基于多水平模型的家庭医生签约影响因素研究  

Factors affecting the willingness to sign family doctor contracted services using multi-level generalized hierarchical model

作　　者：傅佩佩 孙懿泓 周成超 FU Peipei;SUN Yihong;ZHOU Chengchao(Center for Health Management and Policy,School of Public Health,Shandong University,Jinan,Shandong 250012,China;Key Laboratory of Health Economics and Policy,National Health Commission,Shandong University,Jinan,Shandong 250012,China)

机构地区：[1]山东大学卫生管理与政策研究中心,山东济南250012 [2]山东大学国家卫生健康委员会卫生经济与政策研究重点实验室,山东济南250012

出　　处：《中国农村卫生事业管理》2024年第8期538-543,共6页Chinese Rural Health Service Administration

基　　金：国家自然科学基金项目(72204147)。

摘　　要：目的了解山东省农村居民对家庭医生的签约意愿并探讨其影响因素,为促进家庭医生签约服务在山东省农村地区的顺利开展提供政策建议。方法在山东省采用随机抽取6个样本县进行问卷调查,利用多水平广义分层线性模型进行影响因素探讨。结果山东省2978名签约家庭医生的居民中,27.73%的居民签约了家庭医生。多水平模型回归结果表明,个体层面上,受教育程度越高的农村居民(高中及以上:OR=1.71,P=0.001)、经常参加体育锻炼(OR=1.40,P=0.001)、患有多重慢病(OR=1.53,P=0.006)的农村居民更倾向于签约家庭医生;在村级层面上,有较好的村卫生室信息化程度有更高的签约率(OR=1.31,P=0.005);在镇级层面,卫生院基本药物供应充足(OR=1.53,P=0.032)、信息化程度较好(OR=1.28,P=0.005)、参加过家庭医生相关培训(OR=3.19,P=0.002)以及是中心卫生院(OR=1.92,P<0.001)都与较高的签约概率相关。结论加强对基层居民的宣传,提高健康意识,合理配置卫生资源,提升基层卫生服务整体水平,并引导居民合理就医,进而提升家庭医生的签约率以及运行效率。Objective To assess the willingness of rural residents in Shandong Province to engage with family doctors and to explore associated determinants,thereby providing policy recommendations for the successful implementation of family doctor contracted services in rural areas of Shandong Province.Methods A questionnaire survey was conducted in six randomly selected counties in Shandong Province,employing a multi-level generalized hierarchical linear model to explore influencing factors.Results Among 2978 residents in Shandong Province who were approached for family doctor contracting,27.73%had engaged in such contracts.Regression analyses results revealed that at the individual level,rural residents with higher education(high school and above:OR=1.71,P=0.001),regular physical exercise(OR=1.40,P=0.001),presence of multiple chronic diseases(OR=1.53,P=0.006)were more willing to contract with family doctors;at the village level,clinics with higher degrees of informatization had higher signing rates;and at the town level,health centers with sufficient availability of essential medications(OR=1.53,P=0.032),higher degree of informatization(OR=1.28,P=0.005),and with doctors having family doctor training(OR=3.19,P=0.002)and central hospitals(OR=1.92,P<0.001)had greater signing probabilities.Conclusions It is recommended to enhance publicity of family doctor contracted services among residents,improve their health literacy,achieve equitable allocation of healthcare resources,elevate overall standards of primary healthcare services,and encourage rational healthcare-seeking behaviors among residents,so as to augment family doctor signing rates and operational efficiency.

关 键 词：家庭医生 签约服务 影响因素 乡村医生 基层医疗机构 多水平广义分层模型 农村 

分 类 号：R197[医药卫生—卫生事业管理]