Multiple chronic diseases have become an important characteristic of the development of chronic diseases, the chronic disease response method based on community health services has been recognized as one of the most cost-effective solutions, the quality of community health services affects the well-being of the public. Ratchet effect is beneficial for behavioral research, and we can provide useful reference for the evaluation of community health service quality for patients with multiple chronic diseases based on the perspective of doctor-patient behavior.

Research on the influencing factors of community health service' quality evaluation for patients with multiple chronic diseases based on ratchet effect.

Using multi-stage sampling method to select patients with multiple chronic diseases as the research subjects from 18 communities in Guangzhou, Guangdong Province, during July to August 2023. The community health service quality assessment questionnaire was used the PCAT scale developed by the Johns Hopkins Primary Care Center in the United States. Exploring the impact on the evaluation of community health service quality for patients with multiple chronic diseases under the moderation effect of medical insurance by constructing a multiple linear regression model.

We included 282 subjects with 129 males and 153 females, their average age was (38.0±8.0) years old. Married accounted for the majority of the participants, with 165 (58.51%); local residents predominated, with 215 individuals (76.24%); the distribution of educational backgrounds was balanced, with postgraduates constituting the largest group: 112 individuals (39.73%); the majority of residents' monthly income were below 5 000 yuan, with 163 individuals (57.80%); a total of 242 participants (85.81%) reported their health status as good or very good; the majority of participants were covered by public healthcare, urban employee social insurance, and urban resident social insurance, with 239 individuals (84.75%). The PCAT score for patients with multiple chronic conditions was (104.47±13.63) points. Statistically significant differences (P<0.05) were observed in PCAT scores based on different monthly income levels and health statuses. There was a statistically significant difference (P<0.05) in PCAT among institutions which had two levels of familiarity with multiple chronic diseases' patients, and the same for variations in willingness to utilize primary care services. Medical insurance had a positive moderating effect on the evaluation of community health service quality for patients with multiple chronic diseases (P<0.05). The behavior indicators of doctor-patient relationship had a ratchet effect on the evaluation of community health service quality for patients with multiple chronic diseases. That is to say, the higher the familiarity of community health service institutions with patients with multiple chronic diseases and the stronger the intention of patients with multiple chronic diseases to seek medical treatment at the grassroots level, the higher the evaluation of the quality of community health services for patients with multiple chronic diseases, it showed a phenomenon of only increasing without decreasing.

Medical insurance can enhance the evaluation of community health service quality by patients with multiple chronic conditions. The state should continue to introduce beneficial policies for improving the patients' medical experience. At the same time, we should advocate for the establishment of effective two-way communication between doctors and patients. Furthermore, we should continue to strengthen the awareness of primary care for patients with multiple chronic diseases.