云南省社区居民家庭医生签约意愿及影响因素研究
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摘要
背景云南省的家庭医生签约服务工作起步较晚,了解社区居民的签约意愿及影响因素,有利于进一步促进家庭医生服务的利用与开展成效,切实提高医疗服务的覆盖率。目的了解云南省社区居民的家庭医生签约意愿,并进一步探讨影响其签约意愿的因素,为推动家庭医生签约服务开展提供建议。方法采用分层抽样法,根据云南省昆明市13个区(县)的地理位置和经济发展状况,选取2个区1个县;采用典型抽样法,分别从每个区(县)中选取1个社区,依次为五华区的红云社区、西山区的前卫社区、晋宁区古城镇;采用方便抽样法,在每个社区中抽取90户家庭,以符合条件的家庭成员为研究对象。于2017年7—9月,采用自行设计的问卷进行调查,主要内容为居民的基本情况、就诊行为及签约意愿等。共发放问卷1 412份,回收有效问卷1 318份,有效回收率为93.3%。结果1 318例居民中,有签约意愿者1 187例(90.1%)。不同年龄、受教育程度、医疗保险类型、个人年收入、城乡环境、患慢性病情况、选择社区首诊情况、在社区卫生服务中心候诊时间、到社区卫生服务中心花费时间的居民家庭医生签约意愿比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,医疗保险类型、城乡环境、患慢性病情况、在社区卫生服务中心候诊时间、到社区卫生服务中心花费时间是居民家庭医生签约意愿的影响因素(P<0.05)。结论云南省社区居民的家庭医生签约意愿较高,参保城镇居民医疗保险、居住在城区、患慢性病、在社区卫生服务中心候诊时间≤0.5 h、到社区卫生服务中心花费时间≤0.5 h的居民具有更高的签约意愿。
Background The implementation of the contracted services of family doctors in Yunnan Province started late.Understanding the intention and influencing factors of signing a health service contract with the family doctor in community-dwelling residents in this province,is conducive to further improving the utilization and effectiveness of such services,and enhancing the medical service coverage in a tangible way.Objective To explore the intention and influencing factors of signing a health service contract with the family doctor in community-dwelling residents in Yunnan Province,and based on this,to put forward suggestions for promoting the residents' contract signing rate.Methods By geographical and economic stratification,two districts and one county from 13 districts(counties) in Kunming City,Yunnan Province were selected.Then by typical sampling,Hongyun Community,Qianwei Community and Gucheng County were selected from Wuhua District,Xishan District,Jinning District,respectively.Then,by convenience sampling,the family members of 90 households were selected from each of the communities and participated in a survey conducted between July and September 2017.A selfdesigned questionnaire was used in the survey,which mainly included basic personal characteristics,health seeking behavior,and the intention of signing a health service contract with the family doctor.Of the 1 412 residents,1 318 returned responsive questionnaires,achieving a response rate of 93.3%.Results Of the 1 318 respondents,1 187(90.1%) intended to sign ahealth contract with the family doctor.The intention of signing a health contract with the family doctor differed significantly among the respondents by age,educational level,type of medial insurance,annual income,living environment(urban or rural area),chronic illness,initially consulted institution,waiting time for consultation in a community health center,and time needed to get to the nearby community health center(P<0.05).Multivariate Logistic regression analysis showed that the type of medical insurance,living area(urban or rural),chronic diseases,waiting time for consultation in a community health center,time needed to get to the nearby community health center were significantly associated with respondents' intention of signing a health service contract with the family doctor(P<0.05).Conclusion The prevalence of intention to sign a health service contact with the family doctor is high among community-dwelling residents in Yunnan Province.Having medical insurance, living in urban areas, suffering from at least one chronic illness, access to consultation after waiting for no more than half an hour, and getting to the nearby community health center within half an hour are associated with higher level of intention of signing a health service contract with the family doctor.
Background The implementation of the contracted services of family doctors in Yunnan Province started late.Understanding the intention and influencing factors of signing a health service contract with the family doctor in community-dwelling residents in this province,is conducive to further improving the utilization and effectiveness of such services,and enhancing the medical service coverage in a tangible way.Objective To explore the intention and influencing factors of signing a health service contract with the family doctor in community-dwelling residents in Yunnan Province,and based on this,to put forward suggestions for promoting the residents' contract signing rate.Methods By geographical and economic stratification,two districts and one county from 13 districts(counties) in Kunming City,Yunnan Province were selected.Then by typical sampling,Hongyun Community,Qianwei Community and Gucheng County were selected from Wuhua District,Xishan District,Jinning District,respectively.Then,by convenience sampling,the family members of 90 households were selected from each of the communities and participated in a survey conducted between July and September 2017.A selfdesigned questionnaire was used in the survey,which mainly included basic personal characteristics,health seeking behavior,and the intention of signing a health service contract with the family doctor.Of the 1 412 residents,1 318 returned responsive questionnaires,achieving a response rate of 93.3%.Results Of the 1 318 respondents,1 187(90.1%) intended to sign ahealth contract with the family doctor.The intention of signing a health contract with the family doctor differed significantly among the respondents by age,educational level,type of medial insurance,annual income,living environment(urban or rural area),chronic illness,initially consulted institution,waiting time for consultation in a community health center,and time needed to get to the nearby community health center(P<0.05).Multivariate Logistic regression analysis showed that the type of medical insurance,living area(urban or rural),chronic diseases,waiting time for consultation in a community health center,time needed to get to the nearby community health center were significantly associated with respondents' intention of signing a health service contract with the family doctor(P<0.05).Conclusion The prevalence of intention to sign a health service contact with the family doctor is high among community-dwelling residents in Yunnan Province.Having medical insurance, living in urban areas, suffering from at least one chronic illness, access to consultation after waiting for no more than half an hour, and getting to the nearby community health center within half an hour are associated with higher level of intention of signing a health service contract with the family doctor.
引文
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[14]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(31):3715-3718.DOI:10.3969/j.issn.1007-9572.2013.31.022.ZHANG Y H,ZHANG T H,WANG Z F.Investigation on the status quo and influencing factors of the signing of doctor-type services for residents in Desheng District,Beijing[J].Chinese General Practice,2013,16(31):3715-3718.DOI:10.3969/j.issn.1007-9572.2013.31.022.
[15]肖筱,袁立,周昌明,等.推行家庭医生签约对社区卫生服务利用的影响[J].中国卫生资源,2015,18(1):64-67.DOI:10.13688/j.cnki.chr.2015.14158.XIAO X,YUAN L,ZHOU C M,et al.The impact of family doctors'signing on the use of community health services[J].Chinese Health Resources,2015,18(1):64-67.DOI:10.13688/j.cnki.chr.2015.14158.
[16]邓明,张柠.医联体服务模式下慢性病患者社区首诊意愿分析[J].中国全科医学,2017,20(36):4534-4538.DOI:10.3969/j.issn.1007-9572.2017.00.092.DENG M,ZHANG N.Analysis of the willingness of the first diagnosis of chronic disease patients in the medical service mode[J].Chinese General Practice,2017,20(36):4534-4538.DOI:10.3969/j.issn.1007-9572.2017.00.092.
[17]陈洁.家庭医生式服务签约居民对预约门诊的接受意愿及影响因素研究[J].中国全科医学,2016,19(10):1143-1146.DOI:10.3969/j.issn.1007-9572.2016.10.008.CHEN J.Study on the willingness to accept and the influencing factors of the residents of family doctor services[J].Chinese General Practice,2016,19(10):1143-1146.DOI:10.3969/j.issn.1007-9572.2016.10.008.
[18]芦炜,张宜民,梁鸿,等.基于需方的家庭医生签约服务实施效果评价:以慢性病为重点[J].中国卫生政策研究,2016,9(8):23-30.DOI:10.3969/j.issn.1674-2982.2016.08.005.LU W,ZHANG Y M,LIANG H,et al.Evaluation of the implementation effect of family doctors'contract-based services based on demand:focusing on chronic diseases[J].Chinese Journal of Health Policy,2016,9(8):23-30.DOI:10.3969/j.issn.1674-2982.2016.08.005.
[19]江萍,赵晓鸣,徐蕾,等.上海市长宁区家庭责任医生制度设计与实施方案[J].中国卫生政策研究,2012,5(6):9-13.DOI:10.3969/j.issn.1674-2982.2012.06.003.JIANG P,ZHAO X M,XU L,et al.The experience of design and implementation of family doctor system in Changning District,Shanghai[J].Chinese Journal of Health Policy,2012,5(6):9-13.DOI:10.3969/j.issn.1674-2982.2012.06.003.
[2]新华社.云南家医签约注重提质增效[J].中国数字医学,2018,13(4):117.Xinhua News Agency.Yunnan family doctors pay attention to improve quality and efficiency[J].Chinese Digital Medicine,2018,13(4):117.
[3]ZHOU M,WANG H,ZHU J,et al.Cause-specific mortality for240 causes in China during 1990-2013:a systematic subnational analysis for the Global Burden of Disease Study 2013[J].The Lancet,2016,387(10015):251-272.DOI:10.1016/S0140-6736(15)00551-6.
[4]唐圆圆,魏晓瑶,高东平,等.国外家庭医生服务模式[J].中国初级卫生保健,2015,29(2):9-11.DOI:10.3969/j.issn.1001-568X.2015.02.0004.TANG Y Y,WEI X Y,GAO D P,et al.Foreign family doctor service model[J].Chinese Primary Health Care,2015,29(2):9-11.DOI:10.3969/j.issn.1001-568X.2015.02.0004.
[5]STANGE K C,NUTTING P A,MILLER W L,et al.Defining and measuring the patient-centered medical home[J].J Gen Intern Med,2010,25(6):601-612.DOI:10.1007/s11606-010-1291-3.
[6]SILCOCK J,RAYNOR D K,PETTY D.The organisation and development of primary care pharmacy in the United Kingdom[J].Health Policy,2004,67(2):207-214.
[7]刘姗姗,葛敏,江萍,等.签约居民对家庭医生签约服务的认知与利用研究[J].中国全科医学,2018,21(4):411-414.DOI:10.3969/j.issn.1007-9572.2018.04.008.LIU S S,GE M,JIANG P,et al.Awareness and utilization of the contractual services among residents signing a contract with a family doctor[J].Chinese General Practice,2018,21(4):411-414.DOI:10.3969/j.issn.1007-9572.2018.04.008.
[8]蒋茜璇,赵梅,苏丹,等.合肥市社区居民对家庭医生制服务需求情况调查[J].安徽医学,2017,38(4):486-489.DOI:10.3969/j.issn.1000-0399.2017.04.030.JIANG Q X,ZHAO M,SU D,et al.Study on demand of community residents in Hefei for family doctor system service[J].Anhui Medical Journal,2017,38(4):486-489.DOI:10.3969/j.issn.1000-0399.2017.04.030.
[9]肖蕾,张太慧,张雅莉,等.分级诊疗视角下家庭医生签约服务“签而不约”的原因及对策研究[J].中国全科医学,2018,21(25):3063-3068.DOI:10.12114/j.issn.1007-9572.2018.25.007.XIAO L,ZHANG T H,ZHANG Y L,et al.Reasons and countermeasures of residents signing the contract with the family doctor but not making appointments during the implementation of hierarchical medical system[J].Chinese General Practice,2018,21(25):3063-3068.DOI:10.12114/j.issn.1007-9572.2018.25.007.
[10]李灿,辛玲.调查问卷的信度与效度的评价方法研究[J].中国卫生统计,2008,25(5):541-544.DOI:10.3969/j.issn.1002-3674.2008.05.034.LI C,XIN L.Research on the evaluation method of reliability and validity of questionnaire[J].Chinese Journal of Health Statistic,2008,25(5):541-544.DOI:10.3969/j.issn.1002-3674.2008.05.034.
[11]原国家卫生和计划生育委员会.中国卫生和计划生育统计年鉴[M].北京:中国协和医科大学出版社,2017.National Health and Family Planning Commission.China health and family planning statistics yearbook[M].Beijing:China Union Medical University Press,2017.
[12]沈鹏悦,刘晓珊,李瑞锋.我国家庭医生签约服务发展现状分析[J].中国医药导报,2017,14(26):169-172.SHEN P Y,LIU X S,LI R F.Analysis on the status quo of the development of family doctors'contract service in China[J].China Medical Herald,2017,14(26):169-172.
[13]梁世民,于晓飞,李晨,等.河南省居民对家庭医生式服务的签约意愿及影响因素研究[J].中国全科医学,2017,20(28):3488-3492.DOI:10.3969/j.issn.1007-9572.2017.28.008.LIANG S M,YU X F,LI C,et al.Study on the willingness to sign and the influencing factors of residents in Henan Province[J].Chinese General Practice,2017,20(28):3488-3492.DOI:10.3969/j.issn.1007-9572.2017.28.008.
[14]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(31):3715-3718.DOI:10.3969/j.issn.1007-9572.2013.31.022.ZHANG Y H,ZHANG T H,WANG Z F.Investigation on the status quo and influencing factors of the signing of doctor-type services for residents in Desheng District,Beijing[J].Chinese General Practice,2013,16(31):3715-3718.DOI:10.3969/j.issn.1007-9572.2013.31.022.
[15]肖筱,袁立,周昌明,等.推行家庭医生签约对社区卫生服务利用的影响[J].中国卫生资源,2015,18(1):64-67.DOI:10.13688/j.cnki.chr.2015.14158.XIAO X,YUAN L,ZHOU C M,et al.The impact of family doctors'signing on the use of community health services[J].Chinese Health Resources,2015,18(1):64-67.DOI:10.13688/j.cnki.chr.2015.14158.
[16]邓明,张柠.医联体服务模式下慢性病患者社区首诊意愿分析[J].中国全科医学,2017,20(36):4534-4538.DOI:10.3969/j.issn.1007-9572.2017.00.092.DENG M,ZHANG N.Analysis of the willingness of the first diagnosis of chronic disease patients in the medical service mode[J].Chinese General Practice,2017,20(36):4534-4538.DOI:10.3969/j.issn.1007-9572.2017.00.092.
[17]陈洁.家庭医生式服务签约居民对预约门诊的接受意愿及影响因素研究[J].中国全科医学,2016,19(10):1143-1146.DOI:10.3969/j.issn.1007-9572.2016.10.008.CHEN J.Study on the willingness to accept and the influencing factors of the residents of family doctor services[J].Chinese General Practice,2016,19(10):1143-1146.DOI:10.3969/j.issn.1007-9572.2016.10.008.
[18]芦炜,张宜民,梁鸿,等.基于需方的家庭医生签约服务实施效果评价:以慢性病为重点[J].中国卫生政策研究,2016,9(8):23-30.DOI:10.3969/j.issn.1674-2982.2016.08.005.LU W,ZHANG Y M,LIANG H,et al.Evaluation of the implementation effect of family doctors'contract-based services based on demand:focusing on chronic diseases[J].Chinese Journal of Health Policy,2016,9(8):23-30.DOI:10.3969/j.issn.1674-2982.2016.08.005.
[19]江萍,赵晓鸣,徐蕾,等.上海市长宁区家庭责任医生制度设计与实施方案[J].中国卫生政策研究,2012,5(6):9-13.DOI:10.3969/j.issn.1674-2982.2012.06.003.JIANG P,ZHAO X M,XU L,et al.The experience of design and implementation of family doctor system in Changning District,Shanghai[J].Chinese Journal of Health Policy,2012,5(6):9-13.DOI:10.3969/j.issn.1674-2982.2012.06.003.