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Factors associated with residents' contract behavior with family doctors in community health service centers: A longitudinal survey from China.

ABSTRACT: BACKGROUND:China adopted family doctor (FD) to help achieve "Healthy China 2030" through providing continuous, comprehensive, and life-cycle contract services. However, there is a disparity between actual and targeted FD use, as residents continue to visit specialists in large hospitals. The government implemented initiatives to improve residents' willingness to sign up with and visit their FDs. Factors that influence contract behavior are therefore significant for frontier policy research. METHODS:Two survey waves were conducted in Shanghai (2013 and 2016). The first wave included 2754 people and the second 1995 people. Exploratory factor analysis was used to synthesize "satisfaction" as a predictor of contract behavior. Pearson's chi-square, pooled and logistic regression models were used to estimate associations between influencing factors and contract behavior, and clarify variations in factors across the two waves. RESULTS:Four factors were extracted from 15 satisfaction items: "Treatment Environment," "Medical Technology," "Service Specification" and "Service Attitude". Consistent with descriptive analysis, longitudinal analysis showed sociodemographic characteristics (age, education, marital status, and hukou) were significant predictors of contract behavior. The odds ratio of non-communicable diseases (NCD) patients for contract behavior was 2.218 times that of residents without NCD. Contract behavior was positively correlated with awareness of FD services (OR = 21.674, 95%CI = 15.043-31.229), satisfaction with Service Attitude (OR = 1.210, 95%CI = 1.009-1.451), and visit compliance (OR = 1.959, 95%CI = 1.564-2.452). Over time, the odds ratios of the married, Shanghai hukou, NCD, and awareness of FD services declined from 0.456, 1.795, 2.492, 28.690 to 0.443, 1.678, 1.910 and 14.031 respectively, while those of age, and visit compliance increased from 1.027, 1.521 to 1.041 and 2.305 respectively. In 2016, an education-contract gradient had formed (the higher the education level, the higher probability of signing with a FD), whereas high school education had the highest odds ratio (OR = 1.163,95%CI = 0.740-1.827) in 2013. Service Attitude was the only significant satisfaction-related predictor (OR = 1.358, 95%CI = 1.001-1.842) in 2016, compared with "Treatment Environment" (OR = 1.224, 95%CI = 1.001-1.496) and "Service Specification" in 2013(OR = 1.270, 95%CI = 1.040-1.552). CONCLUSIONS:Except for the socio-demographic variables, NCD, awareness of FD services, satisfaction and visit compliance were significant predictors of contract behavior with FDs. The effect of visit compliance had increased over time while NCD and awareness of FD services were losing impact over time. Significant satisfaction factors had also changed from "Treatment Environment" and "Service Specification" to "Service Attitude".

SUBMITTER: Huang J

PROVIDER: S-EPMC6264849 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Factors associated with residents' contract behavior with family doctors in community health service centers: A longitudinal survey from China.

Huang Jiaoling J Huang Jiaoling J Liu Shanshan S He Rongrong R Fang Shuai S Lu Wei W Wu Jun J Liang Hong H Zhang Yimin Y

PloS one 20181129 11

<h4>Background</h4>China adopted family doctor (FD) to help achieve "Healthy China 2030" through providing continuous, comprehensive, and life-cycle contract services. However, there is a disparity between actual and targeted FD use, as residents continue to visit specialists in large hospitals. The government implemented initiatives to improve residents' willingness to sign up with and visit their FDs. Factors that influence contract behavior are therefore significant for frontier policy resear ...[more]

PMID: 30496254

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Project description:BackgroundMost previous studies of the family doctor contract services (FDCS) evaluated its quality by using residents' signing rates, awareness, and satisfaction. We hypothesize that renewal willingness could be another important indicator to examine the quality of FDCS.ObjectiveTo measure residents' willingness to maintain contracts with family doctors and examine the influencing factors.DesignCross-sectional study.Participants11,250 residents in 31 provincial administrative regions across China.Main methodsA multistage stratified random sampling method was used to recruit participants. Univariate analysis, mixed-effect regression model analysis, and stepwise multivariate logistic regression analysis were performed to determine the influencing factors of residents' willingness to maintain contracts with family doctors.Key resultsAbout 71.3% participants who contracted with and received healthcare services from family doctors were willing to maintain contracts with family doctors in China. Residents registering as local households (OR = 1.192, 95% CI = 1.039-1.368), enrolled in medical insurance (OR = 1.299, 95% CI = 1.011-1.668), reporting better health (OR = 1.246, 95% CI = 1.100-1.413), with shorter walking time to the nearest healthcare center (compared with > 30 min walking time, < 15 min: OR = 1.209, 95% CI = 1.003-1.458; 15-30 min: OR = 1.288, 95% CI = 1.124-1.475), and trusting in (OR = 4.403, 95% CI = 3.849-5.036) and satisfied with (OR = 18.514, 95% CI = 16.195-21.165) their family doctors had significantly higher willingness to maintain contracts with family doctors.ConclusionsResidents' willingness to maintain contracts with family doctors could be another evaluation indicator of the quality of FDCS in China. Improving the accessibility and quality of healthcare services from family doctors may increase residents' willingness to keep contracts with family doctors and promote the implementation of FDCS.

Project description:ImportanceLongitudinal Milestones data reported to the Accreditation Council for Graduate Medical Education (ACGME) can be used to measure the developmental and educational progression of learners. Learning trajectories illustrate the pattern and rate at which learners acquire competencies toward unsupervised practice.ObjectiveTo investigate the reliability of learning trajectories and patterns of learning progression that can support meaningful intervention and remediation for residents.Design, setting, and participantsThis national retrospective cohort study included Milestones data from residents in family medicine, representing 6 semi-annual reporting periods from July 2016 to June 2019.InterventionsLongitudinal formative assessment using the Milestones assessment system reported to the ACGME.Main outcomes and measuresTo estimate longitudinal consistency, growth rate reliability (GRR) and growth curve reliability (GCR) for 22 subcompetencies in the ACGME family medicine Milestones were used, incorporating clustering effects at the program level. Latent class growth curve models were used to examine longitudinal learning trajectories.ResultsThis study included Milestones ratings from 3872 residents in 514 programs. The Milestones reporting system reliably differentiated individual longitudinal patterns for formative purposes (mean [SD] GRR, 0.63 [0.03]); there was also evidence of precision for model-based rates of change (mean [SD] GCR, 0.91 [0.02]). Milestones ratings increased significantly across training years and reporting periods (mean [SD] of 0.55 [0.04] Milestones units per reporting period; P < .001); patterns of developmental progress varied by subcompetency. There were 3 or 4 distinct patterns of learning trajectories for each of the 22 subcompetencies. For example, for the professionalism subcompetency, residents were classified to 4 groups of learning trajectories; during the 3-year family medicine training period, trajectories diverged further after postgraduate year (PGY) 1, indicating a potential remediation point between the end of PGY 1 and the beginning of PGY 2 for struggling learners, who represented 16% of learners (620 residents). Similar inferences for learning trajectories were found for practice-based learning and improvement, systems-based practice, and interpersonal and communication skills. Subcompetencies in medical knowledge and patient care demonstrated more consistent patterns of upward growth.Conclusions and relevanceThese findings suggest that the Milestones reporting system provides reliable longitudinal data for individualized tracking of progress in all subcompetencies. Learning trajectories with supporting reliability evidence could be used to understand residents' developmental progress and tailored for individualized learning plans and remediation.

Project description:BackgroundThe Chinese government offered various types of training programs for strengthening the role of doctors working in community health service institutions (CHSIs). The study intended to investigate the current training programs and training needs of doctors nationally in urban CHSIs in China, and to provide propositions for training more qualified doctors in the future.MethodsTotal 3098 doctors in 192 urban CHSIs were chosen from 9 provinces (Hebei, Liaoning, Shandong, Zhejiang, Fujian, Hunan, Guangxi, Guizhou, Ningxia) and one municipality (Beijing) among 31 provinces in eastern, central, and western regions by stratified sampling methods in Mainland China. All doctors in the selected CHSIs were investigated in this study. We discharged 3073 questionnaires, and the response rate was 98.0%. Descriptive statistics were used to describe the characteristics, training contents, problems and needs of doctors. Differences in training contents, problems and needs between eastern, central and western regions were analyzed with chi-square tests.Results49.3% of doctors in CHSIs had Bachelor's degree and beyond. 12.9% of doctors had senior professional titles. The most frequent training topics for the doctors in eastern, central and western regions were "basic clinical theory knowledge" (52.4%), "community health service competency" (59.6%), "clinical practice skills" (45.9%) respectively. The most serious problem for doctors was "insufficient training time" in eastern (36.8%), central (36.5%) and western (39.6%). The biggest knowledge need for doctors both in eastern (79.8%) and central region (79.1%) was "the updated international medical knowledge", in western region it was "the updated domestic medical knowledge" (73.2%). The biggest skill-related training need for doctors in eastern region (84.1%) and central region (82.6%) was "communication skills", and "diagnosis and differential diagnosis" in western region (78.2%).ConclusionGovernment should design proper training contents according to the knowledge and skill needs of different design. Furthermore, a uniform, rigorous training and evaluation system focus on practicability should be established to promote community health service system in Mainland China.

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Factors associated with residents' contract behavior with family doctors in community health service centers: A longitudinal survey from China.

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Factors associated with residents' contract behavior with family doctors in community health service centers: A longitudinal survey from China.

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