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Multimorbid Patient Experiences With Primary Care at Community Health Centers in Shanghai, China

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journal contribution
posted on 2021-08-03, 03:04 authored by H Jin, Z Wang, L Shi, C Chen, Y Huo, W Huang, Y Zhang, Yuan LuYuan Lu, X Ge, J Shi, D Yu
Objective: Primary care in China is facing mounting challenges with multimorbidity as the aging population grows. Knowing how patients experience primary care may highlight the deficiencies of the care system and guide health system reform. The purpose of this study was to compare the quality of primary care experienced by patients with and without multimorbidity at community health centers (CHCs) in Shanghai, China and to examine the factors influencing these experiences. Methods: A cross-sectional survey was conducted from August to December 2019 using the validated Chinese Primary Care Assessment Tool-Adult Edition (PCAT-AE). ANOVA was performed to compare the overall and domain-specific quality of primary care for patients with and without multimorbidity. Multivariate linear regressions were used to assess the factors associated with primary care quality while controlling for patients' sociodemographic and healthcare characteristics. Results: From 2,404 completed questionnaires, patients with multimorbidity reported higher PCAT scores in the domains of first contact-utilization (3.54 ± 0.55 vs. 3.48 ± 0.56, P < 0.01), accessibility (2.93 ± 0.49 vs. 2.86 ± 0.47, P < 0.001), and ongoing care (3.20 ± 0.39 vs. 3.14 ± 0.43, P < 0.001), while reporting lower scores in coordination (information system) (2.72 ± 0.41 vs. 2.79 ± 0.35, P < 0.001) and family-centeredness (3.23 ± 0.63 vs. 3.30 ± 0.64, P < 0.01). Multimorbidity (ß = 0.355, P < 0.01), education level (ß = 0.826, P < 0.01), district (suburb: ß = 1.475, P < 0.001), and self-perceived good health status (ß = 0.337, P < 0.05) were associated with better patient experiences in primary care. Patients between the age 61 and 70 (ß = −0.623, P < 0.001; >70 years: ß = −0.573, P < 0.01), with a monthly household income ≥6,000 RMB (ß = −1.385, P < 0.001) and with more than 20 outpatient visits the previous year (ß = −1.883, P < 0.001) reported lower total PCAT scores. Conclusion: The findings of our study suggest that CHCs in China have contributed to better primary care experiences for patients with multimorbidity in certain quality domains, including first contact-utilization, accessibility, and ongoing care. However, there is still room for improvement in care coordination and family-centeredness.


The design of this study was supported by Shanghai Medicine and Health Development Foundation (Se1201931). Data extraction was funded by Shanghai Excellent Young Talents Project in Health System (2018YQ52) and Shanghai Pujiang Program (2019PJC072). Analysis and interpretation of the data guided by statisticians were funded by Project of Shanghai Health Committee (201840132) and Hospital Management Research Fund of Shanghai Hospital Association (X1901099). The writing and revision, including language improvement were sponsored by Shanghai Leading Talents Program (YDH-20170627).


Publication Date



Frontiers in Public Health



Article Number

ARTN 606188







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