兰州新区家庭医生签约居民续签意愿及影响因素研究
|
摘要
背景 家庭医生签约服务是以全科医生和被签约居民为主体建立起来的一种契约式服务,家庭医生是签约服务的第一责任人,为签约居民提供安全、有效、方便、价廉的基本医疗卫生服务,引导居民合理利用卫生资源,保障居民健康状况,实现人人享有初级卫生保健的目标。目的了解兰州新区已签约居民续签意愿及其影响因素。方法 2018年3—6月,采用分层随机抽样法,选择兰州新区3个乡镇54个行政村的650例签约居民,采用自行设计的《已签约居民家庭医生式服务需求评估问卷》进行问卷调查。问卷内容包括:居民基本情况及家庭医生签约服务知晓情况、利用情况、需求情况及续签意愿。采用Logistic回归分析签约居民续签意愿的影响因素。结果共发放调查问卷650份,回收有效问卷622份,有效回收率为95.7%。签约居民有续签意愿者占82.0%(510/622)。Logistic回归分析显示,是否清楚建有健康档案、是否愿意在社区继续康复治疗、是否需要家庭医生提供上门服务对签约居民的续签意愿有影响(P<0.05)。结论是否清楚建有健康档案影响居民的续签意愿,愿意在社区继续康复护理者续签意愿较高,需要家庭医生提供上门服务者续签意愿较高。建议促进医疗卫生资源合理下沉,根据居民健康需求提供个性化服务,完善差别化医保政策,畅通转诊渠道。
Background Family doctor services are a kind of contractual services provided by the contracted general practitioner(GP) for the contracted residents.GP is the first person who is liable for providing contracted residents with safe,effective,easy access and inexpensive essential health care services,guiding them to use health resources in a reasonable way,and safeguarding their health,realizing the goal of universal health coverage eventually.Objective To examine the implementation status of contracted family doctor services,contracted residents' intention of renewing the contract and associated factors in Lanzhou New Area.Methods This survey was implemented from March to June 2018.By use of stratified random sampling,650 contracted residents were selected from administrative villages of 3 towns in Lanzhou New Area.Contracted Residents' Needs of Family Doctor Services,a questionnaire designed by our research team,was used in the survey,which included sociodemographic characteristics,awareness,use and needs of contracted family doctor services,and the intention to renew the contract.Logistic regression analysis was adopted to explore the factors associated with contracted residents' intention of renewing the contract.Results The survey obtained a response rate of 95.7%(622/650).The prevalence of intending to renew the contract was 82.0%(510/622).Logistic regression analysis demonstrated that,building health records,intention of continuing to receive community-based rehabilitation therapy,and needs of home-based health services had great impact on contracted residents' intention to renew the contract(P<0.05).Conclusion Building health records had significant effect on the intention of renewing the contract among the contracted residents.Higher level of intention to renew the contact was found in those who were willing to continue to receive community-based rehabilitation therapy,and those who needed home-based services.In view of this,allocation of health resources to primary health care institutions should be promoted reasonably,personalized targeted services should be delivered,coverage gap of different medical insurance schemes should be narrowed,and the referral pathways should be barrier-free.
Background Family doctor services are a kind of contractual services provided by the contracted general practitioner(GP) for the contracted residents.GP is the first person who is liable for providing contracted residents with safe,effective,easy access and inexpensive essential health care services,guiding them to use health resources in a reasonable way,and safeguarding their health,realizing the goal of universal health coverage eventually.Objective To examine the implementation status of contracted family doctor services,contracted residents' intention of renewing the contract and associated factors in Lanzhou New Area.Methods This survey was implemented from March to June 2018.By use of stratified random sampling,650 contracted residents were selected from administrative villages of 3 towns in Lanzhou New Area.Contracted Residents' Needs of Family Doctor Services,a questionnaire designed by our research team,was used in the survey,which included sociodemographic characteristics,awareness,use and needs of contracted family doctor services,and the intention to renew the contract.Logistic regression analysis was adopted to explore the factors associated with contracted residents' intention of renewing the contract.Results The survey obtained a response rate of 95.7%(622/650).The prevalence of intending to renew the contract was 82.0%(510/622).Logistic regression analysis demonstrated that,building health records,intention of continuing to receive community-based rehabilitation therapy,and needs of home-based health services had great impact on contracted residents' intention to renew the contract(P<0.05).Conclusion Building health records had significant effect on the intention of renewing the contract among the contracted residents.Higher level of intention to renew the contact was found in those who were willing to continue to receive community-based rehabilitation therapy,and those who needed home-based services.In view of this,allocation of health resources to primary health care institutions should be promoted reasonably,personalized targeted services should be delivered,coverage gap of different medical insurance schemes should be narrowed,and the referral pathways should be barrier-free.
引文
[1]习近平主持召开中央全面深化改革领导小组第二十三次会议[EB/OL].(2016-04-18)[2018-08-08].http://www.gov.cn/xinwen/2016-04/18/content_5065495.htm.
[2]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.
[3]滕黎,麦陈耀.南充市社区门诊患者签约家庭医生的意愿及影响因素研究[J].现代医药卫生,2016,32(24):3763-3766.DOI:0.3969/j.issn.1009-5519.2016.24.008.TENG L,MAI C Y.Study on willingness and influencing factors of family doctor in community outpatients in Nanchong City[J].JMod Med Health,2016,32(24):3763-3766.DOI:0.3969/j.issn.1009-5519.2016.24.008.
[4]周苑,江启成.我国分级诊疗背景下家庭医生服务研究的现状及问题探讨[J].中国农村卫生事业管理,2017,37(6):633-636.DOI:10.3969/j.issn.1005-5916.2017.06.003.ZHOU Y,JIANG Q C.Current status and problems in the study of family physician services under China's hierarchical medical system[J].Chinese Rural Health Service Administration,2017,37(6):633-636.DOI:10.3969/j.issn.1005-5916.2017.06.003.
[5]牛玉敬,余苗文,邱岳,等.广州市试点地区家庭医生签约和续约现况及影响因素研究[J].中华医院管理杂志,2017,33(12):939-943.DOI:10.3760/cma.j.issn.1000-6672.2017.12.015.NIU Y J,YU M W,QIU Y,et al.Status and influencing factors of contracting and renewing on family doctor service in pilot areas in Guangzhou[J].Chinese Journal of Hospital Administration,2017,33(12):939-943.DOI:10.3760/cma.j.issn.1000-6672.2017.12.015.
[6]浦雪,吴爽,曹志辉,等.衡水市农村老年人卫生服务利用现状及影响因素分析[J].卫生软科学,2017,31(4):55-59.DOI:10.3969/j.issn.1003-2800.2017.04.015.PU X,WU S,CAO Z H,et al.Analysis on status and influencing factors of health service utilization in rural elderly in Hengshui City[J].Soft Science of Health,2017,31(4):55-59.DOI:10.3969/j.issn.1003-2800.2017.04.015.
[7]贺哲,邵飘飘,邵天,等.湖北省基于家庭医生视角的家庭医生签约服务开展影响因素及对策研究[J].中国全科医学,2018,21(28):3447-3452.DOI:10.12114/j.issn.1007-9572.2018.28.008.HE Z,SHAO P P,SHAO T,et al.Influencing factors and countermeasures of the development of contracted community-based family doctor services from family doctors'perspective in Hubei Province[J].Chinese General Practice,2018,21(28):3447-3452.DOI:10.12114/j.issn.1007-9572.2018.28.008.
[8]孔颖文,曹杰,郑艳芳,等.基于利益相关者理论的双向转诊“下转难”研究[J].中国全科医学,2017,20(10):1173-1176.DOI:10.3969/j.issn.1007-9572.2017.10.006.KONG Y W,CAO J,ZHENG Y F,et al."Down-referral being difficult"phenomenon in the two-way referral based on stakeholder theory[J].Chinese General Practice,2017,20(10):1173-1176.DOI:10.3969/j.issn.1007-9572.2017.10.006.
[9]关于印发推进家庭医生签约服务指导意见的通知[EB/OL].(2016-06-06)[2018-08-08].http://www.nhfpc.gov.cn/tigs/s3577/201606/e3e7d2670a8b4163b1fe8e409c7887af.shtml.
[2]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.
[3]滕黎,麦陈耀.南充市社区门诊患者签约家庭医生的意愿及影响因素研究[J].现代医药卫生,2016,32(24):3763-3766.DOI:0.3969/j.issn.1009-5519.2016.24.008.TENG L,MAI C Y.Study on willingness and influencing factors of family doctor in community outpatients in Nanchong City[J].JMod Med Health,2016,32(24):3763-3766.DOI:0.3969/j.issn.1009-5519.2016.24.008.
[4]周苑,江启成.我国分级诊疗背景下家庭医生服务研究的现状及问题探讨[J].中国农村卫生事业管理,2017,37(6):633-636.DOI:10.3969/j.issn.1005-5916.2017.06.003.ZHOU Y,JIANG Q C.Current status and problems in the study of family physician services under China's hierarchical medical system[J].Chinese Rural Health Service Administration,2017,37(6):633-636.DOI:10.3969/j.issn.1005-5916.2017.06.003.
[5]牛玉敬,余苗文,邱岳,等.广州市试点地区家庭医生签约和续约现况及影响因素研究[J].中华医院管理杂志,2017,33(12):939-943.DOI:10.3760/cma.j.issn.1000-6672.2017.12.015.NIU Y J,YU M W,QIU Y,et al.Status and influencing factors of contracting and renewing on family doctor service in pilot areas in Guangzhou[J].Chinese Journal of Hospital Administration,2017,33(12):939-943.DOI:10.3760/cma.j.issn.1000-6672.2017.12.015.
[6]浦雪,吴爽,曹志辉,等.衡水市农村老年人卫生服务利用现状及影响因素分析[J].卫生软科学,2017,31(4):55-59.DOI:10.3969/j.issn.1003-2800.2017.04.015.PU X,WU S,CAO Z H,et al.Analysis on status and influencing factors of health service utilization in rural elderly in Hengshui City[J].Soft Science of Health,2017,31(4):55-59.DOI:10.3969/j.issn.1003-2800.2017.04.015.
[7]贺哲,邵飘飘,邵天,等.湖北省基于家庭医生视角的家庭医生签约服务开展影响因素及对策研究[J].中国全科医学,2018,21(28):3447-3452.DOI:10.12114/j.issn.1007-9572.2018.28.008.HE Z,SHAO P P,SHAO T,et al.Influencing factors and countermeasures of the development of contracted community-based family doctor services from family doctors'perspective in Hubei Province[J].Chinese General Practice,2018,21(28):3447-3452.DOI:10.12114/j.issn.1007-9572.2018.28.008.
[8]孔颖文,曹杰,郑艳芳,等.基于利益相关者理论的双向转诊“下转难”研究[J].中国全科医学,2017,20(10):1173-1176.DOI:10.3969/j.issn.1007-9572.2017.10.006.KONG Y W,CAO J,ZHENG Y F,et al."Down-referral being difficult"phenomenon in the two-way referral based on stakeholder theory[J].Chinese General Practice,2017,20(10):1173-1176.DOI:10.3969/j.issn.1007-9572.2017.10.006.
[9]关于印发推进家庭医生签约服务指导意见的通知[EB/OL].(2016-06-06)[2018-08-08].http://www.nhfpc.gov.cn/tigs/s3577/201606/e3e7d2670a8b4163b1fe8e409c7887af.shtml.