Quality Evaluation Of Community Health Service Based On Patients' Experience In One District In Changchun

Community health service system is the first link of the three-level medical service network,which provides residents community oriented,providing integrated,coordinated,continuous,"six integrated" services.Community health service plays an important role in solving the major health problems of residents and realizing the seamless connection between health care systems of upper and lower levels.Therefore,primary care quality has attracted domestic and international attention.Taking patients as the main character to evaluate quality can reflect quality from the aspects of process and results of which health services provided.Additionally,it can also help to understand people's true health demand.Thus,it has important practical value to promote the recent development of community health service system,to enhance quality,to strengthen function and eventually to improve residents' health status.Objective:This study aims to investigate residents' current situation of community health service utilization,to evaluate the function and quality of community health service based on patients' experience,to discusses factors that may affect the quality of community health service,to comprehend the existing problems in the operation of community health service,and to understand residents' expectations and requirements of the basic health services.Eventually,this study would put forward targeted policy recommendations.Methods:Residents of 5 community health service centers in one district in Changchun were surveyed and interviewed between November and December in 2016.Questionnaire including personal characteristics,utilization of community health services,and community health service quality assessment based on personal experience(Using Primary Care Assessment Tool—PCAT-AS developed by Johns Hopkins university in the United States).A total of 459 questionnaires were distributed and 430 questionnaires were validated.The valid response rate was 93.68%.Personal interviews were conducted among residents who were surveyed and willing to continue their conversation.The content of interviews including the motivation of residents to visit here,and comments and thoughts on the existing problems of community health services.Results:1.Women,people aged 60 or above,pensioners and veterans,those per capita monthly income was below 3000 RMB,and those who had bad health situation were the main users of community health service.Among them,women,the elderly aged 60 and above,pensioners and veterans,and those per capita monthly income was below 3000 RMB accounted for 73.7%,65.8%,75.1% and 79.3% respectively;Those with chronic diseases and pootrf self-rated health status were 82.6% and 70.2%,respectively.2.77.4% of respondents reported having usual source of care(USC),and only 27.0% reported regarding community health service centers(CHC)as USC.During the period of investment,the rate of cognition of community family doctor contract services of respondents was 39.3%,and self-reported contract rate was 12.1%.Residents came to community health centers to buy drugs and to use some free basic public health services mainly,accounting for 48.8% and 23.0% respectively.3.The mean value of PCAT was 23.41,ranged above-average of the total score.Mean scores of 10 level of PCAT ranged from high to low were comprehensiveness(services available)(2.85),family centeredness(2.60),first contact(accessibility)(2.47),comprehensiveness(services provided)(2.45)and cultural competency(2.39),coordination(information system)(2.37),longitudinality(2.27),first contact(utilization)(2.16),coordination(referral service)(2.03),and community orientation(1.81).4.There were differences in the quality evaluation of CHC of residents in different socioeconomic characteristics of respondents.Age was one of the influencing factors of PCAT scores,and the higher the age was,the lower the evaluation would be.Specifically,the elderly gave lower assessment in the following dimensions: first contact(access),longitudinality,coordination(information system and referral service),family centeredness,community orientation and cultural competency compared with people aged below 60;People who had less average per capita family income gave higher evaluation in dimensions of first contact(utilization),coordination(information system)and cultural competency.People with lower educational background scored higher in first contact(utilization),but scored lower in comprehensive(services available),family-centeredness,and community-oriented dimensions.Compared to people with jobs,retired people gave a higher evaluation to the first contact(access),longitudinality,coordination(referral services),coordination(information system),comprehensiveness(services available),centered on family,community orientation and cultural competency and overall evaluation;There were a better evaluation of the comprehensive(available services)and family-centered dimensions in the flock of people with a spouse.5.People with different health status also showed a difference in CHC quality assessment.Residents having chronic diseases and poor health status reported lower assessment of coordination(referral services),coordination(information system),and comprehensive(available services).6.People had disparate CHC utilization would gave different score in making evaluation of community health service quality.Regarding CHC as USC and having contract with family physicians were two positive influencing factors of the total score of PCAT.The longer people contacted with CHC,the higher the first contact(utilization)and longitudinality would be.The more frequent people used CHC,the higher the evaluation of the logitudinality and coordination(information system)would be;As to those regarding CHC as USC,the result showed that except the insignificant difference on dimensions of comprehensiveness(services available)and family centeredness between who regarded CHC as USC and who didn't,there were significant differences on other dimensions of PCAT.People who had heard about family physicians contract services and who had already had a contract with family doctors evaluated greater on dimensions of first contact(utilization and access),comprehensiveness(service available),comprehensiveness(service provided),community oriented and the total PCAT score.Meanwhile,those who signed the contract services also had a better assessment on dimension of longitudinality.7.Incomplete drugs,limited medicine purchase policy,poor equipment,low level of technology of medical staff were common problems currently according to patients' reflection.Patients wished CHC to improve service levels of medical skills and human service,to expand inspections and service type,to increase new kinds of drug supplies,and to improve environment.Conclusion:1.CHC plays an important role in providing health services for vulnerable people,such as women,the elderly,poor people and people with poor health status accessibly.2.Residents' total score of quality evaluation of CHC ranged above-average of the full mark.Among 10 dimensions,people gave higher scores in providing comprehensive services,first contact access and family-centered services.However,People gave lower evaluation in continuous,cooperated and community oriented services provided by community medical staff.3.To increase residents' utilization,to promote people to regard CHC as USC,and to have contract with the family doctors can help CHC promote higher service quality.4.Patients wished CHC to improve itself from the aspects of drug supplying,medical skills and human service of medical staff,health education by medical staff,CHC environment and service types.5.To improve the quality of CHC,the following strategies could be taken: to promote family physicians contract services that take enhancing quality as core,to increase investment in basic health service construction,to strengthen the protection of primary human resources,to encourage CHC to build strong connection to upper medical institutions,to speed up the construction of information sharing platform,to ensure the drug supply,to expand the service types of CHC,to encourage to build the third party inspection agencies,to encourage medical experts to sink into primary care,and to promote CHC staff to reach into community and family.