TY - JOUR T1 - Can unsuccessful treatment in primary medical institutions influence patients’ choice? A retrospective cluster sample study from China JF - BMJ Open JO - BMJ Open DO - 10.1136/bmjopen-2018-022304 VL - 9 IS - 1 SP - e022304 AU - Yadong Niu AU - Liang Zhang AU - Ting Ye AU - Yan Yan AU - Yan Zhang Y1 - 2019/01/01 UR - http://bmjopen.bmj.com/content/9/1/e022304.abstract N2 - Objective China has been attempting to control the patients’ choice of high-level medical institutions through series measures of first point of contact at primary medical institutions, but the outcome is considered poor. We aim to analyse whether unsuccessful treatment in primary medical institutions can lead to the patients’ choice of high-level medical institutions.Design A retrospective cluster sample study.Setting The study setting was in Macheng city, Hubei province.Participants The respondents are township–county (TC) patients (patients who first went to township hospitals and then county hospitals within 30 days for the same disease) who experienced unsuccessful treatment in primary medical institutions. A total of 2090 TC patients were screened out based on the New Rural Cooperative Medical System database in 2013.Main outcome measures The choice of patients between township hospitals (primary medical institutions) and county hospitals was observed. We compared TC patients’ ratio of choosing county hospitals (RoCC) before TC experience with after TC experience. Thereafter, we compared RoCC of TC patients and non-TC patients (patients who did not experience TC) based on coarsened exact matching.Results The ratio of TC for outpatient in township hospitals is 0.68% and that of TC for inpatient in township hospitals is 3.37%. RoCC for TC disease increased from 20.8% to 35.5% (p<0.001), RoCC for other disease increased from 35% to 37.3% (p=0.01). TC patients had significantly higher RoCC than non-TC patients (p<0.001).Conclusions Patients’ choice of high-level medical institutions is highly associated with the experience of unsuccessful treatment in primary medical institutions. Moreover, people likely select high-level medical institutions thereafter regardless of conditions in rural China. Unsuccessful treatment in primary medical institutions is inevitable for patients. Thus, additional measures should be considered in lowering the potential risks for patients when treatments fail.Trial registration number ChiCTR-OOR-14005563. ER -