Comparison of Primary Care Services among Six Cities in Pearl River Delta, China

Backgrounds: China's current healthcare reform has an overall goal towards re-strengthening primary care. Establishment and expansion of primary care network based on community health centres (CHCs) in urban areas has been prioritized. Due to various socio-economic status of local population and policy context across urban areas in mainland China, primary care is delivered by three main organisational models: government-owned CHCs, hospital-owned CHCs, and privately-owned CHCs with each model being adopted in various localities. This PhD study focuses on studying the process of primary care provided under different CHC models in the six cities of Pearl River Delta (PRD) and it is part of a larger study entitled "A Study of Comparing Primary Care Services among Six Cities in the Pearl River Delta" funded by Bauhinia Foundation Research Centre, in which other co-investigators have studied the structure and outcome of the primary care.;Objectives: This PhD study aims to use the Primary Care Assessment Tool (PCAT) within Donabedian's framework of structure, process and outcome to measure and compare the quality attributes of primary care from patient's perspective under different CHC models in the six cities of PRD where each city has different responses to the national policy for delivering primary care services.;Methods: A comprehensive literature search was conducted to review the utilization of PCAT both globally and locally. The PCAT - Adult Edition (short version) was translated into Mandarin Chinese following an internationally recognized procedure and was cross-culturally adapted into Chinese context. The reliability and validity of the PCAT instrument were evaluated through test-retest approach, exploratory factor analysis, and internal consistency reliability analysis. Multistage cluster sampling method was adopted to select CHCs in the six cities of PRD. All interviews were conducted on-site by trained interviewers. Statistical analysis including multiple linear regression and multivariate analysis of covariance were used to assess and compare the quality attributes of primary care (PCAT scores) provided by different organisational models of CHCs in the six cities of PRD.;Results: The Mandarin Chinese version of PCAT-AE (short version) contains nine primary care scales with good construct validity. Cronbach's alpha within all the nine primary care scales achieved moderate to high internal consistency reliability. A total number of 3,360 adult primary care service users were surveyed on-site at CHCs with an overall response rate of 86.1%. Descriptive city-by-city analysis based on the PCAT scores was conducted to depict primary care process in each of the six cities. Primary care service users under government-owned CHC model reported receiving better primary care experiences than those under privately-owned CHC model and hospital-owned CHC model, largely because of the greater achievements in first contact utilization and better score in the coordination domain (information system).;Conclusions: The Mandarin Chinese version of PCAT-AE (short version) was found to be reliable and valid as a measure of primary care in mainland China from patients' perspective. The study suggested that the government-owned CHCs had better quality attributes than other organisational models, and offered a direction for quality improvement in the five domains of primary care.