签约居民与未签约居民社区卫生服务利用差异分析
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摘要
目的通过实证研究考察签约家庭医生是否促进了分级诊疗、有序就诊和健康管理等服务的普及。方法通过多阶段随机抽样,抽取上海市虹口区欧阳路街道18个居委100户居民家庭,共1 800名常住居民,通过问卷调查,了解签约居民与未签约居民社区卫生服务利用情况。结果签约家庭医生的居民更好地实现了有序就诊。在社区卫生服务中心首诊、双向转诊方面的比例均高于未签约居民。签约居民选择社区首诊的比例为35.15%,转诊的比例为21.43%,未签约居民分别为16.87%和9.61%。签约居民利用较多的社区医疗服务项目包括:在社区看病配药、免费健康体检和参加健康讲座。未签约居民使用最多的项目同样如此,但使用比例低于签约居民。结论较未签约居民而言,签约居民下沉就诊比例更高并且社区卫生服务利用比例更高,这表明签约服务已经初显成效。扩大社区卫生机构药品目录、鼓励居民与家庭医生建立长期稳定的服务关系是完善家庭医生制度的重要内容。
OBJECTIVE Through empirical study to investigate whether family doctors promote the popularization of tiered medical services,orderly medical treatment,health management services and so on. METHODS Through multi-stage random sampling,a total of 1800 permanent residents from 100 households of the 18 neighborhood committees in Ouyang Street of Hongkou District of Shanghai wereselected as objects. Through questionnaire survey to investigate the utilization of community health services between contracted residents and unsigned residents. RESULTS Contracted residents could obtain better orderly medical treatment. The proportion of contracted residents choosing community first diagnosis and two-way referral was higher than that of unsigned residents. 35.15% of contracted residents chose community first diagnosis and 21.43% chose two-way referral,while the proportion of unsigned residents was only 16.87% and 9.61%. The most used community medical services were dispensing medicine in community, free health examination and attending health lectures. Contracted residents used more than unsigned residents. CONCLUSION Compared with unsigned residents,the proportion of contracted was higher,which proved contracted services had achieved initial success. Residents who saw the doctors in community and made use of community health services should expand the list of drugs in community health institutions,encourage residents andfamily doctors to establish long-term stable service relationship in order to improve family doctor system.
OBJECTIVE Through empirical study to investigate whether family doctors promote the popularization of tiered medical services,orderly medical treatment,health management services and so on. METHODS Through multi-stage random sampling,a total of 1800 permanent residents from 100 households of the 18 neighborhood committees in Ouyang Street of Hongkou District of Shanghai wereselected as objects. Through questionnaire survey to investigate the utilization of community health services between contracted residents and unsigned residents. RESULTS Contracted residents could obtain better orderly medical treatment. The proportion of contracted residents choosing community first diagnosis and two-way referral was higher than that of unsigned residents. 35.15% of contracted residents chose community first diagnosis and 21.43% chose two-way referral,while the proportion of unsigned residents was only 16.87% and 9.61%. The most used community medical services were dispensing medicine in community, free health examination and attending health lectures. Contracted residents used more than unsigned residents. CONCLUSION Compared with unsigned residents,the proportion of contracted was higher,which proved contracted services had achieved initial success. Residents who saw the doctors in community and made use of community health services should expand the list of drugs in community health institutions,encourage residents andfamily doctors to establish long-term stable service relationship in order to improve family doctor system.
引文
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[5]全市408万市民签约家庭医生[EB/OL]. 2018-05-20.http://www.sohu.com/a/232211409_164508.
[6]石亚丽,李宁燕,赵建功.北京市西城区居民社区首诊意愿及影响因素研究[J].中国全科医学,2016,19(16):1939-1942.
[7]杜娟,韩琤琤,葛彩英,等.北京市城区家庭医生式服务签约居民社区首诊意愿及影响因素调查[J].医学与社会,2017,30(4):8-12.
[8]葛敏,江萍,朱敏杰,等.家庭医生签约服务联动改革对有序诊疗格局的作用效果研究[J].中国全科医学,2018(4):415-419.
[9]刘姗姗,葛敏,江萍,等.家庭医生签约服务对社区居民就诊行为的影响研究[J].中国全科医学,2018(4):407-410.
[10]蔡利强,侯进.家庭医生与居民建立稳定契约关系对2型糖尿病健康管理的效果评价[J].社区医学杂志,2018(9):7-8.
[2]汤春红.英国初级卫生保健制度对上海开展家庭医生制服务的启示[J].上海医药,2012,33(16):15-18.
[3]唐圆圆,魏晓瑶,高东平.国外家庭医生服务模式[J].中国初级卫生保健,2015,29(2):9-11.
[4]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.
[5]全市408万市民签约家庭医生[EB/OL]. 2018-05-20.http://www.sohu.com/a/232211409_164508.
[6]石亚丽,李宁燕,赵建功.北京市西城区居民社区首诊意愿及影响因素研究[J].中国全科医学,2016,19(16):1939-1942.
[7]杜娟,韩琤琤,葛彩英,等.北京市城区家庭医生式服务签约居民社区首诊意愿及影响因素调查[J].医学与社会,2017,30(4):8-12.
[8]葛敏,江萍,朱敏杰,等.家庭医生签约服务联动改革对有序诊疗格局的作用效果研究[J].中国全科医学,2018(4):415-419.
[9]刘姗姗,葛敏,江萍,等.家庭医生签约服务对社区居民就诊行为的影响研究[J].中国全科医学,2018(4):407-410.
[10]蔡利强,侯进.家庭医生与居民建立稳定契约关系对2型糖尿病健康管理的效果评价[J].社区医学杂志,2018(9):7-8.