| Objective To investigate the utilization of community health services in the main city of Kunming in 2011 and 2013, compare the difference of the utilization in these two years, analysis of the relevant factors affecting the utilization of differences, than to sum up experiences and lessons, put forward suggestions and solutions, to provide a reference to improve the utilization of community health services for community organizations, at the same time to provide the basis for the future development of relevant policies in Kunming.Methods On the basis of literature review and expert advises, a combination of qualitative and quantitative research methods:visit type questionnaire and personal in-depth interviews were been took to collect data. PCAT-AE scale which were developed by primary Health Care policy Center of Johns Hopkins University was used for collecting quantitative data:the utilization of community health services of urban Kunming in 2011 and 2013. Community center leaders and community health care workers were been interviewed. Epidata3.1 and Excel were used for inputting data and imported the data into SPSS software for data analysis in the end.Results1. The two-year study population basic situation:The research community residents for a total was 1260,2013 was 630 and 2011 also was 630. Which two years were mostly women, accounting for 63.02%; the composition of age in two years, mainly in the elderly aged≥45 years, account for 67.78%; marital status to married were mostly married accounted for 83.97% in 2013 and 86.19% in 2011; domicile regard to local accounts mainly local accounts accounted for 74.29% in 2013 and 73.33% in 2011; educational level, mostly high school and lower education level which accounting for 84.76% and 84.60% in 2013 and 2011; the composition of employment, the largest proportion of retirees which accounting for 45.87% and 48.25% in 2013 and 2011; the number of family members living together was less than or equal to 3 people in the majority,2013 was 62.38%,2011 was 63.02%; the total monthly income of these families with the largest share of between $ 3001 to 7000, in 2013 and 2011 were 47.62% and 48.25%. The basic difference between the two cases constitute a community clinic residents were not statistically significant (P> 0.05). In addition, most of the residents to seek treatment for two years, there was a health insurance; in 2013 and 2011 to seek treatment for residents with chronic diseases and the number of people without chronic diseases account for about half of all; by walking to the community health service centers were residents of the majority, the large some residents within 15 minutes to reach the community center, constitute difference two years of residents was also not statistically significant (P> 0.05).2. Two years of community health service utilization2.1 The utilization of’First-contact"care in two years:The average scores of community First contact-use utilization were (7.94 ± 2.09) points in 2013 and (7.66 ± 2.15) points in 2011, by two independent sample t test the difference of two was statistically significant (t=2.352, p=0.019), the utilization of First contact-use in 2013 was higher than in 2011; The average scores of community First contact-availability utilization were (27.76 ± 4.49) points in 2013 and (28.08 ± 5.56) points in 2011, the difference of two was not statistically significant (t=-1.127,p=0.260); and the average scores of "First-contact"care utilization were (35.69 ± 5.49) points in 2013 and (35.73 ± 6.65) points in 2011, divided by two independent samples t-test showed no statistically significant (t=-0.116, P=0.908).2.2 The utilization of continuous care in two years:The average scores of continuous care utilization were (47.86 ± 7.12) points in 2013 and (47.34 ± 7.41) points in 2011, the difference of two was not statistically significant (t=1.278, p=0.201).2.3 The utilization of coordinated care in two years:The average scores of coordination-referral utilization were (23.65 ± 6.42) points in 2013 and (22.79 ± 8.54) points in 2011, the difference of two was statistically significant (t=2.029, p=0.043), the utilization of coordination-referral in 2013 was higher than in 2011; the average scores of coordination-information system utilization were (13.03 ± 2.86) points in 2013 and (12.91 ± 2.82) points in 2011, the difference of two was no statistically significant(t=0.729, p=0.466); the average scores of coordinated care utilization were (36.68 ± 7.63) points in 2013 and (35.70 ± 9.30) points in 2011, the difference of two was statistically significant (t=2.046, p=0.041), the utilization of coordinated care in 2013 was higher than in 2011.2.4 The utilization of comprehensive care in two years:The average scores of comprehensive-available services utilization were (73.83 ± 10.47) points in 2013 and (71.85 ± 11.33) points in 2011, the difference of two was statistically significant (t=3.223, p=0.001), the utilization of comprehensive-available services in 2013 was higher than in 2011; the average scores of comprehensive-service provided utilization were (34.18 ± 9.59) points in 2013 and (33.01 ± 9.81) points in 2011, the difference of two was statistically significant (t=2.138, p=0.033), the utilization of comprehensive-service provided in 2013 was higher than in 2011; the average scores of comprehensive care utilization were (108.01 ± 16.64) points in 2013 and (104.86 ± 17.65) points in 2011, the difference of two was statistically significant (t=3.259, p=0.001), the utilization of comprehensive care in 2013 was higher than in 2011.2.5 The overall utilization of community health services in two years:Integrated the scores of four core domain:Community "First-contact" care, Continuous care, Coordinated care, Comprehensive care which including 7 sub-domain of PCAT-AE Scale, the composite scores of community health services overall utilization were independent sample t test, the difference of two was statistically significant(1=2.729,p=0.GG6),化e degree of utilization of community health services in 2013 compared with 2011 has increase.3. The influence factors of community health service utilization3.1 Residents fadors: The residents of their own health assessment mean score were(70.00 ± 15.12) points in 2013 and(65.65 ± 14.78) points in 2011,the difference oftwo was statistically significant (t=5.162, p<0.001), the self-health assessment overall of residents in 2013 was better than in 2011. The residents when the body feel uncomfortable willing to community treatment of first choice in 2013 was accounted for 91.59% and was accounted for 89.68% in 2011, the difference of two was no statistically significant(x2=1.346, p=0.246).The residents who had been to large public hospitals were 55.08% in 2011 and were only 47.30% in 2013, in addition residents who used other private clinics, other medical facilities services in 2011 were more than in 2013. The times of visiting the central clinic in the past year was insignificant (x2=3.542, p=0.315); the residents who went to the community see a doctor more than five years long in 2013 were 13.18% higher than in 2011, the difference of two was statistically significant (x2=23.319, p<0.001); community centers did not carry out a general practitioner contract service team in 2011, but there were 4.92% of the population with the center signed a general practitioner team signing a service contract in 2013. The total rate of community health service accessibility was 50.16% in 2013 which was 4.76% higher than 2011’s 45.40%, but the difference of two was not statistically significant (x2=2.863, p=0.091); the awareness of community to prevent, community health, community rehabilitation, family planning advice in 2013 were higher than in 2011 (p<0.05), the awareness of health education in two years were no significant differences (x2=0.205, p=0.651), and the awareness of community health care in 2013 is lower than in 2011 (x2=24.469, p<0.001). Residents of the community health care workers expressed confidence in 2013 were accounted for 73.81% which was 16.35% higher than 2011’s 57.46%, the difference of two was statistically significant (x2=37.329, p<0.001); Residents of community center expressed confidence in the overall health service in 2013 were accounted for 69.05% which was 3.34% higher than 2011’s 65.71%, but the difference of two was not statistically significant (x2=1.592, p=0.207). The composite scores of residents’ satisfaction of the community center in 2013 was (3.84 ± 0.53) points and was (3.83 ± 0.63) points in 2011, the difference of two was not statistically significant (t=0.346, p=0.729); but the overall satisfaction rate of residents in 2013 was 78.7% and 74.00% in 2011, the difference of two was statistically significant (x2=3.956, p=0.047), the overall satisfaction rate of residents of the community center in 2013 was higher than in 2011.3.2 Community health center factors: The serving population of four community health centers in 2013 was increased 1.32% compared with 2011. Basic public health services aspect,four community centers archiving personal health records in 2013 was 39.01 higher than in 2011;the times of health education seminar in two years were the same;the number of maternal health and child care in 2013 were higher26.32% and 21.49% compared to in 2011; the numbers of immunization in 2013 increased 37.13% than in 2011; the numbers of patients with hypertension, diabetes standardized management in 2013 increased 21.45% and 25.56% than in 2011, also we can learned that four community centers basic public health services coverage ratio increased and served a wider range in 2013 in than in 2011. The aspect of outpatient services,emergency door four comnumity centers daUy count and the average daily number of Chinese medicine outpatient services in 2013 increased32.32% and 43.04% than in 2011. The aspect of referral services, community centers did not have thestablish a more good contacts with large public hospitals or higher level hospitals in 2011 and carrying out two-way referral service was difficulties, but more than one center had established a good contact with large hospitals or higher level hospitals, the higher the central hospital patients turn green channels,priority admissions, while large hospitals also carry out the "experts into the community"activities. Four comimmity health service ceters were not carrying out a general practitioner team services in 2011, while there were two centers which carried out a general practitioner team services in 2013 which initiai recognized by community residents. The total number of four community health centers electronic file archiving in 2013 increased 223.81% than in 2011,four community centers improved the residents electronic health records to promote the constmction of community information in the two years. Compared in 2011 Portion of community health centers increased staffing in 2013,the serving officers total number of four centers changed little of the two years. The overall times of internal training of four community centers in 2013 increased 26.42% over 2011, the overall times of external training in2013 increased 49.35% over 2011, the interview results indicated that community centers not only increased the times of of training, but also the training content updated every year and the form of training was more and more diverse. Most community health care workers reflected community health service evaluation was intensified and the tasks of community health service was more complicated, but the change of income was little, pay was not proportional compared with work. Four community centers overall revenue in 2013 increased 38.28% than 2011, and total expenditure also increased 34.25%; the overall balance of payments surplus of the four community centers is negative in 2011, but was positive in 2013; community centers per capitation funding for basic public health services increased to 30 yuan from 25 yuan subsidy standards. In addition, except Baiyun community health service center, the other three centers were purchased a new medical equipment after 2011; essential drug list was supplemented every year, the types of drugs in community in 2013 has increased than in 2011.Conclusions The utilization of four sub-domains which are First contact-use, coordination-referral, comprehensive-available services, comprehensive-service provided in 2013 are higher than in 2011, while the difference of the utilization of other three sub-domains which are First contact-availability, continuous care, coordination-information system in two years are little. The difference of the utilization of two domains which are "First-contact" care and the continuous care in two years is little, while the utilization of other two domains which are coordinated care and comprehensive care in 2013 is higher than in 2011. Overall, community health service utilization of Kunming city in 2013 has increased over 2011. The factors that affect community health service utilization in two years are:the factors of community residents, including self-health assessment, other medical institutions service usage, the contact degree of community health center, the degree of awareness and trust and overall satisfaction of community health services; the factors of community health center, the services development situation, the level of health care services, the configuration of medical equipment, types of drugs, the degree of foreign propaganda; the factors of policy, government policies and investment and support for community health services, the regulatory and assessment efforts to the community health agencies and so on.Suggestions Policy level:further optimization of the investment community health services, and to improve the examination system; strengthening the building of community health service personnel; improvement of electronic health records system, promote information technology; robust two-way referral system, strengthen government oversight; improving the basic drug system and enhance implementation efforts. Community health service agency level:implementation of the relevant guidelines and policies about the community health services;to strengthen self-construction of community health service agency, and to improve the services capabilities; continue to promote the service of general practitioner contract team. Community residents level:enhance the health awareness, changing the medical concept; strengthen the contact between residents and the community health service agency; enhance the awareness and trust and satisfaction of the residents. |
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