签约居民与未签约居民社区卫生服务利用差异分析  

An Analysis of Differences in Utilization of Community Health Services between Contracted Residents and Unsigned Residents

作　　者：邱宝华[1] 黄蛟灵[1] 张宜民 梁鸿[1] 张建敏 陈翔 吴建平 宋巨庆 QIU Bao-hua;HUANG Jiao-ling;ZHANG Yi-min(School of Social Development and Public Policy,Fudan University,Shanghai,200433,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]上海市虹口区欧阳路街道社区卫生服务中心,上海200081 [3]上海市虹口区卫生和计划生育委员会,上海200086 [4]上海市浦东卫生发展研究院,上海200129

出　　处：《中国初级卫生保健》2019年第1期21-23,共3页Chinese Primary Health Care

基　　金：国家自然科学基金资助项目(71403171);上海市卫生和计划生育委员会自选课题(2018HP33);复旦大学"家庭医生签约服务的供给与需求评估"横向课题(WAH3548040)

摘　　要：目的通过实证研究考察签约家庭医生是否促进了分级诊疗、有序就诊和健康管理等服务的普及。方法通过多阶段随机抽样,抽取上海市虹口区欧阳路街道18个居委100户居民家庭,共1 800名常住居民,通过问卷调查,了解签约居民与未签约居民社区卫生服务利用情况。结果签约家庭医生的居民更好地实现了有序就诊。在社区卫生服务中心首诊、双向转诊方面的比例均高于未签约居民。签约居民选择社区首诊的比例为35.15%,转诊的比例为21.43%,未签约居民分别为16.87%和9.61%。签约居民利用较多的社区医疗服务项目包括:在社区看病配药、免费健康体检和参加健康讲座。未签约居民使用最多的项目同样如此,但使用比例低于签约居民。结论较未签约居民而言,签约居民下沉就诊比例更高并且社区卫生服务利用比例更高,这表明签约服务已经初显成效。扩大社区卫生机构药品目录、鼓励居民与家庭医生建立长期稳定的服务关系是完善家庭医生制度的重要内容。OBJECTIVE Through empirical study to investigate whether family doctors promote the popularization of tiered medical servic?es,orderly medical treatment,health management services and so on.METHODS Through multi-stage random sampling,a total of 1 800 permanent residents from 100 households of the 18 neighborhood committees in Ouyang Street of Hongkou District of Shanghai were selected as objects.Through questionnaire survey to investigate the utilization of community health services between contracted residents and unsigned residents.RESULTS Contracted residents could obtain better orderly medical treatment.The proportion of contracted resi?dents choosing community first diagnosis and two-way referral was higher than that of unsigned residents.35.15%of contracted residents chosecommunity first diagnosis and 21.43%chose two-way referral,while the proportion of unsigned residents was only 16.87%and 9.61%.The most used community medical services were dispensing medicine in community,free health examination and attending health lectures.Contracted residents used more than unsigned residents.CONCLUSION Compared with unsigned residents,the propor?tion of contracted was higher,which proved contracted services had achieved initial success.Residents who saw the doctors in communi?ty and made use of community health services should expand the list of drugs in community health institutions,encourage residents and family doctors to establish long-term stable service relationship in order to improve family doctor system.

关 键 词：家庭医生 签约服务 社区卫生服务利用 

分 类 号：R197[医药卫生—卫生事业管理]