Factors influencing the perception of medical staff and outpatients of dual practice in Shanghai, People’s Republic of China

Figures & data

Table 1 Basic demographic characteristics of medical staff (N=667)

Variables	Number	Percentage
Sex
Male	368	55.2
Female	299	44.8
Age (years)
18–20	1	0.1
20–30	163	24.4
30–40	332	49.8
40–50	140	21.0
50–60	26	3.9
≥60	5	0.7
Educational level
Junior college	7	1.1
Bachelor	189	28.3
Master	284	42.6
Doctor	173	25.9
Othersa	14	2.1
Title
Hospital leader	3	0.4
Clinical department director	46	6.9
Medical-technical department director	5	0.7
Doctor	579	86.8
Othersb	34	5.2
Technical position
Junior	228	34.2
Intermediate	278	41.7
Vice senior	115	17.2
Senior	46	6.9
Department
Surgical department	254	38.1
Internal medicine department	282	42.3
Medical-technical department	49	7.3
Others	82	12.3

Notes:

a Others include post-doctorate.

b Others include researchers.

Table 2 Basic demographic characteristics of outpatients (N=694)

Variables	Number	Percentage
Sex
Male	333	48.0
Female	361	52.0
Occupation
Student	95	13.7
Factory worker	112	16.1
Farmer	71	10.2
Retiree	154	22.2
Civil servant	21	3.0
Medical personnel	74	10.7
Military personnel	19	2.8
Othersa	148	21.3
Age (years)
18–20	17	2.5
20–30	239	34.4
30–40	128	18.4
40–50	91	13.1
50–60	92	13.3
≥60	127	18.3
Monthly incomeb (RMB)
0	110	15.9
1–2,000	112	16.1
2,001–3,000	200	28.8
3,001–5,000	178	25.6
5,001–8,000	63	9.1
8,001–15,000	21	3.0
15,001–50,000	8	1.2
>50,000	2	0.3
Marital status
Single	177	25.5
Married	482	69.5
Widowed	23	3.3
Others	12	1.7
Educational level
High school diploma or lower	339	48.9
Junior college	146	21.0
Bachelor or higher	209	30.1
Self-rated health status
Very poor	26	3.8
Poor	80	11.5
Ordinary	245	35.3
Healthy	255	36.7
Very healthy	88	12.7
Burden of health expenditures
Completely affordable	99	14.3
Affordable	440	63.4
Not affordable	155	22.3

Notes:

a Others mean freelancers and unemployed personnel.

b RMB, RenMinBi Yuan. The RMB to US $ exchange rate was 0.162 (based on rates for September 15, 2013).

Table 3 Perception of medical staff of dual practice (N=667)

Items	Option	N (%)
The willingness to join dual practice	Yes	420 (63.0)
	No	68 (10.2)
	Not certain	179 (26.8)
Whether hospital administrators advocated dual practice policy in your current workplace	Yes	127 (19.0)
	No	218 (32.7)
	Not certain	322 (48.3)
Whether respondents possessed knowledge of dual practice policy	Yes	157 (23.5)
	No	510 (76.5)
Whether dual practice increased work-related burden	Yes	260 (39.0)
	No	217 (32.5)
	Not certain	190 (28.5)
Whether dual practice could reduce difficulty in consulting a doctor	Yes	362 (54.3)
	No	135 (20.2)
	Not certain	170 (25.5)
Support from the hospital	Very unimportant	15 (2.3)
	Unimportant	13 (2.0)
	General	133 (19.9)
	Important	163 (24.4)
	Very important	343 (51.4)
Whether hospitals’ human resource management system permitted free flow of medical staff	Very unimportant	11 (1.6)
	Unimportant	24 (3.6)
	General	127 (19.0)
	Important	221 (33.1)
	Very important	284 (42.6)
The willingness of medical staff	Very unimportant	11 (1.6)
	Unimportant	18 (2.7)
	General	137 (20.5)
	Important	235 (35.2)
	Very important	266 (39.9)
Existence of a professional dual practice team	Very unimportant	5 (0.7)
	Unimportant	17 (2.5)
	General	132 (19.8)
	Important	266 (39.9)
	Very important	247 (37.0)

Table 4 Perception of outpatients of dual practice (N=694)

Items	Yes, n (%)	No, n (%)	Not certain, n (%)
Whether community health institutions advocated dual practice policy in your current community	138 (19.9)	83 (12.0)	473 (68.2)
Whether dual practice could reduce difficulty in consulting a doctor	309 (44.5)	97 (14.0)	288 (41.5)
Whether dual practice could meet patient demand for health convenience	315 (45.4)	76 (11.0)	303 (43.6)
Whether dual practice could meet patient demand for treatment of minor illness	294 (42.4)	230 (33.1)	170 (24.5)
Whether dual practice could meet patient demand for treatment of chronic disease	373 (53.7)	105 (15.1)	216 (31.1)
Whether community health services were your first choice for treatment of minor illness if community health centers engaged in dual practice	406 (58.5)	142 (20.5)	146 (21.0)
Whether community health services were your first choice for treatment of chronic disease if community health centers engaged in dual practice	379 (54.6)	106 (15.3)	209 (30.1)

Note: Data shown as N (%).

Table 5 Bivariate analysis in medical staff (N=667)

Variables	Whether HAs advocated DP policy in your current workplacea	The willingness to join DPa	Whether respondents possessed knowledge of DP policya	Whether DP increased work-related burdena	Whether dual practice could reduce difficulty in consulting a doctora	Support from the hospitalb	Whether hospitals’ HRMS permitted free flow of medical staffb	The willingness of medical staffb	Existence of a professional DP teamb
Dependent variablea	104.150 (<0.001)*	1.000	28.041 (<0.001)*	24.626 (<0.001)*	95.163 (<0.001)*	130.022 (<0.001)*	149.756 (<0.001)*	91.691 (<0.001)*	84.269 (<0.001)*
Sexc	0.507 (0.779)	0.619 (0.734)	1.5 (0.82)	1.576 (0.452)	3.382 (0.339)	−0.391 (0.696)	−0.421 (0.674)	−0.057 (0.954)	−0.745 (0.456)
Aged	14.778 (0.095)	34.951 (<0.001)*	42.494 (0.001)*	16.798 (0.044)*	30.141 (0.005)*	0.023 (0.552)	0.007 (0.857)	−0.013 (0.741)	0.014 (0.726)
Educational leveld	14.445 (0.107)	30.567 (<0.001)*	24.94 (0.418)	10.824 (0.324)	25.11 (0.022)*	0.244 (0.0001)*	0.246 (0.0001)*	0.181 (0.0001)*	0.179 (0.0001)*
Titlec	12.322 (0.532)	16.525 (0.018)*	60.073 (0.019)*	14.242 (0.314)	27.872 (0.071)	14.637 (0.041)*	15.340 (0.032)*	10.959 (0.0140)*	13.208 (0.067)
Technical positiond	9.681 (0.14)	15.134 (0.019)*	38.587 (<0.001)*	7.559 (0.281)	13.768 (0.132)	0.180 (0.0001)*	0.154 (0.0001)*	0.103 (0.008)*	0.120 (0.002)*
Departmentc	10.607 (0.104)	12.938 (0.044)*	15.34 (0.042)*	19.659 (0.003)*	18.31 (0.032)*	8.017 (0.046)*	4.566 (0.207)	4.364 (0.225)	1.821 (0.610)

Notes: Data shown as χ² (P).

* P<0.05 (two sided).

a Parametric tests (chi-square test and Fisher’s exact test).

b Nonparametric tests, and

c Wilcoxon rank-sum test,

d Spearman’s rank correlation. Data shown in parentheses is P-value. Dependent variable refers to the item “the willingness of medical staff to join dual practice”.

Abbreviations: DP, dual practice; HA, hospital administrator; HRMS, human resource management system.

Table 6 Difference between demographic characteristics and perception of outpatients of dual practice (N=694)

Demographic characteristics	Whether CHI advocated DP policy in your current community	Whether DP could reduce difficulty in consulting a doctor	Whether DP could meet PD for health convenience	Whether DP could meet PD for treatment of minor illness	Whether DP could meet PD for treatment of chronic disease	Whether CHSs were your first choice for treatment of minor illness if CHCs engaged in DP	Whether CHS were your first choice of treatment for chronic disease if CHCs engaged in DP
Sex	0.301 (0.853)	0.963 (0.631)	2.544 (0.291)	1.551 (0.474)	4.231 (0.125)	0.045 (0.983)	1.958 (0.376)
Occupation	29.128 (0.01)*	24.503 (0.04)*	13.933 (0.454)	18.844 (0.175)	11.559 (0.644)	10.468 (0.732)	22.751 (0.065)
Age	10.999 (0.36)	14.073 (0.169)	9.357 (0.5)	7.808 (0.654)	8.275 (0.609)	20.84 (0.023)*	10.366 (0.411)
Monthly income	18.682 (0.141)	31.343 (0.001)*	22.193 (0.052)	15.551 (0.299)	18.859 (0.136)	9.239 (0.806)	12.921 (0.505)
Marital status	5.957 (0.406)	15.073 (0.016)*	6.613 (0.359)	4.597 (0.591)	5.087 (0.521)	5.707 (0.457)	4.051 (0.678)
Educational level	18.293 (0.106)	15.635 (0.211)	8.507 (0.748)	15.049 (0.243)	7.62 (0.818)	9.64 (0.647)	10.008 (0.62)
Self-rated health status	8.664 (0.375)	6.788 (0.571)	18.664 (0.016)*	15.571 (0.05)	7.196 (0.52)	16.653 (0.034)*	11.178 (0.194)
Burden of health expenditure	25.025 (0.001)*	15.739 (0.004)*	20.586 (0.001)*	26.834 (0.001)*	11.617 (0.019)*	13.158 (0.011)*	10.154 (0.037)*

Notes: Data shown as χ² (P).

* P<0.05 (two-sided). Parametric tests (chi-square test and Fisher’s exact test).

Abbreviations: CHC, community health center; CHI, community health institution; CHS, community health service; DP, dual practice; PD, patient demand.

Table 7 Multinomial logistic regression analysis of medical staff (N=667)

Multinomial logistic regression analysis	Variables	Parameter	Estimate	SE	Wald χ^2	P-value	OR	95% CI
								Lower	Upper
Comparison of medical staff who were uncertain about “the willingness to join dual practice” with medical staff who wanted to join dual practicea		Intercept	16.790	1,837.988	0.000	0.993
	Educational level	Masterb	−0.816	0.328	6.177	0.013*	0.442	0.233	0.842
	Whether hospital administrators advocated dual practice policy in your current workplace	Not certainc	1.461	0.375	15.177	<0.001*	4.308	2.066	8.983
	Whether dual practice could reduce difficulty in consulting a doctor	Not certaind	1.340	0.284	22.255	<0.001*	3.820	2.189	6.667
	Support from the hospital	Very unimportante	2.912	1.172	6.171	0.013*	18.396	1.849	183.042
		Generale	1.145	0.459	6.217	0.013*	3.142	1.278	7.728
	Whether hospitals’ human resource management system permitted free flow of medical staff	Generalf	1.140	0.514	4.930	0.026*	3.127	1.143	8.557
		Importantf	1.003	0.384	6.822	0.009*	2.726	1.284	5.786
	The willingness of medical staff	Unimportantg	2.295	1.144	4.024	0.045*	9.926	1.054	93.456
Comparison of medical staff who were opposed to joining in dual practice with medical staff who wanted to join dual practicea		Intercept	−17.141	6,041.594	0.000	0.998
	Department	Internal medicine departmenth	0.791	0.390	4.116	0.042*	2.206	1.027	4.736
	Whether hospital administrators advocated dual practice policy in your current workplace	Noc	1.315	0.489	7.231	0.007*	3.724	1.428	9.710
	Whether dual practice could reduce difficulty in consulting a doctor	Not certaind	1.226	0.414	8.752	0.003*	3.406	1.512	7.673
		Nod	1.506	0.389	14.971	<0.001*	4.508	2.102	9.667
	Whether hospitals’ human resource management system permitted free flow of medical staff	Unimportantf	3.610	1.108	10.609	0.001*	36.956	4.211	324.347
		Generalf	2.102	0.660	10.145	0.001*	8.185	2.245	29.840
		Importantf	1.246	0.507	6.032	0.014*	3.475	1.286	9.388

Notes:

* P<0.05 (two-sided).

a Reference: medical staff who wanted to join dual practice.

b Reference, doctor;

c reference, hospital administrators had advocated dual practice policy in your current workplace;

d reference, medical staff who held the belief that dual practice could reduce difficulty in consulting a doctor;

e reference, medical staff who considered “support from the hospital” as a very important factor of dual practice;

f reference, medical staff who considered “whether hospitals’ human resource management system permitted free flow of medical staff” as a very important factor of dual practice;

g reference, medical staff who considered “the willingness of medical staff” as a very important factor of dual practice;

h reference, surgical department.

Abbreviations: CI, confidence interval; OR, odds ratio; SE, standard error.