• Yanbing Zeng, Weiqian Xu, Lele Chen, Fan Chen, and Ya Fang.
• State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, People's Republic of China.
• Patient Prefer Adher. 2020 Jan 1; 14: 653-662.

IntroductionPatients often seek healthcare at general hospitals rather than at community healthcare centres (CHCs) which leads to inefficiency of health services. The primary healthcare reform developed by Xiamen has proven to break through the barriers of hierarchical diagnosis and treatment. The influencing factors of health-seeking behaviours of patients in the Xiamen reform, however, are unclear.ObjectiveThis study aimed to assess patients' healthcare-seeking preferences and CHCs utilization, and identify influencing factors among patients affected by the Xiamen reform.MethodsA cross-sectional study composed of 2200 individuals with hypertension or diabetes was conducted in association with Xiamen's reform. The choice of health institutions was used to measure health-seeking preference. The probability and frequency of outpatient service use were used to measure CHC utilization. The social ecological model and two-part model were employed to examine influencing factors.ResultsAs high as 72.5% of the subjects, including those who were under 60 years old, had low education level, with long disease duration, good self-report health and low household income expressed a preference for CHC (P<0.05). Also, participants who had good-condition CHCs (χ2=6.736, P=0.010), joined in three-in-one chronic disease management (χ2=81.615, P<0.01) and were insured by medical insurance (χ2=21.142, P<0.01) significantly preferred to visit CHCs for treatment. In addition, patients who had a preference for CHC utilized many more CHCs (P<0.01). Analysis of influencing factors found that education, self-reported health, smoking, household income, condition of the CHC, whether the patient had joined the healthcare reform and whether the patient had medical insurance were important factors affecting health-seeking preference and CHC utilization (P<0.05).ConclusionThe Xiamen healthcare reform made some achievements in improving CHC utilization. However, certain challenges remain. The government should further strengthen CHCs, deepen and expand healthcare reform, and make efforts to guide reasonable healthcare-seeking behaviour and improve the efficiency of primary health systems.© 2020 Zeng et al.

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