Why do they sign but not consult? A study on the effectiveness of China's family doctor contract services from the perspective of patient-doctor interaction.

BACKGROUND

Family doctor contract services (FDCS) in China aim to promote primary care first-contact, yet the "sign but no consult" phenomenon persists Traditional accessibility models fail to explain the heterogeneity in patient behavior. This study introduces Interactive Interpersonal Perceived Quality (IIPQ) as a key construct to understand why and for whom FDCS is effective, from a person-centered perspective.

METHODS

We conducted a cross-sectional study using data from the 2024 Tianjin family doctor service resident survey, which included 4,578 residents across 16 districts in Tianjin, China. We measured potential accessibility (geographic, financial), realized accessibility, and IIPQ (comprising perceived feasibility, desirability, and continuity). The primary outcome was Family Doctor First-Contact Behavior (FDFCB). Latent Profile Analysis (LPA) was employed to identify distinct patient subgroups based on their IIPQ scores, followed by logistic regression to examine the moderating effects.

RESULTS

Three distinct patient profiles were identified via LPA: a low perceived quality group, a moderate perceived quality group and a high perceived quality group. Realized accessibility positively predicted FDFCB, and its effect was significantly moderated by IIPQ, with perceived continuity playing a key role. Notably, traditional potential accessibility measures (geographic and financial) showed no significant direct effect on FDFCB after accounting for other factors.

CONCLUSION

Patients are not a homogenous group; their subjective perception of the doctor-patient relationship is a critical, and often overlooked, determinant of FDCS effectiveness. The impact of service accessibility depends on patients' interpersonal experience. The true value of FDCS lies in its capacity to shift patients' decision-making logic from a reliance on structural convenience to a reliance on relational trusts.