家庭医生签约服务背景下签约居民基层首诊效果评价研究  

Effectiveness Evaluation of Contracted Residents'First Contact in Primary Care in the Context of Contracted Family Doctor Services

作　　者：姜晓利 彭海波 许凌烽 徐娜 尹呈良 孟文奇 柳松艺 尹文强[1] 陈钟鸣[1] 马东平 于倩倩[1] JIANG Xiaoli;PENG Haibo;XU Lingfeng;XU Na;YIN Chengliang;MENG Wenqi;LIU Songyi;YIN Wenqiang;CHEN Zhongming;MA Dongping;YU Qianqian*(School of Management,Weifang Medical University,Weifang 261053,China)

机构地区：[1]潍坊医学院管理学院,山东省潍坊市261053

出　　处：《中国全科医学》2024年第10期1231-1237,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(71804130)。

摘　　要：背景2016年全面推行家庭医生签约服务以来,居民基层首诊意愿逐步提升,但签约居民基层首诊效果评价尚需进一步探讨。目的了解签约居民的首诊性评价现状,探讨其影响因素并提出改善策略。方法采用多阶段分层随机抽样法在山东省三市抽取54所社区卫生服务机构/乡镇卫生院,共4000名签约居民。采用汉化版基本医疗质量评估量表(PCAT)的首诊性维度问卷进行调查,比较不同特征的签约居民首诊性维度得分,采用多元线性回归分析影响签约居民首诊性评价的因素。结果共回收有效问卷3859份,问卷有效回收率为96.48%。其中,乡镇卫生院签约居民为2086名(54.1%),社区卫生服务中心为1773名(45.9%);三个地区的首诊性维度总得分为3.49分,得分最高的条目是“您的签约机构周六、周日开门吗”(3.74分);得分最低的条目是“在非营业期间,如果您在晚上生病了,您的签约机构会有医生或护士出诊吗?”(3.05分)。多元线性回归分析结果显示,签约机构、个人月收入、文化程度、婚姻状况、职业、身体健康、是否确诊慢性疾病是签约居民首诊性维度得分的影响因素(P<0.05)。结论签约居民的首诊性评价较好,但还需加强家庭医生签约服务政策宣传,引导签约居民形成基层首诊的就医观念,通过明确非工作日出诊流程、提升基层医疗卫生机构服务供给能力、加强医疗卫生机构共享平台建设、发挥医疗保障制度杠杆作用等措施推动居民基层首诊,进而提升签约居民首诊性评价。Background Since the comprehensive implementation of the contracted family doctor service in 2016,the willingness of residents to have their first contact in primary care has gradually increased,but the effectiveness evaluation of contracted residents'first contact in primary care needs to be further explored.Objective To understand the current status of contracted residents'first contact evaluation,explore its influencing factors and propose improvement strategies.Methods A multi-stage stratified random sampling method was used to select 54 community health service institutions/township health centers in three cities in Shandong Province,with a total of 4000 contracted residents.The first contact dimension questionnaire of the Chinese version of the Primary Care Quality Assessment Scale(PCAT)was used to conduct the survey,comparing the first contact dimension scores of contracted residents with different characteristics and using multiple linear regression to analyse the factors affecting the first contact evaluation of contracted residents.Results A total of 3859 valid questionnaires were collected,with the effective recovery rate of 96.48%.Among them,2086(54.1%)were residents of township health centers and 1773(45.9%)were residents of community health centers;the total score of the first contact dimension in the three regions was 3.49,with the highest score being"Is your contracted institution open on Saturdays and Sundays?"(3.74);the item with the lowest score was"During non-business hours,if you were sick at night,would your contracted facility have a doctor or nurse available?"(3.05).The results of the multiple linear regression analysis showed that the contracted facility,personal monthly income,education level,marital status,occupation,physical health and diagnosis of chronic disease were the factors influencing the scores of the first contact dimension of contracted residents(P<0.05).Conclusion The first contact evaluation result of contracted residents is good,but there is still a need to strengthen the

关 键 词：社区卫生服务 家庭医生签约服务 首诊性 基本医疗质量评估量表 基层医疗卫生机构 山东省 

分 类 号：R197.1[医药卫生—卫生事业管理]