天津市家庭医生签约居民首诊意愿及影响因素研究

doi:10.12114/j.issn.1007-9572.2019.07.010

摘要/Abstract

摘要： 背景　转变基层医疗卫生服务模式，实行家庭医生签约服务，是深化医药卫生体制改革的重要任务，是建立基层首诊、分级诊疗制度的必然途径，居民作为卫生服务的需求方，其首诊意愿与基层首诊的顺利推行息息相关。目的　了解天津市社区居民选择签约家庭医生首诊意愿，并探讨其影响因素。方法　于2018年1—2月采用随机抽样法从天津市16个行政区划中随机抽取和平区、北辰区、河北区3区，选取760名在该时段有基层就诊经历的社区签约居民进行问卷调查。具体内容包括居民的基本情况、居民对签约家庭医生的满意度及居民对签约家庭医生首诊意愿。比较不同特征社区居民选择签约家庭医生首诊意愿，采用Logistic逐步回归分析其影响因素。结果　共回收有效问卷754份，问卷的有效回收率为99.2%。结果显示，90.3%（681/754）的居民表示愿意选择签约家庭医生作为首诊医生。不同年龄、家庭年收入、医疗保险类型、候诊时间、对签约家庭医生满意度、对家庭医生信任程度、对自身健康问题的了解程度、应对健康问题的能力、保持健康的能力的签约居民基层首诊意愿比较，差异有统计学意义（P<0.05）；不同性别、文化程度、工作状况、患慢性病情况的签约居民基层首诊意愿比较，差异无统计学意义（P>0.05）。Logistic逐步回归分析结果显示，年龄、家庭年收入、候诊时间、对家庭医生信任程度、应对健康问题的能力是居民选择签约家庭医生为首诊医生的影响因素（P<0.05）。结论　天津市社区居民选择签约家庭医生首诊意愿较高，年龄、家庭年收入、候诊时间、对家庭医生信任程度、应对健康问题的能力是居民选择签约家庭医生为首诊医生的影响因素。

关键词: 家庭医生签约服务, 居民, 首诊意愿, 影响因素分析

Abstract: Background　Changing the delivery patterns of primary care and implementation of the contracted family doctor services are important tasks during the deepening the reform of the pharmaceutical and healthcare system，and are necessary approaches to the achievement of initial consultation in primary healthcare institutions and the development of hierarchical medical system.Residents are the demand side of health services.Their intention of choosing the contracted family doctor as a first contact for health problems is closely related to the successful achievement of initial consultation in primary healthcare institutions.Objective　To investigate the intention and influencing factors of choosing the contracted family doctor as a first contact for health problems among community-dwelling residents in Tianjin.Methods　From January to February 2018，by use of convenience sampling，3 （Heping District，Beichen District and Hebei District） of 16 administrative divisions of Tianjin were selected，from which 760 contracted community-dwelling residents with experience of seeking healthcare in primary healthcare institutions were sampled.A survey was conducted in them using a questionnaire composing of the general personal data，residents' satisfaction with the contracted family doctor，and their intention of choosing the contracted family doctor as a first contact for health problems.Logistic stepwise regression was used to analyze the factors associated with their intention.Results　A total of 754 cases handed in responsive questionnaires，with a response rate of 99.2%.The survey results revealed that 90.3% （681/754） of the respondents were willing to choose a contracted family doctor as their first contact for heath problems.The intention associated with initial consultation in primary healthcare institutions changed significantly by age，annual household income，type of medical insurance，waiting time for consultation，level of satisfaction with the contracted family doctor services，level of trust in the contracted family doctor，level of understanding of health problems，level of ability to cope with health problems，and level of ability to maintain health status among the respondents （P<0.05），but not by sex，educational level，employment status and prevalence of chronic diseases （P>0.05）．Logistic regression analysis showed that respondents' age，annual household income，waiting time for consultation，level of trust in the contracted family doctor，and level of ability to cope with health problems were the influencing factors of their intention of choosing the contracted family doctor as a first contact for health problems （P<0.05）．Conclusion　The prevalence of intending to choose the contracted family doctor as the first contact for health problems is high in community-dwelling residents in Tianjin，which is significantly associated with residents' age，annual household income，waiting time for consultation，level of trust in the contracted family doctor，and level of ability to cope with health problems.

Key words: Contracted services of family doctors, Residents, First visit intention, Root cause analysis

张玲玲,孙华君,王延赏,等. 天津市家庭医生签约居民首诊意愿及影响因素研究[J]. 中国全科医学, 2019, 22(7): 794-798. DOI: 10.12114/j.issn.1007-9572.2019.07.010.
ZHANG Lingling,SUN Huajun,WANG Yanshang, et al. Tianjin Residents' Intention of Choosing the Contracted Family Doctor as a First Contact and Its Influencing Factors　[J]. Chinese General Practice, 2019, 22(7): 794-798. DOI: 10.12114/j.issn.1007-9572.2019.07.010.

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