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Awareness of the role of general practitioners in primary care among outpatient populations: evidence from a cross-sectional survey of tertiary hospitals in China
  1. Xiaojun Liu1,2,
  2. Anran Tan1,
  3. Samuel D Towne Jr3,
  4. Zhaoxun Hou1,
  5. Zongfu Mao1,2
  1. 1 School of Health Science, Wuhan University, Wuhan, China
  2. 2 Global Health Institute, Wuhan University, Wuhan, China
  3. 3 School of Health Science, Texas A&M University, College Station, Texas, USA
  1. Correspondence to Professor Zongfu Mao; zfmao{at}


Objective General practitioners (GPs) are highly underutilised in China with many patients going directly to hospitals when seeking routine care. Multiple countries around the world have successfully used GPs in routine care, and as such, China may benefit from the use of GPs. This study examines the status of, and factors associated with, knowledge related to GPs among outpatient populations from China’s tertiary hospitals.

Design This is a cross-sectional survey study.

Study setting and participants The questionnaires were completed by 565 outpatients from four tertiary hospitals in China during 2016. Convenience sampling on different floors and throughout the outpatient building was carried out.

Primary outcome measures We used the logistic regression models to identify GP-related knowledge among different populations.

Results Overall, 50.27% of respondents said they had never heard of GPs. This was also true among females (adjusted OR (AOR)=1.57, 95% CI 1.43 to 2.71), older adults (AOR46–65=1.61, 95% CI 1.39 to 2.98; AOR>65=2.01, 95% CI 1.62 to 3.59), those with lower education level (AORBachelor’s degree=0.61, 95% CI 0.20 to 0.81; AOR≥Master’s degree=0.49, 95% CI 0.23 to 0.76), rural residents (AOR=1.51, 95% CI 1.35 to 2.82) and those with chronic disease (AORwithout chronic disease=0.61, 95% CI 0.22 to 0.71). What is more, less than one-in-ten (9.03%) outpatients were able to accurately describe what a GP was, with less than 30% accurately describing a GP among those receiving GPs’ services.

Conclusions Outpatients who could have received less costly health services from GPs in primary medical institutions were more likely to choose costlier specialist physicians in tertiary hospitals, which is likely linked to limited knowledge about GPs. Policy makers should invest in outreach efforts to improve public awareness of GPs, while at the same time conducting continued surveillance of these efforts to evaluate progress towards this goal.

  • general practitioners (GPs)
  • knowledge
  • influencing factors
  • outpatients
  • China

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  • XL and AT contributed equally.

  • Contributors XL and ZM conceived the study; XL collected data and conducted the data analysis; XL, ZH and AT drafted the paper; ZM, SDT and XL revised the manuscript. All authors read and approved the final manuscript. XL and ZM are guarantors of the paper.

  • Funding This work was performed as part of the Texas A&M University Health Science Center–Wuhan University Global Health Research Partnership. This study was also supported by an internal grant from Wuhan University (grant number: S2017801593).

  • Disclaimer The funding body was not involved in study design, data collection, data analysis or the writing of the article.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was conducted in accordance with the Declaration of Helsinki. Local institutional protocols at Wuhan University were also followed to protect participants’ confidentiality, with ethics approval granted by Wuhan University’s School of Public Health (IRB number: J-17-2016). Informed consent was obtained from all participants. Hospitals are considered public places in China, and approval from the ethics committees of the hospitals was not required. The Institutional Review Board of Texas A&M University (IRB number: IRB2016-0285D) also reviewed and approved study protocols.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon request from the corresponding author. Data requesters are required to provide their research objective, design and ethical approval documents.

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