With the aging of the population and changes in the disease spectrum, the incidence of multimorbidity among the elderly remained high, and have become the focus of the family doctor contracting service at the primary level. At present, there are many studies promoting the signing of family doctors from the perspective of increasing "quantity", but there is still a lack of studies on the factors affecting the effectiveness of family doctor contract services for elderly multimorbidity patients after signing from the perspective of improving "quality".

To explore the important influencing factors of satisfaction and usefulness evaluation of elderly multimorbidity patients with family doctor contract services in urban communities of guangdong province, and to provide a basis for future improvement of multimorbidity management services at the grassroots level.

From September to December 2022, elderly patients with multiple chronic conditions in the community of Guangdong Province (Shenzhen, Zhanjiang and Meizhou) were selected by multi-stage stratified whole cluster random sampling method and surveyed by self-administered questionnaire. Multifactorial Logistic regression analysis was used to explore the influencing factors of satisfaction and usefulness evaluation of family doctor contracting services for elderly multimorbidity patients.

A total of 636 valid questionnaires were collected, with effective recovery rate of 99.69% (636/638). There were 624 family doctors who were relatively satisfied/very satisfied, accounting for 98.11%; The service usefulness evaluation of family doctors was slightly helpful/greatly helpful to 625 people, accounting for 98.27%. The results of multivariate Logistic regression analysis showed that patients with general satisfaction of family doctor contract service were taken as reference. Patients with hyperlipidemia (OR=15.203), disease duration <3 years (OR=48 703 577.681), 4 chronic diseases (OR=135.131), and severe dependence on self-care ability (OR=668 738.913) were more likely to make satisfactory evaluations than patients with complete self-care. Patients with annual personal income of ≤ 30 000 yuan (OR<0.001), >30 000-50 000 yuan (OR<0.001), >50 000-100 000 yuan (OR<0.001) were less likely to make a satisfactory evaluation than patients with income >100 000-200 000 yuan (P<0.05). Patients aged 65-69 years (OR=12.573) were more likely to be very satisfied than those aged ≥70 years, and those with 4 chronic diseases (OR=135.131) were more likely to be very satisfied than those with 5 or more chronic diseases. The average annual income of individuals was ≤ 30 000 yuan (OR<0.001), >30 000-50 000 yuan (OR<0.001), and some understanding of the disease (OR=0.013) or more understanding (OR=0.035) patients were less likely to give a very satisfactory evaluation (P<0.05). Multivariate Logistic regression analysis of the evaluation of the effectiveness of family doctor contract services by elderly patients with comorbidity of chronic diseases showed that taking the family doctor contract service as not very useful as the dependent variable, patients aged 65-69 years old (OR=28.710) were more likely to make a slightly helpful evaluation than patients aged ≥70 years old. Working patients (OR=0.091) were less likely to give a slightly helpful evaluation than unemployed patients (P<0.05). Patients aged 65 to 69 years (OR=56.795) were more likely to make helpful evaluations than those aged ≥70 years, and patients with chronic heart failure (OR=0.023) were less likely to make helpful evaluations than those without the disease (P<0.05) .

The overall level of satisfaction and usefulness evaluation of family doctors contracted services of elderly multimorbidity patients in urban communities of Guangdong province is relatively high, both above 95%, which is influenced by a combination of factors, including changing the type of chronic disease, annual income, knowledge of the condition, and self-care ability. In the future, we should continue to standardize and improve the connotation of family doctor contracted services, optimize the management mode of key populations such as elderly multimorbidity, improve the satisfaction and sense of gain of patients, so as to ultimately enhance the effectiveness of family doctor contracted services.

随着人口老龄化加剧和疾病谱的变化，老年慢性病共病发病率居高不下，已成为基层家庭医生签约服务的重点关注人群。目前，从增"量"角度分析家庭医生签约的研究较多，但尚缺乏从提"质"角度入手，对签约后老年慢性病共病患者家庭医生签约服务的成效进行研究。

探索广东省社区老年慢性病共病患者对家庭医生签约服务的满意度和有用性评价的重要影响因素，为今后基层老年慢性病共病管理服务提供改进依据。

于2022年9—12月，采用多阶段分层整群随机抽样方法，选取广东省（深圳市、湛江市、梅州市）社区老年慢性病共病患者为调查对象，采用自行设计的问卷进行调查。采用多因素Logistic回归分析探讨老年慢性病共病患者家庭医生签约服务满意度和有用性评价的影响因素。

共收回有效问卷636份，有效回收率99.69%（636/638）。家庭医生签约服务满意度评价为比较满意/非常满意624人，占比98.11%；家庭医生签约服务有用性评价为略有帮助/帮助很大625人，占比98.27%。多因素Logistic回归分析结果显示，以对家庭医生签约服务满意度为一般的患者为参照，患高脂血症（OR=15.203）、患病时间<3年（OR=48 703 577.681）、患4种慢性病（OR=135.131）以及自理能力为重度依赖（OR=668 738.913）的患者相对于完全自理的患者易做出比较满意的评价，个人年均收入为≤3万元（OR<0.001）、>3万~5万元（OR<0.001）、>5万~10万元（OR<0.001）的患者相对于收入>10万~20万元的患者更不容易做出比较满意的评价（P<0.05）；65~69岁的患者（OR=12.573）相对于≥70岁的患者，以及患4种慢性病（OR=135.131）相对于患5种及以上慢性病患者易做出非常满意的评价，而对于个人年平均收入为≤3万元（OR<0.001）、>3万元~5万元（OR<0.001）和对病情了解一些（OR=0.013）或比较了解（OR=0.035）的患者相对不容易做出非常满意的评价（P<0.05）。以老年慢性病共病患者对家庭医生签约服务有用性评价为因变量的多因素Logistic回归分析结果显示，以认为家庭医生签约服务帮助不大为参照，65~69岁的患者（OR=28.710）相对≥70岁的患者易做出略有帮助的评价，有工作的患者（OR=0.091）相对无业的患者不易做出略有帮助的评价（P<0.05）；65~69岁的患者（OR=56.795）相对≥70岁的患者易做出帮助很大的评价，患有慢性心力衰竭的患者（OR=0.023）相对未患病的患者不易做出帮助很大的评价（P<0.05）。

广东省老年慢性病共病患者家庭医生签约服务满意度和有用性评价总体水平较高，均在95%以上，该评价受多方因素共同影响，包括患慢性病种类、年收入、对病情了解情况、自理能力。未来应继续规范和完善家庭医生签约服务内涵，优化老年慢性病共病患者等重点人群管理模式，提高患者满意度和获得感，最终提升家庭医生签约服务成效。