Primary healthcare quality of migraine in China: a study using unannounced standardized patients

Abstract

Background

Migraine, a highly prevalent headache disorder, is associated with several adverse health outcomes if not properly managed, but little is known about the quality of primary healthcare for migraine. This study aims to assess the quality of primary healthcare for migraine in China using the unannounced standardized patient (USP) method.

Methods

This cross-sectional study, conducted as part of the Primary Health Care Quality Cohort in China (ACACIA) from April 2021 to January 2023, involved 196 unannounced visits for migraine across seven provinces. A two-step probability-proportional-to-size systematic sampling method was used to select institutions randomly. Ten qualified standardized patients (SPs) conducted the visits following standardized procedures. The quality of healthcare was assessed across five dimensions: effectiveness, safety, patient-centeredness, timeliness, and efficiency. The linear and logistic regression models were used to determine the factors influencing healthcare quality.

Findings

Our findings revealed that clinicians completed an average of 17.6% of the recommended questions and 4.9% of the recommended exams. The correct diagnosis and treatment rates were 31.1% and 62.2%, respectively. The average patient perception of patient-centeredness (PPPC) score was 2.5. The total time, including consultation and waiting time, averaged 14.5 min, with an average fee of 30.1 yuan. We found township health centers and hospitals outperformed clinics in completing recommended questions (β = 4.648, P = 0.024; β = 7.834, P < 0.001, respectively), recommended exams (β = 2.485, P = 0.040 for hospitals) and diagnosis quality (β = 1.396, P = 0.005 for hospitals). Hospitals also charged higher fees (β = 19.666, P = 0.018) and had longer waiting times (β = 8.176, P < 0.001) but shorter consultation times (β = −2.340, P = 0.020). Significant regional disparities were observed in western provinces, which are characterized by lower economic development and perform worse in terms of recommended questions, exams, and treatment despite incurring lower medical fees. While no significant differences in care quality between private and public institutions were found.

Interpretation

The quality of primary healthcare for migraine care in China is suboptimal, particularly in western regions and clinical settings. More actions are needed to enhance the quality of care and reduce regional and institutional disparities.

Funding

This work was supported by the National Science and Technology Major Project of China (2024ZD0523902) and the National Natural Science Foundation of China (Grant No. 72374149).