Family doctor contract services and health-related quality of life among patients with chronic diseases in rural China: what is the role of socioeconomic status?

Abstract

Purpose Few studies explored the relationship between the family doctor contract services (FDCS) and health-related quality of life (HRQOL) among patients with chronic diseases in rural China. This study aims to explore the relationship between the status of signing on FDCS and HRQOL among patients with chronic diseases and examine whether there are differences in the relationship between different socioeconomic status (SES). Methods A total of 1,210 respondents were included in this study. HRQOL was measured by EQ-5D-3L. The contracting status was divided into uncontracted and contracted. Tobit regression and Logistic regression were employed to explore the association between contracting status and HRQOL. The interaction terms were included to explore the differences in the association among different SES. Results Contracting with family doctors was associated with HRQOL (coefficient = 0.042; 95%CI 0.008 to 0.075). The association was different among different socioeconomic levels that the contracting status was only associated with HRQOL in sub-high-income (P < 0.01) and highly educated patients (P < 0.05). Compared with uncontracted patients, contracted patients reported higher ED-5D-3L utility value in the sub-high-income group (coefficient = 0.078; 95%CI 0.017 to 0.140) and high educational attainment (coefficient = 0.266; 95%CI 0.119 to 0.413). Conclusions This study found a significant association between FDCS and HRQOL among chronic patients in rural Shandong, China. This relationship varied by income levels and educational attainment. The government should take efforts to formulate a variety of measures to encourage chronic patients to contract with family doctors, with special attention to people with low SES.

Factors associated with health care utilization and catastrophic health expenditure among cancer patients in China: Evidence from the China health and retirement longitudinal study

“…Our results also found that patients who contracted with a family physician had more frequent outpatient visits and longer inpatient stays. A plausible explanation might be that contracting with a family physician is associated with higher income levels, which could enhance patient disease awareness and treatment compliance ( 37 ). However, family physicians serve as the gatekeepers to health care, aiming to prevent chronic diseases by intervening in disease-related lifestyle behaviors in addition to delivering primary health care services that can efficiently lower the hospitalization and mortality of patients and mitigate the burden of chronic disease in China ( 37 ).…”

“…A plausible explanation might be that contracting with a family physician is associated with higher income levels, which could enhance patient disease awareness and treatment compliance ( 37 ). However, family physicians serve as the gatekeepers to health care, aiming to prevent chronic diseases by intervening in disease-related lifestyle behaviors in addition to delivering primary health care services that can efficiently lower the hospitalization and mortality of patients and mitigate the burden of chronic disease in China ( 37 ). The effect of family physician contracting on the outpatient and inpatient services that were utilized by cancer patients remains for consideration.…”

Analysis on the relationship between effort-reward imbalance and job satisfaction among family doctors in China: a cross-sectional study

“…in Heilongjiang province suggested that there was a gap between actual and desired workplace characteristics, which had a negative influence on workers’ job satisfaction [ 42 ]. The popular researches about family doctors focused on the effect and challenge of family doctor contract services [ 43 – 48 ], chronic disease management to contract with family [ 50 ] and assessment of Chinese family physicians’ service competences [ 51 ]. Up to this point, these studies about job satisfaction and family doctors have been explored, however, these studies usually discussed other medical occupations or the effect of implementation family doctor policies, lacking of the overall occupational perception survey among family doctors at Community health centres.…”

Preference to Family Doctor Contracted Service of Patients with Chronic Disease in Urban China: A Discrete Choice Experiment

“…[6][7][8] The contract service is a voluntary bi-direction free health management supplementary service supported by the central government in China. 5,9,10 The service has been regarded as a critical strategy to provide continuous primary care and improve health awareness of the vulnerable populations, such as senior citizens, pregnant women and patients with non-communicate chronic diseases. 11 Many empirical studies have reported the positive feedback on contract service with cross-sectional data, especially for chronic disease patients.…”

“…11 Many empirical studies have reported the positive feedback on contract service with cross-sectional data, especially for chronic disease patients. 4,10,[12][13][14] Compared with other types of regular primary care and regular primary care doctors, family doctor contract service (FDCS) improved the health outcome of community residents, and households reported to receive follow-up on treatments more efficiently. 14 It was also proved to be a cost-effective intervention for chronic disease patients.…”