title: Determinants of initial utilization of community healthcare services among patients with major non-communicable chronic diseases in South China.
abstract: BACKGROUND
  Although expected to act as gate-keeping primary care providers, as community health service (CHS) facilities are severely under-utilized; Chinese people in both rural and urban areas used predominantly higher-tier facilities for primary care purpose, with significant financial and outcome consequences. This study intends to explore the determinants of initial utilization of CHS among patients with major non-communicable chronic diseases (NCDs) in order to understand the care-seeking behavior among urban and rural residents in South China.
  
  
  METHODS
  A multi-stage cluster random sampling methodology was adopted to create a sample of 19,466 adults with NCDs from 7,970 urban households and 32,035 adults with NCDs from 3,860 rural households in Guangdong, China. Interviews and physical examinations were conducted in 2010 to collect data on patient characteristics, medical conditions, and awareness and utilization of healthcare. Descriptive analysis and logistic regression analysis were performed to study utilization patterns and the factors associated with the patterns.
  
  
  RESULTS
  Prevalence of major NCDs in urban areas was significantly higher than that in rural areas (12.55% vs. 8.70%; p<0.001). Second-tier district hospitals were most preferred for initial consultation (46.05% in rural areas vs. 45.32% in urban areas; p<0.001), followed by tertiary general or specialized hospitals (28.39% in rural areas vs. 33.89% in urban areas; p<0.001). The proportion of patients who had initial use of CHS was relatively low (25.56% in rural areas vs. 20.79% in urban areas; p<0.001). Awareness of self-care and the presence of medical insurance were leading factors associated with first contact of CHS facilities in both urban and rural areas.
  
  
  CONCLUSIONS
  The study suggests that CHS facilities are not often used as the first contact for patients in both rural and urban areas in south China. Much effect must be made to enhance the gatekeeper system and improve medical insurance coverage in future healthcare reforms.
authors.affiliation: School of Public Health, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, China; The Affiliated Liyuan Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430077, China.
authors.forename: Huajie
authors.initials: H
authors.lastname: Yang
authors.affiliation: School of Public Health, Guangzhou Medical University, Guangzhou, 510182, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Huang
authors.affiliation: School of Public Health, Guangzhou Medical University, Guangzhou, 510182, China.
authors.forename: Zhiheng
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong; General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, United Kingdom.
authors.forename: Harry H X
authors.initials: HH
authors.lastname: Wang
authors.affiliation: School of Public Health, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Xinyue
authors.initials: X
authors.lastname: Tong
authors.affiliation: The Affiliated Liyuan Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430077, China.
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Wang
authors.affiliation: School of Public Health, Guangzhou Medical University, Guangzhou, 510182, China.
authors.forename: Jiaji
authors.initials: J
authors.lastname: Wang
authors.affiliation: School of Public Health, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Zuxun
authors.initials: Z
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology*; D003153:Community Health Services / Q000706:statistics & numerical data*; D003710:Demography; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult