基于供方感知视角的家庭医生签约服务质量评价及影响因素研究  

Family Doctor Teams' Evaluation for Contracted Family Doctor Services and Influencing Factors

作　　者：欧晏辰 谢月英 王振邦 赵越 张鑫 左延莉 OU Yanchen;XIE Yueying;WANG Zhenbang;ZHAO Yue;ZHANG Xin;ZUO Yanli(School of Information and Management of Guangxi Medical University,Nanning 530021,China;Medical Insurance Management Office,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Academic Affairs Office of Guangxi Medical University,Nanning 530021,China;General Medical College of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学信息与管理学院,广西壮族自治区南宁市530021 [2]广西医科大学第一附属医院医疗保险管理办公室,广西壮族自治区南宁市530021 [3]广西医科大学教务处,广西壮族自治区南宁市530021 [4]广西医科大学全科医学院,广西壮族自治区南宁市530021

出　　处：《中国全科医学》2024年第22期2773-2779,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(71864006);广西自然科学基金资助项目(2021GXNSFAA196075,2018GXNSFAA138102);广西高等教育本科教学改革工程一般项目A类(2022JGA155);广西医科大学特色新型智库调研课题项目(GXMUZX16)。

摘　　要：背景家庭医生签约服务是基层卫生服务改革工作的重点,当前我国签约服务的覆盖率稳步提升,但履约服务的提供仍存在诸多问题,家庭医生团队对签约服务质量的评价尚不明晰。目的研究家庭医生团队的履约服务现状及影响因素。方法于2022年10月,通过立意抽样和分层整群抽样,选取广西壮族自治区南部、中部、北部和东部的780例家庭医生团队成员进行问卷调查。采用初级卫生保健质量评价工具-供方简化版(PCAT-PS)量表对纳入对象展开调查,涵盖首诊、连续性、协调性等8个维度、43个条目。采用多元线性回归分析家庭医生团队成员PCAT-PS得分的影响因素。结果共回收有效问卷775份,问卷有效回收率为99.36%。家庭医生团队成员PCAT-PS量表平均得分为(32.55±3.90)分。其中,得分较高的2个维度分别为以病人及家庭为中心、综合性(提供的服务),得分较低的2个维度分别为首诊(可及性)、连续性。多元线性回归分析结果显示,机构类别、年龄、职称、团队职责分工和工作方式的变化情况是家庭医生团队PCAT-PS量表得分的影响因素(P<0.05)。结论广西壮族自治区家庭医生团队成员对签约服务质量的评价整体良好,城乡基层医疗卫生机构的感知质量评分存在差异,以团队为形式开展的家庭医生工作模式有利于签约服务质量的提升。建议加快推进“质”“量”并重的家庭医生团队建设,探索薪职一体化协同发展路径,打造“政府-社区-家庭”共同治理、资源共享的整合型家庭医生签约服务网络。Background Contracted family doctor services were implemented as a key action to reform primary care services in China.At present,the coverage of contracting has expanded stably.But the family doctor teams'evaluation of contracted family doctor services is not clear,which also highlights a number of issues that require further improvement in the provision of the services.Objective To study the contracted family doctor services for family doctor teams and associated factors.Methods In October 2022,a combination of purposive sampling and stratified cluster sampling was used for selecting family doctor team members from southern,central,northern and eastern Guangxi to participate in a questionnaire survey.The survey was conducted on the included subjects by using the provider version of the Primary Care Assessment Tools(PCAT-PS),which contains 8 dimensions and 43 items.Multivariate Logistic regression analysis was used to research the influencing factors of family doctor teams'perception of PACT-PS of the services.Results A total of 775 valid questionnaires were collected,with a valid response rate of 99.36%.The average score of the PCAT-PS of the family doctor team members was(32.55±3.90).The dimensions with the relatively high score were family-centeredness and comprehensiveness,but the dimensions of first contact-access and ongoing care of the services had a relatively low-level perception.Multiple linear regression analysis showed that the type of organization,age,professional title,division of team responsibilities and working patterns were the factors that influence the PCAT-PS score of family doctor team members(P<0.05).Conclusion The family doctor team members had an overall good evaluation on contracted family doctor services while differences in the quality of the services among primary health care institutions in urban and rural areas.The working mode of family doctor team has a positive effect on the improvement of contracted family doctor services quality.To further improve the family doctor teams'eval

关 键 词：家庭医生团队 家庭医生签约服务 卫生保健质量 初级保健评估工具 影响因素分析 

分 类 号：R197[医药卫生—卫生事业管理]