新型家庭医生签约服务制度下无锡市老龄人口社区医疗服务机构首诊情况及影响因素研究  

First-contact Care and Influencing Factors in Community Health Institutions among Elderly Patients:a Survey from Wuxi Implementing the"Upgraded"Family Doctor System

作　　者：史华伟 李娟 梁亚浩[2] SHI Huawei;LI Juan;LIANG Yahao(Jiangnan University,Wuxi 214122,China;Wuxi Hospital of Traditional Chinese Medicine,Wuxi 214071,China)

机构地区：[1]江南大学,江苏省无锡市214122 [2]江苏省无锡市中医医院,214071

出　　处：《中国全科医学》2020年第18期2318-2323,共6页Chinese General Practice

基　　金：中央高校基本科研业务费专项资金资助项目(JUSRP51711A);江苏省社科应用研究精品工程课题(19SYA-056);江苏省高校哲学社会科学研究一般项目(2019SJA0765)。

摘　　要：背景为深化医疗改革,让家庭医生服务制度更精准地提供健康服务,无锡市自2018年起面向区域内常住人口推出了新型家庭医生签约服务制度。目的分析推出新型家庭医生签约服务后无锡市老龄人口社区医疗服务机构首诊情况及其影响因素,探讨老龄人口对社区医疗服务机构提供的健康服务需求,进而为完善、推广新型家庭医生签约服务制度提供可行性建议。方法于2019年1—2月,采用分层随机抽样的方法,利用课题组自行设计的结构式自评调查问卷对879例老龄个体开展调研。调查内容包括家庭医生签约服务制度下无锡市老龄人口选择社区医疗服务机构进行首诊的现况,并进一步探讨其对社区医疗服务机构提供的健康服务的需求情况。结果共发放调查问卷879份,回收有效问卷838份,有效问卷回收率为95.3%。首选社区医疗服务机构就诊者429例。单因素分析结果显示,不同身体状况,接受社工的上门服务情况,上一年度平均月收入,接受长期、动态、循环往复的健康管理情况,步行至最近社区医疗服务机构时间,上一年度的医疗费用,知晓分级诊疗制度情况以及知晓家庭医生签约服务制度情况的无锡市患病后选择医疗机构就诊的老龄人口社区医疗服务机构首诊率比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,身体状况(经常患病:OR=2.223,P<0.05;一般:OR=1.449,P<0.05)、上一年度的医疗费用较高(2000~3000元:OR=1.153,P<0.05;>3000~4000元:OR=1.138,P<0.05;>4000元:OR=2.367,P<0.05)、步行至最近社区医疗服务机构时间较短(15~30 min:OR=1.145,P<0.05;<15 min:OR=1.438,P<0.05)、知晓分级诊疗制度(OR=1.367,P<0.05)以及知晓家庭医生签约服务制度(OR=1.573,P<0.05)是无锡市患病后选择医疗机构就诊的老龄人口选择社区医疗服务机构首诊的影响因素。老龄人口健康服务需求意愿前三位分别是:专业的用药指�Background To deepen the medical reform,and to provide precise heath services to satisfy residents'healthcare needs via the implementation of family doctor system,Wuxi City started to implement the"upgraded"family doctor system to provide contracted services for local permanent residents in 2018.Objective To investigate the choice of medical institutions for first-contact care and influencing factors in elderly people in Wuxi after the implementation of the"upgraded"family doctor system,to discuss community-based healthcare needs in this group,offering feasible suggestions for the improvement and promotion of this kind of system.Methods From January to February 2019,by use of multistage stratified random sampling,we enrolled 879 elderly people from Wuxi and surveyed them using a structured self-administered questionnaire designed by our research team for investigating the prevalence of choosing of community healthcare institutions for first-contact care during the implementation of the"upgraded"family doctor system in Wuxi,and their community-based healthcare needs.Results The survey won a response rate of 95.3%(838/879).429 of the respondents chose community healthcare institutions for initial consultation.Single factor analysis revealed that the choice of community healthcare institutions for first-contact care differed significantly by personal conditions,mean monthly income in the past year,prevalence of receiving home services provided by social workers,and receiving long-term repeated dynamic health management,time required to walk to the community healthcare institution nearest to home,medical costs in the past year,awareness levels of the hierarchical medical system and the family doctor system(P<0.05).Multivariate Logistic regression analysis showed that the physical condition(often getting sick:OR=2.223,P<0.05;general disease:OR=1.449,P<0.05),high medical costs in the past year(2000-3000 yuan:OR=1.153,P<0.05;>3000-4000 yuan:OR=1.138,P<0.05;>4000 yuan:OR=2.367,P<0.05),short time required to walk to the c

关 键 词：全科医生 家庭医生 老年人 社区卫生服务 影响因素分析 无锡 

分 类 号：R197.1[医药卫生—卫生事业管理]