Dilemma in primary care facility development:a qualitative study based on grounded theory in Guilin city^☆

Abstract

Background: Since the new medical reform, remarkable progress was achieved in primary care facilities in the number of consultations and essential public health service program. However, the problems including low quality and high mobility of personnel, weakened capacity and low efficiency of service still remain. Therefore, it has become an urgent task to solve the dilemma in primary care facility development.
Objective: To analyze the development dilemma of primary care facilities and propose corresponding countermeasures.
Methods: From April to May 2021 the managers of 16 primary care facilities in 6 counties and 2 districts in Guilin were selected using multi-stage sampling method and invited to attend semi-structured interviews, which main contents included resource allocation, service capacity building, health insurance policy implementation, and development dilemmas. Grounded theory method was applied to classify, summarize and refine the original interview data at each level by NVivo 11.0 software.
Results:A total of 38 initial concepts, 9 initial categories, 4 main categories, and 1 core category were extracted, and nodes of stagnation in four dimensions including "Constraints in Resource Allocation," "Deviation in Functional Positioning," "Obstacles in the approach of the joint reform of 3Ms(medical service system, medical security system and medicine system)," and "Lack of Cohesion in Hospital Group Construction" were obtained.
Conclusion: The development of primary care facilities is constrained by a variety of factors, with resource allocation balance and compensation mechanism improvement as core issue, "approach of the joint reform of 3Ms" as an external condition, "adjustment of functional positioning"(adjustment of functional positioning of primary care facilities) as key link, and the construction of cohesion hospital group as important approach.

Keywords

Primary health care institutions / Development status / Resource allocation / Service ability / Compensation mechanism / Medical alliance / Qualitative research

Declarations

Not applicable.

Authors' contributions

Conceptualization, W.S. and S.W.; Methodology, W.Y. and L.J.; Data curation, W.S. and H.R.; Formal analysis, W.S. and H.R.; Funding acquisition, not applicable; Project administration, W.X; Resources, not applicable; Supervision, not applicable; Validation, not applicable; Writing—original draft, W.S. and H.R.; Writing—review and editing, H.Z. All authors have read and agreed to the published version of the manuscript.

Ethics approval and consent to participate

The study received approval from Guilin Medical University Ethics Review Committee (IRB-GLMC20170912).

Consent for publication

Not applicable.

Availability of data and materials

Data supporting the results of this study are available upon reasonable request from the corresponding author. These data are not publicly available due to privacy or ethical constraints.

Authors' other information

Not applicable.

Funding

This research was supported by grants from the National Natural Science Foundation of China (71764005).

Declaration of Competing Interests

The authors declare that they have no competing interests.

Acknowledgements

Thanks to the leaders and teachers of Guilin Municipal Health Commission, county health bureaus, and township hospitals for their support of the research.

References

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