Dilemma in primary care facility development:a qualitative study based on grounded theory in Guilin city

Abstract

BackgroundSince the new medical reform, remarkable progress was achieved in primary care facilities in the number of consultations and essential public health service program. However, the problems including low quality and high mobility of personnel, weakened capacity and low efficiency of service still remain. Therefore, it has become an urgent task to solve the dilemma in primary care facility development. ObjectiveTo analyze the development dilemma of primary care facilities and propose corresponding countermeasures. MethodsFrom April to May 2021 the managers of 16 primary care facilities in 6 counties and 2 districts in Guilin were selected using multi-stage sampling method and invited to attend semi-structured interviews, which main contents included resource allocation, service capacity building, health insurance policy implementation, and development dilemmas. Grounded theory method was applied to classify, summarize and refine the original interview data at each level by NVivo 11.0 software. ResultsA total of 38 initial concepts, 9 initial categories, 4 main categories, and 1 core category were extracted, and nodes of stagnation in four dimensions including "Constraints in Resource Allocation," "Deviation in Functional Positioning," "Obstacles in the approach of the joint reform of 3Ms(medical service system, medical security system and medicine system)," and "Lack of Cohesion in Hospital Group Construction" were obtained. ConclusionThe development of primary care facilities is constrained by a variety of factors, with resource allocation balance and compensation mechanism improvement as core issue, "approach of the joint reform of 3Ms" as an external condition, "adjustment of functional positioning"(adjustment of functional positioning of primary care facilities) as key link, and the construction of cohesion hospital group as important approach.