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

Figures & data

Table 1. Patient socio-demographic characteristics, health status and primary care utilisation.

	Hospital utilisation during the past six months		p^#
	Yes (N = 398)	No (N = 787)
Gender			0.185
Male	141(35.4)	310(39.4)
Female	257(64.6)	477(60.6)
Age(years)			0.685
18–30	69(17.3)	118(15.0)
31–50	139(34.9)	270(34.3)
51–70	125(31.4)	267(33.9)
>70	65(16.3)	132(16.8)
Marital status			0.662
Unmarried	29(7.3)	53(6.6)
Married, divorced or widowed	369(92.7)	735(93.4)
Education			0.005**
Primary school or below	90(22.6)	224(28.5)
Middle/high school	213(53.5)	432(54.9)
Bachelor’s degree or above	95(23.9)	131(16.6)
Employment status			0.437
Employed	188(47.2)	390(49.6)
Retired	96(24.1)	199(25.3)
Unemployed	114(28.6)	198(25.2)
Monthly household Income (CNY)			0.099
≤5,000	285(71.6)	603(76.6)
5001–10,000	62(15.6)	112(14.2)
>10,000	51(12.8)	72(9.1)
Household status			0.216
Local residence	239(60.1)	443(56.3)
Non-local residence	159(39.9)	344(43.7)
Health insurance			0.471
Yes	358(89.9)	697(88.6)
No	40(10.1)	90(11.4)
Health status			<0.001***
Poor	75(18.8)	82(10.4)
General	195(49.0)	344(43.7)
Good	128(32.2)	361(45.9)
Number of chronic diseases			0.002**
0	190(47.7)	459(58.3)
1	132(33.2)	217(27.6)
2 and above	76(19.1)	111(14.1)
Number of years since first visit to the primary care setting			0.802
< 1	39(9.8)	80(10.2)
1–5	153(38.4)	287(36.5)
> 5	206(51.8)	420(53.4)
Number of visits to the primary care setting in the past two weeks			0.002**
0	44(11.1)	129(16.4)
1	241(60.6)	498(63.3)
2 and above	113(28.4)	160(20.3)
Whether have a family doctor			0.533
Yes	152(38.2)	286(36.3)
No	246(61.8)	501(63.7)

*Values are numbers (percentages); ^#p values associated with Pearson’s chi-square tests.

Table 2. Patient self-reported hospital utilisation in the last six months.

	Self-reported outpatient visits	Self-reported hospital admissions	Self-reported emergency department visits	Self-reported overall hospital utilisation
No	898(75.8)	1,107(93.4)	1,166(98.4)	787(66.4)
Yes	287(24.2)	78(6.6)	19(1.6)	398*(33.6)
Only 1 visit	159(55.4)	64 (82.1)	16(84.2)	–
2–5 visits	107(37.3)	12(15.4)	3(15.8)	–
Over 6 visits	21(7.3)	2(2.6)	0(0.0)	–

*Values are numbers (percentages). –: Not applicable as the overall hospital utilisation was expressed as a dichotomous variable. When patients had encountered any type of hospital utilisation in the last six months, the overall hospital utilisation was considered as ‘yes’, otherwise ‘no’. *In addition to outpatient visits, hospital admissions, and emergency department visits, the remaining 14 patients reported hospital utilisation for reasons such as prescription renewals or routine health check-ups. They were not analysed separately in our study due to limited data.

Table 3. Patient-perceived quality of primary care using the Assessment Survey of primary care scale and the difference between patients with or without self-reported overall hospital utilisation during the past six months.

Domains	All participants^	Self-reported overall hospital utilisation during the past six months		Difference^&	p^#
		Yes^ (N = 398)	No^ (N = 787)
First-contact care	3.06 ± 0.64	3.02 ± 0.69	3.08 ± 0.62	0.06 ± 0.04	0.123
Continuity	2.46 ± 0.69	2.44 ± 0.68	2.46 ± 0.7	0.02 ± 0.04	0.575
Accessibility	3.17 ± 0.66	3.12 ± 0.68	3.20 ± 0.65	0.09 ± 0.04	0.032*
Comprehensiveness	2.38 ± 0.66	2.28 ± 0.67	2.43 ± 0.65	0.16 ± 0.04	<0.001***
Coordination	2.71 ± 0.52	2.41 ± 0.62	2.85 ± 0.39	0.44 ± 0.03	<0.001***
Patient-centred care	2.99 ± 0.65	2.92 ± 0.67	3.03 ± 0.63	0.11 ± 0.04	0.005**
Total score	2.79 ± 0.44	2.70 ± 0.45	2.84 ± 0.42	0.15 ± 0.03	<0.001***

Note: ^Values are means ± standard deviations; &: Values in difference are means ± standard errors, reflecting the variation in patients’ perceived primary care quality. A difference value > 0 indicates higher patient-perceived quality of primary care in patients who reported no hospital utilisation in the past six months compared to those reporting specific hospital utilisation during the same period. #p values associated with independent sample t-tests. *: p < 0.05, **: p < 0.01, ***: p < 0.001.

Table 4. Relationships between primary care assessment score and hospital utilisation in the last six months using logistic regression analyses (N = 1,185).

ASPC scale	Self-reported overall hospital utilisation AOR(95%CI)	Self-reported outpatient visits AOR (95%CI)	Self-reported hospital admissions AOR (95%CI)	Self-reported emergency department visits AOR (95%CI)
Total score	0.417(0.308,0.565)***	0.394(0.275,0.566)***	0.496(0.276,0.891)*	0.750 (0.247,2.277)
First-contact care	0.811(0.666,0.989)*	0.874(0.691,1.105)	0.847(0.581,1.235)	1.133(0.528,2.431)
Continuity	0.917(0.761,1.105)	0.936(0.743,1.179)	0.956(0.658,1.389)	2.252(1.051,4.825)*
Accessibility	0.849(0.706,1.023)	0.838(0.665,1.058)	0.915(0.612,1.366)	0.333(0.169,0.656)**
Comprehensiveness	0.695(0.572,0.843)***	0.715(0.571,0.894)**	0.760 (0.523,1.106)	0.715(0.350,1.458)
Coordination	0.143(0.106,0.195)***	0.125(0.088,0.177)***	0.234(0.148,0.371)***	1.059(0.429,2.619)
Patient-centred care	0.729(0.597,0.890)**	0.702(0.556,0.886)**	0.830(0.564,1.222)	0.975(0.450,2.113)

Note: ASPC scale: Assessment Survey of Primary Care scale. *: p < 0.05, **: p < 0.01, ***: p < 0.001. AOR: adjusted odds ratio. Values highlighted in bold signify statistical significance.

1. Logistic regression analyses were performed to evaluate the relationship between total score and score of each and each type of hospital utilisation in the last six months.

2. Dependent variables were patient self-reported hospital utilisation (Yes/No). Independent variables were the total score or score of each domain in ASPC scale. Confounders were adjusted for patient gender, age, marital status, family monthly household income, employment status, household status, health insurance, cities of recruitment, number of chronic diseases, health status, the number of years since first visit to the primary care setting, the number of visits to the primary care setting, and whether had a family doctor.

3. An AOR < 1 indicated a negative association, implying that an increased score in ASPC scale (total score or score of each domain) is negatively associated with the likelihood of hospital utilisation in last six months.

Table

City	Per Capita Gross Domestic Product (CNY)	Permanent Population at the end of 2022 (10,000 persons)	Proportion of Urban Population to Permanent Population
Guangzhou	153,625	1873.41	86.5%
Shenzhen	183,274	1766.18	99.8%
Zhuhai	163,654	247.72	90.8%
Foshan	132,517	955.23	95.2%
Dongguan	106,803	1043.70	92.2%
Huizhou	89,157	605.02	72.9%
Zhongshan	81,620	443.11	87.0%
Jiangmen	78,146	482.22	67.9%
Maoming	62,685	623.82	45.8%
Meizhou	34,085	385.80	52.7%

Table

Patient characteristics		Guangzhou (N = 185)		Shenzhen (N = 172)		Zhuhai (N = 96)		Foshan (N = 90)		Dongguan (N = 113)		Huizhou (N = 126)		Zhongshan (N = 102)		Jiangmen (N = 111)		Meizhou (N = 93)		Maoming (N = 97)		p
		N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%
Gender	Male	69	37.3	71	41.3	41	42.7	27	30.0	45	39.8	51	40.5	26	25.5	50	45.0	36	38.7	35	36.1	0.125
	Female	116	62.7	101	58.7	55	57.3	63	70.0	68	60.2	75	59.5	76	74.5	61	55.0	57	61.3	62	63.9
Age (years)	18–30	4	2.2	42	24.4	14	14.6	11	12.2	17	15	40	31.7	11	10.8	29	26.1	9	9.7	10	10.3	<0.001
	31–50	15	8.1	76	44.2	48	50	36	40.0	63	55.8	57	45.2	36	35.3	40	36.0	21	22.6	17	17.5
	51–70	102	55.1	41	23.8	29	30.2	30	33.3	21	18.6	27	21.4	39	38.2	25	22.5	42	45.2	36	37.1
	>70	64	34.6	13	7.6	5	5.2	13	14.4	12	10.6	2	1.6	16	15.7	17	15.3	21	22.6	34	35.1
Marital status	Unmarried	4	2.2	26	15.1	3	3.1	0	0.0	6	5.3	15	11.9	2	2	18	16.2	1	1.1	6	6.2	<0.001
	Married, divorced or widowed	181	97.8	146	84.9	93	96.9	90	100.0	107	94.7	111	88.1	100	98	93	83.8	92	98.9	91	93.8
Education	Primary school or below	37	20	14	8.1	19	19.8	27	30.0	23	20.4	23	18.3	32	31.4	41	36.9	40	43	58	59.8	<0.001
	Middle /high school	121	65.4	70	40.7	55	57.3	49	54.4	77	68.1	81	64.3	50	49	55	49.5	51	54.8	36	37.1
	Bachelor’s degree or above	27	14.6	88	51.2	22	22.9	14	15.6	13	11.5	22	17.5	20	19.6	15	13.5	2	2.2	3	3.1
Employment status	Employed	22	11.9	108	62.8	58	60.4	38	42.2	83	73.5	91	72.2	37	36.3	68	61.3	35	37.6	38	39.2	<0.001
	Retired	147	79.5	42	24.4	16	16.7	17	18.9	5	4.4	12	9.5	27	26.5	14	12.6	7	7.5	8	8.2
	Unemployed	16	8.6	22	12.8	22	22.9	35	38.9	25	22.1	23	18.3	38	37.3	29	26.1	51	54.8	51	52.6
Monthly household Income (CNY)	≤5,000	152	82.2	79	45.9	71	74	61	67.8	85	75.2	94	74.6	75	73.5	91	82.0	87	93.5	93	95.9	<0.001
	5001–10,000	28	15.1	45	26.2	14	14.6	13	14.4	18	15.9	19	15.1	14	13.7	15	13.5	4	4.3	4	4.1
	>10,000	5	2.7	48	27.9	11	11.5	16	17.8	10	8.8	13	10.3	13	12.7	5	4.5	2	2.2	0	0
Household status	Local residence	153	82.7	65	37.8	47	49	55	61.1	35	31	21	16.7	57	55.9	63	56.8	91	97.8	95	97.9	<0.001
	Non-local residence	32	17.3	107	62.2	49	51	35	38.9	78	69	105	83.3	45	44.1	48	43.2	2	2.2	2	2.1
Health insurance	Yes	179	96.8	150	87.2	91	94.8	73	81.1	101	89.4	105	83.3	84	82.4	89	80.2	89	95.7	94	96.9	<0.001
	No	6	3.2	22	12.8	5	5.2	17	18.9	12	10.6	21	16.7	18	17.6	22	19.8	4	4.3	3	3.1
Health status	Good	52	28.1	79	45.9	37	38.5	43	47.8	53	46.9	67	53.2	46	45.1	56	50.5	25	26.9	31	32	<0.001
	General	110	59.5	88	51.2	45	46.9	39	43.3	42	37.2	45	35.7	48	47.1	42	37.8	46	49.5	34	35.1
	Poor	23	12.4	5	2.9	14	14.6	8	8.9	18	15.9	14	11.1	8	7.8	13	11.7	22	23.7	32	33
Number of chronic diseases	0	23	12.4	110	64	60	62.5	62	68.9	69	61.1	87	69	53	52	80	72.1	52	55.9	53	54.6	<0.001
	1	69	37.3	47	27.3	23	24	21	23.3	37	32.7	32	25.4	39	38.2	28	25.2	24	25.8	29	29.9
	2 and above	93	50.3	15	8.7	13	13.5	7	7.8	7	6.2	7	5.6	10	9.8	3	2.7	17	18.3	15	15.5
Number of years since first visit to the primary care setting	< 1	5	2.7	40	23.3	9	9.4	15	16.7	8	7.1	9	7.1	12	11.8	13	11.7	6	6.5	2	2.1	<0.001
	1–5	53	28.6	96	55.8	38	39.6	33	36.7	40	35.4	68	54	24	23.5	30	27.0	29	31.2	29	29.9
	> 5	127	68.6	36	20.9	49	51	42	46.7	65	57.5	49	38.9	66	64.7	68	61.3	58	62.4	66	68
Number of visits to the primary care setting in the past two weeks	0	23	12.4	19	11	17	17.7	7	7.8	7	6.2	28	22.2	12	11.8	16	14.4	21	22.6	23	23.7	<0.001
	1	101	54.6	131	76.2	54	56.3	56	62.2	89	78.8	80	63.5	69	67.6	67	60.4	41	44.1	51	52.6
	2 and above	61	33	22	12.8	25	26	27	30.0	17	15	18	14.3	21	20.6	28	25.2	31	33.3	23	23.7
Whether have a family doctor	No	53	28.6	146	84.9	45	46.9	52	57.8	77	68.1	69	54.8	79	77.5	103	92.8	56	60.2	67	69.1	<0.001
	Yes	132	71.4	26	15.1	51	53.1	38	42.2	36	31.9	57	45.2	23	22.5	8	7.2	37	39.8	30	30.9

*N = numbers; % = percentages; #p values associated with Pearson’s chi-square tests.

Table

Self-reported hospital utilisation types		Guangzhou		Shenzhen		Zhuhai		Foshan		Dongguan		Huizhou		Zhongshan		Jiangmen		Meizhou		Maoming		p value
		(N = 185)		(N = 172)		(N = 96)		(N = 90)		(N = 113)		(N = 126)		(N = 102)		(N = 111)		(N = 93)		(N = 97)
		N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%
Overall hospital utilisation	No	112	60.5	110	64.0	69	71.9	57	63.3	79	69.9	88	69.8	59	57.8	80	72.1	62	66.7	71	73.2	0.152
	Yes	73	39.5	62	36.0	27	28.1	33	36.7	34	30.1	38	30.2	43	42.2	31	27.9	31	33.3	26	26.8
Outpatient visits	No	140	75.7	118	68.6	78	81.3	62	68.9	85	75.2	98	77.8	66	64.7	88	79.3	74	79.6	86	88.7	0.002
	Yes	45	24.3	54	31.4	18	18.8	28	31.1	28	24.8	28	22.2	36	35.3	23	20.7	19	20.4	11	11.3
Hospital admissions	No	172	93.0	167	97.1	87	90.6	85	94.4	110	97.3	119	94.4	98	96.1	102	91.9	86	92.5	81	83.5	0.002
	Yes	13	7.0	5	2.9	9	9.4	5	5.6	3	2.7	7	5.6	4	3.9	9	8.1	7	7.5	16	16.5
Emergency department visits	No	177	95.7	168	97.7	95	99.0	90	100.0	111	98.2	126	100.0	101	99.0	108	97.3	93	100.0	97	100.0	0.046
	Yes	8	4.3	4	2.3	1	1.0	0	0.0	2	1.8	0	0.0	1	1.0	3	2.7	0	0.0	0	0.0

*N = numbers; % = percentages; #p values associated with Pearson’s chi-square tests.

Table

ASPC scale	Guangzhou	Shenzhen	Zhuhai	Foshan	Dongguan	Huizhou	Zhongshan	Jiangmen	Meizhou	Maoming
First-contact care	3.35 ± 0.63	2.73 ± 0.68	3.12 ± 0.65	3.00 ± 0.52	3.08 ± 0.56	3.09 ± 0.55	3.08 ± 0.65	2.78 ± 0.63	3.22 ± 0.55	3.17 ± 0.64
Continuity	2.70 ± 0.67	2.20 ± 0.64	2.28 ± 0.68	2.46 ± 0.62	2.43 ± 0.68	2.21 ± 0.63	2.75 ± 0.66	2.29 ± 0.72	2.85 ± 0.61	2.50 ± 0.66
Accessibility	2.91 ± 0.69	3.02 ± 0.74	3.29 ± 0.61	2.71 ± 0.75	3.03 ± 0.56	3.59 ± 0.43	3.31 ± 0.50	3.38 ± 0.61	3.36 ± 0.54	3.33 ± 0.58
Comprehensiveness	2.38 ± 0.65	2.36 ± 0.64	2.37 ± 0.67	2.21 ± 0.62	2.42 ± 0.67	2.31 ± 0.78	2.52 ± 0.73	2.36 ± 0.56	2.42 ± 0.59	2.47 ± 0.64
Coordination	2.74 ± 0.63	2.54 ± 0.53	2.73 ± 0.44	2.52 ± 0.45	2.73 ± 0.48	2.75 ± 0.53	2.76 ± 0.56	2.70 ± 0.41	2.89 ± 0.47	2.77 ± 0.48
Patient-centred care	3.26 ± 0.57	2.93 ± 0.65	2.90 ± 0.69	2.98 ± 0.60	2.86 ± 0.75	2.80 ± 0.63	3.15 ± 0.64	2.96 ± 0.62	3.06 ± 0.54	2.92 ± 0.61
Total score	2.89 ± 0.45	2.63 ± 0.43	2.78 ± 0.41	2.65 ± 0.40	2.76 ± 0.47	2.79 ± 0.43	2.93 ± 0.49	2.74 ± 0.40	2.97 ± 0.36	2.86 ± 0.39

Note: ^Values are means ± standard deviations.

Availability of data and materials

Data are available from the corresponding author upon reasonable request.