The concept of "patients-centered" has presented higher requirements doctor-patient communication and reconstructing doctor-patient relationship in public primary health care institutions.
To analyze the impact of "patients-centered" doctor-patient communication on the quality of primary care services, and provide scientific evidence to promote reforms in public primary health care institutions.
All public community health centers providing primary care services in the main urban area of a city in Inner Mongolia Autonomous Region were selected as the study sites to conduct a field survey in 2021 using the standardized patient method, which included 118 items of doctor-patient communication data involving 26 medical institutions, 59 doctors, and 12 standardized patients. Common cold, asthma, and unstable angina were selected as the types of diseases to be portrayed by the standardized patients in this study. A combination of multiple regression model and Probit model was used to evaluate the impact of "patients-centered" doctor-patient communication on the quality of primary care services.
Results obtained from the 118 items of doctor-patient communication data revealed that the median adherence rate for recommended consultation items was 17.6% (14.6%), and the median adherence rate for recommended examination items was 25.0% (40.0%), among them, 75 cases (63.6%) were correctly diagnosed, and 59 cases (50.0%) were correctly treated. The median total cost was 84.84 yuan (130.44 yuan), and the median drug cost was 37.62 yuan (47.38 yuan), among them, 66 (55.9%) involved unnecessary drugs, and 71 (60.2%) included unnecessary examinations. The median visit duration was 13.625 (10.850) min. The average score for "patients-centered" doctor-patient communication was (26.712±10.658), with the first dimension scoring (12.915±5.355) points, the second dimension scoring (7.492±2.867) points, and the third dimension scoring (6.305±3.465) points. The results of multiple linear regression model and Probit model indicated that for every one-point increase in the total score of patient-centered doctor-patient communication, the adherence rates for both recommended consultation items and recommended examinations items increased by 0.001 percentage points, the correct diagnosis rate increased by an average of 4.6 percentage points, the correct treatment rate increased by 4.2 percentage points, the total cost increased by 1.993 yuan, the drug cost increased by 0.517 yuan, the proportion of unnecessary drugs decreased by 3.4 percentage points, the proportion of unnecessary examinations increased by 0.2 percentage points, and the visit duration decreased by 0.291 minutes.
"Patients-centered" doctor-patient communication enhances the effectiveness and safety of medical services, while it also increases medical costs. It is necessary to promote "patients-centered" doctor-patient communication from the aspects of resource endowment, salary incentives, doctor-patient relationships, and collaborative services, thereby improving the quality of primary care services.
Since the new medical reform, primary health care institutions have made remarkable achievements in the number of consultations and basic public health service projects, however, the problems including low quality and high mobility of personnel, weakened capacity and low efficiency of service still remain. Therefore, it has become an urgent task to solve the development dilemma of primary health care institutions.
To analyze the development dilemma of primary health care institutions and propose corresponding countermeasures.
From April to May 2021, the heads of 16 primary health care institutions in 6 counties and 2 districts in Guilin were selected using multi-stage sampling method to conduct semi-structured interviews, which mainly included resource allocation, service capacity building, health insurance policy implementation, and development dilemmas. NVivo 11.0 qualitative analysis software and the research method of ground theory were used to classify, ummarize and refine the original interview data at each level.
A total of 38 initial concepts, 9 initial categories, 4 main categories, and 1 core category were extracted, and nodes of stagnation in four dimensions including "resource allocation constraints" "obstruction of the path of three medical linkage" "deviation of functional positioning" and "accessibility lacking in medical community construction" were obtained.
The development of primary health care institutions is constrained by a variety of factors, with resource allocation balance and compensation mechanism improvement as core issue, synergy of the three medical linkage paths as external condition, adjustment of functional positioning as key link, and the construction of close medical community as important approach.
