Assessing the impact of general practitioner team service on perceived quality of care among patients with non-communicable diseases in China: a natural experimental study


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Abstract

ObjectiveChina issued the national primary care policy of promoting general practitioner (GP) team service in 2011. We conducted this study to assess the impact of the GP team service on quality of primary care as perceived by patients with non-communicable diseases (NCDs).DesignNatural experimental study.SettingThis study was conducted in Shanghai, where the policy was effectively implemented, and Kunming, where the policy was not implemented.ParticipantsIn both cities, NCD patients were interviewed with primary care assessment tool (PCAT) after their clinical consultations in their community health centers.InterventionThe implementation of GP team service policy.Main Outcome MeasuresMultiple linear regressions were employed to compare PCAT scores between the two rounds of the surveys in each city. Difference-in-difference (DID) analysis was used to identify the changes between two cities over time.ResultsA total of 663 and 587 patients in Shanghai, and 400 and 441 patients in Kunming were surveyed in 2011 and 2013, respectively. The DID analysis showed that the total primary care quality scores improved in Shanghai compared with Kunming between 2011 and 2013 (β = 1.30, 95% CI: 0.74, 1.87). In Shanghai, care quality in 2013 improved significantly for the total score and the six components when compared with those in 2011. No significant changes were observed in Kunming in the same period.ConclusionPrimary care policies that promote long-term provider–patient relationships, coordinated service with hospitals and capitation payment for the GP team may contribute to the improvement of care quality in Shanghai.

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