Consultation length, process quality and diagnosis quality of primary care in rural China: A cross-sectional standardized patient study

• Published in: Patient education and counseling 2022-04, Vol.105 (4), p.902-908
• Main Authors: Wang, Qingzhi, Adhikari, Sasmita Poudel, Wu, Yuju, Sunil, Thankam S., Mao, Yuping, Ye, Ruixue, Sun, Chang, Shi, Yaojiang, Zhou, Chengchao, Sylvia, Sean, Rozelle, Scott, Zhou, Huan
• Format: Article
• Language: English
• Subjects: China; Consultation length; Cross-Sectional Studies; Humans; Primary care providers; Primary Health Care; Process quality and diagnosis quality; Referral and Consultation; Rural China; Standardized patients; Tuberculosis
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2021.08.006

•This paper indicates the short average consultation length among primary care providers in rural China.•It examines the association between consultation length and primary health care.•The longer consultation leads to both better process and diagnosis quality of primary care.•Increasing the length of consultation in township hospitals is suggested to improve quality of primary care. Consultation length, the time spent between patient and health care provider during a visit, is an essential element in measuring quality of health care patients receive from a primary care facility. However, the linkage between consultation length and process quality and diagnosis quality of primary care is still uncertain. This study aims to examine the role consultation length plays in delivering process quality and diagnosis quality, two central components of overall primary care quality, in rural China. We recruited unannounced standardized patients (SPs) to present classic symptoms of angina and tuberculosis in selected healthcare facilities in three provinces of China. The consultation length and primary care quality of SPs were measured and compared with both international and national standards of care. Ordinary Least Squares (OLS) regressions for process quality (continuous dependent variable) and Logistic regressions for diagnosis quality (binary dependent variable) were performed to investigate the relationship between consultation length and primary care quality. The average consultation lengths among patients with classic symptoms of angina and those with symptoms of tuberculosis were approximately 4.33 min and 6.28 min, respectively. Providers who spent more time with patients were significantly more likely to complete higher percentage of recommended checklist items of both questions and examinations for angina (β = 1.39, 95%CI 1.01–1.78) and tuberculosis (β = 0.89, 95%CI 0.69–1.08). Further, providers who spent more time with patients were more likely to make correct diagnosis for angina (marginal effect = 0.014, 95%CI 0.002–0.026) and for tuberculosis (marginal effect = 0.013, 95%CI 0.005–0.021). The average consultation length is extremely short among primary care providers in rural China. The longer consultation leads to both better process and diagnosis quality of primary care. We recommend primary care providers to increase the length of their communication with patients. To do so, government should implement healthcare reforms to clarify the requirements