上海市虹口区居民家庭医生签约行为的影响因素分析
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摘要
背景家庭医生制度在新一轮基层卫生服务改革中被赋予了新的内涵,成为实现全民健康的抓手。而同时,了解民众对于家庭医生的接受程度及其签约行为的主要影响因素十分重要。目的分析上海市虹口区居民家庭医生签约行为的影响因素,为推进基层卫生改革提供理论基础与实证依据。方法 2015年12月—2016年1月采用多阶段整群抽样法对上海市虹口区常住居民进行问卷调查。记录居民家庭医生签约情况,并采用自行设计的《上海市虹口区家庭医生制度评估调查》调查问卷进行问卷调查,问卷内容主要包括基本人口学信息、自身健康状况(是否患慢性病)、首诊就医习惯(首诊医疗机构)、家庭医生签约综合满意度、家庭医生签约服务认知情况(是否清楚家庭医生签约后优惠服务内容)。并采用多元Logistic回归分析分析居民家庭医生签约行为的影响因素。结果共发放问卷900份,回收有效问卷614份,有效回收率68.22%。其中家庭医生签约401例(65.31%),未签约213例(34.69%)。家庭医生签约居民年龄、上海本地户籍率、慢性病患病率、家庭医生签约综合满意度、家庭医生签约服务认知清楚率高于未签约居民,退休率低于未签约居民(P<0.05)。家庭医生签约与未签约居民受教育水平、月收入、首诊就医习惯比较,差异有统计学意义(P<0.05)。多元Logistic回归分析结果显示,受教育水平、首诊就医习惯、家庭医生签约综合满意度、家庭医生签约服务认知情况是居民家庭医生签约行为的影响因素(P<0.05)。结论受教育水平、首诊就医习惯、家庭医生签约综合满意度、家庭医生签约服务认知情况分别是居民家庭医生签约行为的影响因素。
Background Family doctor system has been given new connotations in the new round of grassroots health service reform,and have become the significant measurement for realizing the health of the whole people.At the same time, it is very important to understand the acceptance of family doctors and the main influencing factors of their contracting behavior.Objective To analyze the influencing factors of signing a contract with a family doctor among residents in Shanghai's Hongkou District,providing theoretical basis and empirical evidence for primary care reform.Methods This study was conducted between December 2015 and January 2016.By use of multi-stage cluster sampling,the permanent residents in Shanghai's Hongkou District were enrolled.Through the individual face-to-face interview,the status of signing a contract with a family doctor was collected,and recorded.Implementation Evaluation of the Family Doctor System in Shanghai's Hongkou District,a questionnaire designed by our research group,was used to conduct a survey among the residents,which is mainly composed of demographic data,health status(whether have chronic diseases),habit of seeking first-contact care(the preferred medical institution),overall level of satisfaction with the contracted family doctor services(CFDSs),and awareness of the CFDSs(favorable items).Multiple Logistic regression was adopted to analyze the influencing factors of signing a contract with a family doctor among these residents.Results Of the 900 residents,614 effectively responded to the questionnaire,giving a response rate of 68.22%.Among the respondents,401(65.31%) had signed a contract with a family doctor,but other 213(34.69%) had not.Compared with the non-contracted residents,the contracted ones had older average age,higher rates of having Shanghai hukou and chronic diseases,higher average overall level of satisfaction with CFDSs,and higher average awareness level of CFDSs,but lower retirement rate(P<0.05).Educational level,average income per month and habit of seeking first-contact care were all significantly different between the two groups(P<0.05).Multiple Logistic regression analysis showed that educational level,habit of seeking first-contact care,overall level of the satisfaction with CFDSs and awareness level of CFDSs were influencing factors of signing a contract with a family doctor(P<0.05).Conclusion Educational level,habit of seeking first-contact care,overall level of the satisfaction with CFDSs and awareness level of CFDSs are influencing factors for signing a contract with a family doctor among residents.
Background Family doctor system has been given new connotations in the new round of grassroots health service reform,and have become the significant measurement for realizing the health of the whole people.At the same time, it is very important to understand the acceptance of family doctors and the main influencing factors of their contracting behavior.Objective To analyze the influencing factors of signing a contract with a family doctor among residents in Shanghai's Hongkou District,providing theoretical basis and empirical evidence for primary care reform.Methods This study was conducted between December 2015 and January 2016.By use of multi-stage cluster sampling,the permanent residents in Shanghai's Hongkou District were enrolled.Through the individual face-to-face interview,the status of signing a contract with a family doctor was collected,and recorded.Implementation Evaluation of the Family Doctor System in Shanghai's Hongkou District,a questionnaire designed by our research group,was used to conduct a survey among the residents,which is mainly composed of demographic data,health status(whether have chronic diseases),habit of seeking first-contact care(the preferred medical institution),overall level of satisfaction with the contracted family doctor services(CFDSs),and awareness of the CFDSs(favorable items).Multiple Logistic regression was adopted to analyze the influencing factors of signing a contract with a family doctor among these residents.Results Of the 900 residents,614 effectively responded to the questionnaire,giving a response rate of 68.22%.Among the respondents,401(65.31%) had signed a contract with a family doctor,but other 213(34.69%) had not.Compared with the non-contracted residents,the contracted ones had older average age,higher rates of having Shanghai hukou and chronic diseases,higher average overall level of satisfaction with CFDSs,and higher average awareness level of CFDSs,but lower retirement rate(P<0.05).Educational level,average income per month and habit of seeking first-contact care were all significantly different between the two groups(P<0.05).Multiple Logistic regression analysis showed that educational level,habit of seeking first-contact care,overall level of the satisfaction with CFDSs and awareness level of CFDSs were influencing factors of signing a contract with a family doctor(P<0.05).Conclusion Educational level,habit of seeking first-contact care,overall level of the satisfaction with CFDSs and awareness level of CFDSs are influencing factors for signing a contract with a family doctor among residents.
引文
[1]黄蛟灵,高臻耀.家庭医生制度的健康管理实践与成效分析--以上海市长宁区为例[J].中国医疗保险,2017(2):33-36.DOI:10.19546/j.issn.1674-3830.2017.2.008.HUANG J L,GAO Z Y.Health management and effect analysis of family doctor system:a case study from Changning District of Shanghai[J].China Health Insurance,2017(2):33-36.DOI:10.19546/j.issn.1674-3830.2017.2.008.
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[4]上海市人民政府办公厅.市政府办公厅印发关于进一步推进本市社区卫生服务综合改革与发展的指导意见[EB/OL].(2015-05-29)[2018-01-03].http://www.wsjsw.gov.cn/wsj/n2373/n2374/n2378/u1ai135883.html.
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[6]李姝洁,张海瑞,朱丽娜,等.全科医生工作压力和工作满意度现状及其影响因素研究[J].中国全科医学,2015,18(4):387-390.DOI:10.3969/j.issn.1007-9572.2015.04.008.
[7]秦江梅,林春梅,张幸,等.我国全科医生及乡村医生签约服务进展及初步效果[J].中国卫生经济,2016,35(3):60-62.DOI:10.7664/CHE20160316.QIN J M,LIN C M,ZHANG X,et al.The progress and elementary achievement of contract based service delivery by general practitioner and rural doctors in China[J].Chinese Health Economics,2016,35(3):60-62.DOI:10.7664/CHE20160316.
[8]张跃红,张拓红,王志锋.北京市德胜地区居民家庭医生式服务的签约现状及影响因素调查[J].中国全科医学,2013,16(11):3715-3718.DOI:10.3969/j.issn.1007-9572.2013.31.022.ZHANG Y H,ZHANG T H,ZHANG Z F.Status of signing on family doctor service for residents in Desheng Area of Beijing and its influencing factors[J].Chinese General Practice,2013,16(11):3715-3718.DOI:10.3969/j.issn.1007-9572.2013.31.022.
[9]袁立,周昌明,江萍,等.上海市长宁区居民家庭医生制服务的需求情况调查[J].中国全科医学,2014,17(32):3860-3864.DOI:10.3969/j.issn.1007-9572.2014.32.020.YUAN L,ZHOU C M,JIANG P,et al.Community residents'demands for family physician service in Changning District,Shanghai[J].Chinese General Practice,2014,17(32):3860-3864.DOI:10.3969/j.issn.1007-9572.2014.32.020.
[10]韩燕妮,孙建丽.家庭医生签约服务现状及影响因素分析--以上海市嘉定区为例[J].行政事业资产与财务,2015(4):37-38,25.
[11]赵德余,梁鸿.基本医疗卫生服务供给中的医患关系重构--社区卫生服务公众签约与就诊行为决策的影响因素分析[J].世界经济文汇,2007(4):3-14.DOI:10.3969/j.issn.0488-6364.2007.04.002.ZHAO D Y,LIANG H.Restructuring the hospital-patient relationship in the provision of basic medical services:an analysis of the determinants of contract formation and demand in community medical services[J].World Economic Papers,2007(4):3-14.DOI:10.3969/j.issn.0488-6364.2007.04.002.
[2]梁鸿.专题导读--推进分级诊疗制度的关键是建立和完善家庭医生制度[J].中国卫生政策研究,2016,9(8):1-2.DOI:10.3969/j.issn.1674-2982.2016.08.001.
[3]黄蛟灵,梁鸿,张宜民,等.家庭医生制度本土化困境与策略:以上海市虹口区为例[J].中国卫生政策研究,2016,9(8):37-43.DOI:10.3969/j.issn.1674-2982.2016.08.007.HUANG J L,LIANG H,ZHANG Y M,et al.Promoting the localization dilemma and strategy for the family doctor system:a case study of Hongkou District,Shanghai[J].Chinese Journal of Health Policy,2016,9(8):37-43.DOI:10.3969/j.issn.1674-2982.2016.08.007.
[4]上海市人民政府办公厅.市政府办公厅印发关于进一步推进本市社区卫生服务综合改革与发展的指导意见[EB/OL].(2015-05-29)[2018-01-03].http://www.wsjsw.gov.cn/wsj/n2373/n2374/n2378/u1ai135883.html.
[5]骆达,杨文秀,韩超.天津市全科医生执业满意度及其影响因素研究[J].中国全科医学,2015,18(22):2701-2704.DOI:10.3969/j.issn.1007-9572.2015.22.019.
[6]李姝洁,张海瑞,朱丽娜,等.全科医生工作压力和工作满意度现状及其影响因素研究[J].中国全科医学,2015,18(4):387-390.DOI:10.3969/j.issn.1007-9572.2015.04.008.
[7]秦江梅,林春梅,张幸,等.我国全科医生及乡村医生签约服务进展及初步效果[J].中国卫生经济,2016,35(3):60-62.DOI:10.7664/CHE20160316.QIN J M,LIN C M,ZHANG X,et al.The progress and elementary achievement of contract based service delivery by general practitioner and rural doctors in China[J].Chinese Health Economics,2016,35(3):60-62.DOI:10.7664/CHE20160316.
[8]张跃红,张拓红,王志锋.北京市德胜地区居民家庭医生式服务的签约现状及影响因素调查[J].中国全科医学,2013,16(11):3715-3718.DOI:10.3969/j.issn.1007-9572.2013.31.022.ZHANG Y H,ZHANG T H,ZHANG Z F.Status of signing on family doctor service for residents in Desheng Area of Beijing and its influencing factors[J].Chinese General Practice,2013,16(11):3715-3718.DOI:10.3969/j.issn.1007-9572.2013.31.022.
[9]袁立,周昌明,江萍,等.上海市长宁区居民家庭医生制服务的需求情况调查[J].中国全科医学,2014,17(32):3860-3864.DOI:10.3969/j.issn.1007-9572.2014.32.020.YUAN L,ZHOU C M,JIANG P,et al.Community residents'demands for family physician service in Changning District,Shanghai[J].Chinese General Practice,2014,17(32):3860-3864.DOI:10.3969/j.issn.1007-9572.2014.32.020.
[10]韩燕妮,孙建丽.家庭医生签约服务现状及影响因素分析--以上海市嘉定区为例[J].行政事业资产与财务,2015(4):37-38,25.
[11]赵德余,梁鸿.基本医疗卫生服务供给中的医患关系重构--社区卫生服务公众签约与就诊行为决策的影响因素分析[J].世界经济文汇,2007(4):3-14.DOI:10.3969/j.issn.0488-6364.2007.04.002.ZHAO D Y,LIANG H.Restructuring the hospital-patient relationship in the provision of basic medical services:an analysis of the determinants of contract formation and demand in community medical services[J].World Economic Papers,2007(4):3-14.DOI:10.3969/j.issn.0488-6364.2007.04.002.