Rural-to-Urban Migrants' Experiences with Primary Care under Different Types of Medical Institutions in Guangzhou, China

<div><p>Objectives</p><p>China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Migrants are in a vulnerable state when they attempt to access to primary care services. This study was designed to explore rural-to-urban migrants’ experiences in primary care, comparing their quality of primary care experiences under different types of medical institutions in Guangzhou, China.</p><p>Methods</p><p>The study employed a cross-sectional survey of 736 rural-to-urban migrants in Guangzhou, China in 2014. A validated Chinese version of Primary Care Assessment Tool—Adult Short Version (PCAT-AS), representing 10 primary care domains was used to collect information on migrants’ quality of primary care experiences. These domains include first contact (utilization), first contact (accessibility), ongoing care, coordination (referrals), coordination (information systems), comprehensiveness (services available), comprehensiveness (services provided), family-centeredness, community orientation and culturally competent. These measures were used to assess the quality of primary care performance as reported from patients’ perspective. Analysis of covariance was conducted for comparison on PCAT scores among migrants accessing primary care in tertiary hospitals, municipal hospitals, community health centers/community health stations, and township health centers/rural health stations. Multiple linear regression models were used to explore factors associated with PCAT total scores.</p><p>Results</p><p>After adjustments were made, migrants accessing primary care in tertiary hospitals (25.49) reported the highest PCAT total scores, followed by municipal hospitals (25.02), community health centers/community health stations (24.24), and township health centers/rural health stations (24.18). Tertiary hospital users reported significantly better performance in first contact (utilization), first contact (accessibility), coordination (information system), comprehensiveness (service available), and cultural competence. Community health center/community health station users reported significantly better experience in the community orientation domain. Township health center/rural health station users expressed significantly better experience in the ongoing care domain. There were no statistically significant differences across settings in the ongoing care, comprehensiveness (services provided), and family-centeredness domains. Multiple linear regression models showed that factors positively associated with higher PCAT total scores also included insurance covering parts of healthcare payment (P<0.001).</p><p>Conclusions</p><p>This study highlights the need for improvement in primary care provided by primary care institutions for rural-to-urban migrants. Relevant policies related to medical insurance should be implemented for providing affordable healthcare services for migrants accessing primary care.</p></div

High Prevalence of HIV, HCV and Tuberculosis and Associated Risk Behaviours among New Entrants of Methadone Maintenance Treatment Clinics in Guangdong Province, China

<div><p>Background</p><p>Methadone maintenance treatment (MMT) has been available in Guangdong province, China since 2006. This study aims to estimate the prevalence levels of HIV, Hepatitis C (HCV), Tuberculosis (TB) and their co-infections and associated demographic and risk behaviours among MMT entrants.</p> <p>Method</p><p>A total of 2296 drug users at the time of their MMT enrolment were recruited from four clinics during 2006-2011. Participants’ demographic characteristics, infection status and self-reported high-risk drug-use and sexual behaviours were surveyed. Log-linear contingency analysis was employed to investigate the demographic and behavioural differences between gender and drug-user type, while multivariate regression analysis was used to identify the associated factors of HIV, HCV and TB infections.</p> <p>Results</p><p>Female drug users demonstrate significantly higher frequency of daily drug consumption (Log-linear contingency analysis, G²=10.86, <i>p</i>=0.013) and higher proportion of having had sex in the past three months (G²=30.22, <i>p</i><0.001) than their male counterparts. Among injecting drug users, females also inject (χ²=16.15, <i>p</i>=0.001) and share syringes (χ²=13.24, <i>p</i>=0.004) more frequently than males. Prevalence of HIV, HCV and TB among MMT entrants are 6.3%, 78.7% and 4.4% respectively. Co-infections of HIV/HCV, HIV/TB, HCV/TB and HIV/HCV/TB reportedly infect 5.6%, 0.5%, 3.8% and 0.3% of study participants. Infection risks of HIV, HCV and TB are consistently associated with increasing length of drug use, injecting drugs, financial dependence and reduced sexual activities.</p> <p>Conclusion</p><p>Injecting drug use is the major contributing factor in prevalence levels of HIV, HCV and TB among MMT entrants. Female drug users are more disadvantaged in their social status and risk-taking in their drug use behaviours than males.</p> </div

Kaplan-Meier failure curve for (a) probability of drop-out after first enrolment; (b) probability of re-enrolment from the onset of first drop-out.

<p>Kaplan-Meier failure curve for (a) probability of drop-out after first enrolment; (b) probability of re-enrolment from the onset of first drop-out.</p

Associated factors of drop-out and re-enrolments of MMT participants based on multivariate Cox regression.

<p>Associated factors of drop-out and re-enrolments of MMT participants based on multivariate Cox regression.</p

Significant associated factors for TB infections among MMT entrants by multivariate regression analysis.

<p>The figure demonstrates the adjusted odds ratios (together with 95% confidence intervals) of factors that are significant associated with TB infections among MMT entrants. The top dashed line denotes the scale for the continuous variables, whereas the bottom solid line denotes that for categorical variables.</p

Linear regression analysis on primary care assessment total scores.

<p>Linear regression analysis on primary care assessment total scores.</p

Binary logistic regression analysis on satisfaction.

<p>Binary logistic regression analysis on satisfaction.</p

The Flow Chart of Sampling.

<p>Three inclusion criteria were established in the selection of study participants: 1. The study participants should be aged 18 or older. 2. The study participants must sign the written consent. 3. The study participants must have visited a VC at least once in the past year. The interviewers were postgraduates and undergraduate students from the School of Health Management of Guangzhou Medical University. They were trained on how to conduct the survey in order to improve the completeness and consistency of the investigation. The interviewers were introduced to the participants by local acquaintances, and they could be village heads, women's directors, or the respected senior citizens. The data were collected through face-to-face interviews, and the questionnaires were administrated by the investigators at respondents’ home. It took about 20 minutes to finish the survey, and a gift was given to each participant as a token of appreciation for the participation.</p

Duration of MMT participation and gaps between dropout and re-enrolment events.

<p>Duration of MMT participation and gaps between dropout and re-enrolment events.</p

Geographical location, HIV prevalence and 12-month retention rates of study participants in 14 MMT clinics in Guangdong province in 2013.

<p>Geographical location, HIV prevalence and 12-month retention rates of study participants in 14 MMT clinics in Guangdong province in 2013.</p