摘要
背景 转变基层医疗卫生服务模式,实行家庭医生签约服务,是深化医药卫生体制改革的重要任务,是建立基层首诊、分级诊疗制度的必然途径,居民作为卫生服务的需求方,其首诊意愿与基层首诊的顺利推行息息相关。目的了解天津市社区居民选择签约家庭医生首诊意愿,并探讨其影响因素。方法于2018年1—2月采用随机抽样法从天津市16个行政区划中随机抽取和平区、北辰区、河北区3区,选取760名在该时段有基层就诊经历的社区签约居民进行问卷调查。具体内容包括居民的基本情况、居民对签约家庭医生的满意度及居民对签约家庭医生首诊意愿。比较不同特征社区居民选择签约家庭医生首诊意愿,采用Logistic逐步回归分析其影响因素。结果共回收有效问卷754份,问卷的有效回收率为99.2%。结果显示,90.3%(681/754)的居民表示愿意选择签约家庭医生作为首诊医生。不同年龄、家庭年收入、医疗保险类型、候诊时间、对签约家庭医生满意度、对家庭医生信任程度、对自身健康问题的了解程度、应对健康问题的能力、保持健康的能力的签约居民基层首诊意愿比较,差异有统计学意义(P<0.05);不同性别、文化程度、工作状况、患慢性病情况的签约居民基层首诊意愿比较,差异无统计学意义(P>0.05)。Logistic逐步回归分析结果显示,年龄、家庭年收入、候诊时间、对家庭医生信任程度、应对健康问题的能力是居民选择签约家庭医生为首诊医生的影响因素(P<0.05)。结论天津市社区居民选择签约家庭医生首诊意愿较高,年龄、家庭年收入、候诊时间、对家庭医生信任程度、应对健康问题的能力是居民选择签约家庭医生为首诊医生的影响因素。
Background Changing the delivery patterns of primary care and implementation of the contracted family doctor services are important tasks during the deepening the reform of the pharmaceutical and healthcare system,and are necessary approaches to the achievement of initial consultation in primary healthcare institutions and the development of hierarchical medical system.Residents are the demand side of health services.Their intention of choosing the contracted family doctor as a first contact for health problems is closely related to the successful achievement of initial consultation in primary healthcare institutions.Objective To investigate the intention and influencing factors of choosing the contracted family doctor as a first contact for health problems among community-dwelling residents in Tianjin.Methods From January to February 2018,by use of convenience sampling,3(Heping District,Beichen District and Hebei District)of 16 administrative divisions of Tianjin were selected,from which 760 contracted community-dwelling residents with experience of seeking healthcare in primary healthcare institutions were sampled.A survey was conducted in them using a questionnaire composing of the general personal data,residents’satisfaction with the contracted family doctor,and their intention of choosing the contracted family doctor as a first contact for health problems.Logistic stepwise regression was used to analyze the factors associated with their intention.Results A total of 754 cases handed in responsive questionnaires,with a response rate of 99.2%.The survey results revealed that 90.3%(681/754)of the respondents were willing to choose a contracted family doctor as their first contact for heath problems.The intention associated with initial consultation in primary healthcare institutions changed significantly by age,annual household income,type of medical insurance,waiting time for consultation,level of satisfaction with the contracted family doctorservices,level of trust in the contracted family doctor,level of un
作者
张玲玲
孙华君
王延赏
邹佳辰
杜汋
陈欣
ZHANG Lingling;SUN Huajun;WANG Yanshang;ZOU Jiachen;DU Zhuo;CHEN Xin(School of Public Health,Tianjin Medical University,Tianjin 300070,China)
出处
《中国全科医学》
CAS
北大核心
2019年第7期794-798,共5页
Chinese General Practice
基金
2018年天津市哲学社会科学规划项目(重点项目)(TJKSZDWT1836)--习近平总书记关于"健康中国"战略思想研究
天津市社科界千名学者服务基层活动调研项目(180711001)--家庭医生签约服务配套医保政策研究
关键词
家庭医生签约服务
居民
首诊意愿
影响因素分析
Contracted services of family doctors
Residents
First visit intention
Root cause analysis
