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The Influencing Factors of Health-Seeking Preference and Community Health Service Utilization Among Patients in Primary Care Reform in Xiamen, China

Authors Zeng Y, Xu W, Chen L, Chen F, Fang Y

Received 12 December 2019

Accepted for publication 15 March 2020

Published 30 March 2020 Volume 2020:14 Pages 653—662

DOI https://doi.org/10.2147/PPA.S242141

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Naifeng Liu


Yanbing Zeng,1 Weiqian Xu,1 Lele Chen,2 Fan Chen,3 Ya Fang1

1State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, People’s Republic of China; 2School of Social and Behavioral Sciences, Nanjing University, Nanjing, Jiangsu, People’s Republic of China; 3Xiang’An Hospital of Xiamen University, Xiamen, Fujian, People’s Republic of China

Correspondence: Ya Fang
School of Public Health, Xiamen University, Xiang’an Nan Road, Xiang’an District, Xiamen, Fujian 361102, People’s Republic of China
Tel +86 592-2880636
Fax +86 592-2880639
Email fangya@xmu.edu.cn

Introduction: Patients often seek healthcare at general hospitals rather than at community healthcare centres (CHCs) which leads to inefficiency of health services. The primary healthcare reform developed by Xiamen has proven to break through the barriers of hierarchical diagnosis and treatment. The influencing factors of health-seeking behaviours of patients in the Xiamen reform, however, are unclear.
Objective: This study aimed to assess patients’ healthcare-seeking preferences and CHCs utilization, and identify influencing factors among patients affected by the Xiamen reform.
Methods: A cross-sectional study composed of 2200 individuals with hypertension or diabetes was conducted in association with Xiamen’s reform. The choice of health institutions was used to measure health-seeking preference. The probability and frequency of outpatient service use were used to measure CHC utilization. The social ecological model and two-part model were employed to examine influencing factors.
Results: As high as  72.5% of the subjects, including those who were under 60 years old, had low education level, with long disease duration, good self-report health and low household income expressed a preference for CHC (P< 0.05). Also, participants who had good-condition CHCs (χ2=6.736, P=0.010), joined in three-in-one chronic disease management (χ2=81.615, P< 0.01) and were insured by medical insurance (χ2=21.142, P< 0.01) significantly preferred to visit CHCs for treatment. In addition, patients who had a preference for CHC utilized many more CHCs (P< 0.01). Analysis of influencing factors found that education, self-reported health, smoking, household income, condition of the CHC, whether the patient had joined the healthcare reform and whether the patient had medical insurance were important factors affecting health-seeking preference and CHC utilization (P< 0.05).
Conclusion: The Xiamen healthcare reform made some achievements in improving CHC utilization. However, certain challenges remain. The government should further strengthen CHCs, deepen and expand healthcare reform, and make efforts to guide reasonable healthcare-seeking behaviour and improve the efficiency of primary health systems.

Keywords: health-seeking preference, community health services utilization, social ecological determinants, chronic diseases, primary care reform

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