Patient views of the good doctor in primary care: a qualitative study in six provinces in China

Attributes Desired in a General Practitioner by Adults: Implications for Humanization in Medicine and Enhancement of the Patient Experience

BACKGROUND

Progress in medical education is reflected in healthcare quality and patient satisfaction. However, there are still gaps in knowledge regarding the patients' expectations of general practitioners (GPs), even though patients' interactions with GPs are among the most frequent in healthcare. Accordingly, this study investigated the qualities desired by adults in GPs, intending to include them in future medical humanization education to enhance the patients' experience.

METHODS

Using an online survey, 1057 respondents (52.8% female; mean age, 46.55 years old, SD 16.03) were asked to rate 15 statements on a scale of 1 to 10 regarding desirable characteristics of general practitioners. In addition to the respondents' high regard for their GP's ongoing education and sincerity in conveying both positive and negative information, the findings suggest that the socio-demographic attributes of the respondents influence their expectations of GPs.

RESULTS

Women had higher overall expectations than men. In addition, those who reported higher satisfaction with their lives and recent healthcare users had higher expectations of GPs than those who were dissatisfied. The youngest group of respondents exhibited the lowest expectations of the GPs' attributes, except for their greater willingness to engage in discussions with GPs regarding personal or professional issues, compared with the older groups.

CONCLUSIONS

The information presented in this work can be utilized during medical students' humanization training and physicians' continuing education. The knowledge gained should enhance GPs' awareness of the distinctions in patients' expectations, enabling them to adapt their approach and services to align with their patients' unique needs, expectations, and experiences.

Patients' sense of medical gain on family doctor contracting services in China: scale development and preliminary validation

BACKGROUND AND AIM

The system of family doctor contract services is a crucial component of China's primary healthcare system. Patients enrolled in family doctor contract services typically receive more comprehensive health services. However, it remains uncertain whether the family doctor contract services can fully meet the healthcare needs of patients. Despite extensive research on family doctor contract services, there has been relatively little investigation from the perspective of patients' sense of gain, and there are no specific tools available to measure patients' sense of gain in healthcare. Therefore, this study aims to develop a scale to measure patients' sense of gain in family doctor contract services.

METHODS

This study enrolled 600 patients under family doctor contracts. It utilized a review of literature and Delphi expert consultation to form the concept of patients' sense of medical gain in the context of family doctor services, establish an item pool, screen items, and evaluate the scale's reliability and validity. Factor analysis assessed the scale's structural validity, while Cronbach's alpha coefficient evaluated its internal consistency. Test-retest reliability and split-half reliability were used to assess the scale's reliability.

RESULTS

The Patients' Sense of Medical Gain in the context of Family Doctor services(PSMG-FD) scale for assessing sense of medical gain among family doctor contract patients comprises 19 items, categorized into five factors: Medical convenience, continuity, reliability, humanistic care, and experience. Confirmatory factor analysis results indicated satisfactory fit indices: χ2/df = 2.781, RMSEA = 0.077, RMR = 0.031, GFI = 0.875, NFI = 0.918, IFI = 0.946, TLI = 0.934, CFI = 0.945, and RFI = 0.901. The AVE values for different dimensions were 0.544, 0.739, 0.741, 0.755, and 0.654, all surpassing the threshold of 0.5. The CR values for each dimension were 0.820, 0.919, 0.919, 0.925, and 0.850, all exceeding 0.7, indicating satisfactory convergent validity. The interdimensional correlation coefficients were lower than the square roots of the corresponding AVEs, suggesting correlation among latent variables while maintaining sufficient discriminant validity. The PSMG-FD scale demonstrated good reliability and validity, with a Cronbach's α coefficient of 0.947, test-retest reliability of 0.955, and split-half reliability of 0.895.

CONCLUSION

The scale exhibits good reliability and validity, making it a suitable instrument for evaluating sense of medical gain among family doctor contract patients in China.

Relationship between patient-perceived quality of primary care and self-reported hospital utilisation in China: A cross-sectional study

BACKGROUND

Reducing avoidable hospital admissions is a global healthcare priority, with optimal primary care recognised as pivotal for achieving this objective. However, in developing systems like China, where primary care is evolving without compulsory gatekeeping, the relationship between patient-perceived primary care quality and hospital utilisation remains underexplored.

OBJECTIVES

This study aimed to explore the association between patient-perceived primary care quality and self-reported hospital utilisation in China.

METHODS

Data were collected from 16 primary care settings. Patient-perceived quality of primary care was measured using the Assessment Survey of Primary Care scale across six domains (first-contact care, continuity, comprehensiveness, accessibility, coordination, and patient-centredness). Hospital utilisation included patient self-reported outpatient visits, hospital admissions, and emergency department (ED) visits in the last six months. Logistic regression analyses were examined associations between self-reported hospital utilisation and perceived primary care quality adjusted for potential confounders.

RESULTS

Of 1,185 patients recruited, 398 (33.6%) reported hospital utilisation. Logistic regression analyses showed that higher total scores for patient-perceived quality of primary care were associated with decreased odds of hospital utilisation (adjusted odds ratio(AOR): 0.417, 95% confidence interval (CI): 0.308-0.565), outpatient visits (AOR: 0.394, 95% CI: 0.275-0.566) and hospital admissions (AOR: 0.496, 95% CI: 0.276-0.891). However, continuity of care was positively associated with ED visits (AOR: 2.252, 95% CI: 1.051-4.825).

CONCLUSION

Enhanced patient-perceived quality of primary care in China is associated with a reduction in self-reported overall hospital utilisation, including outpatient visits and hospital admissions. However, better continuity of care may be associated with increased ED visits. Further research is warranted for precise insights and validation of these findings.

Community Health Centers' Responsiveness and Its Associated Factors Among Outpatients in Southeast China: A Cross-Sectional Study

Background

The responsiveness of community health centers can reflect the soft capacity of medical institutions and is related to the improvement of health outcome indicators. This study is aimed at assessing the level and distribution of community health centers' responsiveness and its associated factors among outpatients under the health-oriented integrated healthcare system in China.

Methods

A total of 634 outpatients were recruited from six community health centers in Zhejiang Province, China, in July 2022. SPSS software was used to conduct the analysis (version 23.0). Health system responsiveness was used as a measure of outpatient responsiveness to health care services through a self-administered questionnaire. Determinants of community health centers' responsiveness were determined by using a multiple linear regression model at a p-value <0.05.

Results

The total score of community health centers responsiveness was 8.25±1.01, and the Gini coefficient is 0.027. Within these domains, social support and dignity received the highest scores, while choice of providers and autonomy scored the lowest. Age group between 60-74 years (β: 0.129; 95% CI: 0.042-0.529), ≥75 years (β: 0.095; 95% CI: 0.006-0.707), monthly income with 8000 RMB and above (β: 0.098; 95% CI: 0.035-0.653), having a family doctor (β: 0.124; 95% CI: 0.096-0.410), and satisficing with community health service (β: 0.298; 95% CI: 0.848-1.428) were significant predictors of community health centers' responsiveness.

Conclusion

The Chinese community health centers show high responsiveness, indicating that the construction of a health-oriented integrated healthcare system has been effective. The family doctor contract service is important and should continually enhance both technical proficiency and health promotion capabilities. Encourage residents to actively participate in their treatment process is also essential.

High performing primary health care organizations from patient perspective: a qualitative study in China

BACKGROUND

There is a global call to build people-centred primary health care (PHC) systems. Previous evidence suggests that without organization-level reform efforts, the full potential of policy reforms may be limited. This study aimed to generate a profile of high performing PHC organizations from the perspective of patients.

METHODS

We conducted semi-structured interviews with 58 PHC users from six provinces (Shandong, Zhejiang, Shaanxi, Henan, Shanxi, Heilongjiang) in China using purposive and snowball sampling techniques. Transcription was completed by trained research assistants through listening to the recordings of the interviews and summarizing them in English by 30-s segments to generate the narrative summary. Informed by the Classification System of PHC Organizational Attributes, thematic analysis aimed to identify domains and attributes of high performing PHC organizations.

RESULTS

A profile of a high performing PHC organization with five domains and 14 attributes was generated. The five domains included: (1) organizational resources including medical equipment, human and information resource; (2) service provision and clinical practice including practice scope, internal integration and external integration; (3) general features including location, environment and ownership; (4) quality and cost; and (5) organizational structure including continuous learning mechanism, administrative structure and governance.

CONCLUSIONS

A five-domain profile of high performing PHC organizations from the perspective of Chinese PHC users was generated. Organizational resources, service delivery and clinical practices were most valued by the participants. Meanwhile, the participants also had strong expectation of geographical accessibility, high quality of care as well as efficient organizational structure. These organizational elements should be reflected in further reform efforts in order to build high performing PHC organizations.