Determinants of initial utilization of community healthcare services among patients with major non-communicable chronic diseases in South China

Yang, H., Huang, X., Zhou, Z., Wang, H. H.X., Tong, X., Wang, Z., Wang, J. and Lu, Z. (2014) Determinants of initial utilization of community healthcare services among patients with major non-communicable chronic diseases in South China. PLoS ONE, 9(12), e116051. (doi:10.1371/journal.pone.0116051) (PMID:25545636) (PMCID:PMC4278805)

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Abstract

Background: Although expected to act as gate-keeping primary care providers, as community health service (CHS) facilities are severely under-utilized; Chinese people in both rural and urban areas used predominantly higher-tier facilities for primary care purpose, with significant financial and outcome consequences. This study intends to explore the determinants of initial utilization of CHS among patients with major non-communicable chronic diseases (NCDs) in order to understand the care-seeking behavior among urban and rural residents in South China.

Methods: A multi-stage cluster random sampling methodology was adopted to create a sample of 19,466 adults with NCDs from 7,970 urban households and 32,035 adults with NCDs from 3,860 rural households in Guangdong, China. Interviews and physical examinations were conducted in 2010 to collect data on patient characteristics, medical conditions, and awareness and utilization of healthcare. Descriptive analysis and logistic regression analysis were performed to study utilization patterns and the factors associated with the patterns.

Results: Prevalence of major NCDs in urban areas was significantly higher than that in rural areas (12.55% vs. 8.70%; p<0.001). Second-tier district hospitals were most preferred for initial consultation (46.05% in rural areas vs. 45.32% in urban areas; p<0.001), followed by tertiary general or specialized hospitals (28.39% in rural areas vs. 33.89% in urban areas; p<0.001). The proportion of patients who had initial use of CHS was relatively low (25.56% in rural areas vs. 20.79% in urban areas; p<0.001). Awareness of self-care and the presence of medical insurance were leading factors associated with first contact of CHS facilities in both urban and rural areas.

Conclusion: The study suggests that CHS facilities are not often used as the first contact for patients in both rural and urban areas in south China. Much effect must be made to enhance the gatekeeper system and improve medical insurance coverage in future healthcare reforms.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Wang, Professor Harry Haoxiang
Authors: Yang, H., Huang, X., Zhou, Z., Wang, H. H.X., Tong, X., Wang, Z., Wang, J., and Lu, Z.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
Journal Name:PLoS ONE
Publisher:Public Library of Science
ISSN:1932-6203
ISSN (Online):1932-6203
Copyright Holders:Copyright © 2014 The Authors
First Published:First published in PLoS One 9(12):e116051
Publisher Policy:Reproduced under a Creative Commons License

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