摘要
目的了解上海市社区卫生服务中心老年就诊居民“1+1+1”签约状况,分析影响居民签约的因素.方法本研究采用中心城区、郊区分层抽样及方便抽样的原则,于2017年9-11月选取上海市复旦大学附属中山医院全科定点带教的6家社区卫生服务中心的老年就诊居民进行问卷调查.查阅相关资料及文献,结合之前课题定性访谈研究结果的基础上设计调查问卷.问卷内容包括居民基本情况、健康状况、对“1+1+1”签约的了解程度、签约与否及其原因等.结果本次调查问卷574份,有效问卷564份,有效率98.25%.其中,300例(53.2%)已签约,264例(46.8%)未签约.单因素分析显示,年龄、自评健康状况、患慢性病种类、长期服药情况、社区卫生服务中心就诊次数、本次就诊目的、对社区卫生服务中心满意程度、规律体检情况、健康知识关注情况、社区首诊意愿、社区转诊意愿、签约知晓与否对签约的影响有统计学意义(P<0.05).多因素分析显示,“1+1+1”签约知晓情况、社区转诊意愿、自评健康状况对签约的影响有统计学意义(P<0.05).签约的具体原因主要为看病配药更方便(69.00%,207/300)及与家庭医生熟悉(29.33%,88/300).未签约的具体原因主要为不了解政策(65.15%,172/264)、觉得签约意义不大(25.38%,67/264)、担心限制就医(7.58%,20/264).结论“1+1+1”签约知晓情况、社区转诊意愿、自评健康状况是签约的主要影响因素.建议完善相关政策,重视基层医疗机构,加强对政策的有效宣传,加强全科医生培养,让家庭医生与居民建立稳固的医患关系,推进“1+1+1”签约的可持续发展.
Objective To investigate the signing status of combination contract("1+1+1"contract)for primary care among elderly residents in Shanghai communities and its influencing factors.Methods The policy of combination contract for primary care has been implemented in Shanghai since 2015,the residents signed a service contract with general practitioners in community health service center as well as with one of the secondary or tertiary hospitals("1+1+1").The questionnaire survey on the signing status of"1+1+1"contract was conducted among residents over 60 years in 6 communities in Shanghai which were selected by stratified and convenience sampling method from September 2017 to November 2017.The questionnaire was designed based on the previous research results of the qualitative interviews.The contents of the questionnaire included the basic characteristics,health status,understanding of the"1+1+1"signing policy,the status and reasons for contract signing,and so on.The date were analyzed by descriptive method,chi-square test,and binary logistic regression.Results Total 574 questionnaires were distributed and 564 valid questionnaires were retrieved with a recovery rate of 98.25%.Among all participants,300(53.2%)had signed and 264(46.8%)had not signed.Univariate analysis showed that age,self-evaluated health status,chronic disease,medication,visits to the community health service center,the purpose of this visit,satisfaction with the community health service center,medical examination,concerning health knowledge,the willingness of community doctor as gatekeeper,the willingness of community referral,whether or not know the"1+1+1"contract policy,influence the rate of signing were associated with the signing of the contract(all P<0.05).Multivariate analysis showed that whether or not know the"1+1+1"contract policy,the willingness of community referral,and self-evaluation health status were independent factors affecting"1+1+1"contract signing(all P<0.05).The reason for signing the contract were convenience to visit doctor(69.00%,207/300),and having a good relationship with family doctor(29.33%,88/300).The reasons for not signing the contract were not understanding the policy(65.15%,172/264),lack of help for signing(25.38%,67/264),and restricted choice of seeking medical services(7.58%,20/264).Conclusion Whether or not know the"1+1+1"contract policy,the willingness of community referral,and self-evaluation health status are the main influencing factors of signing"1+1+1"contract for primary care among elderly residents in Shanghai communities.
作者
黄翠玲
寿涓
李娅玲
刘瑶
Huang Cuiling;Shou Juan;Li Yaling;Liu Yao(Department of General Practice,Xiamen Branch of Zhongshan Hospital,Fudan University,Xiamen 361015,China;Department of General Practice,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Weifang Community Health Service Center,Pudong New Area,Shanghai 200122,China)
出处
《中华全科医师杂志》
2019年第11期1064-1069,共6页
Chinese Journal of General Practitioners
关键词
分级诊疗
家庭医生
影响因素
Hierarchical medical
Family doctor
Influencing factors
作者简介
通信作者:寿涓,Email:asyura55@126.com。
