家庭医生签约服务协同改革对居民健康管理的影响  

Effect of the collaborative reform of family doctor contract service on residents' health management

作　　者：黄蛟灵[1] 方帅[1] 梁鸿[1] 刘姗姗 王良晨 芦炜[3] 张宜民 HUANG Jiao-ling;FANG Shuai;LIANG Hong;LIU Shan-shan;WANG Liang-chen;LU Wei;ZHANG Yi-min(School of Social Development and Public Policy,Fudan University,Shanghai 200433,China;Pudong Institute for Health Development,Shanghai 200233,China;School of Economics and Management,Hainan Normal University,Haikou 571158,Hainan China)

机构地区：[1]复旦大学社会发展与公共政策学院,上海200433 [2]上海市浦东卫生发展研究院,上海200233 [3]海南师范大学经济与管理学院,海口571158

出　　处：《中国卫生资源》2018年第4期329-332,341,共5页Chinese Health Resources

基　　金：国家自然科学基金项目(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(PWRd2014-13);上海市浦东新区卫生计生科技项目(PW2016A-3)

摘　　要：目的在家庭医生签约服务与医疗保险支付方式协同改革背景下,探讨家庭医生签约服务对居民健康管理的影响。方法随机抽取上海市某区常住居民3 040人,分别于2013年及2016年进行跟踪问卷调查。结果两次调查签约居民血压测量频率均明显高于未签约居民。2013年签约的高血压患者中每周至少测量一次血压者比例为60.30%,明显高于未签约的高血压患者(47.11%);2016年签约患者血压测量频率依然高于未签约患者。2013年签约糖尿病患者中每周至少测量一次血糖者比例仅18.80%,低于未签约患者(21.16%);2016年签约患者该比例上升至42.28%,明显高于未签约患者(36.94%)。签约高血压与糖尿病患者总体健康状况评价与并发症干预成效均优于未签约患者。但是,签约和未签约患者并发症有效干预比例均出现下滑。结论家庭医生签约服务对慢性病患者的健康管理已产生积极作用,将来应进一步加强对慢性病并发症的干预管理。Objective To explore the effect of family doctor contract service on residents’health management in the context of collaborative reform of family doctor contract service and medical insurance payment.Methods A total of 3 040 residents were randomly selected from one district in Shanghai.Follow-up questionnaire survey was conducted in 2013 and 2016 respectively.Results According to the two surveys,the frequency of blood pressure measurement for contracted residents was significantly higher than that of the uncontracted ones.A total of 60.30%of the contracted residents with hypertension measured blood pressure at least once a week in 2013,which was significantly higher than that of the uncontracted ones(47.11%).The situation was similar in 2016.In 2013,the percentage of the contracted diabetic patients measuring blood glucose at least once a week was only 18.80%,which was lower than that of the uncontracted ones(21.16%).However,the percentage increased to 42.28%in 2016 for the contracted residents,which was significantly higher than that of the uncontracted ones(36.94%).The overall health status of the contracted patients with hypertension and with diabetes and the effect of complication intervention were better than those of the uncontracted ones.However,the proportion of effective complication intervention declined.Conclusion Family doctor contract service has a positive effect on health management of patients with chronic diseases.It is necessary to strengthen the intervention and management of chronic complications

关 键 词：家庭医生 健康管理 协同改革 

分 类 号：R197[医药卫生—卫生事业管理]