上海市家庭医生制度的实施效应研究

Effect of the Implementation of Family Doctor System in Shanghai

目的了解上海市社区居民对家庭医生制度的认知、动机、需求、行为及结果评价情况,为上海市进一步推广家庭医生制度、完善家庭医生服务体系提供参考依据。方法采用分层随机抽样方法,选取上海市徐汇区、静安区、长宁区、虹口区、闵行区、松江区、宝山区、浦东区8个区,在每个区随机选取3个街道,每个街道随机选取4个站点,最终共选取了21个街道的社区卫生服务中心、73个社区卫生服务站点的社区居民844人作为调查对象。于2014年7月上旬,采用自制调查问卷进行调查。主要从居民对家庭医生制度的认知、动机、需求、行为、结果评价5个方面,了解上海市家庭医生制度的实施效应。结果本次发放问卷844份,有效回收问卷844份,有效回收率为100.0%。(1)对于签约家庭医生后可享受的优惠政策,有85.1%(718/844)的居民表示了解,其中非签约居民为58.7%(74/126),签约居民为89.7%(633/706),另有问卷空白缺失11人。两组比较,差异有统计学意义(χ2=74.54,P=0.000)。签约居民了解家庭医生服务信息的来源:53.4%(377/706)为通过医务人员推介,21.0%(148/706)为居民区宣传栏。对于家庭医生应该提供的服务内容,69.3%(585/844)的居民认为应提供慢性病管理服务,52.7%(445/844)的居民认为应提供健康教育和健康促进服务。(2)844名社区居民中,有83.6%(706/844)为签约居民。85.7%(605/706)的签约居民是为了方便,有问题可以随时向家庭医生求助。对于不签约的原因:31.0%(39/126)认为家人健康而没有必要签约,27.8%(35/126)不知道怎么签约,27.0%(34/126)对家庭医生政策不了解。(3)58.8%(496/844)的居民看重签约医生的服务态度,46.8%(395/844)看重技术水平。63.2%(533/844)的居民希望得到家庭医生提供的门诊就诊服务,59.7%(504/844)希望获得上门就诊服务,50.6%(427/844)希望得到电话咨询服务。(4)有82.4%(570/692)的签约居民找过家庭医生就诊,有46.3%(327/706)表示只要生病首先找家庭医生。有33.0%(188/570)进行过预约服务,其中55.9%(105/188)认为预约服务很方便,29.8%(56/188)认为比较方便。有75.4%(430/570)接受过转诊服务,其中56.3%(242/430)认为转诊服务很方便,29.8%(128/430)认为比较方便。(5)有68.9%(427/620)的居民认为费用有所减少;有93.5%(533/570)的居民认为医患关系有所改善。结论上海市社区居民对家庭医生制度的认知、效果评价较好;但还需引进家庭医生,并进行激励和培训,推广家庭医生制度,满足居民的医疗需求。

Objective To investigate community residents＇ cognition,motivation,demand,behavior and outcomeevaluation for family doctor system in Shanghai and to provide references for further implementation and improvement of the family doctor system in Shanghai. Methods By using stratified randomized sampling method, eight districts including Hongkou,Baoshan,Jing＇an,Xuhui,Pudong,Songjiang,Minhang and Changning were chosen,then three streets were selected from each district,and four community health centers were further selected from each street. A total of 844 community residents from73 community health service station in 21 streets were selected. A self- made questionnaire was employed in early July 2014 to investigate the effect of implementation of family doctor system from five dimensions,including cognition,motivation,demand,behavior,and outcome evaluation of residents for family doctor system. Results A total of 844 questionnaires were sent out,and844 effective questionnaires were returned with 100. 0% effective return rate. 1. Residents who knew about the preferential policy of family doctor service contract accounted for 85. 1%（ 718 /844） in all respondents,58. 7%（ 74 /126） in non- contract respondents and 89. 7%（ 633 /706） in contract respondents,with 11 respondents＇ information missing; the difference between contract and non- contract residents was significant（ χ2= 74. 54,P = 0. 000）. For information source,53. 4%（ 377 /706） of contracted residents acquired information from health workers, and 21. 0%（ 148 /706） acquired from publicity column in community. For service content,69. 3%（ 585 /844） thought chronic disease management service should be provided, and52. 7%（ 445 /844） thought health education and health promotion should be provided. 2. Of 844 community residents,contracted residents took up 83. 6%（ 706 /844）; 85. 7%（ 605 /706） signed the contract for convenience of health consultation. For reasons of not signing the contract,31. 0%（ 39 /126） thought it unnecessary because families were healthy,27. 8%（ 35 /126） didn＇t know how to become contracted,and 27. 0%（ 34 /126） didn＇t know it. 3. Respondents who regarded service attitude as the most important accounted for 58. 8%（ 496 /844）,and 46. 8%（ 395 /844） regarded professional level as the most important. Respondents who preferred outpatient service accounted for 63. 2%（ 533 /844）; 59. 7%（ 504 /844）preferred door- to- door service; 50. 6%（ 427 /844） preferred phone consultation. 4. Respondents who had received family doctor service took up 82. 4%（ 570 /692）,and 46. 3%（ 327 /706） would find family doctor immediately when getting ill. For service appointment,33. 0%（ 188 /570） had made appointments of family doctor service,55. 9%（ 105 /188） thought it very convenient,and 29. 8%（ 56 /188） thought it relatively convenient. For referral service,75. 4%（ 430 /570） had received it,56. 3%（ 242 /430） thought it very convenient,and 29. 8%（ 128 /430） thought it relatively convenient. 5. Respondents who saw lower cost in family doctor service took up 68. 9%（ 427 /620）,and respondents who saw a better doctor- patient relation in family doctor service accounted for 93. 5%（ 533 /570）. Conclusion Community residents in Shanghai have a good awareness and a well outcome evaluation about family doctor service. However,more efforts should be done,including the recruitment of more qualified family doctors,more incentives and training,in order to promote family doctor system and to meet the residents＇ medical demand.