The association between the supply and utilization of community-based primary care and child health in a context of hospital-oriented healthcare system in urban districts of Guangdong, China: a panel dataset, 2014-2016

Effect of family physician contract service on patients' perceived quality of primary child healthcare in urban China: Analysis using propensity score matching

OBJECTIVES

The family physician contract service (FPCS) policy has been implemented for several years within primary healthcare (PHC) institutions in China. However, the specific impact of the FPCS on patients' perceived quality of primary child healthcare remains unclear. Therefore, this study investigates the effect of the FPCS on the perceived quality of primary child healthcare in urban China.

STUDY DESIGN

A cross-sectional survey was conducted across twelve community health centers (CHCs) in four provinces of urban China in April 2022.

METHODS

A multistage stratified convenience sampling method was employed to recruit parents of children under the age of 16 who had visited CHCs at least once to participate in the study. A validated Mandarin Chinese version of the Primary Care Assessment Tool (PCAT) was utilized to gather information from parents regarding their experiences with primary child healthcare services. To address selection and confounding bias, propensity score matching (PSM) was applied to estimate the average treatment effect on the treated (ATT), followed by a weighted one-way analysis of variance to compare each primary care attribute score reported by the two groups.

RESULTS

A total of 7429 respondents were surveyed, with 1976 (26.6 %) in the contracted group and 5453 (73.4 %) in the control group. Following PSM, 3942 participants (1971 in each group) were analyzed, revealing significant pre-matching disparities in demographic and health characteristics, which were balanced post-matching. The analysis indicated that the average total PCAT score notably increased by 6.44 points for those with a contract with a family physician team, with a reduction of 6.25 points would occur if contracted participants discontinued their contract. Each domain score of primary care attributes was significantly higher in the contracted group compared to the control group, both before and after PSM, with notable differences in first-contact utilization, accessibility, continuity of care, coordination of services, and community orientation.

CONCLUSIONS

This study underscores the importance of family physician contract services in enhancing the quality of primary child healthcare and emphasizes the need for policy interventions to broaden access and equity in health service provision.

Effectiveness of WeChat-group-based parental health education in preventing unintentional injuries among children aged 0-3: randomized controlled trial in Shanghai

BACKGROUND

Unintentional injuries to children are a major public health problem. The online social media is a potential way to implement health education for caregivers in online communities. Using WeChat, a free and popular social media service in China, this study evaluated the effectiveness of social online community-based parental health education in preventing unintentional injuries in children aged 0-3.

METHODS

We recruited 365 parents from two community health centers in Shanghai and allocated them into intervention and control groups randomly. Follow-up lasted for one year. The intervention group received and followed their WeChat group and a WeChat official account for dissemination of reliable medical information. The control group received only the WeChat group.

RESULTS

Between the intervention and control groups, changes in unintentional injuries (OR = 1.71, 95% CI: 1.02-2.87, P = .04), preventability (β = 0.344, 95% CI: 0.152-0.537, P < .001), daily supervision behavior (β = 0.503, 95% CI: 0.036-0.970, P = .04), and behaviors for preventing specific injuries (β = 2.198, 95% CI: 1.530-2.865, P < .001) were significantly different, and change in first-aid skills for treating a tracheal foreign body were nearly significant (P = .06).

CONCLUSIONS

The WeChat-group-based parental health education can reduce the occurrence of unintentional child injuries by improving parents' skills, beliefs, and behaviors. Online social communities promote health education and reduce unintentional injuries among children.

TRIAL REGISTRATION

ChiCTR1900020753. Registered on January 17, 2019.

Association between Primary Care Utilization and Emergency Room or Hospital Inpatient Services Utilization among the Middle-Aged and Elderly in a Self-Referral System: Evidence from the China Health and Retirement Longitudinal Study 2011-2018

With rapid economic growth and aging, hospital inpatient and emergency services utilization has grown rapidly, and has emphasized an urgent requirement to adjust and optimize the structure of health service utilization. Studies have shown that primary care is an effective way to reduce inpatient and emergency room (ER) service utilization. This study aims to examine whether middle-aged and elderly individuals who selected primary care outpatient services in the last month had less ER and hospital inpatient service utilization than those who selected hospitals outpatient services via the self-referral system. Data were obtained from four waves of the nationally representative China Health and Retirement Longitudinal Study (CHARLS). We pooled respondents who had outpatient visits and were aged 45 years and above. We used logistic regressions to explore the association between types of outpatient and ER visits or hospitalization, and then used zero-truncated negative binomial regression to examine the impact of outpatient visit types on the number of hospitalizations and the length of hospitalization days. A trend test was used to explore the trend of outpatient visit types and the ER or hospital inpatient services utilization with the increase in outpatient visits. Among the 7544 respondents in CHARLS, those with primary care outpatient visits were less likely to have ER visits (adjusted OR = 0.141, 95% CI: 0.101-0.194), hospitalization (adjusted OR = 0.623, 95% CI: 0.546-0.711), and had fewer hospitalization days (adjusted IRR = 0.886, 95% CI: 0.81-0.969). The trend test showed that an increase in the number of total outpatient visits was associated with a lower hospitalizations (p = 0.006), but a higher odds of ER visits (p = 0.023). Our findings suggest that policy makers need to adopt systematic policies that focus on restructuring and balancing the structure of resources and service utilization in the three-tier healthcare system.

Parents' attitudes as mediators between knowledge and behaviours in unintentional injuries at home of children aged 0-3 in Shanghai, Eastern China: a cross-sectional study

OBJECTIVE

Parental behaviours are important in preventing unintentional injury at home among young children. Previous research showed an inconsistent relationship between knowledge and behaviours, indicating that the mechanisms may vary for different behaviours. This study aimed to examine the mediating roles of different attitudes in the mechanism of knowledge acting on different behaviours.

DESIGN

Cross-sectional study.

SETTING

Eastern China.

PARTICIPANTS

Participants were recruited using stratified community-based sampling. A total of 488 parents of children aged 0-3 years participated in the study and 476 (97.5%) valid questionnaires were recovered.

PRIMARY OUTCOME MEASURES

Parents' knowledge, attitudes (including injury attribution, preventability and responsibility) and behaviours (including supervision behaviours, risky behaviours and providing a safe home environment).

RESULTS

The results of mediation analysis showed that the mediator variables were different for different behaviours and that all associations were positive. Parents' knowledge (β 0.19, 95% CI 0.13 to 0.24) and attitude of injury attribution (β 0.37, 95% CI 0.21 to 0.46) were directly associated with risky behaviours. Attitude of preventability was directly associated with parents' supervision behaviour (β 0.27, 95% CI 0.14 to 0.40). Parents' attitude of preventability mediated the positive association between knowledge, attitudes of injury attribution and responsibility, and supervision behaviours, as well as providing a safe home environment. In addition, the occurrence of child injuries at home was directly associated with home environment (β -0.41, 95% CI -0.82 to -0.01).

CONCLUSIONS

The current findings confirm that attitudes play varying mediating roles between knowledge and different behaviours. An important recommendation is that parents' attitudes, especially towards preventability and responsibility, need to be considered when health providers develop health education programmes targeted at improving parental supervision behaviours and providing a safe home environment.