Knowledge, attitudes, and practices related to the establishment of the National Hierarchical Medical System (NHMS) among outpatients in Chinese tertiary hospitals

This study sought to assess the status of, and factors associated with, knowledge, attitudes, and practices (KAP) related to the establishment of the National Hierarchical Medical System (NHMS) among outpatients receiving care in tertiary hospitals in China. A cross-sectional study surveying tertiary outpatients was conducted. This study investigated KAP concerning the establishment of the NHMS among outpatients from tertiary hospitals, who could have sought medical care from a general practitioner in surrounding primary care medical institutions. Several factors associated with outpatients’ knowledge were identified and included in fully adjusted analyses using logistic regression. Survey questionnaires were completed by 565 outpatients in 4 tertiary hospitals. Approximately half (51.86%) of the sample was aware of the NHMS. In multivariable analysis sex, age, education level, and place of residence were associated (P < .05) with knowledge of NHMS. Overall 74.69% of respondents expressed positive attitudes toward the establishment of the NHMS. However, a much lower proportion, 21.95%, was willing to choose nearby grassroots sub-unit hospitals as their first choice when seeking health care. The present study revealed outpatients in China may lack knowledge of the NHMS, yet most have a positive attitude toward the establishment of the NHMS. Even so, there was hesitation in terms of seeking care from the NHMS, indicating the need for policy makers to take action to increase public awareness surrounding NHMS-related information to improve the public's KAP on the establishment of the NHMS. This study highlights information useful for policy makers in China and other countries planning or evaluating related policies.