家庭医生签约服务对社区居民就诊行为的影响研究  

Effects of Contractual Services from Family Doctors on the Healthcare-seeking Behavior among Community Residents

作　　者：刘姗姗 葛敏 江萍 朱敏杰 梁鸿 黄蛟灵[3] 方帅[3] 赵德余[3] 张宜民[1] LIU Shan-shan;GE Min;JIANG Ping;ZHU Min-jie;LIANG Hong;HUANG Jiao-ling;FANG Shuai;ZHAO De-yu;ZHANG Yi-min(Pudong Institute for Health Development,Shanghai 200129,China;Health and Family Planning Commission of Changning District,Shanghai 200050,China;School of Social Development and Public Policy,Fudan University,Shanghai 200433,China)

机构地区：[1]浦东卫生发展研究院,上海市200129 [2]上海市长宁区卫生和计划生育委员会,200050 [3]复旦大学社会发展与公共政策学院,上海市200433

出　　处：《中国全科医学》2018年第4期407-410,共4页Chinese General Practice

基　　金：国家自然科学基金资助项目(71403171);上海市浦东新区卫生和计划生育委员会学科带头人计划项目(PWRd2014-13);上海市浦东新区卫生;计生科技项目(PW2016A-3)

摘　　要：目的探讨家庭医生签约服务对社区居民就诊行为的影响。方法于2013年12月采用多阶段随机抽样法,在上海市长宁区的10个街道/镇抽取社区居民3 040例。采用本课题组研制的问卷对纳入居民进行调查,本文涉及的主要内容包括居民最近一次患病的就诊医疗机构、选择就诊医疗机构的原因、通过社区卫生服务中心转诊情况,问卷有效回收2 750份。另于2016年6月,对该3 040例居民进行追踪调查,确定问卷有效回收的居民2 004例。结果 2013年和2016年分别有51.4%(213/414)、40.7%(209/514)的签约居民最近一次患病选择到社区卫生服务中心就诊;签约居民的社区卫生服务中心就诊率高于未签约居民,差异有统计学意义(P<0.05);2016年签约居民的社区卫生服务中心就诊率低于2013年,差异有统计学意义(P<0.05)。2016年签约居民选择到社区卫生服务中心就诊的原因排在前3位的分别为就诊方便(27.7%,180/649)、病情轻(13.4%,87/649)、费用较低(11.6%,75/649)。2013年和2016年分别有7.6%(45/589)、11.9%(77/649)的签约居民通过社区卫生服务中心转诊;签约居民通过社区卫生服务中心转诊率高于未签约居民,差异有统计学意义(P<0.05);2016年签约居民通过社区卫生服务中心转诊率高于2013年,差异有统计学意义(P<0.05)。2016年46.7%(36/77)的签约居民通过家庭医生转诊,83.3%(40/48)的未签约居民通过普通门诊转诊;签约居民与未签约居民通过社区卫生服务中心转诊的方式比较,差异有统计学意义(P<0.05)。结论居民签约后就诊行为有所改善,但转诊服务利用率较低,分级诊疗格局仍有待加强。Objective To investigate the effects of contractual services from family doctors on the healthcare-seeking behavior among community residents.Methods In December 2013,by multistage cluster random sampling,we selected 3 040 community residents from 10 neighborhoods/townships in Changning District of Shanghai and surveyed them using a questionnaire developed by our research group for collecting the data mainly about the medical institution visited last time,reasons for choosing this medical institution,and the referral in community health service centers(CHSCs).Analysis was limited to the 2 750 who returned responsive questionnaires.Then,in June 2016,we conducted a follow-up survey among these 3 040 residents with the same questionnaire,among whom 2 004 responded effectively.Results The percentage of contracted residents visited CHSCs the last time for 2013 and 2016 was 51.4%(213/414),40.7%(209/514),respectively,indicating that in 2016 it decreased significantly(P<0.05).Both in 2013 and 2016,the percentages of contracted residents visited CHSCs the last time were much higher compared with those uncontracted(P<0.05).The three leading reasons for contracted residents seeking healthcare in CHSCs in 2016 were easy to access medical services(27.7%,180/649),light illness(13.4%,87/649)and low cost(11.6%,75/649).The rate of contracted residents who were referred from the community health service center to hospital in 2013 and 2016 was 7.6%(45/589),11.9%(77/649),respectively,demonstrating that in 2016 it increased significantly(P<0.05).Both in 2013 and 2016,the percentages of contracted residents who were referred from the community health service center to hospital were much higher compared with those uncontracted(P<0.05).In 2016,46.7%(36/77)of the contracted residents were referred to hospital by their contracted family doctor,83.3%(40/48)of those uncontracted were referred by the general outpatient doctor,which showed that the referral way between these two groups was significantly different(P<0.05).Conclusion The health

关 键 词：家庭医生签约服务 就诊行为 居民 

分 类 号：R197[医药卫生—卫生事业管理]