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Can unsuccessful treatment in primary medical institutions influence patients’ choice? A retrospective cluster sample study from China
OBJECTIVE: China has been attempting to control the patients’ choice of high-level medical institutions through series measures of first point of contact at primary medical institutions, but the outcome is considered poor. We aim to analyse whether unsuccessful treatment in primary medical instituti...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340440/ https://www.ncbi.nlm.nih.gov/pubmed/30647031 http://dx.doi.org/10.1136/bmjopen-2018-022304 |
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author | Niu, Yadong Zhang, Liang Ye, Ting Yan, Yan Zhang, Yan |
author_facet | Niu, Yadong Zhang, Liang Ye, Ting Yan, Yan Zhang, Yan |
author_sort | Niu, Yadong |
collection | PubMed |
description | OBJECTIVE: China has been attempting to control the patients’ choice of high-level medical institutions through series measures of first point of contact at primary medical institutions, but the outcome is considered poor. We aim to analyse whether unsuccessful treatment in primary medical institutions can lead to the patients’ choice of high-level medical institutions. DESIGN: A retrospective cluster sample study. SETTING: The study setting was in Macheng city, Hubei province. PARTICIPANTS: The respondents are township–county (TC) patients (patients who first went to township hospitals and then county hospitals within 30 days for the same disease) who experienced unsuccessful treatment in primary medical institutions. A total of 2090 TC patients were screened out based on the New Rural Cooperative Medical System database in 2013. MAIN OUTCOME MEASURES: The choice of patients between township hospitals (primary medical institutions) and county hospitals was observed. We compared TC patients’ ratio of choosing county hospitals (RoCC) before TC experience with after TC experience. Thereafter, we compared RoCC of TC patients and non-TC patients (patients who did not experience TC) based on coarsened exact matching. RESULTS: The ratio of TC for outpatient in township hospitals is 0.68% and that of TC for inpatient in township hospitals is 3.37%. RoCC for TC disease increased from 20.8% to 35.5% (p<0.001), RoCC for other disease increased from 35% to 37.3% (p=0.01). TC patients had significantly higher RoCC than non-TC patients (p<0.001). CONCLUSIONS: Patients’ choice of high-level medical institutions is highly associated with the experience of unsuccessful treatment in primary medical institutions. Moreover, people likely select high-level medical institutions thereafter regardless of conditions in rural China. Unsuccessful treatment in primary medical institutions is inevitable for patients. Thus, additional measures should be considered in lowering the potential risks for patients when treatments fail. TRIAL REGISTRATION NUMBER: ChiCTR-OOR-14005563. |
format | Online Article Text |
id | pubmed-6340440 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-63404402019-02-02 Can unsuccessful treatment in primary medical institutions influence patients’ choice? A retrospective cluster sample study from China Niu, Yadong Zhang, Liang Ye, Ting Yan, Yan Zhang, Yan BMJ Open Health Services Research OBJECTIVE: China has been attempting to control the patients’ choice of high-level medical institutions through series measures of first point of contact at primary medical institutions, but the outcome is considered poor. We aim to analyse whether unsuccessful treatment in primary medical institutions can lead to the patients’ choice of high-level medical institutions. DESIGN: A retrospective cluster sample study. SETTING: The study setting was in Macheng city, Hubei province. PARTICIPANTS: The respondents are township–county (TC) patients (patients who first went to township hospitals and then county hospitals within 30 days for the same disease) who experienced unsuccessful treatment in primary medical institutions. A total of 2090 TC patients were screened out based on the New Rural Cooperative Medical System database in 2013. MAIN OUTCOME MEASURES: The choice of patients between township hospitals (primary medical institutions) and county hospitals was observed. We compared TC patients’ ratio of choosing county hospitals (RoCC) before TC experience with after TC experience. Thereafter, we compared RoCC of TC patients and non-TC patients (patients who did not experience TC) based on coarsened exact matching. RESULTS: The ratio of TC for outpatient in township hospitals is 0.68% and that of TC for inpatient in township hospitals is 3.37%. RoCC for TC disease increased from 20.8% to 35.5% (p<0.001), RoCC for other disease increased from 35% to 37.3% (p=0.01). TC patients had significantly higher RoCC than non-TC patients (p<0.001). CONCLUSIONS: Patients’ choice of high-level medical institutions is highly associated with the experience of unsuccessful treatment in primary medical institutions. Moreover, people likely select high-level medical institutions thereafter regardless of conditions in rural China. Unsuccessful treatment in primary medical institutions is inevitable for patients. Thus, additional measures should be considered in lowering the potential risks for patients when treatments fail. TRIAL REGISTRATION NUMBER: ChiCTR-OOR-14005563. BMJ Publishing Group 2019-01-15 /pmc/articles/PMC6340440/ /pubmed/30647031 http://dx.doi.org/10.1136/bmjopen-2018-022304 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Health Services Research Niu, Yadong Zhang, Liang Ye, Ting Yan, Yan Zhang, Yan Can unsuccessful treatment in primary medical institutions influence patients’ choice? A retrospective cluster sample study from China |
title | Can unsuccessful treatment in primary medical institutions influence patients’ choice? A retrospective cluster sample study from China |
title_full | Can unsuccessful treatment in primary medical institutions influence patients’ choice? A retrospective cluster sample study from China |
title_fullStr | Can unsuccessful treatment in primary medical institutions influence patients’ choice? A retrospective cluster sample study from China |
title_full_unstemmed | Can unsuccessful treatment in primary medical institutions influence patients’ choice? A retrospective cluster sample study from China |
title_short | Can unsuccessful treatment in primary medical institutions influence patients’ choice? A retrospective cluster sample study from China |
title_sort | can unsuccessful treatment in primary medical institutions influence patients’ choice? a retrospective cluster sample study from china |
topic | Health Services Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340440/ https://www.ncbi.nlm.nih.gov/pubmed/30647031 http://dx.doi.org/10.1136/bmjopen-2018-022304 |
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