Changes in primary health care service experiences and urban-suburban disparities among Shanghai residents: a two-year comparative study.

Abstract

Background: Primary health care (PHC) is central to achieving universal health coverage, yet longitudinal assessments of residents' experiences-especially regarding urban-suburban disparities-remain scarce. This study aims to examine changes in PHC service experiences among Shanghai residents between 2023 and 2024, identify urban-suburban differences, and explore key influencing factors.

Methods: A two-wave cross-sectional survey was conducted at 248 community health centers in Shanghai from May to June in 2023 and 2024. The Chinese version of the Primary Care Assessment Tool-Adult Short Version (PCAT-AS) was used. Propensity score matching ensured comparability between survey waves. Descriptive statistics, hypothesis testing, and multiple linear regression were employed to assess temporal changes, regional disparities, and associated predictors.

Results: Residents reported significantly improved PHC experiences in 2024 across all domains (P < 0.001), with the largest gains in service comprehensiveness (+ 0.23) and referral coordination (+ 0.18). Urban residents consistently reported better experiences in continuity, service delivery, and cultural competence, while suburban residents rated higher in first-contact accessibility and service availability. Improvements from 2023 to 2024 were most notable in first-contact accessibility (Δ = +0.11) and comprehensiveness (Δ = +0.10), though domains such as family-centeredness and cultural competence showed limited progress (Δ = +0.01). Multivariate analyses identified residential location, chronic disease burden, psychological distress, and self-rated health as significant predictors of overall PCAT scores. Suburban residence was associated with lower scores (B = - 1.59, P < 0.001), while comorbidities (B = 1.94, P < 0.001) and psychological distress (B = 2.06, P < 0.001) were linked to higher scores.

Conclusion: This study demonstrates that while overall perceptions of PHC services among permanent residents in Shanghai improved significantly compared to the previous year-particularly in terms of service comprehensiveness and referral coordination-urban-suburban disparities persist. Specifically, urban residents reported more favorable experiences in first-contact utilization, continuity of care, and cultural competence, whereas suburban residents expressed better perceptions of first-contact accessibility and service availability. Notably, the urban-suburban gaps in first-contact accessibility and service comprehensiveness narrowed between 2023 and 2024, suggesting a positive trajectory toward greater equity in basic health service delivery. Multivariate regression analysis further indicated that residential location, chronic disease burden, psychological distress, and self-rated health status were significant determinants of residents' PHC experiences. Based on these findings, we recommend the implementation of more targeted interventions focusing on enhancing continuity of care and strengthening integrated management for both mental health and chronic conditions. Special attention should be given to addressing structural disparities between urban and suburban areas and to meeting the health service needs of priority populations, in order to continuously advance both equity and quality in PHC delivery.