Evaluating quality and utilisation of primary care among older adults in Hong Kong: a mixed-methods study protocol

Background: Hong Kong’s rapidly ageing population poses significant challenges to the sustainability of its healthcare system. With over 75% of adults aged 65 and above experiencing at least one chronic condition, enhancing the accessibility and quality of primary care is critical. Despite policy efforts such as the Primary Healthcare Blueprint and District Health Centres (DHCs), significant structural and operational challenges persist, including low service engagement, fragmented multidisciplinary care coordination, and socioeconomic inequities in access, perceived service quality, and satisfaction. Building on evidence that socioeconomic factors would influence care access, this study examines how these disparities shape older adults’ primary care experiences. Methods: This mixed-methods study investigates the quality and utilisation of primary care among older adults in Hong Kong. Phase 1 involves a quantitative survey using the Chinese version of the Primary Care Assessment Tool (PCAT-C), combined with validated measures of service quality, satisfaction, trust, and revisit intention. A geographically and socioeconomically stratified cluster sampling strategy will be used to collect 510 responses. Phase 2 consists of qualitative focus group discussions with at least 25 older adults and their caregivers to explore in-depth experiences and expectations regarding primary care. Discussion: Findings will provide a multidimensional understanding of primary care delivery and its impact on older adults’ satisfaction and behavioural intentions. Early data suggest that while technical care remains difficult for patients to evaluate, non-clinical service quality, such as staff communication and system efficiency greatly influences perceived value. Socioeconomic disparities also affect care continuity and trust. This study will identify gaps in meeting the needs and expectations of older adults for primary care service and propose targeted interventions to enhance primary care accessibility and quality for older adults. Insights will inform policy adjustments to better support healthy ageing and reduce dependence on overstretched hospital services.