The effects of gatekeeping on the quality of primary care in Guangdong Province, China: a cross-sectional study using primary care assessment tool-adult edition

• Published in: BMC family practice 2019-07, Vol.20 (1), p.93-93, Article 93
• Main Authors: Liang, Cuiying, Mei, Jie, Liang, Yuan, Hu, Ruwei, Li, Li, Kuang, Li
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analysis; China; Cities and towns; Cross-Sectional Studies; Cross-sectional survey; Female; Gatekeeping; General practitioners; Health Care Reform; Humans; Male; Management; Medical care; Medical communication; Middle Aged; Pilot Projects; Practice; Primary care; Primary Health Care - standards; Propensity Score; Propensity score matching; Quality of Health Care; Quality of primary care; Surveys and Questionnaires; Utilization Review
• ISSN: 1471-2296; 1471-2296
• DOI: 10.1186/s12875-019-0982-z

Developed countries have widely implemented a gatekeeping system as a core policy of primary care, also known as the system of first visit in the community. As gatekeepers, general practitioners are responsible for the diagnosis and treatment of residents in the community health centres, and referring patients to specialists as appropriate. After several years of healthcare reform, gatekeeping policy has achieved remarkable success in China. Shenzhen and Dongguan were the first batch of pilot cities that implemented the policy of gatekeeping. This study aims to examine the effects of gatekeeping on the quality of primary care between the gatekeeping and non-gatekeeping groups in these two pilot cities. A cross-sectional survey was conducted in five community health centres in Shenzhen and Dongguan cities, both located within Guangdong Province, China, using a validated Chinese version of the Primary Care Assessment Tool-Adult Edition (PCAT-AE) and carrying out face-to-face interviews with patients 18 years and older. Analyses were grouped according to whether or not patients had gatekeepers. Propensity Score Matching was used to control for confounding factors. A chi-square test was used to compare the factors mentioned above and an independent t-test was performed to compare the eight domains of the core functions of primary care between the two groups of patients. In total, 765 valid questionnaires were collected for analysis, after matching the sample size were 238 pairs. All the confounding factors observed between the gatekeeping and non-gatekeeping groups were balanced. The PCAT-AE scores for first-contact utilisation (3.29 > 2.66, p  1.95, p