居民社区卫生机构就诊经历对其就诊意愿的影响

Effect of Use Experience on Use Wishes of Community Health Service

目的从居民的社区就诊经历及其对就诊意愿影响的角度为社区卫生服务的可持续发展提供依据和建议。方法采用分层整群抽样和挨家挨户、面对面访谈的方式进行调查。自变量为6个社区就诊经历指标,即就诊环境、态度、过程认真程度、技术水平、程序方便程度和费用等,因变量为社区就诊意愿;控制变量包括社会人口学变量和健康状况等。结果调查对象最近1年到社区卫生服务机构就诊的占31.85%。在6个就诊经历指标中,评价好的指标为手续方便（92.05%）、态度友好（82.31%）、过程认真（79.74%）、就医环境（72.45%）、收费便宜（60.38%）和技术水平（42.67%）。多因素分析结果显示,对居民社区就诊意愿有影响的变量是社区就医环境因素（OR=2.02,95%CI：1.06-3.85）和社区就诊费用（OR=2.55,95%CI：1.40-4.67）。结论社区环境状况对居民就诊的显著性影响可能与第一印象有关;提高居民社区就诊的保报销比例,有利于提高居民的社区就诊意愿。

Objectives To provide evidence and policy recommendations for the sustainable development of community health service（CHS）for China in view of the effect of use experience on use wishes.Methods A cross-sectional survey with stratified cluster sampling method was conducted door-to-door and face-to-face in Wuhan city.The independent variables were 6index of the use experience of community health service,namely medical circumstances,medical staff attitude,medical staff carefulness,technical level,convenience of seeking medical service and medical expenses.The dependent variables were views to use CHS.Socio-demographic variables and health status were used as control variables.Results The results showed that respondents who went to see a doctor in CHS in recent years accounted for 31.85% of the total respondents.The satisfaction of the six indexes of the use experience were ranked from high to low：convenience of seeking medical service with 92.05%,medical staff attitude with 82.31%,medical staff carefulness with 79.74%%,medical circumstances with 72.45%,medical expenses with 60.38% and technical level with 42.67%.After controlling for social demography variable and health variable,the indexes that affected the use wishes were medical environments（OR=2.02,95%CI：1.06-3.85）and community medical expenses（OR=2.55,95%CI：1.40-4.67）,while the other four indexes showed no significance.Conclusions The effect of medical environments on use wishes of residents may be associated with their first impression.Increasing the reimbursement ratio of the medical insurance can help to improve the residents＇ use wishes.