摘要
背景基层医疗卫生机构资源供需不匹配,不均衡是城乡基层医疗卫生机构之间存在的主要问题。为了提高城乡基层医疗服务质量,促进同质化建设,准确了解城乡基层医疗服务质量差异至关重要。目的对成都市城乡基层医疗卫生机构服务质量进行评价、比较,并分析不同患者特征对医疗服务质量体验的影响。方法于2019年11月—2020年1月对成都市22个区(县)所有基层医疗卫生机构进行调查,采用方便抽样法选取各基层医疗卫生机构所有注册全科医生的已就诊患者为研究对象,结合欧洲基层医疗服务质量和成本(QUALICOPC)患者体验问卷和成都实际情况编制“成都市基层医疗服务质量患者问卷”,包含患者基本特征及医疗服务可及性、连续性、协调性、综合性4个维度,使用多重逐步线性回归分析基层医疗服务质量的影响因素。结果共纳入患者2153例,乡镇卫生院的服务可及性、连续性、协调性、综合性维度得分分别为(0.45±0.26)(0.68±0.41)(0.48±0.41)(0.37±0.40)分;社区卫生服务中心各维度得分分别为(0.45±0.27)(0.69±0.39)(0.46±0.42)(0.29±0.38)分,乡镇卫生院的综合性维度得分高于社区卫生服务中心(P<0.05)。目前工作状况(乡镇卫生院:β=-0.031,P=0.006;社区卫生服务中心:β=-0.028,P=0.003)、有无签约医生(乡镇卫生院:β=0.128,P<0.001;社区卫生服务中心:β=0.169,P<0.001)是基层医疗卫生机构服务综合性的影响因素。结论成都市城乡基层医疗卫生机构基层医疗服务质量可及性、协调性、连续性水平较高,乡镇卫生院综合性维度得分高于社区卫生服务中心;目前工作状况对基层医疗卫生机构综合性服务体验有负向预测作用,有签约医生对基层医疗卫生机构服务综合性具有正向预测作用。
Background The imbalance and uneven distribution of resources among primary healthcare institutions constitute the primary issues between urban and rural ones.To enhance the quality of primary medical services in urban and rural areas and promote standardized construction,it is of vital significance to accurately grasp the disparities in the quality of primary medical services between them.Objective To evaluate and compare the service quality of urban and rural primary medical institutions in Chengdu,and to analyze the impact of different patient characteristics on the quality and experience of medical services.Methods A survey was carried out from November 2019 to January 2020 covering all primary healthcare institutions in 22 districts(counties)of Chengdu City.In this study,all registered general practitioners'patients who had received treatment at these institutions were selected as the research subjects through a convenient sampling method.A Questionnaire on the Quality of primary healthcare services and costs(QUALICOPC)was utilized,and a questionnaire on the quality of primary healthcare services in Chengdu was compiled by integrating it with the actual situation in Chengdu.It encompasses four dimensions:accessibility,continuity,coordination,and comprehensiveness of medical services,and multiple stepwise linear regression analysis was employed to analyze the influencing factors of the quality of primary healthcare services.Results A total of 2153 patients were included,with the scores of the accessibility,continuity,coordination,and comprehensiveness dimensions of rural health clinics being(0.45±0.26)points,(0.68±0.41)points,(0.48±0.41)points,and(0.37±0.40)points,respectively.The scores of the dimensions of community health service centers were(0.45±0.27)points,(0.69±0.39)points,(0.46±0.42)points,and(0.29±0.38)points,respectively.The comprehensiveness dimension score of rural health clinics was higher than that of community health service centers,with a statistically significant difference(P<0.05).The current working conditions(rural health clinics:β=-0.031,P=0.006;community health service centers:β=-0.028,P=0.003)and whether there was a contracted doctor(rural health clinics:β=0.128,P<0.001;community health service centers:β=0.169,P<0.001)are influencing factors of the comprehensiveness of primary healthcare services.Conclusion The level of accessibility,coordination,and continuity of PHC quality in urban and rural primary medical and healthcare institutions in Chengdu is relatively high;the comprehensive score of township healthcare centers is higher than that of community healthcare service centers.The current working status has a negative prediction effect on the comprehensive service experience of primary medical and health institutions,and some contracted doctors have a positive prediction effect on the comprehensive service of primary medical and health institutions.
作者
黄传应
刘力滴
张鹏
张亚琳
杨荣
杨梓钰
伍佳
程玉
代华
廖晓阳
HUANG Chuanying;LIU Lidi;ZHANG Peng;ZHANG Yalin;YANG Rong;YANG Ziyu;WU Jia;CHENG Yu;DAI Hua;LIAO Xiaoyang(Department of Emergency,West China Hospital,Sichuan University,Chengdu 610041,China;General Practice Medical Center,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Internal Medicine,Chengdu Qingbaijiang Maternal&Child Health Care Hospital,Chengdu 610300,China)
出处
《中国全科医学》
北大核心
2025年第28期3541-3547,共7页
Chinese General Practice
基金
四川省科技厅项目(2021JDR0296)
四川省科技厅软科学项目(2022JDR0325)
四川省卫生健康委员会项目(TJZ201909)。
关键词
卫生服务研究
患者视角
基层医疗
服务质量
欧洲基层医疗服务质量和成本
Health services research
Parents'perspective
Primary healthcare
Quality of service
Quality and costs of primary care
作者简介
通信作者:代华,副主任医师,E-mail:19541343@qq.com;通信作者:廖晓阳,教授/博士生导师,E-mail:625880796@qq.com;共同第一作者:黄传应;共同第一作者:刘力滴。
