title: Attributes of primary care in community health centres in China and implications for equitable care: a cross-sectional measurement of patients' experiences.
abstract: BACKGROUND
  China has been undergoing a health-care reform, and community health centres (CHCs) are being established as primary care provider across urban areas.
  
  
  OBJECTIVE
  To evaluate primary care attributes in CHCs by measuring patients' experiences.
  
  
  METHODS
  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.
authors.affiliation: From the JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, P.R. China, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK, School of Public Health, Guangzhou Medical University, Guangzhou 510182, P.R. China and Bauhinia Foundation Research Centre, Hong Kong From the JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, P.R. China, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK, School of Public Health, Guangzhou Medical University, Guangzhou 510182, P.R. China and Bauhinia Foundation Research Centre, Hong Kong From the JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, P.R. China, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK, School of Public Health, Guangzhou Medical University, Guangzhou 510182, P.R. China and Bauhinia Foundation Research Centre, Hong Kong.
authors.forename: H H X
authors.initials: HH
authors.lastname: Wang
authors.affiliation: From the JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, P.R. China, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK, School of Public Health, Guangzhou Medical University, Guangzhou 510182, P.R. China and Bauhinia Foundation Research Centre, Hong Kong yeungshanwong@cuhk.edu.hk.
authors.forename: S Y S
authors.initials: SY
authors.lastname: Wong
authors.affiliation: From the JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, P.R. China, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK, School of Public Health, Guangzhou Medical University, Guangzhou 510182, P.R. China and Bauhinia Foundation Research Centre, Hong Kong.
authors.forename: M C S
authors.initials: MC
authors.lastname: Wong
authors.affiliation: From the JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, P.R. China, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK, School of Public Health, Guangzhou Medical University, Guangzhou 510182, P.R. China and Bauhinia Foundation Research Centre, Hong Kong.
authors.forename: J J
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: From the JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, P.R. China, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK, School of Public Health, Guangzhou Medical University, Guangzhou 510182, P.R. China and Bauhinia Foundation Research Centre, Hong Kong.
authors.forename: X L
authors.initials: XL
authors.lastname: Wei
authors.affiliation: From the JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, P.R. China, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK, School of Public Health, Guangzhou Medical University, Guangzhou 510182, P.R. China and Bauhinia Foundation Research Centre, Hong Kong.
authors.forename: D K T
authors.initials: DK
authors.lastname: Li
authors.affiliation: From the JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, P.R. China, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK, School of Public Health, Guangzhou Medical University, Guangzhou 510182, P.R. China and Bauhinia Foundation Research Centre, Hong Kong.
authors.forename: J L
authors.initials: JL
authors.lastname: Tang
authors.affiliation: From the JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, P.R. China, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK, School of Public Health, Guangzhou Medical University, Guangzhou 510182, P.R. China and Bauhinia Foundation Research Centre, Hong Kong.
authors.forename: S M
authors.initials: SM
authors.lastname: Griffiths
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002681:China; D003151:Community Health Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006302:Health Services Research / Q000379:methods; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D011594:Psychometrics; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D019037:Urban Health Services / Q000458:organization & administration