慢性病患者的基层卫生服务质量评价研究  

Quality of Primary Care Services:a Perspective from Chronic Disease Patients

作　　者：张锦丹 陈小帆 毛秀华 王晨曦 梁欣婷 张璐 陈爱云[1] ZHANG Jindan;CHEN Xiaofan;MAO Xiuhua;WANG Chenxi;LIANG Xinting;ZHANG Lu;CHEN Aiyun(School of Health Management,Guangzhou Medical University,Guangzhou 511436,China;Faculty of Medicine,Macao University of Science and Technology,Macao 999078,China)

机构地区：[1]广州医科大学卫生管理学院,广东省广州市511436 [2]澳门科技大学医学院,中国澳门特别行政区999078

出　　处：《中国全科医学》2022年第19期2391-2398,共8页Chinese General Practice

基　　金：国家自然科学基金青年科学基金项目(72004040)——家庭医生签约背景下慢性病服务质量及影响机制研究;广东省医学科研基金(A2020285)——基于慢性病管理模型的基层整合型卫生服务现状及优化策略研究。

摘　　要：背景当前我国慢性病患病人数持续升高,提供慢性病防治服务成为基层卫生服务机构长期的重要工作。但基层卫生服务的提供存在诸多问题,影响了居民尤其是慢性病患者的服务感知。目的了解慢性病患者对基层卫生服务质量的评价,为提升基层慢性病管理服务质量提供依据。方法于2020年7—8月,采用多阶段分层随机抽样法在广东省潮州市选取至基层医疗卫生机构就诊的慢性病患者630例。采用初级保健评估工具-成人简易版(PCAT-AS)调查慢性病患者对基层医疗卫生服务质量的评价情况,包括首诊可及性、连续性、持续性、综合性及面向社区等10个维度。采用多元线性回归分析慢性病患者PCAT-AS得分的影响因素。结果共回收有效问卷553份,问卷有效回收率为87.8%。慢性病患者PCAT-AS的平均得分为(95.88±13.44)分。其中,标准化得分较高的3个维度分别为综合性(服务需求)(7.89分)、首诊可及性(7.72分)、首诊利用(7.58分),标准化得分较低的3个维度分别为连续性(转诊)(5.61分)、面向社区(6.11分)、以患者和家庭为中心(6.40分)。多元线性回归分析结果显示:城乡类别〔农村低于城市,b(95%CI)=-6.983(-10.598,-3.368)〕、文化程度〔高中及以上高于初中及以下,b(95%CI)=4.046(0.966,7.125)〕、户籍〔本地低于常住,b(95%CI)=-5.360(-9.517,-1.202)〕、自评健康状况〔较差低于好,b(95%CI)=-4.962(-8.438,-1.486);差低于好,b(95%CI)=-7.787(-12.789,-2.786)〕、是否签约家庭医生〔已签约高于未签约,b(95%CI)=4.686(2.508,6.865)〕、患常见病时首选医疗机构〔社区卫生服务中心高于村卫生室,b(95%CI)=-5.865(-9.951,-1.779);社区卫生服务中心高于区(县)级及以上医院,b(95%CI)=-6.061(-11.330,-0.792)〕、近一年至基层医疗卫生机构就诊次数〔4~6次高于1~3次,b(95%CI)=5.876(3.367,8.384);≥7次高于1~3次,b(95%CI)=9.045(6.512,11.579)〕、对基层医疗卫生服务满意度〔Background Since the number of chronic disease patients is increasing,relevant prevention and treatment services have become important long-term tasks for primary care institutions.However,problems in the provision of primary care services seriously affect the perception of such services in residents,especially chronic disease patients.Objective To understand chronic disease patients'assessment of the quality of primary care services,providing evidence for improving the quality of chronic disease management services in primary care.Methods A survey was conducted between July and August,2020 with chronic disease patients(n=630)selected from primary care settings in Guangdong's Chaozhou by use of multistage stratified random sampling.The Primary Care Assessment Tool-Adult Simplified Version(PCAT-AS)(consists of 10 domains,including first contact accessibility,coordination,ongoing,comprehensiveness,community orientation and other 5 domains)was used in the survey for understanding chronic disease patients'assessment of the quality of primary care services.Multiple linear regression was adopted to identify factors potentially associated with the PCAT-AS score.Results Altogether,553 cases(87.8%)who returned responsive questionnaires were enrolled for analysis.The average total PCAT-AS score for all respondents was(95.88±13.44).The top three domains ranked in terms of average standardized score were comprehensiveness(services needed)(7.89),first contact accessibility(7.72),and first contact utilization(7.58),and the bottom three-ranked domains were coordination(referrals)(5.61),community orientation(6.11)and patient and family centeredness(6.40).Multiple linear regression analysis indicated that higher total PCAT-AS score was associated with living in urban areas in contrast to rural areas〔b(95%CI)=-6.983(-10.598,-3.368)〕,senior high school and higher education level instead of junior high school and lower education level〔b(95%CI)=4.046(0.966,7.125)〕,permanent residents without the local hukou in contrast to th

关 键 词：卫生保健质量 获取和评价 初级卫生保健 社区卫生服务 慢性病管理 评价研究 初级保健评估工具 

分 类 号：R197[医药卫生—卫生事业管理]