Primary care bypass behavior was reported by 8.61 percent of older adults with chronic diseases in Shanghai, China, according to a cross-sectional study evaluating healthcare utilization patterns. Researchers investigated this behavior—defined as seeking medical care at a higher-level healthcare facility rather than at a nearby primary healthcare institution—to address challenges facing hierarchical healthcare delivery.
The study analyzed data from 1,498 older adults with chronic conditions drawn from a healthy aging surveillance survey. To evaluate bypass choices directly, investigators restricted the sample to individuals whose residence was located closest to a primary healthcare facility.
Variable selection for the analysis was guided by the Andersen Behavioral Model. To evaluate the factors linked to primary care bypass behavior across the overall cohort and within specific geographic settings, the research team applied Firth’s logistic regression modeling.
Geographic location demonstrated a pronounced association with healthcare-seeking decisions. Compared with participants living in central urban areas, suburban residents exhibited higher odds of bypassing primary care institutions (odds ratio, 3.44; 95% confidence interval, 1.46–8.37), while rural residents showed the highest likelihood of bypass behavior (odds ratio, 6.27; 95% confidence interval, 2.66–15.32).
Patient perceptions of healthcare facilities also correlated strongly with bypass choices. High perceived convenience of the visited facility was associated with significantly lower odds of bypassing primary care (odds ratio, 0.05; 95% confidence interval, 0.03–0.08). In contrast, high perceived technical competence of the facility visited was associated with higher odds of bypass behavior (odds ratio, 3.63; 95% confidence interval, 1.88–7.04).
Underlying health conditions also influenced patient choices. Compared with having cardio-metabolic diseases alone, individuals diagnosed with other chronic diseases, mixed chronic conditions, or unclassified diseases exhibited higher odds of seeking care at higher-level medical institutions.
In stratified analyses conducted after false discovery rate correction, perceived convenience of the visited facility remained associated with lower odds of bypass behavior across all residential areas, whereas high perceived technical competence remained associated with higher odds in suburban areas. Other area-specific findings were classified as exploratory, and the authors concluded that regional disparities and potential geographic heterogeneity highlight the need for region-specific and disease-specific strategies to advance hierarchical medical systems.
Subject of Research: Primary care bypass behavior among older adults with chronic diseases in Shanghai
Article Title: Primary care bypass behavior among older adults with chronic diseases in Shanghai, China: a cross-sectional study
Article References: Sheng, Y., Zhang, X., Li, R., Zhang, Y., Wang, M., Wang, N., Gao, J., & Zhao, Q. (2026). Primary care bypass behavior among older adults with chronic diseases in Shanghai, China: a cross-sectional study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-16045-1
Image Credits: AI Generated
DOI: 10.1186/s12913-026-16045-1
Keywords: primary care bypass behavior, older adults, chronic diseases, Shanghai, cross-sectional study, hierarchical healthcare system, Andersen Behavioral Model, Firth’s logistic regression, perceived convenience, perceived technical competence, cardio-metabolic diseases, rural healthcare utilization, suburban healthcare utilization, healthy aging surveillance survey, false discovery rate correction, regional disparities, healthcare utilization
Tags: Andersen behavioral modelcardio-metabolic diseasesChronic DiseasesCross-sectional Studyfalse discovery rate correctionFirth’s logistic regressionHealthcare utilizationhealthy aging surveillance surveyhierarchical healthcare systemolder adultsperceived convenienceperceived technical competenceprimary care bypass behaviorRegional disparitiesrural healthcare utilizationShanghaisuburban healthcare utilization
