Effect of family practice contract services on the quality of primary care in Guangzhou, China: a cross-sectional study using PCAT-AE

Abstract

ObjectiveCurrent 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.DesignA 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.SettingThree community health centres in Guangzhou, China.Participants698 patients aged 18–89 years.Main outcome measuresThe 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).ResultsA 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.ConclusionOur 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.