兰州新区家庭医生签约居民续签意愿及影响因素研究

doi:10.12114/j.issn.1007-9572.2019.07.009

摘要/Abstract

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。

关键词: 家庭医生签约服务, 续签意愿, 影响因素分析, Logistic回归, 兰州新区

Abstract: 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.

Key words: Contracted services of family doctors, Renewing intention, Root cause analysis, Logistic analysis, Lanzhou New Area

张倩倩,郑亚君,李红丽,等. 兰州新区家庭医生签约居民续签意愿及影响因素研究[J]. 中国全科医学, 2019, 22(7): 789-793. DOI: 10.12114/j.issn.1007-9572.2019.07.009.
ZHANG Qianqian,ZHENG Yajun,LI Hongli, et al. Intention of Renewing the Health Service Contract with the Family Doctor and Associated Factors among Contracted Residents in Lanzhou New Area　[J]. Chinese General Practice, 2019, 22(7): 789-793. DOI: 10.12114/j.issn.1007-9572.2019.07.009.

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