A total of 960 patients were approached for study inclusion, 828patients responded to the questionnaire, and 132 patients did not complete investigation. This response rate was 86.25%.The most common reason for non-response was having no time. Since the questionnaire was collected through face-to-face interviews, the completed questionnaire had almost no missing values. The average age was 61.9. Over 60% of patients were over 60. Of the interviewees, 453 patients had signed the contract (54.7%) and 375 did not (45.3%). There were no significant differences in terms of gender, marital status, self-evaluated physical health and chronic conditions between the two groups (p > 0.05). However, significant differences were reported in the dimensions of age, education, family monthly income, patient satisfaction, and proportion of medical expenditure to total family expenditure (p < 0.05)(table 1).
Table One: The socio-demographic status and health care service utilization between the contracted and un-contracted patients
Variable | Scales | Total (n = 828) | Contracted (n = 453) | Un-contracted (n = 375) | χ2 | P |
Socio-demographic characteristics | | | | | |
gender | Male | 310(37.4) | 174(38.4) | 136(36.3) | 0.403 | 0.564 |
| Female | 518(62.6) | 279(61.6) | 239(63.7) | | |
Age | 18–34 | 55(6.6) | 17(3.8) | 38(10.1) | 38.111 | < 0.001 |
| 35–59 | 237(28.6) | 102(22.5) | 135(36.0) | | |
| ≥ 60 | 536(64.7) | 334(73.7) | 202(53.9) | | |
Marital status | Yes | 150(18.1) | 80(17.7) | 70(18.7) | 0.140 | 0.718 |
| No | 678(81.9) | 373(82.3) | 305(81.3) | | |
Education | Junior high and lower | 580 (70.0) | 360(79.5) | 220(58.7) | 42.321 | 0.000 |
| Senior high and above | 248(30.0) | 93(20.5) | 155(41.3) | | |
Family monthly income | ≥ 3000 RMB | 532(64.3) | 320(70.6) | 212(56.5) | 17.775 | 0.000 |
| < 3000 RMB | 296(35.7) | 133(29.4) | 163(43.5) | | |
Service utilization | | | | | |
Self-evaluated | Good | 283(34.2) | 149(32.9) | 134(35.7) | 0.736 | 0.418 |
physical health | | | | | | |
| Fair and poor | 545(65.8) | 304(67.1) | 241(64.3) | | |
Patient | Satisfied | 621(75) | 354(78.1) | 267(71.2) | 5.279 | 0.024 |
satisfaction | | | | | | |
| Unsatisfied | 207(25) | 99(21.9) | 108(28.8) | | |
Proportion of medical | < 10% | 358(43.2) | 212(46.8) | 146(38.9) | 5.172 | 0.024 |
expenditures to total Family expenditures | 10%以上 | 470(56.8) | 241(53.2) | 229(61.1) | | |
Chronic conditions | yes | 434(52.4) | 248(54.7) | 186(49.6) | 3.274 | 0.195 |
| no | 393(47.5) | 205(45.3) | 188(50.1) | | |
Since continuity referral was limited to patients who had been referred to large hospitals, only 45.2% patients who were qualified to answer within this dimension. To avoid possible bias, the calculation of PCAT total score excluded this continuity (referral) dimension. The average of PCAT score was 27.68. Covariate analysis was adopted to compare the two gro-up of patients’ perceived feeling of the quality of each dimension as well as the PCAT score controlling for the socio-demographic and service utilization factors. The adjusted score of each PCAT dimension were calculated, and P value was offered to show the difference between groups, after controlling for gender, age, marital status, education, family monthly income, self-evaluated physical health, patient satisfaction, proportion of medical expenditure to total family expenditure, and chronic conditions. The patients who received family doctor contract services reported higher scores than those that did not, in the dimensions of total Pact score (28.79 vs26.43;p < 0.001),first contact-utilization(3.40vs3.17;p < 0.001),first contact accessibility(3.00vs2.63;p < 0.001),continuity(3.03 vs2.71;p < 0.001), coordination(referral)(3.17vs2.82,p0.001),comprehensiveness(service utilization)(3.40vs3.06;p < 0.001), and comprehensiveness(service provision)(3.50vs 3.25;p < 0.001);family-centeredness(2.87vs2.69;p < 0.01), community orientation(2.99vs2.40;p < 0.001),No significant difference was found in coordination(information system) and culture orientation between the two groups of patients(Table Two).
Table Two - Primary care quality scores between contracted and un-contracted patients, adjusted
| Adjusted-mean(95%CI) | P |
Dimension | contracted (1) | Un-contracted (2) | D-value (1)-(2) | |
First contact-utilization | 3.40(3.35,3.46) | 3.17(3.11,3.23) | 0.23 | < 0.001 |
first-contact-accessibility | 3.00(2.95,3.07) | 2.63(2.56,2.70) | 0.37 | < 0.001 |
continuity | 3.03(2.97,3.09) | 2.71(2.64,2.78) | 0.32 | < 0.001 |
coordination (referral) | 3.17(3.07,3.28) | 2.82(2.70,2.94) | 0.35 | < 0.001 |
coordination | 3.32(3.25,3.39) | 3.23(3.15,3.31) | 0.09 | 0.137 |
(information system) | | | | |
comprehensiveness | 3.40(3.35,3.46) | 3.06(3.00,3.12) | 0.34 | < 0.001 |
(utilization) | | | | |
comprehensiveness | 3.50(3.43,3.57) | 3.25(3.18,3.32) | 0.25 | < 0.001 |
(provision) | | | | |
family-centeredness | 2.87(2.79,2.94) | 2.69(2.61,2.78) | 0.18 | 0.003 |
community orientation | 2.99(2.93,3.05) | 2.40(2.33,2.47) | 0.59 | < 0.001 |
culture orientation | 3.26(3.20,3.32) | 3.17(3.11,3.24) | 0.09 | 0.056 |
total score | 28.79(28.45,29.14) | 26.34(25.96,26.72) | 2.45 | < 0.001 |
Notes: Nine dimensions were included to calculate the total score. The dimension of coordination (referral) was excluded as it was only answered by a few patients who received referral services. |
Further analyses were made to explore the effect of the contract on the quality of primary care by controlling for the other influencing factors. The multivariate liner regression results showed that the patients who received contract services reported higher PCAT total scores (β=-8.98, P < 0.000) ,first contact-utilization(β=-0.71, P < 0.001), first contact-accessibility(β=-1.49, P < 0.001), continuity(β = 1.27, P < 0.001), coordination(referral) (β=-1.42, < 0.001), comprehensiveness(utilization) (β=-1.70, P < 0.001), comprehensiveness(provision) (β=-0.99, P < 0.001) ,family-centeredness(β=-0.52, P < 0.01),community orientation(β=-1.78, P < 0.001), than those who did not receive contract services after controlling for socio-demographic and service utilization factors. There were no statistically significant differences in the coordination (information system) (β=-0.25, P = 0.137) and culture orientation (β=-0.264, P = 0.056). (Table three). In addition, factors significantly associated with higher PCAT total scores included patient satisfaction and chronic conditions. Patients satisfied with primary care institutions and those with chronic conditions tended to report better primary care experiences.
Table Three - multivariate liner regression of the each dimension and
Pact Total Scores
variable | total score β (95% CI) | first contact- utilization β (95% CI) | first contact- accessibility β (95% CI) | continuity β (95% CI) |
Contract | | | | |
yes | | | | |
no | -8.98(-10.83,-7.13) *** | -0.71(0.96,0.45) *** | -1.49(-1.87,-1.12) *** | -1.27(-1.63.-0.90)*** |
socio-demographic | | | | |
gender | | | | |
male(ref) | | | | |
female | − .906(-2.76,0.94) | 0.03(-0.23,0.28) | -0.44(-0.81,-0.06) * | -0.15(-0.52,0.22) |
age | | | | |
18–59(ref) | | | | |
≥ 60 | -1.335(-3.42,0.75) | 0.12(-.17,040) | -0.40(-0.82,0.03) | -0.41(-0.82,0.01) |
Marital status | | | | |
Unmarried(ref) | | | | |
married | 1.31(-.99,3.61) | − .20(0.34,0.29) | 0.20(-0.27,0.67) | -0.39(-0.07,0.85) |
education | | | | |
Junior high and lower(ref) | | | | |
Senior high and above | -0.26(-1.38,0.84) | -0.22(-0.37,-0.07)** | -0.18(-0.41,0.04) | -0.24(-0.46,-0.01) * |
Family monthly income(¥) | | | | |
< 3000(ref) | | | | |
≥ 3000 | -0.25(-1.24,0.74) | -0.17(-0.31,-0.03) * | -0.32(-0.52,-0.12) ** | -0.17(-0.37,-0.03) |
Service utilization | | | | |
Self-evaluated | | | | |
Good(ref) | | | | |
Fair and poor | -0.39(-1.37,0.60) | 0.04(-0.09,-.18) | -0.07(-0.27,0.13) | 0.01(-0.19,0.21) |
Patient’s satisfaction | | | | |
Satisfaction(ref) | | | | |
Un-satisfaction | -9.25(-11.30,-7.20) *** | -0.78(-1.06,-0.50) *** | -1.27(-1.70,-0.86) *** | -1.37(-1.78,-0.96) *** |
Proportion of medical expenditures to total family expenditures | | | | |
≤ 10%(ref) | | | | |
> 10 | 0.66(-1.21,2.52) | -0.12(-0.38,0.13) | 0.37(-0.01,0.75) | 0.05(-0.32,0.43) |
Chronic conditions | | | | |
no(ref) | | | | |
Yes | 2.53(1.00,4.06) ** | 0.20(-0.10,-.41) | -0.04(-0.35,0.26) | 0.42(0.11,0.72) ** |
注: ***P < 0.001, **P < 0.01, *P < 0.05。
Continue Table Three
variable | Coordination (referral) β (95% CI) | Coordination(information system) β (95% CI) | Comprehensiveness (utilization) β (95% CI) | Comprehensiveness (provision) β (95% CI) |
Contract | | | | |
yes | | | | |
no | -1.42(-2.09,-0.74) *** | -0.25(-0.58,-0.08) | -1.70(-2.11,-1.29)*** | -0.99(-1.40,-0.60) *** |
socio-demographic | | | | |
sex | | | | |
male(ref) | | | | |
female | -0.30(-0.98,0.37) | 0.25(-0.08,0.58) | -0.33(-0.73,0.08)) | -0.22(-0.62,0.18) |
age | | | | |
18–59(ref) | | | | |
≥ 60 | 0.26(-0.51,1.04) | -0.08(-0.46,0.29) | -0.08(-0.46,0.29) | 0.05(-0.40,0.50) |
Marital status | | | | |
Unmarried(ref) | | | | |
married | -0.20(-0.99,0.59) | 0.41(-0.01,0.82) | -0.22(-0.73,0.08) | -0.05(-0.54,0.45) |
education | | | | |
Junior high and lower(ref) | | | | |
Senior high and above | -0.42(-0.82,-0.02) | -0.24(0.04,0.44) ** | 0.16(-0.09,0.40) | -0.09(-0.33,0.15) |
Family monthly income(¥) | | | | |
< 3000(ref) | | | | |
≥ 3000 | -0.05(-0.40,0.30) | 0.12(-0.06,-.30) | 0.14(-0.08,0.36) | 0.14(-0.08,0.35) |
Service utilization | | | | |
Self-evaluated | | | | |
Good(ref) | | | | |
Fair and poor | -0.18(-0.18,0.54) | 0.01(-0.17,0.18) | -0.09(-0.31,0.13) | -0.15(-1.60,-0.71) |
Patient’s satisfaction | | | | |
Satisfaction(ref) | | | | |
Un-satisfaction | -0.79(-1.53,-0.05) | -0.65(-1.02,-0.28) ** | -1.17(-1.62,-0.72) *** | -1.15(-1.60,-0.71) *** |
Proportion of medical expenditures to total family expenditures | | | | |
≤ 10%(ref) | | | | |
> 10 | 0.03(-0.71,0.76) | 0.25(-0.09,0.58) | -0.51(-0.92,-0.10) * | 0.21(-0.19,0.61) |
Chronic conditions | | | | |
no (ref) | | | | |
Yes | -0.43(-1.18,0.32) | 0.39(0.11,0.66) ** | 0.53(0.19,0.87) ** | 0.49(0.16,0.82) ** |
注: ***P < 0.001, **P < 0.01, *P < 0.05。
Continued Table Three
variable | Family-centeredness β (95% CI) | Community- orientation β (95% CI) | Culture- orientation β (95% CI) |
Contract | | | |
yes | | | |
no | -0.52(-0.86,-0.18) ** | -1.78(-2.06,-1.49) *** | -0.26(-0.54,0.01) |
socio-demographic | | | |
sex | | | |
male(ref) | | | |
female | -0.03(-0.37,-.31) | -0.30(-0.58,-0.01) ** | 0.28(0.01,0.55) |
age | | | |
18–59(ref) | | | |
≥ 60 | -0.35(-0.74,0.03) | -0.35(-0.74,0.03) | -0.19(-0.49,-.12) |
Marital status | | | |
Unmarried(ref) | | | |
married | 0.08(-0.34,0.50) | 0.13(-0.23,0.48) | 0.40(0.06,0.73) * |
education | | | |
Junior high and lower(ref) | | | |
Senior high and above | 0.11(-0.09,0.31) | -0.08(-0.25,0.09) | 0.04(-0.124,0.20) |
Family monthly income(¥) | | | |
< 3000(ref) | | | |
≥ 3000 | -0.05(-0.23,-.14) | -0.02(-0.17,0.14) | 0.08(-0.07,0.23) |
Service utilization | | | |
Self-evaluated | | | |
Good(ref) | | | |
Fair and poor | -0.13(-0.32,-.04) | -0.04(-0.19,-.12) | 0.04(-0.11,0.18) |
Patient’s satisfaction | | | |
Satisfaction(ref) | | | |
Un-satisfaction | -0.93(-1.30,-0.55) *** | -1.16(-1.48,-0.84) *** | -0.77(-1.07,-0.47) *** |
Proportion of medical expenditures to total family expenditures | | | |
≤ 10%(ref) | | | |
> 10 | 0.47(0.13,0.81) ** | -0.06(-0.35,0.23) | 0.01(-0.27,0.28) |
Chronic conditions | | | |
no (ref) | | | |
Yes | 0.31(0.03,0.59) * | 0.04(-0.20,0.27) | 0.20(-0.02,0.42) |
注:***P < 0.001, **P < 0.01, *P < 0.05。