上海市长宁区居民家庭医生制服务的需求情况调查  

Community Residents' Demands for Family Physician Service in Changning District,Shanghai

作　　者：袁立[1] 周昌明[1] 江萍 徐蕾 赵琦[1] 徐飚[1] 

机构地区：[1]复旦大学公共卫生学院,上海市200032 [2]长宁区卫生局 [3]长宁区社区卫生管理中心

出　　处：《中国全科医学》2014年第32期3860-3864,共5页Chinese General Practice

基　　金：上海市加强公共卫生体系建设三年行动计划(2011-2013年)(GWⅢ-24)

摘　　要：目的调查上海市长宁区居民对家庭医生制服务的需求现状,为制定以需求为导向的家庭医生服务包提供科学依据。方法于2013年5—6月采用分层随机整群抽样法,在长宁区周家桥街道抽取3个居委会,每个居委会抽取120户居民,对家庭内所有成员进行问卷调查。问卷内容包括居民基本信息、签约情况、签约意愿、家庭医生基本服务需求情况、履行义务配合情况等。结果共发放问卷436份,回收问卷436份,回收率为100%;有效问卷436份,有效率为100%。436名社区居民中已与家庭医生签约230名(52.8%)。多因素Logistic回归分析结果显示,年龄对非签约居民签约意愿有影响(P<0.05)。在目前已开展或拟开展的家庭医生服务包中,社区居民对家庭医生提供的各项服务需求率居前三位的是优先获得疾病康复指导(86.0%)、开展中医预防保健指导(85.6%)、定向转至二级医院(85.3%)。有13.8%(60/436)的居民认为不能满足自身需求,建议家庭医生能够增加坐诊时间、提供上门服务等。居民最想获得的家庭医生制基本服务居前三位的是在家庭医生处可比社区获得更多种类的药品(73.7%)、病情稳定的慢性病患者可以一次多配几周的药物(58.1%)、定向转至二级医院看病(55.1%)。定点就诊迫切需求率(57.4%)、全科分诊迫切需求率(32.8%)、转诊迫切需求率(52.5%)及健康咨询、评估、指导迫切需求率(50.4%)比较,差异有统计学意义(χ2=13.671,P=0.003),其中定点就诊迫切需求率高于其他服务内容(P<0.05)。居民履行义务配合率居前三位的是家庭医生建立健康档案(87.6%)、接受由家庭医生提供的健康指导服务(86.9%)、住院治疗后接受家庭医生的出院后随访(85.8%)。签约居民对家庭医生制基本服务需求率和签约后基本义务配合率均高于非签约居民(P<0.001)。结论家庭医生服务制社区接受度较高,服务总体需求量较大,在改革过程中要Objective To investigate the community residents＇ demands for family physician service in Changning District,Shanghai. Methods From May to June 2013,in Zhoujiaqiao Street of Changning District,to choose 360 families from 3neighborhood committees to undergo questionnaire survey among all family members by stratified cluster sampling method. The questionnaire included residents＇ basic information,contract- signing status,contract- signing will,demands for family doctor basic services,obligation fulfilling and coordination,etc. Results A total of 436 questionnaires were distributed,and 436 returned（ 100%）,436 were valid（ 100%）. Among the 436 residents,230 had signed the contracts with family doctors（ 52. 8%）. Multivariate Logistic regression analysis showed that age,influenced non- signing residents＇ will to sign contracts（ P 〈0. 05）. The top 3 of residents＇ demands for family doctors＇ services were： priority of acquiring rehabilitation guidance（ 86.0%）,guidance for TCM prevention and health care（ 85.6%）,directionally transferring to second- class hospitals（ 85.3%）. 13.8%（ 60/436） residents believed that the actual services could not meet their needs and suggested that family doctors should supply both clinic and door- to- door services. The top 3 of residents＇ demands for basic services were： supply of more kinds of drugs（ 73. 7%）,more drugs for a few more weeks at a time for chronic disease patients in a stable state（ 58.1%）,directionally transferring to second-class hospitals（ 55.1%）. The pressing need rate was 57.4% for doctor visiting at fixed locations,32. 8% for triage,52. 5% for transfer treatment,50. 4% for health counseling,assessment,guidance;the difference was significant（ χ2= 13. 671,P = 0. 003）. The top 3 of residents＇ obligation fulfilling and coordination rate were：health record establishment（ 87. 6%）,acceptance of health guidance services supplied by family doctors（ 86. 9%）,acceptance of family doctors＇ follow- ups（ 8

关 键 词：卫生服务需求 社区卫生服务 家庭医生 上海 

分 类 号：R197[医药卫生—卫生事业管理]