东莞市长安镇参保人社区首诊制利用效果及影响因素研究

Utilization Effect of Community First Contact Care System Among Medically Insured Residents in Chang'an Town of Dongguan and Influencing Factors

目的了解东莞市长安镇参保人社区首诊制利用效果,并探讨其影响因素,为进一步完善首诊制服务提供依据。方法采集2012—2014年东莞市社区卫生服务信息系统中长安镇社区卫生服务中心的相关数据,包括全中心参保人就诊率、转诊率及各站人力资源配置、基本药物品规配置数、参保人均次医疗费、覆盖区域其他医疗资源配置程度、覆盖参保人密集程度。参保人就诊率、转诊率与各指标的相关性采用Spearman相关分析。结果 3年来全中心参保人平均就诊率与全市平均水平比较〔15.35%(315.45/2 055.45)比14.32%(3 023.72/21 112.36)〕,差异无统计学意义(P>0.05);而平均转诊率低于全市平均水平〔11.06%(34.89/315.45)比22.60%(683.39/3 023.72)〕,差异有统计学意义(P<0.05)。参保人社区就诊率与诊治设备配置及项目开展程度、覆盖参保人密集程度呈正相关(P<0.05);转诊率与基本药物品规配置数呈负相关(P<0.05),与覆盖区域其他卫生资源配置程度呈正相关(P<0.05)。结论长安镇参保人社区就诊率与全市平均水平持平,转诊率低于全市平均水平。为进一步提高社区首诊制的实施效果,需通过提高基本医疗诊治设备配置及开展能力,加强人才队伍建设,完善基本药物制度管理,以家庭医生式服务为契机,优化参保人指定门诊就医点捆绑。

Objective To investigate the utilization effect of community first contact care system among medically insured residents in Chang＇an Town of Dongguan and influencing factors,in order to provide references for improving community first contact care system. Methods We collected relevant data of Chang＇an Town community health service center in 2012—2014Dongguan City community health service information system, and the data included outpatient rate and referral rate among medically insured residents under the administration of the center and human resource allocation,number of categories of basic medicine,medical expense per people per time,allocation degree of other medical resources in covered area and the intensity of medically insured residents in each affiliated station. Correlation among outpatient rate and referral rate of medically insured residents and other indexes was investigated by Spearman correlation analysis. Results The three- year average outpatient rate among medically insured residents under the administration of the center was not significantly different from the city overall level〔15. 35%（ 315. 45 /2 055. 45） vs. 14. 32%（ 3 023. 72 /21 112. 36） 〕（ P〈0. 05）,and the average referral rate was lower than the city overall level 〔11. 06%（ 34. 89 /315. 45） vs. 22. 60%（ 683. 39 /3 023. 72） 〕（ P〈0. 05）. The outpatient rate was positively correlated with the medical equipment,the progress of the program and the intensity of medically insured residents（ P〈0. 05）; the referral rate was negatively correlated with the number of categories of basic medicine（ P〈0. 05）,and was positively correlated with the allocation degree of other medical resources in the covered area（ P〈0. 05）. Conclusion The outpatient rate among medically insured residents in Chang＇ an Town is equal with the city overall rate,and the transfer rate is lower than city overall rate. In order to further improve the implementation effect of community first contact care system, it is needed to improve the allocation of basic medical equipment and implementation ability,reinforce the team of talents,improve the management of essential drug system and take family doctor service as an opportunity to optimize the binding of designated clinics with medically insured residents.