Association of Continuity of General Practitioner Care with Utilisation of General Practitioner and Specialist Services in China: A Mixed-Method Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Quantitative Phase
2.2.1. Data Collection and Subjects
2.2.2. Measurements
Outcome Variables
Measurement of COC
Other Covariates
2.2.3. Statistical Analysis
2.3. Qualitative Phase
2.3.1. Sampling and Interviews
2.3.2. Content Analysis
3. Results
3.1. Quantitative Findings
3.2. Qualitative Findings
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Dimension | Items |
---|---|
IC | 1. I know the GP very well |
2. I believe that the GP knows my previous medical history very well | |
3. I believe the GP knows my living environment very well | |
4. I believe the GP knows my daily activities very well | |
5. I believe the GP knows a general level of my health very well | |
MC | 6. I feel comfortable consulting the GP about my doubts or health problems |
7. During the consultation process, the GP can inquire about my physical condition carefully | |
8. The GP is very clear about what kind of treatment is most effective for me | |
RC | 9. I can contact the GP easily when needed |
10. I go to visit the same GP every time I become sick | |
11. The GP can provide services in my home, such as home visits or home care beds | |
12. The GP can communicate with me and teach me health knowledge |
Characteristics of Respondents | n | % |
---|---|---|
Gender | ||
Male | 249 | 39.9 |
Female | 375 | 60.1 |
Age (years) | ||
18–25 | 128 | 20.5 |
26–35 | 278 | 44.6 |
36–45 | 112 | 17.9 |
46–55 | 57 | 9.1 |
≥56 | 49 | 7.9 |
Education | ||
Primary school or below | 24 | 3.8 |
Junior high school | 57 | 9.1 |
High school | 156 | 25.0 |
Bachelor’s degree | 262 | 42.0 |
Graduate degree or above | 125 | 20.0 |
Household income per capita (¥RMB) | ||
<3000 | 39 | 6.3 |
3000– | 162 | 26.0 |
5000– | 153 | 24.5 |
8000– | 101 | 16.2 |
10,000≤ | 169 | 27.1 |
Marital status | ||
Single | 138 | 22.1 |
Married | 447 | 71.6 |
Other | 39 | 6.3 |
Medical insurance | ||
Uninsured | 58 | 9.3 |
Insured | 566 | 90.7 |
Chronic diseases | ||
Yes | 114 | 18.3 |
No | 510 | 81.7 |
Self-rated health status | ||
Bad | 49 | 7.8 |
Fair | 292 | 46.8 |
Good | 283 | 45.4 |
IC | ||
Low | 353 | 56.6 |
High | 271 | 43.4 |
MC | ||
Low | 321 | 51.4 |
High | 303 | 48.6 |
RC | ||
Low | 360 | 57.7 |
High | 264 | 42.3 |
Intention to Visit GP | GP Visits | Specialist Visits | ||||
---|---|---|---|---|---|---|
No | Yes | Mean | SD * | Mean | SD | |
IC | ||||||
Low | 258 | 95 | 0.60 | 1.08 | 0.59 | 0.90 |
High | 142 | 129 | 0.68 | 1.15 | 0.63 | 1.09 |
p | <0.001 | <0.001 | 0.488 | |||
MC | ||||||
Low | 240 | 81 | 0.79 | 1.37 | 0.64 | 1.02 |
High | 160 | 143 | 1.15 | 1.56 | 0.49 | 0.83 |
p | <0.001 | <0.001 | 0.036 | |||
RC | ||||||
Low | 266 | 94 | 0.60 | 0.95 | 0.55 | 0.98 |
High | 124 | 130 | 1.32 | 1.25 | 0.45 | 0.73 |
p | <0.001 | <0.001 | 0.099 |
Characteristics | Intention to Visit GP | GP Visits | Specialist Visits | ||||||
---|---|---|---|---|---|---|---|---|---|
OR * | 95% CI * | p | β | 95% CI | p | β | 95% CI | p | |
IC (ref. = low) | |||||||||
High | 3.583 | 1.828–7.024 | <0.001 | 0.418 | 0.100–0.735 | 0.010 | 0.128 | −0.277–0.533 | 0.535 |
MC (ref. = low) | |||||||||
High | 0.924 | 0.436–1.959 | 0.837 | −0.030 | −0.412–0.352 | 0.878 | −0.438 | −0.874–−0.001 | 0.037 |
RC (ref. = low) | |||||||||
High | 1.758 | 0.843–3.666 | 0.132 | 0.446 | 0.089–0.804 | 0.014 | −0.142 | −0.637–0.243 | 0.381 |
Gender (ref. = male) | |||||||||
Female | 0.929 | 0.627–1.375 | 0.711 | −0.053 | −0.233–0.128 | 0.569 | −0.009 | −0.234–0.215 | 0.935 |
Age (ref. = 18–25) | |||||||||
26–35 | 1.769 | 0.868–3.604 | 0.116 | 0.509 | 0.127–0.891 | 0.009 | 0.044 | −0.401–0.490 | 0.846 |
36–45 | 2.666 | 1.171–6.161 | 0.020 | 0.541 | 0.106–0.975 | 0.015 | 0.224 | −0.261–0.710 | 0.366 |
46–55 | 3.589 | 1.358–9.488 | 0.010 | 0.804 | 0.328–1.279 | 0.001 | −0.106 | −0.702–0.491 | 0.728 |
≥56 | 4.096 | 1.338–12.538 | 0.013 | 0.656 | 0.571–1.542 | 0.001 | 0.065 | −0.562–0.692 | 0.839 |
Education (ref. = primary school or below) | |||||||||
Junior high school | 0.909 | 0.289–2.861 | 0.870 | −0.236 | −0.646–0.174 | 0.259 | −0.410 | −1.152–0.331 | 0.278 |
High school | 0.627 | 0.212–1.849 | 0.397 | −0.157 | −0.551–0.237 | 0.434 | 0.342 | −0.300–0.984 | 0.296 |
Bachelor’s degree | 0.523 | 0.176–1.554 | 0.244 | −0.152 | −0.564–0.260 | 0.471 | 0.241 | −0.416–0.898 | 0.472 |
Graduate degree or above | 0.513 | 0.160–1.640 | 0.260 | −0.386 | −0.851–0.080 | 0.104 | 0.417 | −0.268–1.102 | 0.233 |
Income (ref. ≤ 3000) | |||||||||
3000– | 0.362 | 0.162–0.809 | 0.013 | 0.664 | 0.233–1.095 | 0.003 | 0.759 | 0.090–1.428 | 0.026 |
5000– | 0.297 | 0.131–0.676 | 0.004 | 0.544 | 0.087–1.001 | 0.020 | 0.543 | −0.146–1.232 | 0.122 |
8000– | 0.316 | 0.132–0.759 | 0.010 | 0.564 | 0.078–1.050 | 0.023 | 0.544 | −0.167–1.255 | 0.134 |
≥10,000 | 0.154 | 0.065–0.367 | 0.000 | 0.561 | 0.095–1.027 | 0.018 | 0.940 | 0.256–1.625 | 0.007 |
Marital status (ref. = Single) | |||||||||
Married | 0.510 | 0.259–1.006 | 0.052 | −0.022 | −0.363–0.318 | 0.898 | 0.223 | −0.179–0.333 | 0.295 |
Other | 0.381 | 0.135–1.078 | 0.069 | −0.405 | −0.866–0.055 | 0.084 | 0.222 | −0.307–0.461 | 0.446 |
Medical insurance (ref. = Uninsured) | |||||||||
Insured | 0.608 | 0.323–1.144 | 0.123 | 0.118 | −0.231–0.466 | 0.509 | 0.406 | −0.077–0.888 | 0.099 |
Chronic diseases (ref. = no) | |||||||||
Yes | 0.913 | 0.494–1.685 | 0.770 | 0.364 | 0.114–0.614 | 0.004 | 0.549 | 0.253–0.844 | 0.001 |
Self-rated health status (ref. = bad) | |||||||||
Fair | 0.807 | 0.376–1.732 | 0.582 | −0.464 | −0.733–−0.195 | 0.001 | −0.330 | −0.677–0.017 | 0.063 |
Good | 0.953 | 0.439–2.071 | 0.903 | −0.619 | −0.905–0.333 | 0.000 | −0.378 | −0.739—0.016 | 0.041 |
Domains | Associated Themes | Example of Verbatim Transcript |
---|---|---|
Service capabilities | Effective treatment (20 interviewees) | “…When I get sick, I go to a tertiary hospital, because the treatment is very effective, and the general practitioners in the community are not technical…” “…The diagnosis and treatment skills of general practitioners are not as good as those of specialists in tertiary hospitals, so I still choose tertiary hospitals…” |
Working experience and education of GPs (18 interviewees) | “…Most of the general practitioners’ academic qualifications are college or undergraduate qualifications, and the level of education is generally low…, but the qualifications of specialists in tertiary hospitals are mostly Ph.D.” “…Many general practitioners are very young and have no experience, so I have no confidence in their skills. I am afraid that there will be misdiagnosis and missed diagnosis…” | |
Accuracy of diagnosis (16 interviewees) | “…Community health service centres lack a lot of medical equipment, and some laboratory tests cannot be done…, Only essential medicines are provided, and other medicines cannot be used…” | |
Doctor–patient interaction | Doctor–patient communication (19 interviewees) | “…For some minor illnesses, I usually visit a GP because he has time to communicate with me and tell me what I should pay attention to in my daily life…” |
Doctor–patient familiarity (17 interviewees) | “…I signed a GP as my family doctor. He often visits for follow-up visits, so he knows my situation well. So, it’s very convenient for me to visit GP…” | |
Doctor–patient trust (14 interviewees) | “…I am a hypertensive patient and often come to community health service centres. I know general practitioners very well. They will prescribe different drugs for me according to my blood pressure. Currently my blood pressure is controlled very well, I trust them very much… Sometimes they followed up regularly and give some guidance on diet and drug use” | |
Time provision | Waiting time (15 interviewees) | “…The community health service centre is very close to my home. It is very convenient for me to come here to see a general practitioner. At the same time, it’s not like a tertiary hospital where you have to wait in line for a long time…” |
Service time (12 interviewees) | “…General practitioners also provide me with service lasting at least 15 min of and ask me carefully about my condition, but specialists in tertiary hospitals spend about 5 min each time…” |
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Zhang, T.; Wang, X. Association of Continuity of General Practitioner Care with Utilisation of General Practitioner and Specialist Services in China: A Mixed-Method Study. Healthcare 2021, 9, 1206. https://doi.org/10.3390/healthcare9091206
Zhang T, Wang X. Association of Continuity of General Practitioner Care with Utilisation of General Practitioner and Specialist Services in China: A Mixed-Method Study. Healthcare. 2021; 9(9):1206. https://doi.org/10.3390/healthcare9091206
Chicago/Turabian StyleZhang, Tao, and Xiaohe Wang. 2021. "Association of Continuity of General Practitioner Care with Utilisation of General Practitioner and Specialist Services in China: A Mixed-Method Study" Healthcare 9, no. 9: 1206. https://doi.org/10.3390/healthcare9091206