Research On Status And Countermeasures Of Interpersonal Continuity Of Health Care In Rural Areas

[Objectives]As a core feature of primary care, interpersonal continuity contributes to improve patients satisfaction and compliance and reduce health care costs. However, current studies about health care in China scarcely focus on interpersonal continuity of care delivered to rural residents. This study aims to investigate the status and influence factors of interpersonal continuity of health care in rural China. and explore the barriers which prevent health care achieving high interpersonal continuity. And proposals about how to improve interpersonal continuity of primary health care in rural areas will be put forward on the basis of analysis of situation of locations, health reform plans and policy orientation.[Methods]1. Literature reviewAn extensive review of the literature were conducted through the databases of CNKI,WanFang,PubMed. Concepts and themes of interpersonal continuity and related objectives were analyzed and indicates were selected. So as to give a research foundation and explain the meaning and methods of our research.2. Questionnaire and interviewWe select Henan, Qinghai and Fujian provinces as sample areas from respectively central, western and eastern China. With their six counties was selected at random and 200 rural residents were questioned per county. Rural practitioners, president of health clinic in township,director of health bureau and NCMS were interviewed to explore idea and behavior about health care, local health and medical insurance policy and critical events involving achieving interpersonal continuity of primary health care in rural areas.3. Key information extractionDifferent from previous researches, with great care being taken to ensure the confidentiality and anonymity of participants, visit experiences data in this study was extracted from reimbursement records of new rural cooperative medical system(inpatientrecords and town- and village-level outpatient records) and HIS of county-level hospitals(county-level outpatient records). Survey responses of residents questionnaires combined with visit experiences formed the data resource of analyses in the next step. Policy documents were extracted from sample institutions.4. Statistical analysisDescriptive analysis and ? 2 test was used to present and compare demographic characteristics of respondents and some other results of categorical variable. non-parametric test were used to the compare centralization, dispersion, sequence and other ranked data among groups classified by gender, sickness status et al. Analysis of ANOVA were applied to mean comparison of measurement data. We rely on a 0.05 significant level in this paper.Software used in this research include Microsoft Excel 2007 and SPSS 13.0.[Results]1. First contact health sectors and visit habitsOf 1177 valid questionnaires recollected, respondents from Henan, Qinghai, Fujian provinces were respectively 449, 444, 284. Most respondents select village clinic as first contact health sector(53.40%), followed by county-level hospital(19.54%), health clinic in township(16.23%), municipal hospital or above(6.54%), others(4.25%). Distribution of first contact health sectors selected by rural rural residents with different locations, age groups,source of income and chronic disease state are significantly different(P<0.05). The most important factor influencing selection of first contact health sectors is traffic condition,followed by severity of illness, medical technology of hospital, being familiar with doctors,hospitalization cost, service attitudes et al. Approximately one third respondents provide related information about visit properly.2. Duration of interpersonal continuity70.5% of respondents(830/1177) reported that they have an usual doctor(the doctor rural residents trust and see frequently). Of 830 respondents who have an usual doctor, 62.8 have an over 10 years-longitudinal continuity. Location, degree of education, and chronic disease state are factors that have an influence on whether a resident have an usual doctor or not. Theprofessional institutions in proper order of usual doctors are village clinic,(72.77%)、health clinic in township(13.25%)、county-level hospital(6.43%)、individual clinic(4.22%),and others(3.13%). The distribution of professional institutions of usual doctors reported by residents grouped with different location, gender, marriage and chronic disease state were significantly different.3. Utilization of health services and most frequent sectors507 questionnaires was matched with visit experiences data. Of 507 respondents who have visit experiences, mean times of visit was 6 and there are 376 residents who have 3times visit experience or above. Location,age group,chronic state, and health statue are factors that influence utilization of health service of rural residents. The most frequent sectors according to visit experiences in proper order were village clinic( 41.54%),county-level hospital( 33.46%) 、 health clinic in township(20.40%),municipal hospital or above(4.60%). The distributions of most frequent sectors and of first contact health sectors are significantly different(P<0.001). Location,age group,and source of income are influencing factors of distribution of most frequent sectors.4. Density, dispersion and sequence of interpersonal continuityDensity, dispersion and sequence of interpersonal continuity of primary health care are measured by UPC, COC, Secon. The medians of 3 indicators are respectively 0.75,0.60,0.71.Sequence of interpersonal continuity was inferior to density, difference of which was statistically significant. 109 respondents’ interpersonal continuity measured by three indicators were 1.00, which suggest that these residents went to same health sectors every times in 2014. Rural residents from different provinces had different interpersonal continuity.Sequence of interpersonal continuity has a tendency to become bigger along with more times of visit.5. Analyze on behaviors of primary health providers and health policiesPrimary health care providers, especially rural practitioner, are familiar with most of their customers. And they attach importance to maintenance and utilization of interpersonal continuity(relationship) to provider superior services. Health policy and medical reformmeasurements that have an effect on interpersonal continuity of primary health care in sample areas include hierarchical treatment, cooperation medical services, integrated development of urban and rural medical insurance, Pooling Funds of Outpatient Service et al.These reform program-mes have an influence on behaviors of primary health care providers and demanders, which further have an impact on interpersonal continuity of primary health care.[ Conclusions]Compare to village clinic and county-level hospitals, health clinic in township receive less trust from rural residents, especially in western and eastern China. When people seek health care, their willingness to go to primary health sectors is not sufficient. The main objects that rural residents have connection with are primary health care providers, rural practitioners above all. The interpersonal continuity(longitudinal continuity) between rural residents and providers are generally with long duration of time, however, low quality.Density, dispersion and sequence of interpersonal continuity of primary health care maintain high levels, nonetheless, flow and habits on medicine of rural residents remain to be improved. Economic and social development level and health and medical reform measurements varying with location, interpersonal continuity of health care are different.Rural residents in Fujian province got highest scores on density, dispersion, sequence of interpersonal continuity while respondents in Qinghai had longest time on longitudinal continuity. At the same time, the most intimate relational connection between residents and providers were from residents of Henan.Practical proposals should be put forward about how to improve interpersonal continuity of primary health care based on summaries of effective measures in sample areas. Take Xi County of Henan for example followed, cooperation medical services should be pursued to promote more care from primary health sectors. And Pooling Funds of Outpatient Service should be generalized to increase rural residents’ utilization of primary health care.