The quality of primary care in community health centers: comparison among urban, suburban and rural users in Shanghai, C
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RESEARCH ARTICLE
Open Access
The quality of primary care in community health centers: comparison among urban, suburban and rural users in Shanghai, China Jianwei Shi1,2,3†, Hua Jin2,3,4†, Leiyu Shi5, Chen Chen6, Xuhua Ge2,3,4, Yuan Lu2,3,4, Hanzhi Zhang2,3,4, Zhaoxin Wang1,2,3* and Dehua Yu2,3,4*
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). Keywords: Primary care, Community health centers, Quality, PCAT
* Correspondence: [email protected]; [email protected] † Jianwei Shi and Hua Jin are co-first authors on this paper. 1 School of Public Health, Shanghai Jiaotong University School of Medicine, 227 Chongqing South RD, Shanghai 200025, China 2 Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai 200090, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a cre
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