社区卫生服务中心长程家庭医生签约需求的影响因素研究  

Factors Influencing the Demand for Long-term Family Doctor Contract in Community Health Service Centers

作　　者：熊刘芳 邹晓昭 马涵英[1] 赵铁夫[1] XIONG Liufang;ZHOU Xiaozhao;MA Hanying;ZHAO Tiefu*(Department of General Practice,Beijing Anzhen Hospital,Capital Medical University,Beijing 100000,China)

机构地区：[1]首都医科大学附属安贞医院全科医学科,北京市100000

出　　处：《中国全科医学》2024年第10期1238-1244,共7页Chinese General Practice

摘　　要：背景我国社区慢性病患者逐年增加,家庭医生签约服务是我国促进人民群众健康的重要途径,长程家庭医生签约将有助于提高健康管理的连续性和治疗效果,分析患者对长程签约的需求,对于国家推进家庭医生服务至关重要。目的探究北京市朝阳区社区患者对于长程家庭医生签约服务的需求并分析其影响因素,为临床改进家庭医生服务提供理论依据。方法采用连续入组,于2020年1月—2021年1月在北京市朝阳区八里庄社区卫生服务中心、太阳宫社区卫生服务中心和将台社区卫生服务中心纳入家庭医生签约患者500例作为研究对象。根据患者是否愿意长程签约服务分为同意长程签约组(简称签约组)和拒绝长程签约组(简称拒签组)。2020年1月—2021年1月通过线上系统检索患者健康档案录入患者性别、年龄、慢性病等资料,其余一般资料包括文化程度、收入状况、医疗支出、健康状况、住址距离、依从性、是否独居等指标通过问卷调查方式进行收集和补充。2021年1—3月使用问卷调查法收集一般资料、服务质量评价以及长程家庭医生签约意愿。通过文献检索、专家咨询以及研究前期开放性问卷调查结果设计家庭医生服务质量评价SERVQUAL量表,分别从期望质量、感受质量以及重要程度维度按1~5分进行打分,期望评分与感知评分用于计算服务质量评分(SQ),后者用于进行重要程度矫正后SQ评分。采用多因素Logistic回归分析探讨长程家庭医生签约服务需求的影响因素。结果本研究共发放500份问卷,共回收问卷423份,包括微信平台(73例,17.2%)、线下问卷(190例,44.9%)以及电话访谈(160例,37.8%),问卷有效率为84.6%。签约组283例(66.9%),拒签组140例(33.1%)。SEVRQUAL量表的SQ平均分为-0.54,感知平均分为3.98分,期望平均分为4.52分。两组矫正后SQ评分及各维度平均分比较,差异有统计学意义(P<0.05);�Background The number of patients with chronic diseases in the community of China is increasing annually.Family doctor contract service is an important way to promote people's health in China,and long-term family doctor contract will help to improve the continuity of health management and the treatment outcomes.Analyzing patient demand for longterm family doctor contract is critical to the advancement of family medicine services in China.Objective To investigate the demand for long-term family doctor contract among community patients in Beijing Chaoyang Distrct and analyze its influencing factors,so as to provide a theoretical basis for achieving high quality family medicine services.Methods Using continuous enrollment,500 patients who were enrolled in family doctor contract service at Baliqiao community health service center,Taiyanggong community health service center and Jiangtai community health service center in Chaoyang District,Beijing from January 2020 to January 2021 were included as the study subjects and categorized into the agreement group(those willing to sign long-term contracts)and the refusal group(those unwilling to sign long-term contracts).Data on patient demographics,chronic diseases,educational level,income status,medical expenses,health status,distance from home to the community health service center,compliance,living arrangements,and other indicators were collected through online system retrieval of health records and supplemented by questionnaire surveys from January 2020 to January 2021.From January to March 2021,a questionnaire survey was conducted to collect general information,service quality evaluation,and willingness to sign long-term family doctor contracts.The SERVQUAL scale was designed based on literature retrieval,expert consultation,and preliminary open-ended questionnaire survey results to evaluate the quality of family doctor services.Scores were assigned for expected quality,perceived quality,and importance,ranging from 1 to 5.Expectation scores and perception scores were use

关 键 词：社区卫生服务 家庭医生签约 健康管理 影响因素分析 

分 类 号：R197.1[医药卫生—卫生事业管理]