| Objective:This study conducted a cross-sectional survey of residents in Jiangxi Province to understand the current status of primary healthcare service quality experienced by patients,analyze the factors affecting residents’ willingness to seek primary care,explore the relationship between residents’ exerience of primary healthcare services and their willingness to seek care,and provide evidence for improving patient experience in primary healthcare services,promoting primary care as the first point of contact,and advancing tiered diagnosis and treatment.Methods:Using the Chinese Rapid Primary Care Assessment Tool(CR-PCAT),the Chinese version of the Wake Forest Physician Trust Scale,and a self-designed questionnaire,a survey was conducted from January to May 2021 among residents seeking primary healthcare services in Jiangxi Province.The survey mainly covered general demographic information,health status,healthcare-seeking behavior,willingness to seek care,patient experience ofhealthcare service quality,patient satisfaction,patient trust,and patient loyalty.The questionnaire was created as an electronic form on the "Wenjuanxing" platform and a QR code was generated for respondents to complete the survey online.Statistical analysis was conducted using SPSS 26.0 software.The internal consistency reliability of each scale was evaluated using Cronbach’s α coefficient,and the construct validity of the scales was evaluated using Bartlett’s χ2 sphericity test and KMO test t-tests or ANOVA were used to compare patient experience of primary healthcare service quality scores among respondents with different characteristics and healthcare-seeking behaviors.χ2 tests were used to compare primary care-seeking behaviors among respondents with different characteristics and healthcare-seeking behaviors.Multiple linear regression was used to analyze the influencing factors of patient experience of primary healthcare service quality,and logistic regression was used to analyze the influencing factors of primary healthcare seeking and willingness.A structural equation model was constructed with patient experience,patient trust,patient loyalty,patient satisfaction,and healthcare-seeking willingness as latent variables to analyze the relationship between patient experience and patient trust,loyalty,and satisfaction,as well as their impact on primary healthcare-seeking willingness.Results:1.A total of 1580 residents participated in the survey,and 1575 valid questionnaires were obtained.Among them,731(46.4%)were male and 844(53.6%)were female,with an age range of 15 to 76 years and an average age of(31±12)years.Only 218 people(13.84%)had chronic diseases in the past year,and 291 people(18.48%)believed that their health condition was very good2.According to the survey,the willingness to seek primary care as the first point of contact was 54.86%.Among the 1043 people who sought care for minor illnesses,32.44%said they would choose primary healthcare service institutions for major illnesses.Among the 864 people who were willing to seek care at primary healthcare service institutions,74.54%cited proximity as the reason for their choice,52.43%cited mild illness,and 36.32%cited low medical expenses.Among the 1043 people who were willing to seek care at primary healthcare service institutions for minor illnesses,64.14%cited proximity as the reason for their choice,51.39%cited mild illness,and 37.30%cited low medical expenses.Among the 511 people who were willing to seek care at primary healthcare service institutions for major illnesses,45.21%cited proximity and 45.21%cited mild illness while 42.27%cited low medical expenses.3.The patient experience of primary healthcare service quality score was 36.42,with the highest score in the comprehensive service dimension(2.49),followed by accessibility of first-contact service(2.44),continuity of care(2.43),coordination of care(2.40),and the lowest score in the utilization of first-contact service dimension(2.36).4.Multiple linear regression analysis showed that patient loyalty(β=0.573,P<0.001)and trust(β=0.045,P=0.015)towards primary care,occupation(farmers:β=-1.405,P=0.047),current residence(urban-rural fringe:β=2.044,P=0.001),family size(β=0.488,P=0.002),severity of illness(β=1.222,P<0.001),whether the patient can freely choose their doctor(β=0.808,P=0.020),and willingness to seek care at hospitals for major illnesses(β=-1.562,P=0.004)were all factors that influenced the patient experience of primary healthcare services.5.The results of the logistic regression analysis showed that high patient loyalty(OR=1.072,P<0.001),female gender(OR=1.409,P=0.019),choosing the institution for care by oneself(OR=2.305,P<0.001),choosing the institution designated by medical insurance(OR=1.808,P=0.005),having the freedom to choose their doctor(OR=1.947,P<0.001),visiting the doctor for the first time(OR=1.862,P<0.001),and high patient compliance(OR=1.900,P=0.024)were all favorable factors for seeking care at primary healthcare service institutions,while having public medical insurance(OR=0.298,P=0.011)was an unfavorable factor.Conclusion:1.The patient experience of primary healthcare service quality score in Jiangxi province,China is at a medium level with considerable room for improvement.2.The willingness to seek primary care as the first point of contact was 54.86%,which is at the national average level.However,compared with other economically developed areas,the willingness to seek primary care as the first point of contact is relatively low.The main reasons for seeking primary care as the first point of contact are proximity,mildillness,and low medical expenses.3.The higher the patient loyalty and trust towards primary care,the higher the score for patient experience of primary healthcare services among residents who live in urban and suburban areas,have larger family sizes,have more severe illnesses,can freely choose their doctor,and are willing to seek care at primary care institutions for maj or illnesses.The score for patient experience of primary healthcare services is lower among farmers,company employees,and government staff,as well as among those who are willing to seek care at hospitals fo rmajor illnesses.4.Among various factors related to demographic characteristics,health status,healthcare-seeking behavior,and patient experience,the factors that influence willingness to seek primary care as the first point of contactinclude patient loyalty,gender,medical insurance type,choice of healthcare institution for care,freedom to choose their doctor,visiting the doctor for the first time,and patient compliance.5.There is no direct relationship between patient experience,patient trust and willingness to seek care.The patient experience of primary healthcare service quality indiretly affects willingness to seek care through satisfaction and loyalty,and there is a positive correlation among these variables.Although patient experience of primary healthcare service quality is positively correlated with patient trust,patient trust does not directly affect willingness to seek care,but indirectly affects willingness to seek care through... |
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