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Wu Y, Liang Y, Cai Z, Li L, Sun C, Sylvia S, Zhou H, Feng J, Rozelle S. Process quality, diagnosis quality, and patient satisfaction of primary care in Rural Western China: A study using standardized patients. PATIENT EDUCATION AND COUNSELING 2024; 123:108208. [PMID: 38377708 DOI: 10.1016/j.pec.2024.108208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/26/2023] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES Patient satisfaction is an essential indicator of the doctor-patient relationship. This study aimed to investigate the relationship between primary care quality and patient satisfaction for non-communicable diseases (NCDs) in rural western China. METHODS The study utilized the standardized patients (SPs) approach to present typical symptoms of unstable angina and diabetes to rural healthcare providers. After the consultations, the SPs completed a satisfaction survey. Ordinary least squares and quantile regression were used to examine the association between quality of primary care and patient satisfaction. RESULTS We examined 178 anonymous SPs visits. The results showed that higher process quality for angina SPs was correlated with stronger satisfaction for provider ability at a low quantile of ability satisfaction. For diabetes SPs, higher process quality increased overall satisfaction at a low quantile of overall satisfaction, whereas a correct diagnosis significantly contributed to communication satisfaction at a high quantile of communication satisfaction. CONCLUSIONS The study found positive associations between process and diagnosis quality and SPs satisfaction. Notably, the influence of process quality was most significant among patients with lower satisfaction levels. PRACTICE IMPLICATIONS Provider's process quality could be a key area of improving the satisfaction levels, especially for patients with lower levels of satisfaction.
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Affiliation(s)
- Yuju Wu
- Department of Health Behavior and Social Science,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yizhi Liang
- Department of Global Health and Population, Harvard Chan School of Public Health, 677 Huntington Ave, Boston 02115, MA, USA
| | - Zhengjie Cai
- Department of Health Behavior and Social Science,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Linhua Li
- Department of Health Behavior and Social Science,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chang Sun
- Department of Health Behavior and Social Science,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Huan Zhou
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu 610041, Sichuan, China.
| | - Jieyuan Feng
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
| | - Scott Rozelle
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
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Liang H, Li J, Zhang N, Wu F, Chen X, Luo H, He W, Liu S, Kang T, Zhang R, Liu Y, Huang Z, Zhang L, Zhao Q, Lv S, Li C, Xie Y, Xu DR. Improving eye care quality through brief verbal intervention on optometry service provider by using unannounced standardized patient with refractive error: study protocol for a randomized controlled trial. BMC Ophthalmol 2023; 23:275. [PMID: 37328796 PMCID: PMC10276370 DOI: 10.1186/s12886-023-03023-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Improper refractive correction can be harmful to eye health, aggravating the burden of vision impairment. During most optometry clinical consultations, practitioner-patient interactions play a key role. Maybe it is feasible for patients themselves to do something to get high-quality optometry. But the present empirical research on the quality improvement of eye care needs to be strengthened. The study aims to test the effect of the brief verbal intervention (BVI) through patients on the quality of optometry service. METHODS This study will take unannounced standardized patient (USP) with refractive error as the core research tool, both in measurement and intervention. The USP case and the checklist will be developed through a standard protocol and assessed for validity and reliability before its full use. USP will be trained to provide standardized responses during optical visits and receive baseline refraction by the skilled study optometrist who will be recruited within each site. A multi-arm parallel-group randomized trial will be used, with one common control and three intervention groups. The study will be performed in four cities, Guangzhou and three cities in Inner Mongolia, China. A total of 480 optometry service providers (OSPs) will be stratified and randomly selected and divided into four groups. The common control group will receive USP usual visits (without intervention), and three intervention groups will separately receive USP visits with three kinds of BVI on the patient side. A detailed outcome evaluation will include the optometry accuracy, optometry process, patient satisfaction, cost information and service time. Descriptive analysis will be performed for the survey results, and the difference in outcomes between interventions and control providers will be compared and statistically tested using generalized linear models (GLMs). DISCUSSION This research will help policymakers understand the current situation and influencing factors of refractive error care quality, and then implement precise policies; at the same time, explore short and easy interventions for patients to improve the quality of optometry service. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200062819. Registered on August 19, 2022.
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Affiliation(s)
- Huijuan Liang
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Jiaqi Li
- School of Public Health, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Nan Zhang
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Fang Wu
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Xiaoshan Chen
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Huanyuan Luo
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China
| | - Wenjun He
- School of Public Health, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Siyuan Liu
- School of Public Health, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Ting Kang
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Ruotong Zhang
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Yujie Liu
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Zizhen Huang
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Lanping Zhang
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Qing Zhao
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Sensen Lv
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Chunping Li
- School of Public Health, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Yunyun Xie
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Dong Roman Xu
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China.
- Center for World Health Organization Studies, Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China.
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China.
- Acacia Labs, School of Public Health, Southern Medical University, Guangzhou, China.
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Izadi R, Habibolahi A, Jahanmehr N, Khodakarim S. Irrational prescription and its costs in neonatal surfactant therapy: public and private hospitals of Iran in 2018. BMC Pediatr 2023; 23:251. [PMID: 37210481 DOI: 10.1186/s12887-023-04045-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/27/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Irrational prescription and its subsequent costs are a major challenge worldwide. Health systems must provide appropriate conditions for the implementation of national and international strategies to prevent irrational prescription. The aim of the present study was to determine the irrational surfactant prescription among neonates with respiratory distress and the resulting direct medical costs for private and public hospitals in Iran. METHODS This was a cross-sectional descriptive study performed retrospectively using data belonged to 846 patients. Initially, the data were extracted from the patients' medical records and the information system of the Ministry of Health. The obtained data were then compared with the surfactant prescription guideline. Afterward, each neonatal surfactant prescription was evaluated based on the three filters listed in the guideline (including right drug, right dose, and right time). Finally, chi-square and ANOVA tests were used to investigate the inter-variable relationships. RESULTS The results showed that 37.47% of the prescriptions were irrational and the average costs of each irrational prescription was calculated as 274.37 dollars. It was estimated that irrational prescriptions account for about 53% of the total surfactant prescription cost. Among the selected provinces, Tehran and Ahvaz had the worst and the best performance, respectively. As well, public hospitals outperformed private hospitals in terms of the in drug selection, but they underperformed them in terms of the right dose determination. CONCLUSION The results of the present study are considered as a warning to insurance organizations, in order to reduce unnecessary costs caused by these irrational prescriptions by developing new service purchase protocols. Our suggestion is the use of educational interventions to reduce irrational prescriptions due to drug selection as well as using computer alert approaches to reduce irrational prescriptions caused by wrong dose administration.
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Affiliation(s)
- Reyhane Izadi
- Department of Health Care Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Habibolahi
- Neonatal Health Department, Population, Family and School Health Office, Deputy of Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Nader Jahanmehr
- Health Economics, Management and Policy Department, Virtual School of Medical Education & Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Soheila Khodakarim
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Si Y, Bateman H, Chen S, Hanewald K, Li B, Su M, Zhou Z. Quantifying the financial impact of overuse in primary care in China: A standardised patient study. Soc Sci Med 2023; 320:115670. [PMID: 36669284 DOI: 10.1016/j.socscimed.2023.115670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Overuse of health care is a potential factor in explaining the rapid increase in health care expenditure in many countries; however, it is difficult to measure overuse. This study employed the novel method of using unannounced standardised patients (SPs) to identify overuse, document its patterns and quantify its financial impact on patients in primary care in China. We trained 18 SPs to present consistent cases of two common chronic diseases and recorded 492 physician-patient interactions in 63 public and private primary hospitals in a capital city in western China in 2017 and 2018. Overuse, defined as the provision of unnecessary medical tests and drugs, was identified by a panel of medical experts based on national clinical guidelines. We estimated linear regression models to investigate how hospital, physician and patient characteristics were associated with overuse and to quantify the financial impact of overuse after controlling for a series of fixed effects. We found overuse in 72.15% of the SP visits. The high prevalence of overuse was similar among public and private hospitals, low-competence and high-competence physicians, male and female physicians, junior and senior physicians and male and female patients, but it varied between patients presenting different diseases. Compared to the non-overuse group, overuse significantly increased the total cost by 117.8%, the test cost by 58.8% and the drug cost by 100.3%. The financial impact of overuse was consistent across the aforementioned hospital, physician and patient characteristics. We suggest that the overuse observed in this study is unlikely to be attributable to physician incompetence but rather to the financing framework for primary care in China. These findings illuminate the cost escalation of primary care in China, which is a form of medical inefficiency that should be urgently addressed.
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Affiliation(s)
- Yafei Si
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia; School of Risk & Actuarial Studies, University of New South Wales, Sydney, Australia.
| | - Hazel Bateman
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia; School of Risk & Actuarial Studies, University of New South Wales, Sydney, Australia
| | - Shu Chen
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia; School of Risk & Actuarial Studies, University of New South Wales, Sydney, Australia
| | - Katja Hanewald
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia; School of Risk & Actuarial Studies, University of New South Wales, Sydney, Australia
| | - Bingqin Li
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
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Chen Y, Sylvia S, Dill SE, Rozelle S. Structural Determinants of Child Health in Rural China: The Challenge of Creating Health Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13845. [PMID: 36360724 PMCID: PMC9654689 DOI: 10.3390/ijerph192113845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Over the past two decades, the literature has shown a clear gradient between child health and wealth. The same health-wealth gradient is also observed among children in China, with a large gap in health between rural and urban children. However, there are still unanswered questions about the main causes of China's rural-urban child health inequality. This paper aims to review the major factors that have led to the relatively poor levels of health among China's rural children. In addition to the direct income effect on children's health, children in rural areas face disadvantages compared with their urban counterparts from the beginning of life: Prenatal care and infant health outcomes are worse in rural areas; rural caregivers have poor health outcomes and lack knowledge and support to provide adequate nurturing care to young children; there are large disparities in access to quality health care between rural and urban areas; and rural families are more likely to lack access to clean water and sanitation. In order to inform policies that improve health outcomes for the poor, there is a critical need for research that identifies the causal drivers of health outcomes among children. Strengthening the pediatric training and workforce in rural areas is essential to delivering quality health care for rural children. Other potential interventions include addressing the health needs of mothers and grandparent caregivers, improving parenting knowledge and nurturing care, improving access to clean water and sanitation for remote families, and most importantly, targeting poverty itself.
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Affiliation(s)
- Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sarah-Eve Dill
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, CA 94305, USA
| | - Scott Rozelle
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, CA 94305, USA
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Daniels B, Shah D, Kwan AT, Das R, Das V, Puri V, Tipre P, Waghmare U, Gomare M, Keskar P, Das J, Pai M. Tuberculosis diagnosis and management in the public versus private sector: a standardised patients study in Mumbai, India. BMJ Glob Health 2022; 7:bmjgh-2022-009657. [PMID: 36261230 PMCID: PMC9582305 DOI: 10.1136/bmjgh-2022-009657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/13/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There are few rigorous studies comparing quality of tuberculosis (TB) care in public versus private sectors. METHODS We used standardised patients (SPs) to measure technical quality and patient experience in a sample of private and public facilities in Mumbai. RESULTS SPs presented a 'classic, suspected TB' scenario and a 'recurrence or drug-resistance' scenario. In the private sector, SPs completed 643 interactions. In the public sector, 164 interactions. Outcomes included indicators of correct management, medication use and client experience. Public providers used microbiological testing (typically, microscopy) more frequently, in 123 of 164 (75%; 95% CI 68% to 81%) vs 223 of 644 interactions (35%; 95% CI 31% to 38%) in the private sector. Private providers were more likely to order chest X-rays, in 556 of 639 interactions (86%; 95% CI 84% to 89%). According to national TB guidelines, we found higher proportions of correct management in the public sector (75% vs 35%; (adjusted) difference 35 percentage points (pp); 95% CI 25 to 46). If X-rays were considered acceptable for the first case but drug-susceptibility testing was required for the second case, the private sector correctly managed a slightly higher proportion of interactions (67% vs 51%; adjusted difference 16 pp; 95% CI 7 to 25). Broad-spectrum antibiotics were used in 76% (95% CI 66% to 84%) of the interactions in public hospitals, and 61% (95% CI 58% to 65%) in private facilities. Costs in the private clinics averaged rupees INR 512 (95% CI 485 to 539); public facilities charged INR 10. Private providers spent more time with patients (4.4 min vs 2.4 min; adjusted difference 2.0 min; 95% CI 1.2 to 2.9) and asked a greater share of relevant questions (29% vs 43%; adjusted difference 13.7 pp; 95% CI 8.2 to 19.3). CONCLUSIONS While the public providers did a better job of adhering to national TB guidelines (especially microbiological testing) and offered less expensive care, private sector providers did better on client experience.
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Affiliation(s)
- Benjamin Daniels
- McCourt School of Public Policy, Georgetown University, Washington, District of Columbia, USA
| | - Daksha Shah
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Ada T Kwan
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ranendra Das
- Institute for Socio-Economic Research on Development and Democracy, Delhi, India
| | - Veena Das
- Department of Anthropology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Varsha Puri
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Pranita Tipre
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Upalimitra Waghmare
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Mangala Gomare
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Padmaja Keskar
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Jishnu Das
- McCourt School of Public Policy, Georgetown University, Washington, District of Columbia, USA
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal, Québec, Canada
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Su M, Zhou Z, Si Y, Fan X. The Association Between Patient-Centered Communication and Primary Care Quality in Urban China: Evidence From a Standardized Patient Study. Front Public Health 2022; 9:779293. [PMID: 35186869 PMCID: PMC8854212 DOI: 10.3389/fpubh.2021.779293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background Effective patient-physician communication has been considered a central clinical function and core value of health system. Currently, there are no studies directly evaluating the association between patient-centered communication (PCC) and primary care quality in urban China. This study aims to investigate the association between PCC and primary care quality. Methods The standardized patients were used to measure PCC and the quality of health care. We recruited 12 standardized patients from local communities presenting fixed cases (unstable angina and asthma), including 492 interactions between physicians and standardized patients across 63 CHCs in Xi'an, China. PCC was scored on three dismissions: (1) exploring disease and illness experience, (2) understanding the whole person, and (3) finding common ground. We measured the quality of the primary care by (1) accuracy of diagnosis, (2) consultation time, (3) appropriateness of treatment, (4) unnecessary exams; (5) unnecessary drugs, and (6) medical expenditure. Ordinary least-squares regression models with fixed effects were used for the continuous variables and logistic regression models with fixed effects were used for the categorical variables. Results The average score of PCC1, PCC2, and PCC3 was 12.24 ± 4.04 (out of 64), 0.79 ± 0.64 (out of 3), and 10.19 ± 3.60 (out of 17), respectively. The total score of PCC was 23.22 ± 6.24 (out of 84). We found 44.11% of the visits having a correct diagnosis, and 24.19% of the visits having correct treatment. The average number of unnecessary exams and drugs was 0.91 ± 1.05, and 0.45 ± 0.82, respectively. The average total cost was 35.00 ± 41.26 CNY. After controlling for the potential confounding factors and fixed effects, the PCC increased the correct diagnosis by 10 percentage points (P < 0.01), the correct treatment by 7 percentage points (P < 0.01), the consultation time by 0.17 min (P < 0.01), the number of unnecessary drugs by 0.03 items (P < 0.01), and the medical expenditure by 1.46 CNY (P < 0.01). Conclusions This study revealed pretty poor communication between primary care providers and patients. The PCC model has not been achieved, which could be one source of the intensified physician-patient relationship. Our findings showed the PCC model in the primary care settings has positive associations with the quality of the primary care. Interactions with a higher score of PCC were more likely to have a correct diagnosis and correct treatment, more consultation time, more unnecessary drugs, and higher medical expenditure. To improve PCC, the clinical capacity and communication skills of primary care providers need to be strengthened. Also, strategies on reforming the pay structure to better reflect the value of physicians and providing a stronger motivation for performance improvement are urgently needed.
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Affiliation(s)
- Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
- *Correspondence: Zhongliang Zhou
| | - Yafei Si
- School of Risk & Actuarial Studies and CEPAR, University of New South Wales, Sydney, NSW, Australia
| | - Xiaojing Fan
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
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