The quality of primary care in community health centers: comparison among urban, suburban and rural users in Shanghai, China

Author:

Shi Jianwei,Jin Hua,Shi Leiyu,Chen Chen,Ge Xuhua,Lu Yuan,Zhang Hanzhi,Wang Zhaoxin,Yu Dehua

Abstract

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).

Funder

Excellent Young Talents Fund Program of Higher Education Institutions of Anhui Province

Data extraction was financially funded by the Natural Science Foundation of China

The analysis and interpretation of the data guided by the statisticians were funded by the supported by grants from the National Key R&D Program of China

Shanghai Pujiang Program

Publisher

Springer Science and Business Media LLC

Subject

Family Practice

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