Abstract
PurposeFew studies explored the relationship between the family doctor contract services (FDCS) and health-related quality of life (HRQOL) among patients with chronic diseases in rural China. This study aims to explore the relationship between the status of signing on FDCS and HRQOL among patients with chronic diseases and examine whether there are differences in the relationship between different socioeconomic status (SES).MethodsA total of 1,210 respondents were included in this study. HRQOL was measured by EQ-5D-3L. The contracting status was divided into uncontracted and contracted. Tobit regression and Logistic regression were employed to explore the association between contracting status and HRQOL. The interaction terms were included to explore the differences in the association among different SES.ResultsContracting with family doctors was associated with HRQOL (coefficient = 0.042; 95%CI 0.008 to 0.075). The association was different among different socioeconomic levels that the contracting status was only associated with HRQOL in sub-high-income (P < 0.01) and highly educated patients (P < 0.05). Compared with uncontracted patients, contracted patients reported higher ED-5D-3L utility value in the sub-high-income group (coefficient = 0.078; 95%CI 0.017 to 0.140) and high educational attainment (coefficient = 0.266; 95%CI 0.119 to 0.413).ConclusionsThis study found a significant association between FDCS and HRQOL among chronic patients in rural Shandong, China. This relationship varied by income levels and educational attainment. The government should take efforts to formulate a variety of measures to encourage chronic patients to contract with family doctors, with special attention to people with low SES.
Highlights
With the aging of the population and the change of disease spectrum, the morbidity and mortality of chronicLi et al Int J Equity Health (2021) 20:191 showed that grass-root preventive interventions could improve the unhealthy lifestyles of people with chronic diseases
Other studies have demonstrated there was a differential association between chronic conditions and Health-related quality of life (HRQOL) across different socioeconomic status (SES) positions [20]. These findings suggest the association between family doctor contract services (FDCS) and HRQOL might be different among patients of chronic diseases with different SES, which needs to be clarified
The independent-samples t-test results showed that there were significant differences in EQ-5D-3L utility value between different contracting status, the mean EQ-5D-3L utility values were higher among contracted patients than uncontracted patients, and more problems were reported in the uncontracted group of all dimensions
Summary
With the aging of the population and the change of disease spectrum, the morbidity and mortality of chronicLi et al Int J Equity Health (2021) 20:191 showed that grass-root preventive interventions could improve the unhealthy lifestyles of people with chronic diseases. The family doctor system originated in the United States in the 1960s, which incorporated health management into the community general practitioner service model, and conducted active follow-up observation on patients with chronic diseases [7, 8]. Doctors provide residents who have signed with basic medical services and public health services. In terms of basic medical services, family doctors provide services packages including common diseases treatment, follow-ups, and referrals. In terms of public health services, family doctors conduct proactive life intervention measures to prevent and manage chronic conditions, create and manage individual health records, and give annual physical health examinations for the contracted residents
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