摘要
目的系统评价中国居民家庭医生签约服务的续约意愿率。方法计算机检索PubMed、Web of Science、EMbase、ScienceDirect、CNKI、WanFang Data和VIP数据库,搜集有关中国居民家庭医生签约服务续约意愿的横断面研究,检索时限均为建库至2021年11月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 16.0软件进行Meta分析。结果共纳入23个横断面研究,包括22629例居民。Meta分析结果显示,我国已签约家庭医生的居民续约意愿率为84.2%[95%CI(80.0%,88.3%)]。亚组分析结果显示,2011至2015年(85.7%)、东部(87.0%)、城区(84.7%)、年龄≥60岁(88.5%)、女性(85.1%)、非在婚(86.5%)、小学及以下学历(91.4%)、拥有城镇职工医保(84.5%)和城乡居民医保(85.2%)、非在职(77.9%)、健康状况较好或一般(84.5%)、患有慢病(86.7%)、一般疾病首选基层医疗机构(89.5%)、家庭至附近社区卫生服务机构步行所需时间≤30分钟(86.9%)的签约居民续约意愿率相对较高。签约后健康状况改善(91.0%)、医疗开支减少(91.5%)、就医便利性提高(88.4%)、对签约服务较为满意(85.3%)、对签约医生较为信任(87.9%)、知道家庭医生名字(86.7%)和联系方式(84.2%)、能够享受到上门服务(79.7%)、电话随访(79.6%)、建立健康档案(80.1%)的签约居民续约意愿较强。结论当前证据表明,我国家庭医生服务签约居民的续约意愿较高,但仍有提升空间。续约意愿受健康状况、医疗费用、便利性和服务满意度等影响较大。
Objective To systematically review the willingness rate of Chinese residents to renew family doctors contract services.Methods PubMed,Web of Science,EMbase,ScienceDirect,CNKI,WanFang Data and VIP databases were electronically searched to collect cross-sectional studies related to the willingness of Chinese residents to renew family doctors contract services from inception to November 2021.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of the included studies.Meta-analysis was then performed by using Stata 16.0 software.Results A total of 23 cross-sectional studies involving 22629 subjects were included.The results of meta-analysis showed that the willingness rate of Chinese residents to renew family doctors contract services was 84.2%(95%CI 80.0%to 88.3%).The results of subgroup analysis showed that contracted residents who were surveyed in 2011 to 2015(85.7%),living in eastern(87.0%)and urban(84.7%),above age 60(88.5%),females(85.1%),non-married(86.5%),with primary school and below education level(91.4%),with employee medical insurance(84.5%)and residents medical insurance(85.2%),not working(77.9%),with high and medium levels of health status(84.5%),with chronic diseases(86.7%),preferred to consult general diseases in primary health care institutions(89.5%),and walking to nearby community health service institutions requiring less than 30 minutes(86.9%)had a relatively high willingness to renew contracts.The contracted residents whose health status improved(91.0%),medical expenses reduced(91.5%)and medical portability improved(88.4%),more satisfied with contracted services(85.3%),more trusted in contracted doctors(87.9%),knowing family doctors’name(86.7%)and contact information(84.2%)and enjoying visiting medical service(79.7%),telephone follow-up(79.6%),and health files establishment(80.1%)were more willing to renew contracts.Conclusion Current evidence suggests that the willingness of Chinese residents to renew family doctors contract services is high,however,it remains to be improved.Due to the limited quality and quantity of the included studies,more high-quality studies are needed to verify the above conclusion.
作者
贾琳琳
詹雨婷
曹雪霏
侯艳红
JIA Linlin;ZHAN Yuting;CAO Xuefei;HOU Yanhong(China Pharmaceutical University,Nanjing 211198,P.R.China)
出处
《中国循证医学杂志》
CSCD
北大核心
2022年第3期324-331,共8页
Chinese Journal of Evidence-based Medicine
基金
教育部人文社会科学研究青年基金项目(编号:19YJC630183)。
关键词
中国
家庭医生签约服务
续约意愿
META分析
系统评价
横断面研究
China
Family doctors contract service
Renewal willingness
Meta-analysis
Systematic review
Cross-sectional study
作者简介
通信作者:侯艳红,Email:1020092084@cpu.edu.cn。
