Usual source of care and the quality of primary care: a survey of patients in Guangdong province, China

International Journal for Equity in Health

Ruwei Hu²  Yuantao Hao¹  Chien-Chou Chen³  Yu Liao¹  Zhicheng Du¹ 

[1] Department of Medical Statistics and Epidemiology, Health Information Research Center, Guangdong Key, Laboratory of Medicine, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou 510080, Guangdong Province, Peoples Republic of China;Department of health management, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou 510080, Guangdong Province, Peoples Republic of China;Department of International Business, Ling Tung University, Taichung City 40852, Taiwan, R.O.C

关键词: Community health centers;    Quality of care;    Primary care;    Usual source of care;   

Others  :  1222802
DOI  :  10.1186/s12939-015-0189-4

 received in 2015-05-21, accepted in 2015-07-17,  发布年份 2015

【 摘 要 】

Introduction

Usual source of care (USC) refers to the provider or place a patient consults when sick or in need of medical advice. No studies have been conducted in China to compare the quality of primary care provided with or without USC. The purpose of this study was to fill this gap in the literature by examining the quality of primary care provided between those having a USC and those without. Results of the study would provide implications for policymakers in terms of improving primary care performance in China, and help guide patients in their health care seeking behaviors.

Methods

A cross-sectional survey with patients was conducted in Guangdong province of China, using the Chinese validated Primary Care Assessment Tool (PCAT). ANOVA was performed to compare the overall and ten domains of primary care quality for patients with and without USC. Multivariate analyses were used to assess the association between USC and quality of primary care attributes while controlling for sociodemographic and health care characteristics.

Results

The study added evidence that having a USC can provide higher quality of primary care to patients than those without a USC. Results of this study showed that the PCAT score associated with those having a USC was significantly higher than those not having a USC. Moreover, the study showed that having a usual provider of care was also independently and significantly associated with patients’ satisfaction with care.

Conclusions

This study added evidence that in China, patients with a USC reported higher quality of medical care experiences compared with those without a USC. The efforts to improve quality of care should include policies promoting USC.

【 授权许可】

   
2015 Du et al.

【 图 表 】

Fig. 1.

Fig. 2.

【 参考文献 】

• [1]Starfield B. Is primary care essential? Lancet. 1994; 344(8930):1129-1133.
• [2]Damiano PC, Momany ET, Tyler MC, Penziner AJ, Lobas JG. Cost of outpatient medical care for children and youth with special health care needs: investigating the impact of the medical home. Pediatrics. 2006; 118(4):e1187-1194.
• [3]Starfield B, Shi L. The medical home, access to care, and insurance: a review of evidence. Pediatrics. 2004; 113(5 Suppl):1493-1498.
• [4]Smith PJ, Santoli JM, Chu SY, Ochoa DQ, Rodewald LE. The association between having a medical home and vaccination coverage among children eligible for the vaccines for children program. Pediatrics. 2005; 116(1):130-139.
• [5]Mainous AG, Hueston WJ, Love MM, Griffith CH. Access to care for the uninsured: Is access to a physician enough? Am J Public Health. 1999; 89(6):910-912.
• [6]Li C, Dick AW, Fiscella K, Conwell Y, Friedman B. Effect of usual source of care on depression among medicare beneficiaries: An application of a simultaneous-equations model. Health Serv Res. 2011; 46(4):1059-1081.
• [7]Petterson SM, Rabin D, Phillips RL, Bazemore AW, Dodoo MS. Having a usual source of care reduces ED visits. Am Fam Physician. 2009; 79(2):94.
• [8]Safran DG, Karp M, Coltin K, Chang H, Li A, Ogren J, Rogers WH. Measuring patients’ experiences with individual primary care physicians. Results of a statewide demonstration project. J Gen Intern Med. 2006; 21(1):13-21.
• [9]Safran DG, Kosinski M, Tarlov AR, Rogers WH, Taira DH, Lieberman N, Ware JE. The Primary Care Assessment Survey: tests of data quality and measurement performance. Med Care. 1998; 36(5):728-739.
• [10]Schmittdiel J, Selby JV, Grumbach K, Quesenberry CP. Choice of a personal physician and patient satisfaction in a health maintenance organization. JAMA. 1997; 278(19):1596-1599.
• [11]Shi L, Sun Y, Nie X, Meng Q. Job Satisfaction by Chinese Primary Care Doctors Following Health Care Reform. China Health Policy And Management Society. 2013; 4(3):15-27.
• [12]Wei X, Zou G, Zhang H, Walley J, Liu Z, Newell J, Sun Q, Li R. Implementation of the Chinese national microscopy centre policy: health facility survey in Shandong Province. Tropical medicine & international health : TM & IH. 2011; 16(7):847-853.
• [13]Ji L, Newman J, Lu J, Cai X. Understanding the standard of care in the treatment of type 2 diabetes in China: results from a national survey. Chin Med J. 2014; 127(20):3524-3529.
• [14]Goldstein RB, Rotheram-Borus MJ, Johnson MO, Weinhardt LS, Remien RH, Lightfoot M, Catz SL, Gore-Felton C, Kirshenbaum S, Morin SF. Insurance coverage, usual source of care, and receipt of clinically indicated care for comorbid conditions among adults living with human immunodeficiency virus. Med Care. 2005; 43(4):401-410.
• [15]O’Malley AS, Mandelblatt J, Gold K et al.. Continuity of care and the use of breast and cervical cancer screening services in a multiethnic community. Arch Intern Med. 1997; 157:1462-1470.
• [16]Rew L, Resnick M, Beuhring T. Usual sources, patterns of utilization, and foregone health care among Hispanic adolescents. J Adolesc Health. 1999; 25:407-413.
• [17]Weiss GL, Ramsey CA. Regular source of primary medical care and patient satisfaction. QRB Qual Rev Bull. 1989; 15:180-184.
• [18]Gill JM. Can hospitalization be avoided by having a regular source of care? Fam Med. 1997; 29:166-177.
• [19]Sarver JH, Cydulka RK, Baker DW. Usual source of care and nonurgent emergency department use. Acad Emerg Med. 2002; 9:916-923.
• [20]Lambrew JM, DeFriese GH, Carey TS et al.. The effects of having a regular doctor on access to primary care. Med Care. 1996; 34:138-151.
• [21]Weinick RM, Drilea SK. Usual sources of health care and barriers to care, 1996. Stat Bull Metrop Life Insur Co. 1998; 79:11-17.
• [22]Tsai J, Shi L, Yu WL, Lebrun LA. Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese community. Med Care. 2010; 48(7):628-634.
• [23]Shi L, Starfield B, Xu J, Politzer R, Regan J. Primary care quality: community health center and health maintenance organization. South Med J. 2003; 96(8):787-795.
• [24]Yang H, Shi L, Lebrun LA, Zhou X, Liu J, Wang H. Development of the Chinese primary care assessment tool: data quality and measurement properties. Int. J. Qual. Health Care. 2013; 25(1):92-105.
• [25]Green LA. Science and the future of primary care. J Fam Pract. 1996; 42(2):119-122.
• [26]Greenfield S, Rogers W, Mangotich M, Carney MF, Tarlov AR. Outcomes of patients with hypertension and non-insulin dependent diabetes mellitus treated by different systems and specialties. Results from the medical outcomes study. JAMA. 1995; 274(18):1436-1444.
• [27]Politzer RM, Yoon J, Shi L, Hughes RG, Regan J, Gaston MH. Inequality in America: the contribution of health centers in reducing and eliminating disparities in access to care. Med Care Res Rev. 2001; 58(2):234-248.
• [28]Regan J, Lefkowitz B, Gaston MH. Cancer screening among community health center women: eliminating the gaps. J Ambul Care Manage. 1999; 22(4):45-52.