推广签约对社区卫生服务的利用及影响研究——以杭州主城区为例  

Studying on The Utilization of Community Health Services and The Influence from Promoting Contractual Services Sampled with Main Urban Area of Hangzhou

作　　者：胡小璞[1] 候乐荣 邵平[1] 孟凡莉[1] Hu Xiaopu(Hangzhou Normal University,Hangzhou,P.R.China)

机构地区：[1]杭州师范大学医学院,浙江杭州310036 [2]鸿程计算机系统有限公司

出　　处：《中国卫生事业管理》2020年第7期489-493,507,共6页Chinese Health Service Management

基　　金：杭州市社科规划“人才培育计划”专项课题“医养护一体化签约服务中的健康管理策略研究”(2017RCZX36);浙江省社科联研究课题“医养护一体化签约服务的健康管理成效及策略研究”(2018B09)。

摘　　要：目的:了解签约对居民利用社区卫生服务的影响。方法:按分层随机抽样调查杭州市江干区、下城区、拱墅区共721名居民,其中签约居民397人、65岁以上老人330人,了解并分析签约和非签约居民对基本公共卫生服务知晓、社区卫生服务资源使用及签约服务项目的需求。结果:高龄、男性、小学及以下文化程度、丧偶者对基本公共卫生服务知晓程度偏低,慢性病患病及是否签约是基本公共卫生知晓率提升的影响因素。签约的家庭医生移动电话使用高于非签约人群,但在线预约诊疗服务平台使用低于非签约人群,差异有统计学意义。在需求方面,"优先就诊、转诊""咨询服务""预约服务"是居民来社区的主要目的,签约后"疾病门诊""物理治疗""中医预防健康管理"增多,家庭病床服务选择人次数较少且两组无差异。结论:通过签约,促进了居民对基本公共卫生服务的了解,更重要的是,签约促进了居民的就诊就医。然而,健康管理服务项目不足和服务能力提升仍是社区卫生服务的主要痛点,且包含居家医疗在内的个性化签约服务的受益有限。Objective To understand the influence of signing contracts on residents’use of community health services.Methods 721 residents were chosen from Jianggan District,Xiacheng District and Gongshu District in Hangzhou with stratified random sampling method.The awareness of basic public health services,use of community health service resources,and need of contractual services project in contracted and non-contracted residents were comparatively analyzed.Results The awareness of basic public health services was lower in the elderly,male,education background of primary school and lower,and widowed.Suffering chronic diseases and signing contracts were the influencing factors to the improvement of basic public health awareness.The mobile phone use rate of contracted family doctors was significantly higher than that of non-contracted group,but their use rate of online appointment service platform was significantly lower than that of non-contracted group.In terms of demand,treatment and referral priority,consultation service and appointment service were the residents’main purposes to come to the community.After signing a contract,the amount of disease outpatient,physical therapy and preventive health management of traditional Chinese medicine has increased,while the number of family bed service choices has decreased.Conclusion Signing contracts can promote the residents’awareness of basic public health services and their medical treatment.However,insufficient health management service items and service capacity were still the main problems of community health services,and the benefits of personalized contracted services including family bed service were limited.

关 键 词：家庭医生 签约 公共卫生 健康管理 杭州 

分 类 号：R197.1[医药卫生—卫生事业管理]