家庭医生签约服务下农村老年慢性病患者用药服务满意度及影响因素研究  

Study on Satisfaction and Influencing Factors of Medication Service for Rural Elderly Chronic Patients Under Contracted Family Doctor Service

作　　者：吴怡 韩相如 钱东福 林振平[1,2] 何小菁 王屹亭[1,2] 刘汝刚 WU Yi;HAN Xiangru;QIAN Dongfu;LIN Zhenping;HE Xiaojing;WANG Yiting;LIU Rugang(School of Health Policy&Management,Nanjing Medical University,Nanjing 211166,China;Institute of Healthy Jiangsu Development,Nanjing 211166,China)

机构地区：[1]南京医科大学医政学院,江苏省南京市211166 [2]健康江苏研究院,江苏省南京市211166

出　　处：《中国全科医学》2021年第10期1205-1210,共6页Chinese General Practice

基　　金：国家自然科学基金资助项目(71874085)。

摘　　要：背景随着老龄化进程加快且慢性病患者数量不断增加,如何进一步发挥家庭医生签约服务的作用,提高基层用药服务数量和质量,促进农村地区老年慢性病患者合理利用基层卫生资源并提升居民健康水平就显得尤为重要。目的了解江苏省农村地区老年慢性病患者对于家庭医生用药服务的利用情况和满意度。方法于2019年7月在江苏省通过典型抽样和多阶段分层抽样选取1 816例老年慢性病签约患者进行调查,采用自制患者问卷调查农村地区老年慢性病患者对家庭医生用药服务利用情况和满意度。采用二分类Logistic回归分析影响农村地区老年慢性病患者对家庭医生用药服务满意度的因素。结果经数据清理,1 583份有效问卷纳入数据分析。1 167例(73.72%)在村卫生室/社区卫生服务站购买药品,184例(11.62%)在乡镇卫生院/社区卫生服务中心购买药品;1 449例(91.53%)签约患者的用药方案来自村卫生室/社区卫生服务站、乡镇卫生院/社区卫生服务中心的医务人员;1 546例(97.66%)按医嘱服药;621例(39.23%)有自购药品行为。1 402例(88.57%)对家庭医生提供的用药服务感到满意,不同家庭总收入、合并慢性病数、购药地点、用药方案来源、自购药品行为的患者用药服务满意度比较,差异有统计学意义(P<0.05)。不同购药地点患者的药费、自购药品费比较,差异有统计学意义(P<0.05)。二分类Logistic回归分析结果显示:家庭医生讲解易理解程度、家庭医生控制病情发展情况和家庭医生处药费易接受程度是农村老年慢性病患者用药服务满意度的影响因素(P<0.05)。结论江苏省农村地区家庭医生用药服务利用总体情况良好。仍有1/4签约患者有自我购药行为,农村地区家庭医生用药服务不能完全满足老年慢性病患者用药需求,签约患者对药品费用满意度仍有待提高。家庭医生用药服务质量是影响签约患�Background To satisfy the healthcare needs of increased aging population and chronic disease population to improve the national health,it is essential to take actions to make full use of contracted family doctor services,and to improve the use of amount and quality of primary medication services,especially rational use of primary care in rural elderly chronic residents.Objective To investigate the utilization of and satisfaction with medication services provided by the contracted family doctor in rural elderly chronic disease patients from Jiangsu Province.Methods In July 2019,1816 elderly patients with chronic diseases were selected by typical sampling and multi-stage stratified sampling in Jiangsu Province.The self-made questionnaire was used to investigate the utilization and satisfaction of elderly patients with chronic diseases in rural areas.Binary Logistic regression analysis was used to identify the associated factors of the satisfaction with medication services.Results 1583 cases who effectively completed the questionnaire were finally enrolled.The prevalence of purchasing drugs from the village clinic or community health station,and from the township or community health center was 73.72%(1167/1583)and 11.62%(184/1583),respectively.1449(91.53%)used the medication regimen developed by medical workers working at a village clinic or community health station and township health center or community health service center.1546(97.66%)took medicine according to the doctor’s orders.621(39.23%)had self purchase behavior.1402(88.57%)were satisfied with medication services provided by the family doctor.The satisfaction with medication services differed by household income,number of chronic diseases,place for drug purchase,source of medication regimen,and purchasing drugs by oneself(P<0.05).Purchasing place was associated with the difference in the cost of drugs(P<0.05).Purchasing place was associated with the difference in the cost of self-purchased drugs(P<0.05).Binary Logistic regression showed that the degree o

关 键 词：家庭医生签约服务 农村 老年人 用药服务 慢性病 

分 类 号：R197[医药卫生—卫生事业管理]