Abstract
This study aims to explore the attitude, willingness, and satisfaction with contracted service (CS) among staff in community health service (CHS) centers in urban China and to explore the associated factors of satisfaction with CS. From August 2016 to July 2017, five CHS centers in three provinces of China were selected. Setting-level information was collected by official document review; and personal information on demographic characteristics, awareness, willingness, and attitude of CS among staff was collected by questionnaire survey. Univariate and multivariable logistic regression models were fitted to explore the associated factors of satisfaction with CS. Multiple correspondence analysis (MCA) was used to visually demonstrate the correlations among category data related with satisfaction with CS. The CS signing rates were 30.78, 12.72, 22.20, 14.32, and 21.19% in the five CHS centers. A total of 286 staff included family doctors (40.91%), nurses (31.12%), and others (27.97%) completed the survey. For the sense of self-worth, 86.01% (246/286) participants hold a positive attitude. The predominant barrier of CS signing was caused by the work pressure due to CS performance assessment (48.60%, 139/286). About 30% of family doctors and nurses reported a heavy work pressure, and more than 30% of doctors had great feeling of fatigue. Notably, 51.69% family doctors would like to change their job in the future. Compared with other staff, family doctors were more likely to be unsatisfied with CS (OR: 2.793, 95% CI: 1.155–6.754, p = 0.022). Participants in Sichuan province have lower satisfaction than other places. The MCA yielded similar factors consistent with multivariable results of clustering with different levels of CS satisfaction. Our study revealed that the CS coverage and satisfaction among staff from the primary healthcare system varied geographically and are associated with professional field, workload, and pressure. Measures that aim to promote the stability of primary care human resource should be considered in the future.
Highlights
The primary healthcare system in China has contributed substantially to disease prevention and control in China for decades [1]
The number of family doctors (FDs) provided contracted service (CS) for every 100,000 residents were much higher in Yi-cheng center in Shandong province, which is 88, compared with the other four centers of 28, 23, 17, and 24, respectively (Table 1)
The results showed that the predominant factor influencing CS signing was work pressure due to CS performance assessment (48.60%, 139/286), which means that the center should reach a certain proportion of CS signing to meet the strategy established by the National Health Committee
Summary
The primary healthcare system in China has contributed substantially to disease prevention and control in China for decades [1]. Family doctors (FDs), called the family physician or general practitioner, in the community health service (CHS) centers play key role in providing primary healthcare. The CS can be defined as contracts endorsed between FDs and urban citizens in the community units, which will facilitate the doctors to provide more tailored medical care; and the citizens can receive ontime medical service and professional health suggestions. In the mode of CS, residents can choose their FDs voluntarily from local CHS centers. One resident could only sign one health service contract with one FD, but one FD can sign as many contracts with the local residents as is appropriate according to their own wish and capacity [3]
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