Continuity Evaluation of Contracted Family Doctor Services in Rural Areas Using Perceived Quality Framework

doi:10.12114/j.issn.1007-9572.2021.00.182

Abstract

Abstract: Background　In China，the implementation of contracted family doctor services is an important measure to improve the allocation of primary health care resources and quality of health care services. Although the overall contracting rate and quality of contracted services are steadily improving，there is still a lack of systematic and comprehensive tracking，collection，and studies on the continuity of such services. Objective　To investigate the continuity and influencing factors of diagnostic and treatment services provided by rural family doctors for elderly patients with chronic diseases. Methods　Typical sampling and stratified cluster sampling were used to select contracted patients from three representative counties（districts） sampled from central，southern and northern Jiangsu，China（one from each area） to attend a questionnaire survey for investigating their essential socio-demographic characteristics，quality assessment of contracted family doctor services，and health behaviors. This paper mainly analyzes the perception of rural elderly patients with chronic diseases on the service continuity. Results　A total of 1 814 cases attended the survey，1 728 of them returned responsive questionnaires，gaining a response rate of 95.26%. It was found that respondents' mean perceived evaluation score on several questions of horizontal continuity was （4.58±0.519），while that on several questions of vertical continuity was（3.48±0.817）. Seven hundred（40.50%） of the respondents gave a high evaluation of service continuity. The Logistic regression analysis showed that contracted patients' geographical location，source of medication option，evaluation of follow-up services，and guidance for healthy behaviors were the main factors affecting their perceived evaluation of continuity of contracted family doctor services. Conclusion　The continuity of family doctor services still needs to be improved. It is recommended to strengthen doctor-patient communication，establish a new delivery model of primary health care services，and improve the contracting system.

Key words: Contracted family doctor services, Service continuity, Rural, Situation analysis, Root cause analysis

摘要： 背景　家庭医生签约服务是改善基层医疗卫生资源配置及医疗服务质量的重要途径，虽然目前我国总体签约率及签约服务质量稳步提升，但仍缺乏系统全面的连续性服务研究、跟踪、采集。目的　调查了解农村签约的老年慢性病患者家庭医生连续性服务现状及其影响因素。方法　2019年7月，结合典型抽样方法与分层整群抽样方法，在江苏省苏中、苏南、苏北地区三个典型县（区）抽取老年慢性病患者进行问卷调查，调查问卷包括基本信息、家庭医生签约服务质量评估、健康行为等部分，本文主要分析农村老年慢性病患者对家庭医生签约服务连续性的感知情况。结果　共计发放问卷1 814份，回收有效问卷1 728份，问卷有效回收率为95.26%。本次调查中发现在横向连续性几个题项上签约患者对服务的感知分数为（4.58±0.519）分，在纵向连续性几个题项上的感知分数为（3.48±0.817）分，699例（40.45%）签约对象对服务连续性评价较高。Logistic回归分析结果显示，签约患者所在地区、慢性病用药方案主要来源、对家庭医生随访服务和健康行为指导的评价是影响家庭医生签约服务质量连续性感知度评价的因素（P<0.05）。结论　家庭医生签约服务连续性还需提高，建议加强医患沟通，建立基层医疗服务新模式，完善家庭医生签约体系，从而提高家庭医生签约服务质量。

关键词: 家庭医生签约服务, 服务连续性, 农村, 现状分析, 影响因素分析

QIAO Jingyi,CHEN Wangxinyue,YANG Junjie, et al. Continuity Evaluation of Contracted Family Doctor Services in Rural Areas Using Perceived Quality Framework　[J]. Chinese General Practice, 2021, 24(19): 2440-2444. DOI: 10.12114/j.issn.1007-9572.2021.00.182.
乔静怡,陈王心悦,杨君洁等. 基于感知质量评价的农村家庭医生签约服务连续性研究[J]. 中国全科医学, 2021, 24(19): 2440-2444. DOI: 10.12114/j.issn.1007-9572.2021.00.182.

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