Attributes of primary care in community health centres in China and implications for equitable care: a cross-sectional measurement of patients' experiences

Background: China has been undergoing a health-care reform, and community health centres (CHCs) are being established as primary care provider across urban areas. Aim: To evaluate primary care attributes in CHCs by measuring patients’ experiences. Design: Cross-sectional surveys of 3360 adult service users with multistage cluster sampling. Methods: We developed a short assessment tool consisting of 33 items derived from the short version of the original Primary Care Assessment Tool-Adult Edition (PCAT-AE). The reliability and validity of the instrument were evaluated. Score distributions were assessed using descriptive statistics with 95% confidence interval (CI). The overall PCAT scores were categorized into three quantile groups (lower score, medium score and optimal score). Ordinal logistic regression analysis was performed to explore patient characteristics associated with optimal score after controlling for demographic, socio-economic, health conditions and health-care utilization characteristics. Results: One-third (33.4%, 95% CI: 31.0–35.9%) of subjects had optimal overall PCAT scores, while the majority (83.4%) reported medium-to-lower score in the community orientation scale. Patients’ characteristics with respect to health-care utilization had major effects on PCAT scores. Subjects with the presence of social medical insurance had higher odds of having greater experience in most primary care attributes and tended to report optimal primary care experience (aOR 2.30, 95% CI: 1.92–2.75) compared with those without social medical insurance. Conclusions: Equitable primary care is yet to be strengthened with regard to the community orientation attribute, and particularly among patients without social medical insurance, as they tend to have inferior experiences in the primary care sector