First-contact Care and Influencing Factors in Community Health Institutions among Elderly Patients：a Survey from Wuxi Implementing the "Upgraded" Family Doctor System

doi:10.12114/j.issn.1007-9572.2020.00.100

Abstract

Abstract: Background　To deepen the medical reform，and to provide precise heath services to satisfy residents' healthcare needs via the implementation of family doctor system，Wuxi City started to implement the "upgraded" family doctor system to provide contracted services for local permanent residents in 2018.Objective　To investigate the choice of medical institutions for first-contact care and influencing factors in elderly people in Wuxi after the implementation of the "upgraded" family doctor system，to discuss community-based healthcare needs in this group，offering feasible suggestions for the improvement and promotion of this kind of system.Methods　From January to February 2019，by use of multistage stratified random sampling，we enrolled 879 elderly people from Wuxi and surveyed them using a structured self-administered questionnaire designed by our research team for investigating the prevalence of choosing of community healthcare institutions for first-contact care during the implementation of the "upgraded" family doctor system in Wuxi，and their community-based healthcare needs.Results　The survey won a response rate of 95.3%（838/879）.429 of the respondents chose community healthcare institutions for initial consultation.Single factor analysis revealed that the choice of community healthcare institutions for first-contact care differed significantly by personal conditions，mean monthly income in the past year，prevalence of receiving home services provided by social workers，and receiving long-term repeated dynamic health management，time required to walk to the community healthcare institution nearest to home，medical costs in the past year，awareness levels of the hierarchical medical system and the family doctor system（P<0.05）.Multivariate Logistic regression analysis showed that the physical condition（often getting sick：OR=2.223，P<0.05；general disease：OR=1.449，P<0.05），high medical costs in the past year （2 000-3 000 yuan：OR=1.153，P<0.05；>3 000-4 000 yuan：OR=1.138，P<0.05；>4 000 yuan：OR=2.367，P<0.05），short time required to walk to the community healthcare institution nearest to home（15-30 min：OR=1.145，P<0.05；<15 min：OR=1.438，P<0.05），awareness of the hierarchical medical system（OR=1.367，P<0.05） and awareness of the contracted family doctor system（OR=1.573，P<0.05）were the influencing factor of choosing community healthcare institutions for first-contact care.The top three healthcare needs were professional guidance on medication〔75.8%（635/838）〕，scientific guidance on health promotion〔73.1%（612/838）〕，and scientific guidance on health protection〔72.6%（608/838）〕.Conclusion　The rate of choosing community healthcare institutions for first-contact care in elderly people in Wuxi needs to be improved，which is associated mainly with personal conditions，medical costs in the past year，time required to walk to the community healthcare institution nearest to home，awareness levels of the hierarchical medical system and the family doctor system.It is suggested that during the promotion of the "upgraded" family doctor system，more attention should be paid to individual healthcare needs，by which the implementation of the system may become an effective tool for relieving the doctor-patient contradiction in the aging society，and improving medical resources utilization efficiency and ensuring the caring efficiency for the elderly.

Key words: General practitioners, Family doctor, Aged, Community health services, Root cause analysis, Wuxi

摘要： 背景　为深化医疗改革，让家庭医生服务制度更精准地提供健康服务，无锡市自2018年起面向区域内常住人口推出了新型家庭医生签约服务制度。目的　分析推出新型家庭医生签约服务后无锡市老龄人口社区医疗服务机构首诊情况及其影响因素，探讨老龄人口对社区医疗服务机构提供的健康服务需求，进而为完善、推广新型家庭医生签约服务制度提供可行性建议。方法　于2019年1—2月，采用分层随机抽样的方法，利用课题组自行设计的结构式自评调查问卷对879例老龄个体开展调研。调查内容包括家庭医生签约服务制度下无锡市老龄人口选择社区医疗服务机构进行首诊的现况，并进一步探讨其对社区医疗服务机构提供的健康服务的需求情况。结果　共发放调查问卷879份，回收有效问卷838份，有效问卷回收率为95.3%。首选社区医疗服务机构就诊者429例。单因素分析结果显示，不同身体状况，接受社工的上门服务情况，上一年度平均月收入，接受长期、动态、循环往复的健康管理情况，步行至最近社区医疗服务机构时间，上一年度的医疗费用，知晓分级诊疗制度情况以及知晓家庭医生签约服务制度情况的无锡市患病后选择医疗机构就诊的老龄人口社区医疗服务机构首诊率比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，身体状况（经常患病：OR=2.223，P<0.05；一般：OR=1.449，P<0.05）、上一年度的医疗费用较高（2 000~3 000元：OR=1.153，P<0.05；>3 000~ 4 000元：OR=1.138，P<0.05；>4 000元：OR=2.367，P<0.05）、步行至最近社区医疗服务机构时间较短（15~30 min：OR=1.145，P<0.05；<15 min：OR=1.438，P<0.05）、知晓分级诊疗制度（OR=1.367，P<0.05）以及知晓家庭医生签约服务制度（OR=1.573，P<0.05）是无锡市患病后选择医疗机构就诊的老龄人口选择社区医疗服务机构首诊的影响因素。老龄人口健康服务需求意愿前三位分别是：专业的用药指导75.8%（635/838）、科学的养生指导73.1%（612/838）、科学的保健指导72.6%（608/838）。结论　无锡市老龄人口社区医疗服务机构首诊率有待提高，老龄人口身体状况、上一年度的医疗费用、步行至最近社区医疗服务机构时间、是否知晓分级诊疗制度、是否知晓家庭医生签约制度是其首选社区医疗服务机构就诊的影响因素；建议新型家庭医生签约服务制度的推行应该更充分考虑健康服务相关需求，进而使其成为缓解老龄社会医患矛盾、提高医疗资源使用率和保障养老效率的利器。

关键词: 全科医生, 家庭医生, 老年人, 社区卫生服务, 影响因素分析, 无锡

SHI Huawei,LI Juan,LIANG Yahao. First-contact Care and Influencing Factors in Community Health Institutions among Elderly Patients：a Survey from Wuxi Implementing the "Upgraded" Family Doctor System　[J]. Chinese General Practice, 2020, 23(18): 2318-2323. DOI: 10.12114/j.issn.1007-9572.2020.00.100.
史华伟,李娟,梁亚浩. 新型家庭医生签约服务制度下无锡市老龄人口社区医疗服务机构首诊情况及影响因素研究[J]. 中国全科医学, 2020, 23(18): 2318-2323. DOI: 10.12114/j.issn.1007-9572.2020.00.100.

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