Family Doctor Contract Services Research Articles

Impact of Family Doctor Contract Services on Preventable Hospitalizations Amongst Patients with Hypertension in Rural China: Mediating Role of Primary Healthcare Quality.

The objective of this study was to explore the connection between family doctor contract services and preventable hospitalizations. Additionally, we sought to examine the role of primary health care quality as a mediating factor in the link between family doctor contract services and preventable hospitalizations among patients with hypertension. This cross-sectional study was performed in Dangyang (Hubei Province, Central China) and Xishui (Guizhou Province, Western China) counties in July-August 2023. Participants comprised 625 patients selected via a multi-stage sampling method. Causal mediation analysis was conducted to explore the effect of family doctor contract services on preventable hospitalizations and the mediating effect of primary healthcare quality on this relationship. Utilization rate of family doctor contract services of hypertensive patients was 58.6%, score of primary health service quality was 70.75 and incidence of preventable hospitalizations was 28.2%. Amongst hypertensive patients, utilization of family doctor contract services decreased the occurrence of preventable hospitalizations, with a total effect of -0.22 (p < 0.001). Primary healthcare quality mediates the association, with a mediate effect of -0.05 (p < 0.001), explaining 22.73% of the total effect. Improving the utilization of family doctor contract services and primary healthcare quality may result in lower rates of preventable hospitalizations amongst hypertensive patients.

Community Health Centers' Responsiveness and Its Associated Factors Among Outpatients in Southeast China: A Cross-Sectional Study.

The responsiveness of community health centers can reflect the soft capacity of medical institutions and is related to the improvement of health outcome indicators. This study is aimed at assessing the level and distribution of community health centers' responsiveness and its associated factors among outpatients under the health-oriented integrated healthcare system in China. A total of 634 outpatients were recruited from six community health centers in Zhejiang Province, China, in July 2022. SPSS software was used to conduct the analysis (version 23.0). Health system responsiveness was used as a measure of outpatient responsiveness to health care services through a self-administered questionnaire. Determinants of community health centers' responsiveness were determined by using a multiple linear regression model at a p-value <0.05. The total score of community health centers responsiveness was 8.25±1.01, and the Gini coefficient is 0.027. Within these domains, social support and dignity received the highest scores, while choice of providers and autonomy scored the lowest. Age group between 60-74 years (β: 0.129; 95% CI: 0.042-0.529), ≥75 years (β: 0.095; 95% CI: 0.006-0.707), monthly income with 8000 RMB and above (β: 0.098; 95% CI: 0.035-0.653), having a family doctor (β: 0.124; 95% CI: 0.096-0.410), and satisficing with community health service (β: 0.298; 95% CI: 0.848-1.428) were significant predictors of community health centers' responsiveness. The Chinese community health centers show high responsiveness, indicating that the construction of a health-oriented integrated healthcare system has been effective. The family doctor contract service is important and should continually enhance both technical proficiency and health promotion capabilities. Encourage residents to actively participate in their treatment process is also essential.

The association between family doctor contract services and the health of middle-aged and older people in China: an instrumental variables analysis

Previous research on the association between Family Doctor Contract Services (FDCS) and health has only considered a single indicator of health and has not considered the endogeneity of independent variables. This study aimed to evaluate the association from a multidimensional perspective of the health of middle-aged and older people using the instrumental variables method and determine the underlying mechanisms. Using data from the 2018 China Health and Retirement Longitudinal Study surveys, a total of 19,438 sample was obtained. Health was measured by health related-quality of life (HR-QoL), subjective well-being, and cognitive function. The instrumental variables method was used to estimate the association. Mediation analysis was employed to analyze the underlying mechanisms. The results of the instrumental variables method showed a correlation between FDCS and health, such as HR-QoL (η = 33.714, p < 0.01), subjective well-being (η = 1.106, p < 0.05), and cognitive function (η = 4.133, p < 0.05). However, we found no evidence that FDCS improved physical health. We also identified reduced utilization of healthcare services and increased social activities as mediators of the effect of FDCS on health. The Chinese government should improve incentive-based initiatives to improve the quality of FDCS. Moreover, more attention needs to be paid to the multidimensional health of middle-aged and older people, especially vulnerable groups, such as older individuals and those in rural areas.

Study on the evaluation and influencing factors of contracted residents on the coordination of primary medical institutions.

The implementation of family doctor contract service is a pivotal measure to enhance primary medical services and execute the hierarchical diagnosis and treatment system. Achieving service coordination among various institutions is both a fundamental objective and a central element of contract services. The study aims to assess residents' evaluations and determining factors related to the coordination of health services within primary medical institutions across different regions of Shandong Province. The findings intend to serve as a reference for enhancing the coordination services offered by these institutions. The study employed a multi-stage stratified random sampling method to select three prefecture-level cities in Shandong Province with different economic levels. Within each city, three counties (districts) were randomly sampled using the same method. Within each county (district), three community health service centers and township health centers implementing family doctor contract services were selected randomly. Face-to-face questionnaire surveys were conducted with contracted residents using the coordination dimension of the revised Primary Care Assessment Tools Scale (PCAT) developed by the research team. Data analysis was conducted using such methods as one-way analysis of variance and multiple linear regression. The sample included 3,859 contracted residents. The coordination dimension score of primary medical institutions averaged 3.41 ± 0.18, with the referral service sub-dimension scoring 3.60 ± 0.58 and the information system sub-dimension scoring 3.34 ± 0.65. The overall score of the referral service sub-dimension surpassed that of the information system sub-dimension. Regression results indicated that the city's economic status, the type of contracted institutions, gender, education, marital status, income, occupation, health status, and endowment insurance payment status significantly influenced the coordinated service score of primary medical institutions (p < 0.05). The coordination of primary medical institutions in Shandong Province warrants further optimization. Continued efforts should focus on refining the referral system, expediting information infrastructure development, enhancing the service standards of primary medical institutions, and fostering resident trust. These measures aim to advance the implementation of the hierarchical diagnosis and treatment and two-way referral system.

Current situation of family doctor contracting program: A survey of the perspective of general practitioners

BackgroundResearch on family doctor contract services has predominantly focused on residents, with limited attention to the general practitioners (GPs) regarding the current situation of family doctor team contracting. ObjectiveThis study aims to assess the current status of family doctor contract services in primary health care facilities in Guangdong Province from the GPs' perspective and to identify factors influencing the number of people contracting with family doctor teams. MethodsA multi-stage stratified cluster sampling method was used to select GPs from primary health care facilities in Guangdong Province from July 5 to July 31, 2021. A self-developed survey questionnaire was used to collect data. The number of people contracted with family doctor teams under different characteristics of GPs and their teams was compared, and a two-level Logistic regression model was developed using R 4.2.2 software to determine the factors that influence whether enrollment numbers in family doctor teams exceed 2,000. ResultsA total of 3,252 valid responses were collected from family doctor teams with a contracting count above 100. In 2020, the median number of contracts per family doctor team, as reported by GPs, was 1,400(IQR = 2,499). Comparisons of the number of people contracted with family doctor teams among GPs of different genders, ages, educational levels, managerial positions, employment forms, years of professional experience, working facilities, practicing regions, training received, and annual income showed statistically significant differences (P < 0.05). Variables including the number of team members, the population under jurisdiction, the intention for specialist doctors within the health group to join the team, the availability of hospital beds, and guidance from higher-level hospitals also exhibited significant variations (P < 0.05). Zero model fitting results highlighted that the distribution of contracted individuals was regionally clustered among the practicing regions of GPs (P < 0.05). The comprehensive analysis using a two-level Logistic regression model revealed several key findings: GPs holding a college diploma [OR (95 %CI) = 2.79 (1.84, 3.74)] or a vocational school/high school certificate [OR (95 %CI) = 2.83 (1.80, 3.86)] were more likely to manage teams with over 2,000 contracted individuals, compared to those with a master's degree or higher. GPs in managerial positions were less likely [OR (95 %CI) = 0.66 (0.33, 0.99)] to oversee teams exceeding 2,000 contracted individuals, in contrast to those without any managerial role. Formal employment status was associated with a higher likelihood [OR (95 %CI) = 2.02 (1.53, 2.51)] of managing larger numbers of contracted individuals compared to temporary employment. Team size showed a positive correlation with contracting capacity; teams with 4–6 members [OR (95 %CI) = 1.31 (1.05, 1.57)], 7–10 members [OR (95 %CI) = 2.06 (1.75, 2.37)], 11–19 members [OR (95 %CI) = 3.67 (3.31, 4.03)], and ≥20 members [OR (95 %CI) = 3.46 (2.74, 4.18)] were increasingly likely to surpass 2,000 contracted individuals. Teams managing larger populations—2,001–9,999 [OR (95 %CI) = 2.37 (2.12, 2.62)], 10,000–29,999 [OR (95 %CI) = 2.92 (2.65, 3.19)], and ≥30,000 [OR (95 %CI) = 2.86 (2.55, 3.17)]—were more likely to exceed 2,000 contracts compared to those managing ≤2,000 people. The absence of hospital bed resources within a team was positively associated [OR (95 %CI) = 1.38 (1.14, 1.62)] with surpassing the 2,000 contracted individuals threshold. ConclusionThe study findings suggest that a larger family doctor team size and larger population size of jurisdiction positively impact the capacity for contracting with family doctor teams. GPs with higher educational levels, managerial roles, and access to hospital bed resources possess a more profound understanding and control over family doctor contract service policies, leading to optimized management of contracted individuals. Compared to their temporarily employed counterparts, formally employed GPs within family doctor teams are more likely to engage in contracting activities.

The impact of family doctor contract services on the utilization of and satisfaction with primary health care among Chinese residents: A cross-sectional study.

Family doctor contract service (FDCS) is a vital part of China's primary health care system. This study aims to explore whether contracting with FDCS affects residents' utilization of and satisfaction with primary health care. A structured questionnaire was employed to collect data in January 2022. The questionnaire mainly included the following three parts: the social-demographic characteristics, health-related information, and utilization of and satisfaction with primary health care. Propensity score matching (PSM) was used to adjust for social-demographic differences between participants who contracted with a family doctor and those who did not. For the matched population, we used the Chi-square test to examine the differences in the utilization of and satisfaction with primary health care between contracted and non-contracted participants. Moreover, multiple logistic regression and linear regression were used to explore the influencing factors of the utilization of and satisfaction with primary health care. A total of 10,850 people were investigated and 10,419 participants were incorporated into the data analysis. After matching, there were no significant differences in most of the matching variables between the contracted and non-contracted groups (P > 0.05). The utilization rate was significantly higher among the contracted population than of the non-contracted (96.3% vs 92.6%, P < 0.001). The quality of services (e.g., good service attitude, high medical level, and a trusted family doctor) was more likely to be cited as the main reasons for the contracted people to utilize primary health care than for the non-contracted. The contracted people were also significantly more satisfied than the non-contracted in all terms of satisfaction. Moreover, people who contracted with a family doctor were more likely to use primary health care with OR = 1.979 (95% CI, 1.511-2.593). The contracted people were more likely to utilize and be satisfied with primary health care than the non-contracted. In addition, the contracted people tended to use primary health care because of the quality of services rather than because of the close distance or short waiting time. Therefore, it is important to further promote the high quality of FDCS to ensure residents' sense of gain and improve their satisfaction.

Utilizing Group Model Building to Identify Barriers and Facilitators of Hypertension Management in Primary Health Care, China.

Group Model Building (GMB) is a qualitative method that refers to a participatory process. This project aims to identify barriers and facilitators of hypertension management in primary health care in China, through which, the leverage point for intervention may be found. The GMB was used to identify the factors influencing hypertension management. Graphs over time and causal loop diagram (CLD) were main tools of GMB. To propose the influencing factors, key stakeholders were invited to participate in a workshop. During the workshop, stakeholders were encouraged to plot the graphs over time of the variables about research issues and give a descriptive explanation. And based on this, a CLD was initially developed to establish a model of the interaction of factors. After the workshop, the research group further improved the CLD through repeated mutual discussions, and gave feedback to the participants. The Vensim PLE 9.0 software package was used to build CLD. A total of 14 key stakeholders were invited to participate in the workshop. Finally, 26 influencing factors were identified, which were divided into three dimensions, including the institutional, the community health workers (CHWs), and the patient level. And 5 reinforcing loops and 4 balancing loops were formed in the CLD. Promoting the building of the Medical Community/Regional Medical Association, implementing the family doctor contract service (FDCS), and enhancing the motivation of CHWs may be potential leverage points for hypertension management in China. By using GMB, we have identified key factors in the management of hypertension in primary health care and provided comprehensive suggestions to overcome the obstacles.

The impact of hypertension follow-up management on the choices of signing up family doctor contract services: does socioeconomic status matter?

BackgroundThis study aimed to explore the association between hypertension follow-up management and family doctor contract services, as well as to examine whether socioeconomic status (SES) had an interaction effect on this relationship among older adults in China.MethodsWe used data from the sixth National Health Service Survey of Shandong Province, China, including 3,112 older adults (age ≥ 60 years) with hypertension in 2018. Logistic regression models and a margins plot were used to analyze the role of SES in the relationship between hypertension follow-up management and family doctor contract services.ResultsThe regular hypertension follow-up management rate and family doctor contracting rate were 81.8% and 70.9%, respectively, among older adults with hypertension. We found that participants with regular hypertension follow-up management were more likely to sign family doctor contract services (OR=1.28, 95%CI: 1.04, 1.58, P=0.018). The interaction effect occurred in the groups who lived in rural areas (OR=1.55, 95%CI: 1.02, 2.35), with high education level (OR=0.53, 95%CI: 0.32, 0.88) and had high incomes (OR=0.53, 95%CI: 0.35, 0.81).ConclusionsOur findings suggested that regular hypertension follow-up management was associated with family doctor contract services and SES influenced this relationship. Primary health care should improve the contracting rate of family doctors by strengthening follow-up management of chronic diseases. Family doctors should focus on improving services quality and enriching the content of service packages especially for older adults with higher income and education level.

The association of family doctor contract service and patient trust in doctor: evidence from twenty-five village clinics of three counties in rural China

BackgroundChina is implementing the family doctor (FD) system to reform the primary healthcare (PHC). The family doctor contract service (FDCS) policy plays a crucial role in this system implementation, aiming to transform the doctor-patient relationship and enhance PHC quality. This study aims to investigate the impact of FDCS on the doctor-patient relationship in PHCs using field research methodology.MethodThe field research methodology was employed to address the research questions. Quantitative methods were utilized for data collection and analysis. A structure questionnaire was used to collect data based on the research questions. Our investigation encompassed twenty-five village clinics across three counties in China. A total of 574 subjects helped us to finish this investigation in the study. The collected data was analyzed using statistical analysis including ordinary least squares (OLS) model and propensity scores matching model (PSM) to estimate the relationship.ResultThe findings from ordinary least squares (OLS) regression revealed that FDCS had a positive influence on patient trust in doctors within PHCs, with patients who participated the FDCS exhibiting higher levels of trust compared to those who did not participate. Propensity score matching (PSM) analysis further confirmed these results by accounting for selection bias.ConclusionsThe implementation of family doctor contract service has brought about significant transformation in the doctor-patient relationship within rural Chinese PHCs. In essence, it has revolutionized the service model of doctor in PHC, playing a pivotal role in improving primary health quality and enhance the service capability of doctors in PHC. This transformative process has been crucial for carrying out hierarchical diagnosis and treatment policy, which aims to adjust the medical service structure and optimizing the health service system. Therefore, it is imperative for government authorities and health administration departments to ensure continuous support for this essential service through appropriate formulation.

A spatial feature analysis of primary health care utilization in a large city in China and its implications for family doctor contract service policy

BackgroundFamily doctor contract policy is now run by the State Council as an important move to promote the hierarchical medical system. Whether the family doctor contract policy achieves the initial government’s goal should be measured further from the perspective of patient visits between hospitals and community health centers, which are regarded as grass medical agencies.MethodsThe spatial feature measurement method is applied with ArcGIS 10.2 software to analyze the spatial aggregation effect of patient visits to hospitals or community health centers among 20 districts of one large city in China and analyze the family doctor contract policy published in those areas to compare the influence of visit tendencies.ResultsFrom year 2016-2020, visits to hospitals were in the high-high cluster, and the density was spatially overflow, while there was no such tendency in visits to community health centers. The analysis of different family doctor contract policy implementation times in 20 districts reflects that the family doctor contract policy has a very limited effect on the promotion of the hierarchical medical system, and the innovation of the family doctor contract policy needs to be considered.ConclusionsA brief summary and potential implications.A multi-integrated medical system along with family doctor contract policy needs to be established, especially integrated in leadership and governance, financing, workforce, and service delivery between hospitals and community health centers, to promote the hierarchical medical system.

家庭医生签约服务模式在农村老年高血压患者中的研究进展

家庭医生签约服务模式在农村老年高血压患者中的研究进展

Willingness to maintain contracts with family doctors among Chinese residents: results from one national cross-sectional study and a meta-analysis of 25 studies.

A number of studies have investigated the influencing factors regarding the renewal of contracts associated with Family Doctor Contract Services (FDCS) in different regions of China since it was officially implemented in 2009; however, none of the previous studies have been considered using a nationally representative sample in combination with a meta-analysis. A multistage stratified sampling method was used to investigate participants' socio-demographic characteristics, health status, understanding, use, and evaluation of the FDCS, and their willingness to renew contracts in Eastern, Central, and Western China from September to November 2021. We searched the PubMed, Ovid Medline, CNKI, VIP, Wanfang, and SinoMed databases to retrieve previous studies related to the willingness of Chinese residents to renew contracts with their family doctor (FD), and a meta-analysis was performed to systematically summarize the willingness to maintain contracts and influencing factors. Among 2,394 residents, 2,122 (88.64%) were willing to renew their contracts. The mixed-effect logistic regression model results demonstrated that residents who (1) preferred primary health service institutions, (2) had a better knowledge of FDCS, (3) were more willing to visit primary health service after signing the contract with FDs, (4) were not intending to change FDs, (5) were satisfied with FDCS, and (6) trusted in FDs reported a higher level of willingness to maintain contracts with FDs. Our meta-analysis confirmed that older age, being married, having chronic diseases, choosing primary medical institutions for the first contact, having a good knowledge of FDCS/FDs, being satisfied with FDCS and the medical skills of FDs, and trusting FDs were all positively associated with residents' willingness to renew contracts (p < 0.05). The willingness of consumers to maintain contracts with FDs in China varies in different areas. Giving priority services to groups of high need contributed to an improved rate of renewal. We suggest that in order to continue to increase annual contract renewal, it is necessary to strengthen consumer awareness through effective marketing and continue to work toward meeting consumer expectations, thereby increasing confidence and trust in FDCS.

Equality of public health service and family doctor contract service utilisation among migrants in China

China initiated the equalisation of an essential public health service programme in 2009 with the goal of developing a more equitable and effective public health system for all people. This study employs data from the China Migrants Dynamic Survey to examine regional-level and household-level income-related inequalities in public health service utilisation and its determinants. Wagstaff concentration indices indicate that essential public health services and family doctor contract services are concentrated among less developed prefectures and poorer households. Decomposition analysis based on recentered influence function regression shows that education contributes to pro-poor inequality in health records and health education utilisation. China's policies of essential public health services and family doctor contract services reduce income-related inequalities in health service utilisation, which has important implications for developing countries striving to achieve universal health service coverage and equal health outcomes.

Multi-period scheduling problem of combination of home health care and outpatient services: based on Chinese family doctor contract services

Inspired by the service mode of family doctor contract service in China, this paper presents a multi-period problem of the combination of home health care and outpatient service over a planning horizon of multiple days. In the planning horizon, patients receive services with fixed frequencies and have different preferences for different dates. Taking the patients’ service date regulations and doctors’ working regulations into account, we propose a mixed-integer nonlinear and convex programming model, which aims to minimize the total operating costs and maximize the patients’ preference satisfaction. A hybrid tabu search algorithm with an embedded shake procedure is designed to solve the problem. Numerical experiment results imply that the hybrid tabu search algorithm performs well when compared with the exact method on small instances, and it can also provide higher quality solutions when compared with variable neighborhood search method. We also analyze problem properties and parameter sensitivities through some small instances.

Barriers and facilitators of family doctor contract services in caring for disabled older adults in Beijing, China: a mixed methods study

ObjectiveTo evaluate the current state of family doctor contract services (FDCS) in Beijing, identify the roles of family doctors who have worked with disabled older adults and investigate the barriers...

Study on the application effect of the family doctor contract service mode of ‘basic package+personalised package’ in elderly hypertension management in Chengdu, China: a retrospective observational study

ObjectivesWe conducted this study to assess the application effect of the family doctor contract service mode of ‘basic package+personalised package’ in the management of hypertension patients.DesignObservational study.SettingThe study was conducted...

Effect Evaluation and Development Countermeasures of Family Doctor Contract Service from the Perspective of Demand Side

Objective: To study the implementation effect of family doctor contract service in Zhenjiang City with community residents as the main body, analyze the problems existing in the contract service of family doctor in Zhenjiang City, and then explore the optimization strategy of family doctor contract service. Method: Through studying relevant literature and Zhenjiang government documents and reports, we learned about the signing measures of the signing system of family doctors in Zhenjiang in recent years. With the guidance of experts, we designed the questionnaire of the current situation of signing family doctors of residents in Zhenjiang. By random sampling method, we randomly selected three communities in Zhenjiang, randomly selected several households in each community, distributed 120 questionnaires, and recovered 112 questionnaires. There were 8 invalid questionnaires, and the effective rate was 93.33%. Results: At present, the construction of the talented team of family doctors in Zhenjiang City is insufficient. Residents' concept of medical treatment is solidified; Not enough in-depth publicity. Conclusion: Increase the number of talents, improve the quality of service, and enhance the confidence and compliance of residents to community health service; Gradually change the residents concept of medical treatment, promote hierarchical diagnosis and treatment; Carry out in-depth publicity, improve the breadth and depth of the general population's cognition, and improve the utilization rate of residents.

Associations between the signing status of family doctor contract services and cervical cancer screening behaviors: a cross-sectional study in Shenzhen, China

BackgroundAs a core part of the primary healthcare system, family doctor contract services (FDCS) may help healthcare providers promote cervical cancer screening to the female population. However, evidence from population-based studies remains scant. This study aimed to investigate the potential associations between the signing status of FDCS and cervical cancer screening practices in Shenzhen, China.MethodsA cross-sectional survey among female residents was conducted between July to December 2020 in Shenzhen, China. A multistage sampling method was applied to recruit women seeking health services in community health service centers. Binary logistic regression models were established to assess the associations between the signing status of FDCS and cervical cancer screening behaviors.ResultsOverall, 4389 women were recruited (mean age: 34.28, standard deviation: 7.61). More than half (54.3%) of the participants had signed up with family doctors. Women who had signed up for FDCS performed better in HPV-related knowledge (high-level rate: 49.0% vs. 35.6%, P<0.001), past screening participation (48.4% vs. 38.8%, P<0.001), and future screening willingness (95.9% vs. 90.8%, P<0.001) than non-signing women. Signing up with family doctors was marginally associated with past screening participation (OR: 1.13, 95%CI: 0.99–1.28), which tended to be robust among women with health insurance, being older than 25 years old at sexual debut, using condom consistently during sexual intercourse, and with a low level of HPV related knowledge. Similarly, signing up with family doctors was positively associated with future screening willingness (OR: 1.68, 95%CI: 1.29–2.20), which was more pronounced among women who got married and had health insurance.ConclusionsThis study suggests that signing up with family doctors has positive associations with cervical cancer screening behaviors among Chinese women. Expanding public awareness of cervical cancer prevention and FDCS may be a feasible way to achieve the goal of cervical cancer screening coverage.

The Relationship between Family Doctor Contract Services Policy and Perceived Participation in Primary Health Care among Chronic Disease Patients in China: The Mediating Role of the Patient Trust

Participation by patients with chronic diseases under primary health care requires more attention to achieve effective disease management and better health outcomes. In 2016, China proposed accelerating the establishment of a system of family doctors (FDs) and strengthening doctor-patient communication to better meet residents’ health service needs. This study aimed to describe perceived participation in primary health care among patients with chronic diseases in northeastern China and explore the impact of FD contract services and patient’s trust on patients’ perceived participation. A cross-sectional survey of 847 patients with chronic diseases in 16 primary healthcare institutions was conducted in Jilin Province, China. Among all participants, 453 patients reported signing up for FD contract services (62.93%). The perceived participation of patients with chronic diseases was at a low level (mean = 6.71 and SD = 3.35). After controlling for sociodemographic variables and health-related variables, FD contract services directly and indirectly influenced patients’ perceived participation. The patient’s trust was a mediator in the relationship between FD contract services and perceived participation. This study confirmed the valuation of family doctor contract services and provided a theoretical basis for the formulation of primary health service policies. Health organizations should continue to enhance the capacity of primary health services and attract more chronic disease patients to contract with FD teams, thereby enhancing doctor-patient trust and increasing patient’s participation in primary health care.

What factors affect Beijing residents' contracts with family doctors? A comparative study of Beijing's urban and suburban areas.

To improve the health of residents and promote hierarchical diagnosis and treatment to achieve an orderly pattern of medical treatment, Beijing implemented family doctor contract services (FDCSs) in 2011. The aims of this study were to analyze the current status of Beijing residents' contracts with family doctors (FDs), compare the differences in contracting between urban and suburban residents, and explore the factors that affect residents' contract behavior. From August 2020 to October 2020, a stratified sampling method was adopted to select residents from community health centers (CHCs) in districts D (urban area) and S (suburb) of Beijing to conduct a questionnaire survey. Chi-square tests, rank sum tests and logistic regression analyzes were used to analyze the current status and influencing factors of residents' contracting with FDs. A total of 4,113 valid questionnaires were included in the final analysis. District D was rich in medical resources, and the FD contract rate of residents there (93.09%) was significantly higher than that of residents in district S (78.06%; p < 0.05). Residents' district (OR = 1.55, 95% CI = 1.18-2.05), understanding of FDCS policies (OR = 4.13, 95% CI = 3.63-4.69), preferred medical institutions (OR = 0.58, 95% CI = 0.42-0.79 for tertiary hospitals in the district; OR = 0.36, 95% CI = 0.22-0.59 for urban medical institutions in Beijing), age, education level, average annual medical expenses and medical insurance type were factors that influenced residents' contracts with FDs (p < 0.05). This study shows that residents who are located in districts with rich medical resources, prefer CHCs as their first choice, have a better understanding of FDCS policies, and are more inclined to contract with FDs than other residents. It is recommended that the number and quality of FDs in suburban areas be increased and that medical staff strengthen publicity about FDCSs and actively encourage residents to contract with FDs.