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Since 1980, the Chinese health care system has improved greatly by relying on the community health care system, which is funded and owned by the government[1]. However, the privatization of China's economy based on market-oriented economic reforms[2] resulted in the large-scale dismantling of the community health service (CHS) system. In recent years, although the level of CHS had improved and is much better than before, patients still prefer well-known hospitals to community health care facilities owing to their distrust of CHS. Therefore, admissions and visits keep occurring at comprehensive and specialized hospitals[3].
As is well known, the gatekeeping function performed by CHS providers contributes to the formation of an equitable and efficient health care delivery system[4]; however, patients subjected to the gatekeeper policy are therefore restricted with regard to their choices, which may influence their satisfaction with CHS. Patient satisfaction, an indicator of the service quality, includes continuity of the service, doctor-patient relationships, communication, and professional skills of the service providers and is increasingly used to assess care quality and payment schemes by policymakers[5] and health insurance companies[6].
With the near completion of universal health insurance coverage and the establishment of the community health care network[7], the Chinese government has been implementing the gatekeeper policy on special populations such as the elderly, migrant workers, etc., and, in 2009, launched a large pilot program involving all residents with the Urban Employee's Basic Medical Insurance (UEBMI) in Nanjing. The research among this population on patient satisfaction with CHS can be helpful for improving the quality of services and policymaking.
This cross-sectional study was conducted at four community health service centers (CHCs) in Nanjing in 2015. A total of 1, 100 questionnaires were distributed, out of which 1, 058 were completed and collected. The European Patients Evaluate General/ Family Practice (EUROPEP) scale, which contains 23 items, was used to assess patients' satisfaction with CHS. The assessment method has been introduced in a previous publication[8]. A chi-squared (χ2) test and multi-regression analyses were used to explore the influencing factors of patient satisfaction in the context of the gatekeeper policy.
Table 1 shows the sociodemographic characteristics of participants. More than half of the participants were females (59.2%), retired (54.7%), and with chronic conditions (56.9%). Last year, about half of the participants visited the CHC 0-3 times (50.2%), and had higher self-perceived health scores (53.9%). Of the respondents, more than half had good cognition of the gatekeeper policy (59.5%). The distribution of baseline characteristics and patients' assessments of CHS are presented in the attachment (Supplementary Tables 1a-1e, available in www.besjournal.com).
Table 1. Distribution of Patients by Their Socio-demographic Characteristics
Characteristic n (%) Age 18-40 258 (24.4) 40-60 330 (31.2) ≥ 60 470 (44.4) Gender Male 432 (40.8) Female 626 (59.2) Marital status Married 931 (88.0) Single 127 (12.0) Educational background Primary school and below 72 (6.8) Middle school 559 (52.8) College degree and above 427 (40.3) Income of family monthly(RMB) ≤ 3, 000 424 (40.1) 3, 000-5, 000 221 (20.9) ≥ 5, 000 413 (39.0) Occupational type Administrative institution 105 (9.9) Retired 579 (54.7) Enterprise staff 219 (27.5) Other 83 (7.8) Health score ≥ 80 570 (53.9) 60-80 379 (35.8) < 60 109 (10.3) Chronic conditions No 456 (43.1) Yes 602 (56.9) Visiting times to CHC last year 0-3 531 (50.2) 4-6 110 (10.4) 7-12 107 (10.1) ≥ 12 310 (29.3) Cognition of gatekeeper policy Good 630 (59.5) General 148 (14.0) Bad 280 (26.5) The patients' assessment of CHS is presented in Table 2. Among their assessments of five aspects of CHS, patients' positive assessment of the doctor-patient relationship was the highest (48.9%), while their most positive assessment of accessibility was only 13.9%. The Supplementary Table 2a, available in www.besjournal.com highlights the percentage of patients who gave the highest rating ('4' or '5') in the EUROPEP instrument.
Table 2. Distribution of Patients' Satisfaction with Community Health Services
Characteristic Most Positive Assessments* Neutral Assessments# Poor Assessments† n % n % n % Doctor-patient-relationship (6 items) 517 48.9 327 30.9 214 20.2 Medical care (5 items) 425 40.2 229 21.6 404 38.2 Information and support (4 items) 357 33.7 319 30.2 382 36.1 Organization of care (2 items) 339 32 321 30.4 398 37.6 Accessibility (6 items) 147 13.9 221 20.9 690 65.2 Note.*Patients who marked 100% of the answered questions in one of the two most positive answering categories. #Patients who marked 100%-50% of the answered questions in one of the two most positive answering categories. †Patients who marked less than 50% (0%-49%) of the answered questions in one of the two most positive answering categories. Table 3 shows the results of the multiple regression analysis (including only the 100% category and the 0%-49% category) on the five dimensions of patient satisfaction with the care they received at the CHCs. Notably, good cognition of the gatekeeper policy among patients did positively influence their satisfaction on four dimensions, (P < 0.001) especially with regard to accessibility (7.497, 3.552-15.823), but did not positively influence medical care. Besides, it was also the only influencing factor for the dimension of information and support (1.775, 1.734-3.891 for good and 2.056, 1.704-5.094 for general).
Table 3. Multi-factor Analysis of Patients' Satisfaction on Five Dimensions of Community Health Services
Variables Doctor-patient-relationship
(6 items)Medical Care
(5 items)Information and Support
(4 items)Organization of Care
(2 items)Accessibility
(6 items)OR (95% Cl) P OR {95% Cl) P OR (95% Cl) P OR (95% Cl) P OR {95% Cl) P Age 18-40 0.600 (0.277, 1.301) 0.196 1.468 (0.769, 2, 869) 0.238 0.850 (0.427, 1.695) 0.645 0.921 (0.463, 1.831) 0.841 1.350 (0.575, 3.172) 0.41 40-60 0.747 (0.426, 1.309) 0.309 0.856 (0.530, 381) 0.524 0.611 (0.366, 1.019) 0.059 1.091 (0.655, 1.815) 0.738 0.986 (0.504, 1.926) 0.967 ≥60 Reference Reference Reference Reference Reference Gender Female 1.540 (1.078, 2.199) 0.018 1.313 (0.964, 1.793) 0.084 1.372 (0.995, 1.892) 0.054 1.607 2.233) 0.005 1.432 (0.949, 2.161) 0.087 Male Reference Reference Reference Reference Reference Marital status Married 0.731 (0.422, 1.266) 0.263 0.654 (0.393, 1.0S8) 0.102 0.707 (0.438, 1.141) 0.156 0.891 (0.549, 1.446) 0.640 0.806 (0.454, 1.433) 0.463 Single Reference Reference Reference Reference Reference Educational Background Primary school and below 0325 (0.154, 0.689) 0.003 0.412 (0.204, 0.831) 0.013 0.684 (0.337, 1.388) 0.293 0.334 (0.145, 0.774) 0.010 0.247 (0.069, 0.983) 0.033 Middle school 0.834 (0.539, 1.289) 0.414 0.932 (0.645, 1.347) 0.709 0.846 (0.578, 1.237) 0.388 0, 868 (0.590, 1, 275) 0.470 0.646 (0.404, 1.032) 0.068 College degree and above Reference Reference Reference Reference Reference Income of family monthly (RMB) ≤3, 000 0.753 (0.486, 1.165) 0.202 0.871 (0.603, 1.258) 0.462 0.783 (0.532, 1.151) 0.214 0.899 (0.608, 1.B30) 0.594 1.283 (0.787, 2.092) 0.317 3, 000-5, 000 0.655 (0.410, 1.047) 0.077 0.823 (0.551, 1.228) 0.339 0.879 (0.580, 1.3B2) 0.543 0.S9B (0.586, 1.B62) 0.599 1.223 (0.728, 2.055) 0.446 ≥ 5, 000 Reference Reference Reference Reference Reference Occupational type Administrative Institution 0.440 (01804.071) 0.07 0.620 (0.305, 1.261) 0.187 0, 632(0.301, 1.328) 0.226 0.598(0.2914-231) 0.163 0.727 (0.311, 1.701) 0.462 Retired 0.384 (0.164, 0.899) 0.027 0.704 (0.354, 1.401) 0.318 0.638(0.306, 1.331) 0.231 0.600(0.296, 1-216) 0.156 0.567 (0.233, 1.379) 0.221 Enterprise staff 0.573 (0.269, 1.221) 0.149 0.750 (0.407, 1.384) 0.357 0.913 (0.482, 1.729) 0.780 0.703 (0.381, 1.296) 0.259 0.638 (0.306, 1.330) 0.231 Other Reference Reference Reference Reference Reference Health score ≥80 1.865 (0.989, 3.517) 0.054 1.810 (1.053, 3.113) 0.032 1.666 (0.962, 2.886) 0.069 1.089 (0.605, 1.961) 0.775 1.750 (0.731, 4.194) 0.209 60-80 1.429 (0.772, 2.644) 0.256 1.719 (1.013, 2.918) 0.015 1.038 (0.606, 1.778) 0.892 0.832 (0.465, 1.490) 0.537 1.374 (0.577, 3.273) 0.473 < 60 Reference Reference Reference Reference Reference Chronic conditions No 1.039 (0.666, 1.620) 0.866 1.355 (0.916, 2.005) 0.128 1.085 (0.721, 1.632) 0.697 1.214 (0.806, 1.829) 0.352 1.100 (0.661, 1.831) 0.714 Yes Reference Reference Reference Reference Reference Visiting times to CHC last year 0-3 0.339(0.203, 0.566) < 0.001 0.653 (0.431, 0.988) 0.044 0.653 (0.424, 1.006) 0.053 0.458 (0.290, 0.722) 0.001 1.282 (0.727, 2.261) 0.390 4-6 0.584 (0.295, 1.156) 0.122 0.823 (0.474, 1.428) 0.488 0.937 (0.534, 1.643) 0.82 1.048 (0.587, 1.868) 0.875 1.881 (0.923, 3.832) 0.082 7-12 0.376 (0.196, 0.725) 0.003 0.645 (0.374, 1.114) 0.116 0.595 (0.331, 1.070) 0.083 0.804 (0.449, 1.440) 0.464 1.269 (0.600, 2.682) 0.533 ≥12 Reference Reference Reference Reference Reference Cognition of the gatekeeper policy Good 1.780 (1.201, 2.638) 0.004 1.273 (0.892, 1.818) 0.184 1.775 (1.734, 3.891) 0.002 2.962(1.997, 4.392) < 0.001 8.211 (3.878, 17.386) < 0.001 General 1.230(0.729, 2.076) 0.437 1.431 (0.883, 2.321) 0.146 2.056 (1.704, 5.094) 0.005 2.847 (1.674, 4.843) < 0.001 9.335 (4.034, 21.602) < 0.001 Bad Reference Reference Reference Reference Reference China's health care reform has resulted in the expansion of health insurance coverage and strengthened the infrastructure of primary health facilities since 2009. However, it is difficult to transform investments and insurance coverage into cost-effective services with fragmented and inefficient health care delivery[7]. In this case, the asymmetries in medical information between patients and health care providers make it difficult for patients to make sound choices without guidance and, in return, aggravate the inefficient delivery of health service. In many developed countries, gatekeeper policies play an important role in the process of forming an effective health service system[4]. In China, many pilot programs of gatekeeper policy have been launched, and this study is the first attempt to assess patients' satisfaction among the population with UEBMI.
The EUROPEP scale is beneficial for the makers of health policies in developing First Step systems and has been implemented in 16 European countries[8]. In China, few studies on patient satisfaction have been conducted using the EUROPEP scale and only one study[9] evaluated its reliability (Cronbach's α = 0.945). Our study shows that the EUROPEP scale is suitable for assessing patient satisfaction with high reliability and validity (Cronbach's α = 0.960 and KMO = 0.958), and we believe it will contribute to international comparisons of patient satisfaction with CHS, especially in countries where the general practitioner (GP) is the gatekeeper.
Consistent with the previous study[10], our study indicates that sociodemographic differences with statistical significance vary in assessments of CHS. In China, doctor-patient relationships have become a public health concern to which close attention is paid. Our results suggest that patients are most satisfied with the doctor-patient relationship aspect, which indicates the advantage of CHCs and the importance of the gatekeeper policy. In addition, our study shows that a high proportion of patients poorly assessed the aspect of medical care, which is an influencing factor of community patients' satisfaction. It is worth noting that patients are least satisfied with accessibility, and the aspects of 'getting through to the practitioner on the phone' and 'getting an appointment to suit you' may be good goals to improve accessibility. Thus, GPs must be prepared to focus on the aspect of accessibility as an indicator of the potential opportunity for improvement. In addition, the item 'waiting time in the waiting room' was positively assessed, which suggests that it is easier for patients to visit doctors at CHCs rather than at hospitals in China.
The multivariable logistic regression analyses suggest that the influencing factors of patients' satisfaction among the five dimensions are diverse and that age, marital status, educational background, self-perceived health status, frequency of visits to CHCs, and chronic diseases influence their assessment of CHS at different levels. As such, excepting to improve services by making residents comprehend the policy may be important to achieve overall satisfaction among patients.
There are some limitations to this study. First, the potential influencing factors of patient satisfaction with CHS are possibly more than those we investigated. Second, the study is based on a convenient sample of patients who had just completed their visits to CHCs. The fact that they were at the CHCs at the moment of the survey may indicate their willingness to seek care at CHCs, which may have induced an overestimated level of satisfaction. Finally, although our results illustrate the high reliability and validity of the EUROPEP scale, more studies are needed to examine the further applicability of the scale to the Chinese population.
Patients' satisfaction, as the basic criteria for acquiring information with regard to what extent their expectations are met, is an important indicator for the assessment of the gatekeeper policy. Patients' good cognition of the policy is positively associated with their satisfaction, and improvements of the aspects of information and support, medical care, and accessibility may be good goals for patient satisfaction.
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Table 1a. Distribution of Characteristics among Patients on Doctor-Patient-Relationship
Item Most Positive
Assessments*
(517)Neutral
Assessments#
(327)Poor Assessments†(214) χ2 P Age 18-40 134 (25.9) 70 (21.4) 54 (25.2) 2.701 0.609 40-60 155 (30.0) 11110 (33.6) 65 (30.4) ≥ 60 228 (44.1) 147 (45.0) 95 (44.4) Gender Male 200 (38.7) 131 (40.1) 100 (46.9) 4.146 0.126 Female 317 (61.3) 196 (59.9) 114 (53.1) Marital status Married 449 (86.8) 293 (89.6) 189 (88.3) 1.466 0.481 Single 68 (13.2) 34 (10.4) 25 (11.7) Educational Background Primary school and below 26 (5.1) 21 (6.4) 25 (11.7) 12.255 0.016 Middle school 274 (53.0) 170 (52.0) 115 (53.7) College degree and above 217 (41.9) 136 (41.6) 74 (34.6) Income of family monthly ≤ 3, 000 201 (38.8) 128 (39.2) 96 (44.7) 6.665 0.155 3, 000-5, 000 103 (20.0) 67 (20.4) 51 (24.0) ≥ 5, 000 213 (41.2) 132 (40.4) 67 (31.3) Occupational type Administrative institution 43 (8.3) 43 (13.1) 19 (8.9) 14.234 0.027 Retired 272 (52.6) 189 (57.8) 118 (55.1) Enterprise staff 158 (30.6) 69 (21.1) 64 (29.9) Other 44 (8.5) 26 (8.0) 13 (6.1) Health score ≥ 80 287 (55.5) 172 (52.6) 111 (51.9) 11.356 0.023 60-80 192 (37.1) 108 (33.0) 79 (36.9) < 60 38 (7.4) 47 (14.4) 24 (11.2) Chronic conditions No 225 (43.5) 133 (40.7) 98 (45.8) 1.456 0.483 Yes 292 (56.5) 194 (59.3) 116 (54.2) Visiting times to CHC last year 0-3 250 (48.4) 146 (44.6) 135 (63.1) 28.434 < 0.001 4-6 55 (10.6) 36 (11.0) 19 (8.9) 7-12 46 (8.9) 35 (10.7) 26 (12.1) ≥ 12 166 (32.1) 110 (33.6) 34 (15.9) Note. *Patients who marked 100% of the answered questions in one of the two most positive answering categories. #Patients who marked 50%-100% of the answered questions in one of the two most positive answering categories. †Patients who marked less than 50% (0%-49%) of the answered questions in one of the two most positive answering categories. Table 1b. Distribution of Characteristics among Patients on Medical Care
Item Most Positive
Assessments* (425)Neutral
Assessments#(229)Poor Assessments†
(404)χ2 P Age 18-40 135 (31.8) 48 (21.0) 75 (18.6) 21.491 < 0.001 40-60 118 (27.8) 75 (32.8) 137 (33.9) ≥ 60 172 (40.5) 106 (46.3) 192 (47.5) Gender Male 164 (38.5) 92 (40.2) 176 (43.5) 2.175 0.337 Female 261 (61.5) 137 (59.8) 228 (56.5) Marital status Married 369 (86.9) 190 (82.9) 371 (91.9) 11.57 0.003 Single 56 (13.1) 39 (17.1) 33 (10.1) Educational Background Primary school and below 18 (4.3) 12 (5.2) 42 (10.4) 18.926 0.001 Middle school 218 (51.2) 119 (52.0) 223 (55.1) College degree and above 189 (44.5) 98 (42.8) 139 (34.5) Income of family monthly ≤ 3, 000 153 (36.0) 93 (40.7) 178 (44.1) 8.172 0.085 3, 000-5, 000 88 (20.8) 45 (19.5) 88 (21.9) ≥ 5, 000 184 (43.2) 91 (39.8) 138 (34.0) Occupational type Administrative institution 43 (10.1) 20 (8.7) 42 (10.4) 12.301 0.056 Retired 207 (48.7) 136 (59.4) 236 (58.4) Enterprise staff 137 (32.2) 55 (24.0) 99 (24.5) other 38 (8.9) 18 (7.9) 27 (6.7) Health score ≥ 80 244 (57.4) 124 (54.1) 202 (50.0) 10.233 0.037 60-80 150 (35.3) 82 (35.8) 147 (36.4) < 60 31 (7.3) 23 (10.0) 55 (13.6) Chronic conditions No 210 (49.4) 90 (39.3) 156 (38.6) 11.567 0.003 Yes 215 (50.6) 139 (60.7) 248 (61.4) Visiting times to CHC last year 0-3 215 (50.6) 108 (47.2) 208 (51.5) 2.618 0.855 4-6 46 (10.8) 26 (11.4) 38 (9.4) 7-12 39 (9.2) 23 (10.0) 45 (11.1) ≥ 12 125 (29.4) 72 (31.4) 113 (28.0) Cognition of the gatekeeper policy Good 265 (62.3) 140 (61.1) 225 (55.7) 13.897 0.008 General 69 (16.3) 21 (9.2) 58 (14.4) Bad 91 (21.4) 68 (29.7) 121 (30.0) Note. *Patients who marked 100% of the answered questions in one of the two most positive answering categories. #Patients who marked 50%-100% of the answered questions in one of the two most positive answering categories. †Patients who marked less than 50% (0%-49%) of the answered questions in one of the two most positive answering categories. Table 1c. Distribution of Characteristics among Patients on Information and Support
Item Most Positive
Assessments* (357)Neutral
Assessments#(319)Poor Assessments†
(382)χ2 P Age 18-40 119 (33.3) 58 (18.2) 81 (21.2) 25.928 < 0.001 40-60 91 (25.5) 107 (33.5) 132 (34.6) ≥ 60 147 (41.2) 154 (48.3) 169 (44.2) Gender Male 137 (38.4) 128 (40.2) 166 (43.5) 2.044 0.360 Female 220 (61.6) 191 (59.2) 216 (56.5) Marital status Married 301 (84.3) 287 (89.9) 343 (89.7) 6.923 0.031 Single 56 (15.7) 32 (10.1) 39 (10.3) Educational Background Primary school and below 21 (5.9) 17 (5.4) 34 (8.9) 13.857 0.008 Junior middle school 168 (47.0) 182 (56.8) 210 (55.0) Associate college 168 (47.0) 120 (37.9) 138 (36.1) Income of family monthly ≤ 3, 000 126 (35.2) 124 (39.0) 174 (45.6) 12.339 0.015 3, 000-5, 000 80 (22.4) 59 (18.4) 83 (21.6) ≥ 5, 000 151 (42.3) 136 (42.5) 125 (32.8) Occupational type Administrative institution 36 (10.1) 29 (9.1) 40 (10.5) 16.752 0.010 Retired 170 (47.6) 193 (60.5) 216 (56.5) Enterprise staff 122 (34.2) 69 (21.6) 100 (26.2) other 29 (8.1) 28 (8.8) 26 (6.8) Health score ≥ 80 217 (60.8) 167 (52.4) 186 (48.7) 13.944 0.007 60-80 109 (30.5) 124 (38.9) 146 (38.2) < 60 31 (8.7) 28 (8.8) 50 (13.1) Chronic conditions No 171 (47.9) 127 (39.8) 158 (41.4) 5.23 0.073 Yes 186 (52.1) 192 (60.2) 224 (58.6) Visiting times to CHC last year 0-3 184 (51.5) 142 (44.5) 205 (53.7) 11.462 0.075 4-6 42 (11.8) 30 (9.4) 38 (9.9) 7-12 30 (8.4) 35 (11.0) 42 (11.0) ≥12 101 (28.3) 112 (35.1) 97 (25.4) Cognition of the gatekeeper policy Good 226 (63.2) 195 (61.1) 209 (54.7) 20.693 < 0.001 General 63 (17.7) 36 (11.3) 49 (12.8) Bad 68 (19.1) 88 (27.6) 124 (32.5) Note.*Patients who marked 100% of the answered questions in one of the two most positive answering categories. #Patients who marked 50%-100% of the answered questions in one of the two most positive answering categories. †Patients who marked less than 50% (0%-49%) of the answered questions in one of the two most positive answering categories. Table 1d. Distribution of Characteristics among Patients on Organisation of Care
Item Most Positive
Assessments* (339)Neutral
Assessments#(321)Poor Assessments†
(398)χ2 P Age 18-40 101 (29.8) 53 (16.5) 104 (26.1) 21.707 < 0.001 40-60 112 (33.0) 101 (31.5) 117 (29.4) ≥ 60 126 (37.2) 167 (52.0) 177 (44.5) Gender Male 114 (33.7) 138 (43.0) 178 (44.9) 10.683 0.005 Female 225 (65.3) 183 (57.0) 218 (55.1) Marital status Married 294 (86.6) 290 (90.3) 340 (87.2) 2.438 0.295 Single 45 (14.5) 31 (9.7) 50 (12.6) Educational Background Primary school and below 11 (3.3) 26 (8.1) 35 (8.8) 15.213 0.004 Middle school 172 (50.7) 181 (56.3) 207 (51.9) College degree and above 156 (46.0) 114 (35.6) 156 (39.3) Income of family monthly ≤ 3, 000 123 (36.4) 134 (41.6) 168 (42.1) 4.789 0.310 3, 000-5, 000 73 (21.5) 61 (18.9) 88 (22.1) ≥ 5, 000 143 (42.1) 126 (39.4) 142 (35.9) Occupational type Administrative institution 36 (10.6) 29 (9.0) 40 (10.1) 17.478 0.008 Retired 161 (47.5) 202 (62.9) 216 (54.3) Enterprise staff 107 (31.6) 72 (22.4) 112 (28.1) other 35 (10.3) 18 (5.6) 30 (7.5) Health score ≥ 80 203 (59.9) 146 (45.5) 221 (55.5) 14.504 0.006 60-80 106 (31.3) 135 (42.0) 138 (34.7) < 60 30 (8.8) 40 (12.5) 39 (9.8) Chronic conditions No 164 (48.4) 108 (33.6) 184 (46.2) 17.143 < 0.001 Yes 175 (51.6) 213 (66.4) 214 (53.8) Visiting times to CHC last year 0-3 161 (47.5) 127 (39.6) 243 (61.1) 58.191 < 0.001 4-6 47 (13.9) 27 (8.4) 36 (9.0) 7-12 40 (11.8) 28 (8.7) 39 (9.8) ≥ 12 91 (26.8) 139 (43.3) 80 (20.1) Cognition of the gatekeeper policy Good 236 (69.5) 188 (58.6) 206 (51.8) 42.825 < 0.001 General 54 (16.0) 44 (13.7) 50 (12.6) Bad 49 (14.5) 89 (27.7) 142 (35.7) Note.*Patients who marked 100% of the answered questions in one of the two most positive answering categories. #Patients who marked 50%-100% of the answered questions in one of the two most positive answering categories. †Patients who marked less than 50% (0%-49%) of the answered questions in one of the two most positive answering categories. Table 1e. Distribution of Characteristics among Patients on Accessibility
Item Most Positive
Assessments*(147)Neutral
Assessments#(221)Poor Assessments†
(690)χ2 P Age 18-40 57 (38.8) 60 (27.1) 141 (20.4) 25.648 < 0.001 40-60 44 (29.9) 68 (30.8) 218 (31.6) ≥ 60 46 (31.3) 93 (42.1) 331 (48.0) Gender Male 52 (35.2) 88 (39.7) 292 (42.3) 2.538 0.281 Female 95 (64.8) 133 (60.3) 398 (57.7) Marital status Married 123 (83.4) 195 (88.2) 612 (88.8) 2.903 0.234 Single 24 (16.6) 26 (11.8) 78 (11.2) Educational Background Primary school and below 3 (2.1) 12 (5.4) 57 (8.3) 22.246 < 0.001 Middle school 62 (42.1) 118 (53.4) 379 (54.9) College degree and above 82 (55.9) 91 (41.2) 254 (36.8) Income of family monthly ≤ 3, 000 52 (35.7) 79 (35.9) 293 (42.4) 4.997 0.288 3, 000-5, 000 33 (22.4) 47 (21.4) 141 (20.5) ≥ 5, 000 62 (42.0) 95 (42.7) 256 (37.1) Occupational type Administrative institution 20 (13.6) 25 (11.3) 60 (8.7) 24.694 < 0.001 Retired 58 (39.5) 111 (50.2) 410 (59.4) Enterprise staff 53 (36.1) 61 (27.6) 177 (25.7) Other 16 (10.9) 24 (10.9) 43 (6.2) Health score ≥ 80 93 (63.3) 126 (57.0) 351 (50.9) 10.276 0.036 60-80 46 (31.3) 72 (32.6) 261 (37.8) < 60 8 (5.4) 23 (10.4) 78 (11.3) Chronic conditions No 79 (53.7) 99 (44.8) 278 (40.3) 9.269 0.010 Yes 68 (46.3) 122 (55.2) 412 (59.7) Visiting times to CHC last year 0-3 82 (55.8) 99 (44.8) 350 (50.7) 10.902 0.091 4-6 18 (12.2) 31 (14.0) 61 (8.8) 7-12 15 (10.2) 25 (11.3) 67 (9.7) ≥ 12 32 (21.8) 66 (29.9) 212 (30.7) Cognition of gatekeeper system Good 106 (72.1) 145 (65.6) 378 (54.9) 53.261 < 0.001 General 32 (21.8) 32 (14.5) 84 (12.2) Bad 9 (6.1) 44 (19.9) 227 (32.9) Note. *Patients who marked 100% of the answered questions in one of the two most positive answering categories. #Patients who marked 50%-100% of the answered questions in one of the two most positive answering categories. †Patients who marked less than 50% (0%-49%) of the answered questions in one of the two most positive answering categories. Table 2a. Distribution of Patients' Most Positive Assessment* of Each Item
What is your opinion of the general practitioner and/or general practice over the last 12 months with respect to... Rank Percent (%) Doctor-patient-relationship 1 making you feel you had time during consultations 4 68.9 2 interest in your personal situation? 5 68.8 3 making it easy for you to tell him or her about your problems? 1 78.1 4 involving you in decisions about your medical care? 10 62.3 5 listening to you? 2 76.4 6 keeping your records and data confidential? 3 71.6 Medical care 7 quick relief of your symptoms? 9 63.2 8 helping you to feel well so that you can perform your normal daily activities? 7 65.8 9 thoroughness? 14 58.8 10 physical examination of you? 13 59.6 11 offering you services for preventing diseases? 16 51.4 Information and support 12 explaining the purpose of tests and treatments (eg. screening, health checks, immunisations) 12 60.0 13 telling you what you wanted to know about your symptoms and/or illness? 8 63.3 14 helping you deal with emotional problems related to your health status? 18 40.3 15 helping you understand the importance of following his or her advice? 11 62.0 Organisation of care 16 knowing what he or she had done or told you during contacts? 15 55.9 17 preparing you for what to expect from specialist or hospital care? 19 38.9 Accessibility 18 the helpfulness of the staff (other than doctor)? 17 50.7 19 getting an appointment to suit you? 22 25.1 20 getting through to the practice on the phone? 23 23.2 21 being able to speak to the general practitioner on the telephone? 20 34.4 22 waiting time in the waiting room? 6 66.1 23 providing quick services for urgent health problems? 21 27.6 Note. *With a score of 4 or 5 on the 5 point Likert scale.
doi: 10.3967/bes2017.092
Factors Affecting Patient Satisfaction with Community Health Service under the Gatekeeper System:A Cross-sectional Study in Nanjing, China
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Abstract: The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service (CHS) under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor-patient relationships, information and support, organization of care, and accessibility (P < 0.001). One or more factors such as gender and self-perceived health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients' satisfaction with CHS by strengthening their awareness of the gatekeeper policy.
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Table 1. Distribution of Patients by Their Socio-demographic Characteristics
Characteristic n (%) Age 18-40 258 (24.4) 40-60 330 (31.2) ≥ 60 470 (44.4) Gender Male 432 (40.8) Female 626 (59.2) Marital status Married 931 (88.0) Single 127 (12.0) Educational background Primary school and below 72 (6.8) Middle school 559 (52.8) College degree and above 427 (40.3) Income of family monthly(RMB) ≤ 3, 000 424 (40.1) 3, 000-5, 000 221 (20.9) ≥ 5, 000 413 (39.0) Occupational type Administrative institution 105 (9.9) Retired 579 (54.7) Enterprise staff 219 (27.5) Other 83 (7.8) Health score ≥ 80 570 (53.9) 60-80 379 (35.8) < 60 109 (10.3) Chronic conditions No 456 (43.1) Yes 602 (56.9) Visiting times to CHC last year 0-3 531 (50.2) 4-6 110 (10.4) 7-12 107 (10.1) ≥ 12 310 (29.3) Cognition of gatekeeper policy Good 630 (59.5) General 148 (14.0) Bad 280 (26.5) 
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Table 2. Distribution of Patients' Satisfaction with Community Health Services
Characteristic Most Positive Assessments* Neutral Assessments# Poor Assessments† n % n % n % Doctor-patient-relationship (6 items) 517 48.9 327 30.9 214 20.2 Medical care (5 items) 425 40.2 229 21.6 404 38.2 Information and support (4 items) 357 33.7 319 30.2 382 36.1 Organization of care (2 items) 339 32 321 30.4 398 37.6 Accessibility (6 items) 147 13.9 221 20.9 690 65.2 Note.*Patients who marked 100% of the answered questions in one of the two most positive answering categories. #Patients who marked 100%-50% of the answered questions in one of the two most positive answering categories. †Patients who marked less than 50% (0%-49%) of the answered questions in one of the two most positive answering categories.
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Table 3. Multi-factor Analysis of Patients' Satisfaction on Five Dimensions of Community Health Services
Variables Doctor-patient-relationship
(6 items)Medical Care
(5 items)Information and Support
(4 items)Organization of Care
(2 items)Accessibility
(6 items)OR (95% Cl) P OR {95% Cl) P OR (95% Cl) P OR (95% Cl) P OR {95% Cl) P Age 18-40 0.600 (0.277, 1.301) 0.196 1.468 (0.769, 2, 869) 0.238 0.850 (0.427, 1.695) 0.645 0.921 (0.463, 1.831) 0.841 1.350 (0.575, 3.172) 0.41 40-60 0.747 (0.426, 1.309) 0.309 0.856 (0.530, 381) 0.524 0.611 (0.366, 1.019) 0.059 1.091 (0.655, 1.815) 0.738 0.986 (0.504, 1.926) 0.967 ≥60 Reference Reference Reference Reference Reference Gender Female 1.540 (1.078, 2.199) 0.018 1.313 (0.964, 1.793) 0.084 1.372 (0.995, 1.892) 0.054 1.607 2.233) 0.005 1.432 (0.949, 2.161) 0.087 Male Reference Reference Reference Reference Reference Marital status Married 0.731 (0.422, 1.266) 0.263 0.654 (0.393, 1.0S8) 0.102 0.707 (0.438, 1.141) 0.156 0.891 (0.549, 1.446) 0.640 0.806 (0.454, 1.433) 0.463 Single Reference Reference Reference Reference Reference Educational Background Primary school and below 0325 (0.154, 0.689) 0.003 0.412 (0.204, 0.831) 0.013 0.684 (0.337, 1.388) 0.293 0.334 (0.145, 0.774) 0.010 0.247 (0.069, 0.983) 0.033 Middle school 0.834 (0.539, 1.289) 0.414 0.932 (0.645, 1.347) 0.709 0.846 (0.578, 1.237) 0.388 0, 868 (0.590, 1, 275) 0.470 0.646 (0.404, 1.032) 0.068 College degree and above Reference Reference Reference Reference Reference Income of family monthly (RMB) ≤3, 000 0.753 (0.486, 1.165) 0.202 0.871 (0.603, 1.258) 0.462 0.783 (0.532, 1.151) 0.214 0.899 (0.608, 1.B30) 0.594 1.283 (0.787, 2.092) 0.317 3, 000-5, 000 0.655 (0.410, 1.047) 0.077 0.823 (0.551, 1.228) 0.339 0.879 (0.580, 1.3B2) 0.543 0.S9B (0.586, 1.B62) 0.599 1.223 (0.728, 2.055) 0.446 ≥ 5, 000 Reference Reference Reference Reference Reference Occupational type Administrative Institution 0.440 (01804.071) 0.07 0.620 (0.305, 1.261) 0.187 0, 632(0.301, 1.328) 0.226 0.598(0.2914-231) 0.163 0.727 (0.311, 1.701) 0.462 Retired 0.384 (0.164, 0.899) 0.027 0.704 (0.354, 1.401) 0.318 0.638(0.306, 1.331) 0.231 0.600(0.296, 1-216) 0.156 0.567 (0.233, 1.379) 0.221 Enterprise staff 0.573 (0.269, 1.221) 0.149 0.750 (0.407, 1.384) 0.357 0.913 (0.482, 1.729) 0.780 0.703 (0.381, 1.296) 0.259 0.638 (0.306, 1.330) 0.231 Other Reference Reference Reference Reference Reference Health score ≥80 1.865 (0.989, 3.517) 0.054 1.810 (1.053, 3.113) 0.032 1.666 (0.962, 2.886) 0.069 1.089 (0.605, 1.961) 0.775 1.750 (0.731, 4.194) 0.209 60-80 1.429 (0.772, 2.644) 0.256 1.719 (1.013, 2.918) 0.015 1.038 (0.606, 1.778) 0.892 0.832 (0.465, 1.490) 0.537 1.374 (0.577, 3.273) 0.473 < 60 Reference Reference Reference Reference Reference Chronic conditions No 1.039 (0.666, 1.620) 0.866 1.355 (0.916, 2.005) 0.128 1.085 (0.721, 1.632) 0.697 1.214 (0.806, 1.829) 0.352 1.100 (0.661, 1.831) 0.714 Yes Reference Reference Reference Reference Reference Visiting times to CHC last year 0-3 0.339(0.203, 0.566) < 0.001 0.653 (0.431, 0.988) 0.044 0.653 (0.424, 1.006) 0.053 0.458 (0.290, 0.722) 0.001 1.282 (0.727, 2.261) 0.390 4-6 0.584 (0.295, 1.156) 0.122 0.823 (0.474, 1.428) 0.488 0.937 (0.534, 1.643) 0.82 1.048 (0.587, 1.868) 0.875 1.881 (0.923, 3.832) 0.082 7-12 0.376 (0.196, 0.725) 0.003 0.645 (0.374, 1.114) 0.116 0.595 (0.331, 1.070) 0.083 0.804 (0.449, 1.440) 0.464 1.269 (0.600, 2.682) 0.533 ≥12 Reference Reference Reference Reference Reference Cognition of the gatekeeper policy Good 1.780 (1.201, 2.638) 0.004 1.273 (0.892, 1.818) 0.184 1.775 (1.734, 3.891) 0.002 2.962(1.997, 4.392) < 0.001 8.211 (3.878, 17.386) < 0.001 General 1.230(0.729, 2.076) 0.437 1.431 (0.883, 2.321) 0.146 2.056 (1.704, 5.094) 0.005 2.847 (1.674, 4.843) < 0.001 9.335 (4.034, 21.602) < 0.001 Bad Reference Reference Reference Reference Reference
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Table 1a. Distribution of Characteristics among Patients on Doctor-Patient-Relationship
Item Most Positive
Assessments*
(517)Neutral
Assessments#
(327)Poor Assessments†(214) χ2 P Age 18-40 134 (25.9) 70 (21.4) 54 (25.2) 2.701 0.609 40-60 155 (30.0) 11110 (33.6) 65 (30.4) ≥ 60 228 (44.1) 147 (45.0) 95 (44.4) Gender Male 200 (38.7) 131 (40.1) 100 (46.9) 4.146 0.126 Female 317 (61.3) 196 (59.9) 114 (53.1) Marital status Married 449 (86.8) 293 (89.6) 189 (88.3) 1.466 0.481 Single 68 (13.2) 34 (10.4) 25 (11.7) Educational Background Primary school and below 26 (5.1) 21 (6.4) 25 (11.7) 12.255 0.016 Middle school 274 (53.0) 170 (52.0) 115 (53.7) College degree and above 217 (41.9) 136 (41.6) 74 (34.6) Income of family monthly ≤ 3, 000 201 (38.8) 128 (39.2) 96 (44.7) 6.665 0.155 3, 000-5, 000 103 (20.0) 67 (20.4) 51 (24.0) ≥ 5, 000 213 (41.2) 132 (40.4) 67 (31.3) Occupational type Administrative institution 43 (8.3) 43 (13.1) 19 (8.9) 14.234 0.027 Retired 272 (52.6) 189 (57.8) 118 (55.1) Enterprise staff 158 (30.6) 69 (21.1) 64 (29.9) Other 44 (8.5) 26 (8.0) 13 (6.1) Health score ≥ 80 287 (55.5) 172 (52.6) 111 (51.9) 11.356 0.023 60-80 192 (37.1) 108 (33.0) 79 (36.9) < 60 38 (7.4) 47 (14.4) 24 (11.2) Chronic conditions No 225 (43.5) 133 (40.7) 98 (45.8) 1.456 0.483 Yes 292 (56.5) 194 (59.3) 116 (54.2) Visiting times to CHC last year 0-3 250 (48.4) 146 (44.6) 135 (63.1) 28.434 < 0.001 4-6 55 (10.6) 36 (11.0) 19 (8.9) 7-12 46 (8.9) 35 (10.7) 26 (12.1) ≥ 12 166 (32.1) 110 (33.6) 34 (15.9) Note. *Patients who marked 100% of the answered questions in one of the two most positive answering categories. #Patients who marked 50%-100% of the answered questions in one of the two most positive answering categories. †Patients who marked less than 50% (0%-49%) of the answered questions in one of the two most positive answering categories.
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Table 1b. Distribution of Characteristics among Patients on Medical Care
Item Most Positive
Assessments* (425)Neutral
Assessments#(229)Poor Assessments†
(404)χ2 P Age 18-40 135 (31.8) 48 (21.0) 75 (18.6) 21.491 < 0.001 40-60 118 (27.8) 75 (32.8) 137 (33.9) ≥ 60 172 (40.5) 106 (46.3) 192 (47.5) Gender Male 164 (38.5) 92 (40.2) 176 (43.5) 2.175 0.337 Female 261 (61.5) 137 (59.8) 228 (56.5) Marital status Married 369 (86.9) 190 (82.9) 371 (91.9) 11.57 0.003 Single 56 (13.1) 39 (17.1) 33 (10.1) Educational Background Primary school and below 18 (4.3) 12 (5.2) 42 (10.4) 18.926 0.001 Middle school 218 (51.2) 119 (52.0) 223 (55.1) College degree and above 189 (44.5) 98 (42.8) 139 (34.5) Income of family monthly ≤ 3, 000 153 (36.0) 93 (40.7) 178 (44.1) 8.172 0.085 3, 000-5, 000 88 (20.8) 45 (19.5) 88 (21.9) ≥ 5, 000 184 (43.2) 91 (39.8) 138 (34.0) Occupational type Administrative institution 43 (10.1) 20 (8.7) 42 (10.4) 12.301 0.056 Retired 207 (48.7) 136 (59.4) 236 (58.4) Enterprise staff 137 (32.2) 55 (24.0) 99 (24.5) other 38 (8.9) 18 (7.9) 27 (6.7) Health score ≥ 80 244 (57.4) 124 (54.1) 202 (50.0) 10.233 0.037 60-80 150 (35.3) 82 (35.8) 147 (36.4) < 60 31 (7.3) 23 (10.0) 55 (13.6) Chronic conditions No 210 (49.4) 90 (39.3) 156 (38.6) 11.567 0.003 Yes 215 (50.6) 139 (60.7) 248 (61.4) Visiting times to CHC last year 0-3 215 (50.6) 108 (47.2) 208 (51.5) 2.618 0.855 4-6 46 (10.8) 26 (11.4) 38 (9.4) 7-12 39 (9.2) 23 (10.0) 45 (11.1) ≥ 12 125 (29.4) 72 (31.4) 113 (28.0) Cognition of the gatekeeper policy Good 265 (62.3) 140 (61.1) 225 (55.7) 13.897 0.008 General 69 (16.3) 21 (9.2) 58 (14.4) Bad 91 (21.4) 68 (29.7) 121 (30.0) Note. *Patients who marked 100% of the answered questions in one of the two most positive answering categories. #Patients who marked 50%-100% of the answered questions in one of the two most positive answering categories. †Patients who marked less than 50% (0%-49%) of the answered questions in one of the two most positive answering categories.
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Table 1c. Distribution of Characteristics among Patients on Information and Support
Item Most Positive
Assessments* (357)Neutral
Assessments#(319)Poor Assessments†
(382)χ2 P Age 18-40 119 (33.3) 58 (18.2) 81 (21.2) 25.928 < 0.001 40-60 91 (25.5) 107 (33.5) 132 (34.6) ≥ 60 147 (41.2) 154 (48.3) 169 (44.2) Gender Male 137 (38.4) 128 (40.2) 166 (43.5) 2.044 0.360 Female 220 (61.6) 191 (59.2) 216 (56.5) Marital status Married 301 (84.3) 287 (89.9) 343 (89.7) 6.923 0.031 Single 56 (15.7) 32 (10.1) 39 (10.3) Educational Background Primary school and below 21 (5.9) 17 (5.4) 34 (8.9) 13.857 0.008 Junior middle school 168 (47.0) 182 (56.8) 210 (55.0) Associate college 168 (47.0) 120 (37.9) 138 (36.1) Income of family monthly ≤ 3, 000 126 (35.2) 124 (39.0) 174 (45.6) 12.339 0.015 3, 000-5, 000 80 (22.4) 59 (18.4) 83 (21.6) ≥ 5, 000 151 (42.3) 136 (42.5) 125 (32.8) Occupational type Administrative institution 36 (10.1) 29 (9.1) 40 (10.5) 16.752 0.010 Retired 170 (47.6) 193 (60.5) 216 (56.5) Enterprise staff 122 (34.2) 69 (21.6) 100 (26.2) other 29 (8.1) 28 (8.8) 26 (6.8) Health score ≥ 80 217 (60.8) 167 (52.4) 186 (48.7) 13.944 0.007 60-80 109 (30.5) 124 (38.9) 146 (38.2) < 60 31 (8.7) 28 (8.8) 50 (13.1) Chronic conditions No 171 (47.9) 127 (39.8) 158 (41.4) 5.23 0.073 Yes 186 (52.1) 192 (60.2) 224 (58.6) Visiting times to CHC last year 0-3 184 (51.5) 142 (44.5) 205 (53.7) 11.462 0.075 4-6 42 (11.8) 30 (9.4) 38 (9.9) 7-12 30 (8.4) 35 (11.0) 42 (11.0) ≥12 101 (28.3) 112 (35.1) 97 (25.4) Cognition of the gatekeeper policy Good 226 (63.2) 195 (61.1) 209 (54.7) 20.693 < 0.001 General 63 (17.7) 36 (11.3) 49 (12.8) Bad 68 (19.1) 88 (27.6) 124 (32.5) Note.*Patients who marked 100% of the answered questions in one of the two most positive answering categories. #Patients who marked 50%-100% of the answered questions in one of the two most positive answering categories. †Patients who marked less than 50% (0%-49%) of the answered questions in one of the two most positive answering categories.
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Table 1d. Distribution of Characteristics among Patients on Organisation of Care
Item Most Positive
Assessments* (339)Neutral
Assessments#(321)Poor Assessments†
(398)χ2 P Age 18-40 101 (29.8) 53 (16.5) 104 (26.1) 21.707 < 0.001 40-60 112 (33.0) 101 (31.5) 117 (29.4) ≥ 60 126 (37.2) 167 (52.0) 177 (44.5) Gender Male 114 (33.7) 138 (43.0) 178 (44.9) 10.683 0.005 Female 225 (65.3) 183 (57.0) 218 (55.1) Marital status Married 294 (86.6) 290 (90.3) 340 (87.2) 2.438 0.295 Single 45 (14.5) 31 (9.7) 50 (12.6) Educational Background Primary school and below 11 (3.3) 26 (8.1) 35 (8.8) 15.213 0.004 Middle school 172 (50.7) 181 (56.3) 207 (51.9) College degree and above 156 (46.0) 114 (35.6) 156 (39.3) Income of family monthly ≤ 3, 000 123 (36.4) 134 (41.6) 168 (42.1) 4.789 0.310 3, 000-5, 000 73 (21.5) 61 (18.9) 88 (22.1) ≥ 5, 000 143 (42.1) 126 (39.4) 142 (35.9) Occupational type Administrative institution 36 (10.6) 29 (9.0) 40 (10.1) 17.478 0.008 Retired 161 (47.5) 202 (62.9) 216 (54.3) Enterprise staff 107 (31.6) 72 (22.4) 112 (28.1) other 35 (10.3) 18 (5.6) 30 (7.5) Health score ≥ 80 203 (59.9) 146 (45.5) 221 (55.5) 14.504 0.006 60-80 106 (31.3) 135 (42.0) 138 (34.7) < 60 30 (8.8) 40 (12.5) 39 (9.8) Chronic conditions No 164 (48.4) 108 (33.6) 184 (46.2) 17.143 < 0.001 Yes 175 (51.6) 213 (66.4) 214 (53.8) Visiting times to CHC last year 0-3 161 (47.5) 127 (39.6) 243 (61.1) 58.191 < 0.001 4-6 47 (13.9) 27 (8.4) 36 (9.0) 7-12 40 (11.8) 28 (8.7) 39 (9.8) ≥ 12 91 (26.8) 139 (43.3) 80 (20.1) Cognition of the gatekeeper policy Good 236 (69.5) 188 (58.6) 206 (51.8) 42.825 < 0.001 General 54 (16.0) 44 (13.7) 50 (12.6) Bad 49 (14.5) 89 (27.7) 142 (35.7) Note.*Patients who marked 100% of the answered questions in one of the two most positive answering categories. #Patients who marked 50%-100% of the answered questions in one of the two most positive answering categories. †Patients who marked less than 50% (0%-49%) of the answered questions in one of the two most positive answering categories.
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Table 1e. Distribution of Characteristics among Patients on Accessibility
Item Most Positive
Assessments*(147)Neutral
Assessments#(221)Poor Assessments†
(690)χ2 P Age 18-40 57 (38.8) 60 (27.1) 141 (20.4) 25.648 < 0.001 40-60 44 (29.9) 68 (30.8) 218 (31.6) ≥ 60 46 (31.3) 93 (42.1) 331 (48.0) Gender Male 52 (35.2) 88 (39.7) 292 (42.3) 2.538 0.281 Female 95 (64.8) 133 (60.3) 398 (57.7) Marital status Married 123 (83.4) 195 (88.2) 612 (88.8) 2.903 0.234 Single 24 (16.6) 26 (11.8) 78 (11.2) Educational Background Primary school and below 3 (2.1) 12 (5.4) 57 (8.3) 22.246 < 0.001 Middle school 62 (42.1) 118 (53.4) 379 (54.9) College degree and above 82 (55.9) 91 (41.2) 254 (36.8) Income of family monthly ≤ 3, 000 52 (35.7) 79 (35.9) 293 (42.4) 4.997 0.288 3, 000-5, 000 33 (22.4) 47 (21.4) 141 (20.5) ≥ 5, 000 62 (42.0) 95 (42.7) 256 (37.1) Occupational type Administrative institution 20 (13.6) 25 (11.3) 60 (8.7) 24.694 < 0.001 Retired 58 (39.5) 111 (50.2) 410 (59.4) Enterprise staff 53 (36.1) 61 (27.6) 177 (25.7) Other 16 (10.9) 24 (10.9) 43 (6.2) Health score ≥ 80 93 (63.3) 126 (57.0) 351 (50.9) 10.276 0.036 60-80 46 (31.3) 72 (32.6) 261 (37.8) < 60 8 (5.4) 23 (10.4) 78 (11.3) Chronic conditions No 79 (53.7) 99 (44.8) 278 (40.3) 9.269 0.010 Yes 68 (46.3) 122 (55.2) 412 (59.7) Visiting times to CHC last year 0-3 82 (55.8) 99 (44.8) 350 (50.7) 10.902 0.091 4-6 18 (12.2) 31 (14.0) 61 (8.8) 7-12 15 (10.2) 25 (11.3) 67 (9.7) ≥ 12 32 (21.8) 66 (29.9) 212 (30.7) Cognition of gatekeeper system Good 106 (72.1) 145 (65.6) 378 (54.9) 53.261 < 0.001 General 32 (21.8) 32 (14.5) 84 (12.2) Bad 9 (6.1) 44 (19.9) 227 (32.9) Note. *Patients who marked 100% of the answered questions in one of the two most positive answering categories. #Patients who marked 50%-100% of the answered questions in one of the two most positive answering categories. †Patients who marked less than 50% (0%-49%) of the answered questions in one of the two most positive answering categories.
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Table 2a. Distribution of Patients' Most Positive Assessment* of Each Item
What is your opinion of the general practitioner and/or general practice over the last 12 months with respect to... Rank Percent (%) Doctor-patient-relationship 1 making you feel you had time during consultations 4 68.9 2 interest in your personal situation? 5 68.8 3 making it easy for you to tell him or her about your problems? 1 78.1 4 involving you in decisions about your medical care? 10 62.3 5 listening to you? 2 76.4 6 keeping your records and data confidential? 3 71.6 Medical care 7 quick relief of your symptoms? 9 63.2 8 helping you to feel well so that you can perform your normal daily activities? 7 65.8 9 thoroughness? 14 58.8 10 physical examination of you? 13 59.6 11 offering you services for preventing diseases? 16 51.4 Information and support 12 explaining the purpose of tests and treatments (eg. screening, health checks, immunisations) 12 60.0 13 telling you what you wanted to know about your symptoms and/or illness? 8 63.3 14 helping you deal with emotional problems related to your health status? 18 40.3 15 helping you understand the importance of following his or her advice? 11 62.0 Organisation of care 16 knowing what he or she had done or told you during contacts? 15 55.9 17 preparing you for what to expect from specialist or hospital care? 19 38.9 Accessibility 18 the helpfulness of the staff (other than doctor)? 17 50.7 19 getting an appointment to suit you? 22 25.1 20 getting through to the practice on the phone? 23 23.2 21 being able to speak to the general practitioner on the telephone? 20 34.4 22 waiting time in the waiting room? 6 66.1 23 providing quick services for urgent health problems? 21 27.6 Note. *With a score of 4 or 5 on the 5 point Likert scale.
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