Skip to main content
Top
Published in: International Journal for Equity in Health 1/2015

Open Access 01-12-2015 | Research

Contribution of primary care to health: an individual level analysis from Tibet, China

Authors: Wenhua Wang, Leiyu Shi, Aitian Yin, Zongfu Mao, Elizabeth Maitland, Stephen Nicholas, Xiaoyun Liu

Published in: International Journal for Equity in Health | Issue 1/2015

Login to get access

Abstract

Introduction

There have been significant improvements in health outcomes in Tibet, health disparities between Tibet and the rest of China has been greatly reduced. This paper tests whether there was a positive association between good primary care and better health outcomes in Tibet.

Method

A validated Tibetan version of the Primary Care Assessment Tool (PCAT-T) was used to collect data on 1386 patients aged over 18 years old accessing primary care. Self-rated health (SRH) was employed to measure health outcomes. A multiple binary logistic regression model was used to explore the association between primary care quality and self-rated health status after controlling for socio-demographic and lifestyle variables.

Results

This study found that primary care quality had a significant positive association with self-rated health status. Among the nine domains of PCAT-T, family centeredness domain had the highest Odds Ratio (OR = 1.013) with SRH. Patients located in rural area, with higher education levels, without depression, and less frequent drinking were more likely to self-rate as “good health” compared with the reference group.

Conclusions

In Tibet, higher quality primary care was associated with better self-rated health status. Primary care should be much strengthened in future health system reform in Tibet.
Literature
1.
go back to reference Starfield B. Primary care: concept, evaluation, and policy. London: Oxford University Press; 1992. Starfield B. Primary care: concept, evaluation, and policy. London: Oxford University Press; 1992.
2.
go back to reference Shi L. The relationship between primary care and life chances. J Health Care Poor Underserved. 1992;3:321–35.CrossRefPubMed Shi L. The relationship between primary care and life chances. J Health Care Poor Underserved. 1992;3:321–35.CrossRefPubMed
3.
go back to reference Shi L, Macinko J, Starfield B, Xu J, Regan J, Politzer R, et al. Primary care, infant mortality, and low birth weight in the states of the USA. J Epidemiol Community Health. 2004;58:374–80.CrossRefPubMedPubMedCentral Shi L, Macinko J, Starfield B, Xu J, Regan J, Politzer R, et al. Primary care, infant mortality, and low birth weight in the states of the USA. J Epidemiol Community Health. 2004;58:374–80.CrossRefPubMedPubMedCentral
4.
go back to reference Macinko J, Starfield B, Erinosho T. The impact of primary health care on population health in low- and middle-income countries. J Ambul Care Manage. 2009;32:150–71.CrossRefPubMed Macinko J, Starfield B, Erinosho T. The impact of primary health care on population health in low- and middle-income countries. J Ambul Care Manage. 2009;32:150–71.CrossRefPubMed
5.
go back to reference Bindman AB, Grumbach L, Osmond D. Primary care and receipt of preventive services. J Gen Intern Med. 1996;11:269–76.CrossRefPubMed Bindman AB, Grumbach L, Osmond D. Primary care and receipt of preventive services. J Gen Intern Med. 1996;11:269–76.CrossRefPubMed
7.
go back to reference Rohde J, Cousens S, Chopra M, Tangcharoensathien V, Black R, Bhutta ZA, et al. 30 years after Alma-Ata: has primary health care worked in countries? Lancet. 2008;372:950–61.CrossRefPubMed Rohde J, Cousens S, Chopra M, Tangcharoensathien V, Black R, Bhutta ZA, et al. 30 years after Alma-Ata: has primary health care worked in countries? Lancet. 2008;372:950–61.CrossRefPubMed
8.
go back to reference Kruk ME, Porignon D, Rockers PC, Van Lerberghe W. The contribution of primary care to health and health systems in low- and middle-income countries: a critical review of major primary care initiatives. Soc Sci Med. 2010;70:904–11.CrossRefPubMed Kruk ME, Porignon D, Rockers PC, Van Lerberghe W. The contribution of primary care to health and health systems in low- and middle-income countries: a critical review of major primary care initiatives. Soc Sci Med. 2010;70:904–11.CrossRefPubMed
9.
go back to reference Kringos DS, Boerma WG, Hutchinson A, van der Zee J, Groenewegen PP. The breadth of primary care: a systematic literature review of its core dimensions. BMC Health Serv Res. 2010;10:65.CrossRefPubMedPubMedCentral Kringos DS, Boerma WG, Hutchinson A, van der Zee J, Groenewegen PP. The breadth of primary care: a systematic literature review of its core dimensions. BMC Health Serv Res. 2010;10:65.CrossRefPubMedPubMedCentral
10.
go back to reference Friedberg MW, Hussey PS, Schneider EC. Primary care: a critical review of the evidence on quality and costs of health care. Health Aff. 2010;29:766–72.CrossRef Friedberg MW, Hussey PS, Schneider EC. Primary care: a critical review of the evidence on quality and costs of health care. Health Aff. 2010;29:766–72.CrossRef
11.
go back to reference Starfield B. Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS report 2012. Gac Sanit. 2012;26 suppl 1:20–6.CrossRefPubMed Starfield B. Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS report 2012. Gac Sanit. 2012;26 suppl 1:20–6.CrossRefPubMed
12.
go back to reference Shi L, Starfield B. Primary care, income inequality, and self-rated health in the United States: a mixed-level analysis. Int J Health Serv. 2000;30:541–55.CrossRefPubMed Shi L, Starfield B. Primary care, income inequality, and self-rated health in the United States: a mixed-level analysis. Int J Health Serv. 2000;30:541–55.CrossRefPubMed
13.
go back to reference Shi L, Starfield B, Politzer R, Regan J. Primary care, self-rated health, and reductions in social disparities in health. Health Serv Res. 2002;37:529–50.CrossRefPubMedPubMedCentral Shi L, Starfield B, Politzer R, Regan J. Primary care, self-rated health, and reductions in social disparities in health. Health Serv Res. 2002;37:529–50.CrossRefPubMedPubMedCentral
14.
go back to reference Tibet Autonomous Regional Statistics Bureau. Tibet statistical yearbook 2014. Beijing: China Statistics Press; 2014. Tibet Autonomous Regional Statistics Bureau. Tibet statistical yearbook 2014. Beijing: China Statistics Press; 2014.
15.
go back to reference Wang W, Shi L, Yin A, Lai Y, Maitland E, Nicholas S. Development and validation of the Tibetan primary care assessment tool. Biomed Res Int. 2014;2014:308739.PubMedPubMedCentral Wang W, Shi L, Yin A, Lai Y, Maitland E, Nicholas S. Development and validation of the Tibetan primary care assessment tool. Biomed Res Int. 2014;2014:308739.PubMedPubMedCentral
16.
go back to reference Wang W, Shi L, Yin A, Mao Z, Maitland E, Nicholas S, et al. Primary care quality among different health care structures in Tibet, China. Biomed Res Int. 2015;2015:206709.PubMedPubMedCentral Wang W, Shi L, Yin A, Mao Z, Maitland E, Nicholas S, et al. Primary care quality among different health care structures in Tibet, China. Biomed Res Int. 2015;2015:206709.PubMedPubMedCentral
18.
go back to reference Hirve S, Juvekar S, Sambhudas S, Lele P, Blomstedt Y, Wall S, et al. Does self-rated health predict death in adults aged 50 years and above in India? Evidence from a rural population under health and demographic surveillance. Int J Epidemiol. 2012;41:1719–27.CrossRefPubMedPubMedCentral Hirve S, Juvekar S, Sambhudas S, Lele P, Blomstedt Y, Wall S, et al. Does self-rated health predict death in adults aged 50 years and above in India? Evidence from a rural population under health and demographic surveillance. Int J Epidemiol. 2012;41:1719–27.CrossRefPubMedPubMedCentral
19.
go back to reference Jia Y, Gao J, Dai J, Zheng P, Wu X, Li G, et al. Difference of the associations between self-rated health and demographic characteristics, lifestyle, and psychosocial work environment between two types of Chinese worksite. BMC Public Health. 2014;14:851.CrossRefPubMedPubMedCentral Jia Y, Gao J, Dai J, Zheng P, Wu X, Li G, et al. Difference of the associations between self-rated health and demographic characteristics, lifestyle, and psychosocial work environment between two types of Chinese worksite. BMC Public Health. 2014;14:851.CrossRefPubMedPubMedCentral
20.
go back to reference Abdulrahim S, El Asmar K. Is self-rated health a valid measure to use in social inequities and health research? Evidence from the PAPFAM women’s data in six Arab countries. Int J Equity Health. 2012;11:53.CrossRefPubMedPubMedCentral Abdulrahim S, El Asmar K. Is self-rated health a valid measure to use in social inequities and health research? Evidence from the PAPFAM women’s data in six Arab countries. Int J Equity Health. 2012;11:53.CrossRefPubMedPubMedCentral
21.
go back to reference Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38:21–37.CrossRefPubMed Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38:21–37.CrossRefPubMed
22.
go back to reference Jylha M, Volpato S, Guralnik JM. Self-rated health showed a graded association with frequently used biomarkers in a large population sample. J Clin Epidemiol. 2006;59:465–71.CrossRefPubMed Jylha M, Volpato S, Guralnik JM. Self-rated health showed a graded association with frequently used biomarkers in a large population sample. J Clin Epidemiol. 2006;59:465–71.CrossRefPubMed
23.
go back to reference Kaplan GA, Pamuk ER, Lynch JW, Cohen RD, Balfour JL. Inequality in income and mortality in the United States: analysis of mortality and potential pathways. BMJ. 1996;312:999–1003.CrossRefPubMedPubMedCentral Kaplan GA, Pamuk ER, Lynch JW, Cohen RD, Balfour JL. Inequality in income and mortality in the United States: analysis of mortality and potential pathways. BMJ. 1996;312:999–1003.CrossRefPubMedPubMedCentral
24.
go back to reference Sung NJ, Markuns JF, Park KH, Kim K, Lee H, Lee JH. Higher quality primary care is associated with good self-rated health status. Fam Pract. 2013;30:568–75.CrossRefPubMed Sung NJ, Markuns JF, Park KH, Kim K, Lee H, Lee JH. Higher quality primary care is associated with good self-rated health status. Fam Pract. 2013;30:568–75.CrossRefPubMed
25.
go back to reference Jeroen KVG, George G. A single- vs. multi-item self-rated health status measure: a 21-country study. Open Public Health J. 2012;5:1–9.CrossRef Jeroen KVG, George G. A single- vs. multi-item self-rated health status measure: a 21-country study. Open Public Health J. 2012;5:1–9.CrossRef
26.
go back to reference National Health and Family Planning Commission. Guidance for rural doctor contract service pilot. Beijing: National Health and Family Planning Commission; 2013. National Health and Family Planning Commission. Guidance for rural doctor contract service pilot. Beijing: National Health and Family Planning Commission; 2013.
27.
go back to reference Tsai J, Ford ES, Li C, Pearson WS, Zhao G. Binge drinking and suboptimal self-rated health among adult drinkers. Alcohol Clin Exp Res. 2010;34:1465–71.PubMed Tsai J, Ford ES, Li C, Pearson WS, Zhao G. Binge drinking and suboptimal self-rated health among adult drinkers. Alcohol Clin Exp Res. 2010;34:1465–71.PubMed
28.
go back to reference Valencia-Martín JL, Galán I, Rodríguez-Artalejo F. Alcohol and self-rated health in a Mediterranean country: the role of average volume, drinking pattern, and alcohol dependence. Alcohol Clin Exp Res. 2009;33:240–6.CrossRefPubMed Valencia-Martín JL, Galán I, Rodríguez-Artalejo F. Alcohol and self-rated health in a Mediterranean country: the role of average volume, drinking pattern, and alcohol dependence. Alcohol Clin Exp Res. 2009;33:240–6.CrossRefPubMed
29.
go back to reference Saarni S, Joutsenniemi K, Koskinen S, Suvisaari J, Pirkola S, Sintonen H, et al. Alcohol consumption, abstaining, health utility and quality of life: a general population survey in Finland. Alcohol. 2008;43:376–86.CrossRef Saarni S, Joutsenniemi K, Koskinen S, Suvisaari J, Pirkola S, Sintonen H, et al. Alcohol consumption, abstaining, health utility and quality of life: a general population survey in Finland. Alcohol. 2008;43:376–86.CrossRef
30.
go back to reference Okosun IS, Seale JP, Daniel JB, Eriksen MP. Poor health is associated with episodic heavy alcohol use: evidence from a National Survey. Public Health. 2005;119:509–17.CrossRefPubMed Okosun IS, Seale JP, Daniel JB, Eriksen MP. Poor health is associated with episodic heavy alcohol use: evidence from a National Survey. Public Health. 2005;119:509–17.CrossRefPubMed
31.
go back to reference Martin R. Measuring and improving patient experience in primary care. Prim Health Care Res Dev. 2012;13:103–5.CrossRef Martin R. Measuring and improving patient experience in primary care. Prim Health Care Res Dev. 2012;13:103–5.CrossRef
Metadata
Title
Contribution of primary care to health: an individual level analysis from Tibet, China
Authors
Wenhua Wang
Leiyu Shi
Aitian Yin
Zongfu Mao
Elizabeth Maitland
Stephen Nicholas
Xiaoyun Liu
Publication date
01-12-2015
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2015
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-015-0255-y

Other articles of this Issue 1/2015

International Journal for Equity in Health 1/2015 Go to the issue