The Influencing Factors of Health-Seeking Preference and Community Health Service Utilization Among Patients in Primary Care Reform in Xiamen, China

Influencing factors of patients' behavior of healthcare seeking: a meta-analysis in China

Objectives

Understanding patient's healthcare seeking behavior (BHS) and identifying the determinants influencing BHS can optimize the allocation of medical resources and enhance the efficacy of healthcare systems. The purpose of this study is to identify the influencing factors of patients' BHS and to assess the extent and variation in their impact on BHS.

Methods

Drawing upon the Anderson Behavioral Model of Health Service Utilization, we summarized the factors influencing patients' BHS into three categories, and examined empirical journal articles published from 2010 to 2023 using meta-analysis. In addition, the Bayesian analysis of variance was introduced to explore the influence of moderators.

Results

A total of 39 empirical journal articles were finally identified for meta-analysis. Ten out of the thirteen factors have a significant and positive influence on BHS, with the exception of trust in medical institutions (z = 0.176, p = 0.077), health record (z = 1.942, p = 0.052), and medical expenses (z = 0.1846, p = 0.065). The results of moderating effect analysis indicate that there is a significant difference in the impact of age (p < 0.001), education level (p < 0.05), family income (p < 0.001), medical insurance (p < 0.001), illness severity (p < 0.01), and healthcare service reputation (p < 0.001) on BHS.

Conclusion

There is a positive and significant influence of the antecedent variables (self-rated health, distance to medical facilities, illness severity, age, family income, education level, marital status, medical insurance, awareness of hierarchical healthcare, health record, and healthcare service reputation) on BHS. Furthermore, the influences of family income, medical insurance, and illness severity on BHS in developed areas are stronger than that in underdeveloped areas, while the influences of age, education level, and healthcare service reputation on BHS in underdeveloped areas are stronger than that in developed areas.

Diabetes Self-Management and Health Care Demand Procrastination Behavior Among Earthquake Victims with Type 2 Diabetes in Earthquake Zone

OBJECTIVES

The aim of this descriptive study was to assess diabetes self-management and health care demand procrastination behaviors among earthquake victims with type 2 diabetes.

METHODS

The population of the study consisted of earthquake victims with Type 2 diabetes in Hatay, Türkiye. The sample included 202 people with type 2 diabetes who lived in 7 distinct container cities. Data were collected using the Introductory Information Form, Diabetes Self-Management Scale, and Healthcare Demand Procrastination Scale via face-to-face interviews.

RESULTS

Participants' average score on the diabetes self-management scale was 58.34 ± 9.11. Being under the age of 60, employed, visiting a medical center on their own, having received diabetes education, and owning a glucometer were associated with better diabetes self-management, whereas being illiterate and having difficulty covering diabetes-related expenses were associated with poor diabetes management (P < 0.05). Participants' average score on the Healthcare Demand Procrastination Scale was 2.35 ± 0.72. Respondents who didn't have a nearby health care institution, whose diabetes diagnosis duration was between 1-5 years, and who didn't have a glucometer had significantly higher scores on the Healthcare Demand Procrastination Scale (P < 0.05).

CONCLUSIONS

Diabetes self-management among earthquake victims with Type 2 diabetes was low. It was also determined that participants' health care demand procrastination behaviors were at a moderate level.

Inpatient preferences among patients with multiple chronic conditions in China: A discrete choice experiment

BACKGROUND

Multiple chronic conditions (MCC) have become a leading cause of low vitality and high mortality among the Chinese population. Although a series of policies has been implemented to promote patients' rational access to health care, patients still prefer a higher level of inpatient service, hampering the efficient utilization of resources in county hospitals, which are the first point of contact for inpatient care. Thus, this study aimed to identify the factors that affect MCC patients' inpatient preferences and the extent to which these factors influence their decisions, thereby guiding inpatient service utilization among MCC patients.

METHODS

Five attributes (institution scale, waiting time for hospital admission, presence of acquaintances, travel time from residence to hospital, and out-of-pocket expenses per visit) were identified to estimate inpatient choice for MCC patients through a discrete choice experiment. A partial factor analysis was performed to generate selection sets. Data were collected from MCC patients aged between 35 and 75 years, in Fuqing City, China. A mixed logit model was used to analyse MCC patients' preferences for each attribute. Willingness to pay was estimated by regression coefficients, and interaction terms were included in the model to estimate the heterogeneity of inpatient preferences among MCC patients.

RESULTS

A total of 504 valid questionnaires were included in the analysis. The most important attribute of patients when choosing inpatient care is out-of-pocket expenses per visit, followed by travel time from residence to hospital, waiting time for hospital admission, institution scale, and presence of acquaintances. In addition, patients were willing to pay ¥1253, ¥434, and ¥323 for shorter times from the residence to the hospital, larger institutional scale, and beds available on the day, respectively. The findings of the interaction analysis indicated that age and gender also influence MCC patients' inpatient preferences.

CONCLUSION

This study provides evidence of the inpatient preferences of MCC patients. Increasing inpatient insurance reimbursement rates, bolstering the leading role of district and county hospitals in the area, and strengthening information systems will empower district and county hospitals to effectively serve as the first point of contact for inpatient care.

Network characteristics of referrals for chronic disease patients: results from hierarchical medical reform in Shenzhen, China

BACKGROUND

The Chinese government has introduced a series of hierarchical medical policies to ensure continuity of care, but referrals remain difficult to implement effectively. This study aimed to evaluate the chronic disease referral network and explore the problems associated with the specific implementation of referrals.

METHODS

This study was a repeated cross-sectional study of monthly data collected between August 2017 and December 2023 in Luohu district, Shenzhen, China. Social network analysis was used to construct a referral network for chronic disease patients. Density, degree centrality, and betweenness centrality were calculated to assess the relationships and status among different levels of care and their trends.

RESULTS

Over seven years, 104,682 chronic disease patients were referred, with a predominance of downward referrals. The number of upward referrals (Z = 2.5776, Ptrend < 0.01) and downward referrals (Z = 4.7723, Ptrend < 0.001) increased significantly. Primary care facilities (PCFs) were strongly associated with the tertiary hospital (0.51-0.98). The out-degree of all levels of medical institutions showed a significant increasing trend (Ptrend < 0.05). The coronavirus disease 2019 (COVID-19) pandemic did not cause significant level changes in network metrics but accelerated the upward trend in the out-degree of secondary hospitals (P < 0.05). The in-degree of secondary hospitals and PCFs showed a significant increasing trend (Ptrend < 0.01). Public PCFs had significantly higher network metrics compared to private PCFs (P < 0.001).

CONCLUSIONS

The referral network has a vertical flow pattern conducive to the division of labour, cooperation, and resource integration of medical institutions in the region, and a hierarchical medical order is taking shape. However, poor communication between secondary hospitals and other institutions, high demand for data informatisation, and the gap between private and public PCFs may hinder further progress.

A study of patients' choice of medical treatment based on rational choice theory: a cross-sectional survey from China

OBJECTIVE

To describe how patients choose between primary care institutions (PCIs) and non-PCIs using rational choice theory from the perspective of survival rationality, economic rationality, and social rationality.

METHODS

Multi-stage stratified sampling and convenience sampling were applied to select 1723 patients to conduct the questionnaire survey. Chi-square test and binary logistic regression were performed to analyze the factors associated with patients' choice of PCIs.

RESULTS

In total 55.83% of 1723 patients would attend a PCIs for healthcare. The results of the univariate analysis revealed that patients who are female (58.46%, P = .015), suffering from chronic diseases (56.26%, P = .047), inpatients (67.58%, P < .001), Beijing (59.62%, P = .002), partial understanding of the family doctor contracting system (62.30%, P < .001), and not understanding of the medical alliance policy (58.04%, P = .031) had significantly higher probability of choosing PCIs. Logistic regression analysis showed that females were more unwilling to attend PCIs (odds ratio (OR) = 0.822, 95%CI: 0.676-0.999). Following survival rationality, patients without chronic diseases were more likely to attend PCIs (OR = 1.834, 95%CI: 1.029-3.268), and inpatients were more unlikely to attend PCIs (OR = 0.581, 95%CI: 0.437-0.774). From an economic rationality perspective, patients from the Fujian province were more likely to attend PCIs (OR = 1.424, 95%CI: 1.081-1.876). From a social rationality perspective, patients who partial understanding of the family doctor contracting system were more unlikely to attend PCIs (OR = 0.701, 95%CI: 0.551-0.892), and patients who partial and complete understanding of the medical alliance policy were more likely to attend PCIs (OR = 1.340, 95%CI: 1.064-1.687; OR = 1.485, 95%CI: 1.086-2.030).

CONCLUSIONS

Survival, economic, and social rationality are involved in patients' choice to attend PCIs. Compared to survival rationality and social rationality, economic rationality showed a lower association with patients' choice to attend PCIs. Medical institutions are recommended to adopt a "patient health-centered" approach when providing medical services and further optimize the family doctor contracting system and construction of medical alliances.

Factors Associated with Health-Seeking Behavior in Indonesia: Evidence from the Indonesian Family Life Survey 2014

Background and Objectives: Health-seeking behavior is a critical determinant of health outcomes, particularly in countries like Indonesia. Given the increasing burden of noncommunicable diseases, understanding the factors that influence health-seeking behavior in this context is essential for developing more accessible and effective public health strategies. This study aimed to identify various factors associated with health-seeking behavior among patients with chronic diseases across Indonesia, especially in formal facilities. Materials and Methods: This study used a cross-sectional research design, utilizing Indonesian Family Life Survey (IFLS)-5 data. The inclusion criteria included respondents aged 20-74 years old with at least one chronic disease based on self-reported data. Respondents who did not receive treatment, practiced self-medication, or provided incomplete data were excluded. We used multivariate logistic regression to identify factors associated with health-seeking behavior in formal facilities. Results: The results revealed that 80.7% (n = 1993) of the 2471 respondents sought treatment in formal facilities, whereas 19.3% (n = 478) opted for informal facilities. Respondents who were Bugis (OR 9.187, 95% CI 2.182-38.683; p = 0.002), retired (OR 2.966, 95% CI 1.233-7.135; p = 0.015), did not smoke (OR 1.604, 95% CI 1.126-2.285; p = 0.009), made less than IDR 1,500,000 a month (OR 1.466, 95% CI 1.174-1.831; p = 0.000), had to travel more than 3 km to reach a treatment facility (OR 1.847, 95% CI 1.41-2.42; p = 0.000), or had more than one comorbidity (OR 1.396, 95% CI; p = 0.01) were more likely to seek treatment at formal facilities. Conclusions: These findings are expected to provide recommendations for policymakers, healthcare providers, and researchers to contribute to the development of targeted interventions that can improve healthcare access and utilization, ultimately enhancing health outcomes and equity in Indonesia.

Healthcare-seeking behavior and out-of-pocket payments in Erbil, Kurdistan Region of Iraq

BACKGROUND

Understanding healthcare-seeking behavior and examining health expenditures can help determine possible barriers to accessing healthcare and direct more effective and inclusive healthcare systems. This study aimed to evaluate healthcare-seeking behavior and out-of-pocket healthcare expenditure in a sample of the population in Erbil, Iraq.

METHODS

We conducted this cross-sectional study in Erbil, Kurdistan Region of Iraq, from October to December 2023. A convenience sample of 414 adults completed a self-administered online survey. The following data were collected: recent illness, sociodemographic characteristics, type of healthcare received, and cost of healthcare.

RESULTS

The most common health conditions reported were communicable diseases (16.3%), musculoskeletal problems (13.1%), and noncommunicable diseases (12.7%). Approximately 85% of patients with health conditions requiring care sought healthcare; most visited private clinics (46.3%) and private hospitals (18.6%). The median total out-of-pocket healthcare expenditure in US dollars was 117.3 (interquartile range (IQR) = 45.6-410.0). The median total cost was much greater for participants who first visited a private health facility (USD 135.5, IQR = 57.3-405.6) than those who first visited a public facility (USD 76.8, IQR = 16.1-459.7). Participants ≥ 60 years spent significantly more than those < 14 years (USD 332, 95% CI = 211-453, p < 0.001). Evermarried participants spent significantly more than unmarried (USD 97, 95% CI = 1 to 192, p = 0.047). Health expenditures were significantly greater for noncommunicable diseases than infectious diseases (USD 232, 95% CI = 96-368, p = 0.001). After adjusting for covariates, age ≥ 60 years was independently associated with higher spending (USD 305, 95% CI = 153-457, p < 0.001).

CONCLUSIONS

Most participants sought care from formal health services, preferring the private sector. Seeking care from private facilities incurred significantly higher costs than seeking care from public ones, which suggests potential barriers to accessing healthcare, particularly affordability. The findings underscore the importance of evaluating existing healthcare policies to enhance effectiveness and identify areas for improvement. This study can help policymakers and healthcare providers design effective interventions, allocate resources efficiently, and improve healthcare delivery.

Characteristics and influencing factors of caregivers' healthcare preferences for young children under COVID-19 lockdown: a cross-sectional study in Shanghai, China

BACKGROUND

Missed or delayed child healthcare caused by the COVID-19 lockdown has threatened young children's health and has had an unpredictable influence on caregivers' child healthcare preferences. This study investigated caregivers' child healthcare preferences and the factors that influence them among families with young children (0-3 years) during the lockdown in Shanghai.

METHODS

Participants in this cross-sectional study were enrolled through random encounter sampling. Questionnaires were distributed online from June 1 to November 10, 2022, in Shanghai. A total of 477 valid questionnaires were received. The demographics of caregivers and their families, children's characteristics, COVID-19-related information, and caregivers' healthcare preferences were analyzed. The statistical analyses included frequency and percentage, chi-square tests, and multinomial logistic regression.

RESULTS

Caregivers preferred child healthcare professionals in the community health service system (CHS; 47.6%) followed by hospital pediatricians (40.0%) during lockdown. Caregivers with the following characteristics preferred CHS: those with an annual household income of CNY 200,000-300,000, those whose youngest children were aged 8-12 months, and those who experienced early childhood physical development issues. Caregivers preferred hospitals if they had experienced healthcare-seeking-related difficulties in accessing professional guidance from hospital pediatricians.

CONCLUSIONS

During pandemic lockdowns, policymakers should allocate more resources to CHS to meet caregivers' childcare demands. Moreover, special attention should be given to the healthcare needs for CHS among families with specific demographics.

TRIAL REGISTRATION

Approval was obtained from the Ethics Committee of Shanghai Jiao Tong University School of Medicine School of Public Health (SJUPN-202,109; June 1, 2022).

The impact of hyperkalemia on ICU admission and mortality: a retrospective study of Chinese emergency department data

OBJECTIVE

This study assesses the influence of hyperkalemia on both disease severity and the risk of mortality among patients admitted to the emergency room.

METHODS

This retrospective observational study utilized data from the Chinese Emergency Triage Assessment and Treatment database (CETAT, version 2.0), which was designed to evaluate and optimize management strategies for emergency room (ER) patients. Patients were systematically categorized based on serum potassium levels. Relationships between serum potassium levels, risk of mortality, and the severity of illness were then analyzed using multifactorial logistic regression and through Receiver Operating Characteristic (ROC) analysis. The effectiveness of various treatments at lowering potassium levels was also investigated.

RESULTS

12,799 emergency patients were enrolled, of whom 20.1% (n = 2,577) were hypokalemic and 2.98% (n = 381) were hyperkalemic. Among hyperkalemic patients, the leading reasons for visiting the ER were altered consciousness 23.88% (n = 91), cardiovascular symptoms 22.31% (n = 85), and gastrointestinal symptoms 20.47% (n = 78). Comparative analysis with patients exhibiting normal potassium levels revealed hyperkalemia as an independent factor associated with mortality in the ER. Mortality risk appears to positively correlate with increasing potassium levels, reaching peaks when blood potassium levels ranged between 6.5 and 7.0. Hyperkalemia emerged as a strong predictor of death in the ER, with an Area Under the Curve (AUC) of 0.89. The most frequently prescribed treatment for hyperkalemia patients was diuretics (57.32%, n = 188), followed by intravenous sodium bicarbonate (50.91%, n = 167), IV calcium (37.2%, n = 122), insulin combined with high glucose (27.74%, n = 91), and Continuous Renal Replacement Therapy (CRRT) for 19.82% (n = 65). Among these, CRRT appeared to be the most efficacious at reducing potassium levels. Diuretics appeared relatively ineffective, while high-glucose insulin, sodium bicarbonate, and calcium preparations having no significant effect on the rate of potassium decline.

CONCLUSION

Hyperkalemia is common in emergency situations, especially among patients with altered consciousness. There is a strong positive correlation between the severity of hyperkalemia and mortality risk. CRRT appears to be the most effective potassium reducting strategy, while the use of diuretics should be approached with caution.

The Needs of Patients With Chronic Disease in Transitional Care From Hospital to Home in Sudan: A Qualitative Study

The growing burden of chronic non-communicable diseases demands improved post-discharge care. The Sudanese healthcare system faces challenges in providing coordinated care for patients with chronic conditions after hospital discharge. This qualitative study explored the experiences of patients with chronic disease in transitional care from hospital to home to identify improvement targets. Purposive sampling was used to interview 17 participants from different hospitals in Khartoum, Sudan. Audio recordings were transcribed and analyzed using principles of content analysis to identify themes and the relationship between them. Thematic analysis revealed 4 main themes describing the perceived needs of the patients. These were (1) feeling well-informed about post-discharge care goals and plans; (2) feeling cared for during hospital admission and follow-up visits; (3) feeling safe during the transitional care process; and (4) having access to follow-up services. This study highlights the importance of improving hospital patient education through effective communication to facilitate care transitions.

Use of Primary Healthcare Among Chinese Older Adults With Functional Limitations

The aim of this study was to assess the factors associated with primary healthcare (PHC) utilization among older adults with functional limitations, providing insights for improving the effectiveness of PHC for this population. We used the China Health and Retirement Longitudinal Study (CHARLS) dataset, which encompasses 28 provinces in China. Logistic regression was used to analyze the people-related, care context-related, and linkage-related factors associated with PHC utilization. Approximately 55.61% of older adults with functional limitations utilized PHC in the past month, regardless of visit frequency or extent. Participants with lower educational attainment, those reporting more pain, and those living in rural areas had a higher likelihood of PHC utilization. Participants who received inpatient care in the past year had a lower likelihood of PHC utilization. We recommend that policymakers complement existing PHC health programs with increased health and social welfare support for this population.

Assessment of type 2 diabetes mellitus patients' behavioral characteristics associated with integrated treatment and prevention services in community health centers in China

Objective

The purpose of this study was to describe behavioral characteristics of type 2 diabetes mellitus (T2DM) patients, identify homogeneous clusters, and explore factors affecting behaviors associated with integrated treatment and prevention (ITP) services for T2DM in community health centers in China.

Methods

A convenient sampling method was employed at a community health center between January and July 2022 in Nanjing. A total of 354 patients completed the self-reported questionnaires. After performing a Cluster Analysis to create a profile of participants' behaviors, a multiple linear regression analysis was conducted to explore the correlations between T2DM patients' characteristics and their behaviors associated with ITP services.

Results

316 T2DM patients with a mean age of 72.09 years (SD = 5.96) were included. The behavior profiles of patients associated with ITP services were clustered into "Lower" (n = 198) and "Higher" (n = 118) groups, with average scores of 54.41 and 71.46, respectively. Of all the behaviors, complication examination and public health utilization scored the lowest. Health insurance, duration of disease, and treatment modality were independent predictors on the patients' behaviors associated with ITP services for T2DM.

Conclusion

Patients' behaviors associated with ITP services for T2DM were moderately good (the score rate was 63.98%). Of all the behaviors, complication examination and public health service utilization scored the lowest and, as such, may warrant further research. The clustering of patients' behaviors tends to be polarization, distributed at the upper and lower ends of the behavior spectrum. It is necessary to develop and implement targeted interventions for different groups to improve T2DM patients' behaviors associated with ITP services.

How to promote the hierarchical diagnosis and treatment system: A tripartite evolutionary game theory perspective

Due to the disorderly access to medical care and inefficient use of health resources, the advancement of the hierarchical diagnosis and treatment is more valued in promoting health system reform. Hence, this article integrates prospect theory into an evolutionary game model of the local government health departments, the medical institutions, and the patients in the system promotion of the hierarchical diagnosis and treatment. The simulation shows the specific influencing mechanism of the psychological perceived value of game subjects. Then by introducing the stochastic evolutionary game model, the system promotion under different medical cultures is also discussed in detail. The results indicate that for local government health departments, the amount and duration of financial subsidies are the key factors influencing the game system's evolution. For medical institutions, participating in the hierarchical diagnosis and treatment system is relatively beneficial. For patients, the recovery rate in primary hospitals matters more than the cost of treatment. Changes in the risk sensitivity coefficient will cause the equilibrium of the game system to change. However, changes in the loss avoidance factor do not change the equilibrium and only have an impact on the speed of convergence. With the health departments' intervention, patients in rural medical culture are more inclined to support the hierarchical diagnosis and treatment system than those in urban or town medical culture. Therefore, in order to promote the hierarchical diagnosis and treatment system, this article recommends that more attention should be paid to the regulatory role of health departments and the participation improvement of medical institutions and patients.

Willingness rate of the first visit to primary healthcare services and the associated factors in China: a meta-analysis

BACKGROUND

In September 2015, the State Council of China issued guidelines on building a hierarchical medical system, stating that the first visit rate to primary healthcare (PHC) facilities should be increased to 70% for all medical facilities by 2017. This meta-analysis aims to estimate the willingness of the first visit to PHC services in China after the year 2015 and identify its determinants.

METHODS

A meta-analysis was conducted.

RESULTS

The combined estimate from 23 studies in China for the willingness rate of the first visit to PHC services was 56% (95% CI: 47-65). Chronic diseases may be one source of heterogeneity. We identified five main associated factors with the pooled odds ratio ranging from 1.39 to 10.28, including fair self-reported health status; high understanding of service content; good service attitude; solid expertise and advanced diagnostic methods; and a good medical environment.

CONCLUSION

In comparison with China's State Council recommendations, the willingness rate for the first visit to PHC services was significantly lower. The Government should develop strategies to facilitate the implementation of a hierarchical system for diagnosis and treatment.

Satisfaction and its determinants of rural upper gastrointestinal cancer screening in China: a preliminary cross-sectional study

OBJECTIVES

To assess participants' satisfaction with and predictors of upper gastrointestinal cancer screening in rural areas.

DESIGN

Cross-sectional study.

SETTING

Ten screening centres in seven cities across five provinces in China.

PARTICIPANTS

Of the 452 participants screened during the survey period, 438 completed the survey (response rate: 96.90%).

PRIMARY OUTCOME MEASURES

Screening satisfaction was the primary outcome and it was assessed using the Patient Satisfaction Questionnaire-18. Ordinal logistic regression analysis was used to analyse the predictors of satisfaction.

RESULTS

The percentages of satisfaction with the General Satisfaction, Technical Quality, Interpersonal Manner, Communication, Financial Aspects, Time Spent With Doctor, and Convenience and Accessibility dimensions were 95.89%, 79.68%, 88.36%, 83.56%, 75.11%, 82.19% and 66.44%, respectively. Education (OR 0.25, 95% CI 0.07 to 0.90), health self-assessment (OR 15.29, 95% CI 2.86 to 81.78) and family history of cancer (OR 4.20, 95% CI 1.29 to 13.71) were associated with General Satisfaction. Residence (OR 4.31, 95% CI 1.89 to 9.81) was associated with Technical Quality. Occupation (OR 0.27, 95% CI 0.08 to 0.88), health self-assessment (OR 11.30, 95% CI 3.94 to 32.43), screening purpose (OR 0.18, 95% CI 0.03 to 0.92) and distance from the screening centre (OR 4.59, 95% CI 1.35 to 15.61) were associated with interpersonal manner. Gender (OR 1.85, 95% CI 1.02 to 3.34), residence (OR 3.23, 95% CI 1.23 to 8.53) and endoscopy in the previous year (OR 2.79, 95% CI 1.13 to 6.90) were associated with Communication. Body mass index (BMI; OR 5.06, 95% CI 1.40 to 18.25) and health self-assessment (OR 2.09, 95% CI 1.12 to 3.88) were associated with financial aspects. Gender (OR 1.90, 95% CI 1.07 to 3.38), residence (OR 3.19, 95% CI 1.30 to 7.79), BMI (OR 5.26, 95% CI 1.14 to 24.34) and health self-assessment (OR 2.14, 95% CI 1.06 to 4.34) were associated with time spent with doctor. Gender (OR 1.64, 95% CI 1.04 to 2.60) and residence (OR 3.17, 95% CI 1.46 to 6.88) were associated with convenience and accessibility.

CONCLUSION

There was heterogeneity across the dimensions of satisfaction with rural upper gastrointestinal cancer screening. Project manager should prioritise improving the aspects related to the convenience and accessibility dimension. Furthermore, to improve the efficiency of potential interventions, the predictors of the various dimensions should be considered.

Patients' Willingness of First Visit in Primary Medical Institutions and Policy Implications: A National Cross-Sectional Survey in China

Background

The Chinese hierarchical treatment system expects patients to first visit primary medical institutions (PMIs), and patients' willingness determined their utilization of primary health care. The aim of this study was to explore the factors associated with patients' willingness to make their first visit to PMIs.

Methods

We employed multistage stratified sampling and convenience sampling to administer questionnaires to 1,507 patients in Beijing, Qinghai, and Fujian. Patients' willingness of first visit in PMIs was analyzed using Chi-square test and binary logistic regression.

Results

Of the 1,507 participants in the survey, 55.1% were willing to make their first visit in PMIs. Fewer patients in Beijing (17.6%) are willing to make their first visit in PMIs than those in Qinghai (71.9%) and Fujian provinces (72.0%). Binary logistic regression analysis revealed that higher recognition of the community first visit policy and higher satisfaction with the medical technology of PMIs are associated with patients' willingness of first visit in PMIs.

Conclusions

Due to differences in local economic conditions, medical resources, and policy formulation, there are differences among provinces in patients' willingness of first visit in PMIs. To increase patients' rate of visits in PMIs, it is important to improve service capacity and quality of PMIs and change residents' attitudes for PMIs.

Analysis on the willingness and influencing factors of choosing primary healthcare institutions among patients with chronic conditions in China: a cross-sectional study

OBJECTIVE

To assess the willingness and factors influencing the choice of primary healthcare (PHC) institutions among patients with chronic conditions in China.

DESIGN

A nationwide population-based study with binary logistic regression was conducted and used to estimate the ORs of the influencing factors of health-seeking at PHC institutions using the Anderson model as a theoretical framework.

SETTING

The China Family Panel Studies (CFPS) database.

PARTICIPANTS

The study sample included 7967 patients with chronic conditions identified from the 2016 and 2018 CFPS databases.

RESULTS

From 2016 to 2018, the rate of choosing PHC institutions for patients with chronic conditions dropped from 51.0% to 47.7%. The logistic regression results showed that patients with low family income (OR value of >60 000 group was 0.57, 95% CI 0.43 to 0.74), low education level (OR value of bachelor degree or above was 0.54, 95% CI 0.35 to 0.83;), older age (OR value of >65 group was 1.31, 95% CI 1.08 to 1.60;), hypertension and diabetes (OR 1.26, 95% CI 1.13 to 1.41), living in rural areas (OR value of urban was 0.47, 95% CI 0.38 to 0.60), immigrating from rural to urban areas (OR 1.64, 95% CI 1.26 to 2.13), reporting good health (OR value of very good was 1.33, 95% CI 1.05 to 1.68) and those from areas with a high proportion of PHC institutions (OR 1.05, 95% CI 1.02 to 1.07) were more inclined to choose PHC institutions. Conversely, patients with urban employee health insurance (OR 0.62, 95% CI 0.49 to 0.80) and more than one chronic disease (OR 0,83, 95% CI 0.75 to 0.92) preferred choosing a hospital.

CONCLUSIONS

The patients' willingness to choose PHC institutions was low. The health-seeking preference of patients with chronic conditions is derived from medical needs and is influenced by the predisposing factors and tendencies of enabling resources. Measures should be taken to improve the capacity of PHC institutions.

Demand for Mobile Health in Developing Countries During COVID-19: Vietnamese's Perspectives from Different Age Groups and Health Conditions

BACKGROUND

Vietnam's economy and intellectual standards have witnessed significant development, improving conditions for residents to acquire novel mHealth applications. Additionally, the outbreak of the COVID-19 pandemic has influenced Vietnamese awareness of healthcare; however, previous studies have only been clinician-centered rather than customer-centered.

METHODS

This study addresses this literature gap by interviewing 50 Vietnamese participants grouped by age, namely Generation X, Generation Y, and Generation Z, and health conditions, namely whether participants or family members have chronic illness. The study utilized semi-structured and in-depth interviews to collect the data and used thematic analysis to analyze the data under the unified theory of acceptance and use of technology framework.

RESULTS

Most participants were willing to adopt this technology and demanded a convenient and user-friendly one-stop-shop solution, endorsements from credible and authoritative sources, and professional customer services. However, each group also had distinctive demands and behaviors.

CONCLUSION

This study contributes theoretically by providing context-rich demand for Vietnamese customers across three generations and healthcare conditions during the COVID-19 pandemic and comparing their behavior with pre-COVID literature. While this research provides helpful information for potential app developers, this study also suggests that mHealth developers and policymakers should pay more attention to the differences in the demand of age groups and health conditions.

A Cross-Sectional Survey of Family Care Behaviors for Children with Upper Respiratory Tract Infections in China: Are There Opportunities for Improvement?

OBJECTIVE

To describe family care behaviors for children with upper respiratory tract infections (URTIs) and explore related factors.

DESIGN AND METHODS

Parents of children with URTIs were included in this cross-sectional study. Family care behaviors, disease-related knowledge, and parental self-efficacy were evaluated with validated measures.

RESULTS

Among the 419 participants, 73.80% recognized diseases based on their children's abnormal presentation. Self-medication was the main home care measure (36.28% used only self-medication; 27.92% used both self-medication and physical cooling methods), and 36.5% received suggestions from medical professionals. All the participants took their children to the hospital, and 28.20% did so two or three times. The proportions of visits to level II or III hospitals were 49.64% and 83.87% for first and third hospital visits, respectively. Parents who had less disease knowledge and assessed children' diseases as more serious took their children to the hospital more often (p < 0.05); those whose nearest medical institution was a community health center were more likely to visit such centers (p < 0.001).

CONCLUSIONS

Most of the parents recognized symptoms of URTIs and provided home care but lacked enough knowledge and professional support to take reasonable measures. Hospital visits were their primary choice.

PRACTICAL IMPLICATIONS

Family care behaviors for children with URTIs could be improved through health education, and an internet nursing service or family doctor system is suggested. A hierarchical medical system is necessary to reduce hospital visits, as are more community health centers with pediatric services.

The trend in primary health care preference in China: a cohort study of 12,508 residents from 2012 to 2018

Background

Residents’ preference for primary health care (PHC) determined their utilization of PHC. This study aimed to assess the determinants of PHC service preference among the residents and the trend in PHC service preference over time in China.

Methods

We employed the nationally representative longitudinal data from 2012 to 2018 based on the China Family Panel Studies. The analysis framework was guided by the Andersen model of health service utilization. We included a total of 12,508 individuals who have been successfully followed up in the surveys of 2012, 2014, 2016, and 2018 without any missing data. Logistic regressions were performed to analyze potential predictors of PHC preference behavior.

Results

The results indicated that individuals’ socio-economic circumstances and their health status factors were statistically significant determinants of PHC preference. Notably, over time, the residents’ likelihood of choosing PHC service represented a decreasing trend. Compare to 2012, the likelihood of PHC service preference decreased by 18.6% (OR, 0.814; 95% CI, 0.764–0.867) in 2014, 30.0% (OR, 0.700; 95% CI, 0.657–0.745) in 2016, and 34.9% (OR, 0.651; 95% CI, 0.611–0.694) in 2018. The decrease was significantly associated with the changes in residents’ health status.

Conclusions

The residents’ likelihood of choosing PHC service represented a decreasing trend, which was contrary to the objective of China’s National Health Reform in 2009. We recommend that policymakers adjust the primary service items in PHC facilities and strengthen the coordination of service between PHC institutions and higher-level hospitals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06790-w.

Whether Public Hospital Reform Affects the Hospital Choices of Patients in Urban Areas: New Evidence from Smart Card Data

The effects of public hospital reforms on spatial and temporal patterns of health-seeking behavior have received little attention due to small sample sizes and low spatiotemporal resolution of survey data. Without such information, however, health planners might be unable to adjust interventions in a timely manner, and they devise less-effective interventions. Recently, massive electronic trip records have been widely used to infer people's health-seeking trips. With health-seeking trips inferred from smart card data, this paper mainly answers two questions: (i) how do public hospital reforms affect the hospital choices of patients? (ii) What are the spatial differences of the effects of public hospital reforms? To achieve these goals, tertiary hospital preferences, hospital bypass, and the efficiency of the health-seeking behaviors of patients, before and after Beijing's public hospital reform in 2017, were compared. The results demonstrate that the effects of this reform on the hospital choices of patients were spatially different. In subdistricts with (or near) hospitals, the reform exerted the opposite impact on tertiary hospital preference compared with core and periphery areas. However, the reform had no significant effect on the tertiary hospital preference and hospital bypass in subdistricts without (or far away from) hospitals. Regarding the efficiency of the health-seeking behaviors of patients, the reform positively affected patient travel time, time of stay at hospitals, and arrival time. This study presents a time-efficient method to evaluate the effects of the recent public hospital reform in Beijing on a fine scale.

Regional Heterogeneity of Application and Effect of Telemedicine in the Primary Care Centres in Rural China

The increasing concerns of the geographical maldistribution of medical resources have sparked worldwide interests in exploring the potential of telemedicine in the rural health system. This study aimed to investigate the application and effect of telemedicine as well as their regional heterogeneity in the primary care centres in rural China. Based on the stratified multistage cluster sampling, a cross-sectional study was conducted among 358 township health centres (THCs) from eastern, central and western China. A self-administered questionnaire was used and the data of the Health Statistical Annual Reports in 2017 were collected to investigate the implication of telemedicine as well as the performance and other characteristics of each THCs. Propensity score matching was used to estimate the effect of telemedicine application on the bed occupancy rate and the number of annual outpatient visits of the THCs, with comparison among the regions. The overall prevalence of telemedicine application was 58.66% in 2017, and it was found to increase the bed occupancy rate of the THCs in the national range (p < 0.1). When divided into different regions, telemedicine was found to improve the number of annual outpatient visits in western China (p < 0.05) and the bed occupancy rate in eastern China (p < 0.1). Disparities in the degree of remoteness and the capability of THCs among the regions were also found in this study, which may be the reasons for the regional heterogeneous effects of telemedicine. These findings suggested the potential of telemedicine in improving the utilization of primary care centres in rural areas. Further studies were needed to investigate the underlying reasons for its regional heterogeneous effects.

Preferences for Primary Healthcare Services Among Older Adults with Chronic Disease: A Discrete Choice Experiment

PURPOSE

The aim of this study was to quantify the relative importance of the preference heterogeneity of Chinese older adults with chronic disease for primary healthcare service (PHCS) in the hypothetical minor chronic disease scenario.

PATIENTS AND METHODS

A discrete choice experiment (DCE) was administered to the patients aged 60 and above with at least one chronic disease in China. Five DCE attributes were considered, including types of service, treatment options, out-of-pocket (OOP) cost per visit, distance to practice, and the seniority of medical practitioners. DCE data were analysed taking into account of potential preference heterogeneity using both a mixed logit model (MLM) and a latent class logit model (LCLM).

RESULTS

A total of 432 respondents consented to complete the questionnaires and 372 valid respondents were included in analysis. All attributes were significantly influencing respondents' PHCS choice except for the types of service. Significant preference heterogeneity was observed among respondents. Based on the preferred LCLM estimates, four latent classes were identified. The first class (28.8%) valued modern medicine service the most, the second class (17.8%) was dominated by distance to practice, the third class (29%) preferred all the attributes except the types of services and valued TCM service most, the fourth class (24.4%) paid more attention to the types of service. Education, gender, age, income, regions of residence, and status of the chronic condition were found to be associated with latent class memberships.

CONCLUSION

A better understanding of the relative importance of PHCS characteristics is a crucial step for the future policy implementations. The significant preference heterogeneity identified in this study highlights that effective policy interventions should be tailored to different patients' characteristics.