家庭医生签约对功能楼宇人群社区卫生服务利用的影响机制研究  

The impact of family doctor contracting on the utilization of community health services for functional building population

作　　者：蔡丞俊 徐昕[1] 邵洁[1] 周路路 张胜冰 黄蛟灵 石建伟 黄倩[1] CAI Chengjun;XU Xin;SHAO Jie;ZHOU Lulu;ZHANG Shengbing;HUANG Jiaoling;SHI Jianwei;HUANG Qian(Weifang Community Health Service Center,Pudong New District,Shanghai 200122,China;不详)

机构地区：[1]上海市浦东新区潍坊社区卫生服务中心,上海200122 [2]上海交通大学医学院公共卫生学院,上海200025

出　　处：《中华全科医学》2025年第3期443-447,共5页Chinese Journal of General Practice

基　　金：国家自然科学基金项目(71904145);上海市浦东新区优秀青年医学人才培养项目(PWRq2021-17);上海市浦东新区卫健委学科带头人培养计划项目(PWRd2021-08)。

摘　　要：目的分析功能楼宇人群社区卫生服务利用的影响因素,探明家庭医生签约服务对社区卫生服务利用的影响机制。方法于2024年3-4月,采用典型抽样法在上海市浦东新区潍坊社区卫生服务中心辖区内选择3个功能楼宇,使用整群随机抽样法抽取396名功能楼宇人群进行调研。问卷包括社会人口学变量,医疗保障和健康状况,近6个月的社区卫生服务和家庭医生签约服务利用情况。采用单因素分析和logistic回归模型分析社区卫生服务利用影响因素,建立结构方程模型分析家庭医生签约服务对社区卫生服务利用提升的机制。结果功能楼宇人群6个月社区卫生服务利用水平为32.83%(130/396),常规家庭医生签约服务利用率为20.71%(82/396),功能楼宇家庭医生签约服务利用率为18.69%(74/396)。婚姻情况、自觉健康水平、患有慢性病、了解家庭医生制度、了解家庭医生的团队组成、信任家庭医生和有利用常规家庭医生签约服务均是社区卫生服务利用水平的影响因素(P<0.05)。结构方程模型提示常规家庭医生签约服务利用对功能楼宇家庭医生签约服务利用、社区卫生服务利用均有驱动作用,功能楼宇家庭医生签约服务利用对常规家庭医生签约服务利用有驱动作用(P<0.05)。结论家庭医生签约服务利用对于社区卫生服务的利用具有直接驱动作用,提高家庭医生知晓率及居民对家庭医生的信任感是继续提升服务利用的基石。Objective To analyze the influencing factors of community health service utilization among functional building populations,and explore the impact mechanism of family doctor contract services on community health service utilization.Methods From March to April 2024,three functional buildings in the district of Weifang Community Health Service Center in Pudong New Area of Shanghai were selected by typical sampling method,and 396 people in functional buildings were selected by cluster random sampling method for investigation.The questionnaire included sociodemographic variables,medical security and health status,utilization of community health services in the last 6 months,and utilization of contracted services by family doctors.Univariate analysis and logistic regression model were used to analyze the influencing factors of community health service utilization,and a structural equation model was established to analyze the mechanism of family doctor contract service to improve the utilization of community health service.Results The utilization level of community health services in functional buildings within 6 months was 32.83%(130/396),the utilization rate of contracted services by conventional family doctors was 20.71%(82/396),and the utilization rate of contracted services by family doctors in functional buildings was 18.69%(74/396).Marital status,perceived health level,chronic disease,understanding of family doctor system,understanding of family doctor team composition,trust in family doctor and use of regular family doctor contract service were all influencing factors on community health consumption level(P<0.05).The structural equation model indicated that the utilization of contracted services by conventional family doctors in functional buildings had a driving effect on both the utilization of contracted services by family doctors in functional buildings and the utilization of community health services,and the utilization of contracted services by family doctors in functional buildings had a driving effect on

关 键 词：家庭医生 签约服务 社区卫生 服务利用 功能楼宇 

分 类 号：R197.61[医药卫生—卫生事业管理]