The Evaluation of Community Health Services for Patients with Multimorbidity in a Community of Shenzhen Based on Contracted Family Doctor Services

doi:10.12114/j.issn.1007-9572.2020.00.222

Abstract

Abstract: Background　Community health service centers with contracted family doctor services as the main body are the main battlefields for the prevention and treatment of multimorbidity.High-quality primary health care services are an essential guarantee for better health outcomes.However，there are few literatures on the evaluation of community health services for patients with multimorbidity.Objective　To investigate the evaluation of community health services for patients with multimorbidity in a community of Shenzhen and its influencing factors.Methods　Patients with multimorbidity were selected by simple random sampling for a baseline investigation in June of 2017.The follow-up survey was conducted at the six and twelve months under the background of contracted family doctor services.The Primary Care Assessment Tool（PCAT） was used to evaluate community health services and the results were analyzed by generalized estimation equation.Results　The average score of community health services was（84.57±19.72） at the baseline survey，（93.74±15.34） at the first follow-up，and （98.39±15.15） at the second follow-up.There were significant differences in scores of community health services in three times of surveys（P<0.001） and in pairwise comparisons（P<0.05）.The results of multivariate analysis showed that education level，marital status，types of medical payment，having contracted family doctors or not，hospitalization in past three years，self-assessment of health status and treatment burden were influencing factors of community health service evaluation.Conclusion　 The evaluation of community health services among patients with multimorbidity in a community of Shenzhen is gradually increasing.Patients with multimorbidity who have contracted family doctor services have a higher evaluation of community health services.For the health management of patients with multimorbidity，the contracted family doctor should be the key point for the comprehensive，continuous，holistic and integrated management.

Key words: Primary health care, Health service research, Community health service evaluation, Multimorbidity, Contracted family doctor services, Generalized estimating equations

摘要： 背景　以家庭医生签约服务为主体的社区健康服务中心是多病共存防治的主战场，高质量的初级卫生保健服务是获得更好的健康结果的重要保障。然而，鲜有文献研究多病共存患者的社区健康服务评价。目的　探讨深圳市社区多病共存患者的社区健康服务评价及其影响因素。方法　2017年6月，采用简单随机抽样的方法抽取多病共存患者进行基线调查，在家庭医生签约服务开展背景下，分别于第6、12个月进行随访调查。采用初级卫生保健评估工具（PCAT）进行评估，运用广义估计方程对结果进行分析。结果　基线调查时社区健康服务评价总分平均为（84.57±19.72）分，第1次随访时总分平均为（93.74±15.34）分，第2次随访时总分平均为（98.39±15.15）分，各次调查多病共存患者的社区健康服务评价总分比较，差异有统计学意义（P<0.001），两两比较，差异均有统计学意义（P<0.05）。多因素分析结果显示：文化程度、婚姻状况、医疗保险类型、有无签约家庭医生、近3年有无住院、自我健康状况评价和治疗负担是社区健康服务评价的影响因素（P<0.05）。结论　深圳市社区多病共存患者的社区健康服务评价呈逐渐升高趋势，签约家庭医生的患者有更高的社区健康服务评价，多病共存患者的健康管理应以签约家庭医生为抓手进行全面、连续、整体、综合管理。

关键词: 社区卫生服务, 卫生服务研究, 社区健康服务评价, 多病共存, 家庭医生签约服务, 广义估计方程

YANG Zhipeng,ZHANG Shengchao,ZHANG Jiayun, et al. The Evaluation of Community Health Services for Patients with Multimorbidity in a Community of Shenzhen Based on Contracted Family Doctor Services　[J]. Chinese General Practice, 2020, 23(13): 1621-1626. DOI: 10.12114/j.issn.1007-9572.2020.00.222.
杨志鹏,张升超,张嘉允等. 家庭医生签约服务背景下深圳市社区多病共存患者社区健康服务评价研究[J]. 中国全科医学, 2020, 23(13): 1621-1626. DOI: 10.12114/j.issn.1007-9572.2020.00.222.

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