上海市某社区居民就医行为调查

Survey of the health seeking behavior of the residents of a community in Shanghai

目的:了解上海某社区居民的就医行为,明确居民的卫生服务需求,探索全科医生在社区医疗中的作用,为社区卫生服务机构的发展提供依据。方法:在上海市某社区中采取整群随机抽样方法抽取280名18岁以上的居民进行问卷调查,问卷内容包括居民的一般情况、健康状况、病史、就医意向、社区卫生服务利用情况、对社区卫生服务的满意度等。结果:回收有效问卷267份,占95.4%。首选市级及以上医疗机构就诊的有72名(占27.0%),首选社区卫生服务中心的有195名(占73.0%)。影响社区居民选择卫生机构就诊的主要因素有年龄、文化程度、职业、是否患有慢性疾病以及是否接受过社区卫生服务(P<0.01)。居民对社区卫生服务不满意的因素依次为药品缺少(60.7%)、担心医疗能力不足延误救治(48.3%)、不方便(10.9%)、服务态度差(5.2%)。结论:居民选择社区卫生服务中心就医的比率较高,在吸引青、壮年和高学历等人群方面还有很大的提升空间;在针对居民迫切的常见病治疗,疾病预防保健知识等方面,全科医生可以发挥积极作用;只有不断增加社区药品种类,提高社区医护人员水平,才能引导居民合理就医。

Objective：To get a better understanding of how the residents in a community of Shanghai saw the doctor and identify their demand for the health services to explore the role that the general practitioners played in the process of the community health service so as to provide the basis for the development of the community health service institutions. Methods：Using the method of the cluster random sampling, 280 residents over the age of 18 were chosen in a community in Shanghai and investigated with the questionnaire which included the contents of the general situation, health condition, illness history, medical intentions, utilization of the community health service, community health service satisfaction and others. Results：Two hundred and seventy valid copies were withdrawn, and the efifciency was 95.4%. There were 72 （27.0%） residents preferring the municipal medical institution and 195 （73.0%） preferring the community health service institutions. The major factors that inlfuenced the people to make such decision were age, education level, occupation, whether they suffered from the chronic diseases and whether they ever received the community health services or not （P〈0.01）. The factors that made the residents feel unsatisifed with the community health service were lack of medicines （60.7%）, fear of lack of medical capacity and then led to delay treatment （48.3%）, inconvenience （10.9%）, and poor service attitude （5.2%） in turn. Conclusion：The rate that the community residents choose the community health service for the medical treatment is higher. There is still a big gap to attract the young, adult and highly educated people for improvement. The general practitioners can play an active role in the aspect of the common disease treatment;disease prevention and health knowledge that the residents urgently need. Only by increasing the types of drugs and improving the capacity of the community health personnel the residents can be led to take the reasonable medical service.