Relationship between patient-perceived quality of primary care and self-reported hospital utilisation in China: A cross-sectional study

Abstract

Background

Reducing avoidable hospital admissions is a global healthcare priority, with optimal primary care recognised as pivotal for achieving this objective. However, in developing systems like China, where primary care is evolving without compulsory gatekeeping, the relationship between patient-perceived primary care quality and hospital utilisation remains underexplored.

Objectives

This study aimed to explore the association between patient-perceived primary care quality and self-reported hospital utilisation in China.

Methods

Data were collected from 16 primary care settings. Patient-perceived quality of primary care was measured using the Assessment Survey of Primary Care scale across six domains (first-contact care, continuity, comprehensiveness, accessibility, coordination, and patient-centredness). Hospital utilisation included patient self-reported outpatient visits, hospital admissions, and emergency department (ED) visits in the last six months. Logistic regression analyses were examined associations between self-reported hospital utilisation and perceived primary care quality adjusted for potential confounders.

Results

Of 1,185 patients recruited, 398 (33.6%) reported hospital utilisation. Logistic regression analyses showed that higher total scores for patient-perceived quality of primary care were associated with decreased odds of hospital utilisation (adjusted odds ratio(AOR): 0.417, 95% confidence interval (CI): 0.308–0.565), outpatient visits (AOR: 0.394, 95% CI: 0.275–0.566) and hospital admissions (AOR: 0.496, 95% CI: 0.276–0.891). However, continuity of care was positively associated with ED visits (AOR: 2.252, 95% CI: 1.051–4.825).

Conclusion

Enhanced patient-perceived quality of primary care in China is associated with a reduction in self-reported overall hospital utilisation, including outpatient visits and hospital admissions. However, better continuity of care may be associated with increased ED visits. Further research is warranted for precise insights and validation of these findings.

KEY MESSAGES

• Improved patient-perceived primary care quality in China was linked to lower self-reported hospital utilisation, including outpatient visits and hospital admissions.

• Better primary care accessibility was associated with decreased self-reported emergency department visits and outpatient visits.

• Continuity of care showed a positive association with emergency department visits, warranting further research.

Keywords:

• Primary care
• quality
• assessment survey of primary care
• self-reported hospital utilisation
• hospital admission
• outpatient visits
• emergency department visits

Acknowledgements

We want to express our sincere gratitude to all the healthcare staff from the community health centres and all the patients who participated in our research for their enormous support on-site during the data collection.

Authors’ contributions

Study design: LK and CZ; Data acquisition: CZ, LL, ZL, CL and MZ; Data interpretation: CZ, JH, NH, and LK; Tables, figures preparation: CZ; Drafting manuscript: CZ, and LK; Critical revision of the manuscript: CZ, JH, NH and LK. All authors have read and approved the manuscript.

Ethics approval and consent to participate

Ethical approval was obtained from the Institutional Review Board of School of Public Health, Sun Yat-Sen University, P.R. China (2018.014). The protocol for this study conforms to the principles embodied in the Declaration of Helsinki.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and materials

Data are available from the corresponding author upon reasonable request.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (Grant No: 71673311). The funder does not interfere in our research. The funding body was not involved in the design of the study; data collection, analysis, and interpretation; or writing the manuscript. Our research group completed all the processes independently.