Usual source of care and experiences with primary care among community health service centre patients in Changchun, China: A cross-sectional survey.

Abstract

Under China's healthcare reforms, community health service centres (CHCs) have been established as the preferred primary care providers. Even with this change, there is still little attention paid to patients' usual source of care (USC) from CHCs in Northeastern China. The main purposes of this study were to explore the determinants of usual source of community health service and to examine the association between usual source of community health service and patients' experiences with primary care. A cross-sectional survey with 515 adult patients at CHCs in Jilin Province, China, was conducted between July 2016 and November 2016. The patients' experiences with primary care were assessed with the Primary Care Assessment Tool (PCAT). Patients with self-perceived poor health status (odds ratio=1.984, 95% confidence interval=1.145-3.437) and chronic disease (odds ratio=2.207, 95% confidence interval=1.203-4.051) were more likely to have a usual source of community health service than patients with self-perceived good health status or without chronic disease. Patients scored the highest on comprehensiveness of services available (Mean=2.87) and the lowest on community orientation (Mean=1.83) in all domains of the PCAT, with values ranging from 1 to 4. A multiple linear regression analysis revealed that patients with a usual source of community health service had significantly higher overall scores than those without (B=0.205, p<.001). This study demonstrated the important role of CHCs in providing affordable health services for patients with chronic disease or poor health status. Moreover, patients who chose a CHC as a USC had better experiences with primary care compared with patients who did not choose a CHC as a USC. However, community-oriented services need to be improved, and efforts to improve patients' experiences should include policies that incentivise patients to adopt a CHC as their USC.