Association between resident status and patients' experiences of primary care: a cross-sectional study in the Greater Bay Area, China

Objectives Patients' experiences are important part of health services quality research, but it's still unclear whether patients' experiences are influenced by resident status. This study aimed to evaluate the association between resident status and patients' primary care experiences with the focus on migrants vs local residents. Design A cross-sectional study using multistage cluster random sampling was conducted from September to November 2019. The data were analysed using general linear models. Setting Six community health centres in Guangzhou, China. Participants 1568 patients aged 20 years or older. Main outcome measures Patients' primary care experiences were assessed using the Primary Care Assessment Tool. The 10 domains included in Primary Care Assessment Tool (PCAT) refers to first contact-utilisation, first contact-access, ongoing care, coordination (referral), coordination (information), comprehensiveness (services available), comprehensiveness (services provided), family-centredness, community orientation and cultural competence from patient's perspective. Results 1568 questionnaires were analysed. After adjusting for age, sex, education, annual family income, self-perceived health status, chronic condition, annual medical expenditure and medical insurance, the PCAT total scores of the migrants were significantly lower than those of local residents (beta=-0.128; 95% CI -0.218 to -0.037). Migrants had significantly lower scores than local residents in first contact utilisation (beta=-0.245; 95% CI -0.341 to -0.148), ongoing care (beta=-0.175; 95% CI -0.292 to -0.059), family-centredness (beta=-0.112; 95% CI -0.225 to 0.001), community orientation (beta=-0.176; 95% CI -0.286 to -0.066) and cultural competence (beta=-0.270; 95% CI -0.383 to -0.156), respectively. Conclusion Primary care experiences of migrants were significantly worse off than those of local residents, especially in terms of primary care utilisation, continuity and cultural competence. Given the wide disparity in primary care experiences between migrants and local residents, Chinese healthcare system reform should focus on improving quality of primary care services for migrants, overcoming language barriers and creating patient-centred primary care services.