Bridging the Gaps Between Patients and Primary Care in China: A Nationwide Representative Survey

作者：William Chi Wai Wong, Sunfang Jiang, Jason J. Ong, Minghui Peng, Eric Yuk Fai Wan, Shanzhu Zhu, Cindy L. K. Lam, Michael Kidd, Martín Roland · 发表于：The Annals of Family Medicine · 年份：2017 · DOI：10.1370/afm.2034 · 被引用次数：45 · 研究领域：Healthcare Systems and Reforms、Primary Care and Health Outcomes、Chronic Disease Management Strategies

PURPOSE: China introduced a national policy of developing primary care in 2009, establishing 8,669 community health centers (CHCs) by 2014 that employed more than 300,000 staff. These facilities have been underused, however, because of public mistrust of physicians and overreliance on specialist care. METHODS: We selected a stratified random sample of CHCs throughout China based on geographic distribution and urban-suburban ratios between September and December 2015. Two questionnaires, 1 for lead clinicians and 1 for primary care practitioners (PCPs), asked about the demographics of the clinic and its clinical and educational activities. Responses were obtained from 158 lead clinicians in CHCs and 3,580 PCPs (response rates of 84% and 86%, respectively). RESULTS: CHCs employed a median of 8 physicians and 13 nurses, but only one-half of physicians were registered as PCPs, and few nurses had training specifically for primary care. Although virtually all clinics were equipped with stethoscopes (98%) and sphygmomanometers (97%), only 43% had ophthalmoscopes and 64% had facilities for gynecologic examination. Clinical care was selectively skewed toward certain chronic diseases. Physicians saw a median of 12.5 patients per day. Multivariate analysis showed that more patients were seen daily by physicians in CHCs organized by private hospitals and those having pharmacists and nurses. CONCLUSIONS: Our survey confirms China's success in establishing a large, mostly young primary car...