Ho Lee
- Department of Family Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
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The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health 2016; 15:151. [PMID: 27852265 PMCID: PMC5112616 DOI: 10.1186/s12939-016-0440-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A usual source of care (USC) has been conceptualized as having a health provider or place available for patients to consult when sick or in need of medical care. Having a USC is a means to achieve longitudinality of care with Primary Health Care (PHC) providers. Brazil has made enormous progress in PHC and thus provides an important opportunity to investigate USC in a middle-income country context. METHODS This study uses data from a nationally representative household survey, the 2013 National Health Survey (n = 62,986), to describe the prevalence of having a USC in Brazil and to investigate to what extent the Family Health Strategy (FHS) has contributed to USC prevalence. Analyses include descriptive, bivariate and multivariable Poisson regression. RESULTS Show very high rates of people reporting any type of USC (74.4 %) and more than one third reporting PHC as their USC. Household enrolment in the FHS was positively associated with having any USC (PR:1.09; 95 % CI: 1.07-1.12) and a stronger association with having PHC as the regular source of care (PR:1.63;95 % CI:1.54-1.73). FHS enrolment was negatively associated with reporting emergency/urgent care facilities as one's USC (PR: 0.67; 95 % CI: 0.59-0.76). The association between the more consolidated FHS with having a USC was strongest in the poorest regions of the country (North, Northeast and Central-West). Having PHC as one's USC showed a positive dose-response relationship with the FHS in all regions, especially in the Central-West. CONCLUSIONS Our results have important implications for the health care model in Brazil and in other countries, especially those seeking to base their national health systems more strongly on primary health care. The study suggests expanding primary health care can increase the establishment of a USC which can help assure better monitoring of chronic conditions and attention to patient needs.
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Ruano AL, Furler J, Shi L. Interventions in Primary Care and their contributions to improving equity in health. Int J Equity Health 2015; 14:153. [PMID: 26694551 PMCID: PMC4688918 DOI: 10.1186/s12939-015-0284-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 12/10/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ana Lorena Ruano
- Centro de Estudios para la Gobernanza en los Sistemas de Salud (CEGSS) Guatemala and Center for International Health, University of Bergen, Bergen, Norway.
| | - John Furler
- Department of General Practice
- Faculty of Medicine, Dentistry and Health Sciences University of Melbourne, Melbourne, USA
| | - Leiyu Shi
- The Primary Care Policy Center Department of Health Policy and Management, John Hopkins Bloomberg School of Public Health, Bloomberg, USA
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