广东省欠发达地区居民家庭医生式服务签约现状及服务需求的影响因素研究

Status of Signing a Contract with a Family Doctor Team and Associated Factors of Needs for Family Doctor Services among Residents in Underdeveloped Areas of Guangdong Province

目的了解广东省欠发达地区居民的家庭医生式服务签约现状,探讨影响居民对家庭医生式服务需求的因素。方法在广东省欠发达地区粤东、粤西、粤北,分别随机抽取2个城市作为样本市;然后在每个样本市的城镇和农村再各随机抽取2个社区卫生中心/站,共24个社区卫生服务中心/站;最后采用方便抽样法,在每个社区卫生中心/站分别选取符合纳入和排除标准的居民共3 000例为调查对象。于2016年8月,采用自行设计的调查问卷进行调查。问卷的主要内容为:居民的基本情况、居民对家庭医生式服务的知晓情况、家庭医生式服务的签约情况和未签约的原因、居民对家庭医生式服务的需求情况。共发放问卷3 000份,回收有效问卷2 887份,问卷的有效回收率为96.2%。结果居民对家庭医生式服务的知晓率为42.7%(1 233/2 887);对家庭医生式服务知晓的居民签约率为56.4%(628/1 114),不签约的原因为不需要者占86.6%(421/486)。居民在了解家庭医生式服务后认为有需求者占89.6%(2 581/2 879)。不同年龄、学历、婚姻状况、工作状况、家庭月收入、自觉健康状况以及有无医疗保险、是否患慢性病的居民对家庭医生式服务的需求率比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄、工作状况、有无医疗保险是居民对家庭医生式服务需求情况的影响因素(P<0.05)。结论广东省欠发达地区居民对家庭医生式服务的知晓水平和签约率较低,但了解家庭医生式服务后居民的需求率较高。年龄、工作状况、有无医疗保险是居民对家庭医生式服务需求情况的影响因素。应加大对家庭医生的政策支持与宣传力度和投入,有针对性制定重点人群的签约服务包,从而促进家庭医生式服务的发展。

Objective To investigate the status of signing a contract with a family doctor team and associated factors of needs for family doctor services among residents in underdeveloped areas of Guangdong Province. Methods Using multi-stage random sampling,at first,we randomly sampled 6 cities from eastern Guangdong,western Guangdong,and northern Guangdong（ 2 from each of the three parts of Guangdong）,then,we randomly selected 2 community health service centers（ CHSCs）/community health service stations（ CHSSs） from the urban and rural areas of each city,respectively（ 24 in total）,and finally,from these CHSCs/CHSSs,we selected 3 000 residents receiving treatment and meeting the inclusion and exclusion criteria of this study as the participants by convenience sampling. In August 2016,we conducted a survey in the participants using a self-designed questionnaire consisting of demographic data,level of awareness of family doctor services,status of signing a contract with a family doctor team, causes for failing to sign a contract with a family doctor team, and the needs for family doctor services. The survey obtained a response rate of 96. 2%（ 2 887/3 000）. Results A total of 42. 7%（ 1 233/2 287） of the final participants had heard of family doctor services,but only 56. 4%（ 628/1 114） of them had already signed a contract with a family doctor team. Among those who did not sign a contract with a family doctor team,86. 6% were due to lack of needs（ 421/486）. After knowing about family doctor services,89. 6%（ 2 581/2 879） thought that they needed the services. The needs for family doctor services varied by age,educational attainment,marital status,employment status,household monthly income,self-perceived health status,status of medical insurance and prevalence of chronic diseases（ P〈0. 05）. Multivariate Logistic regression analysis found that,age,employment status and medical insurance status were associated factors of the needs for the services（ P〈0. 05）. Conclusion Both the awareness level of family doctor services and rate of signing a contract with a family doctor team are unsatisfactory among residents in underdeveloped areas of Guangdong Province. However,the residents＇ needs for family doctor services are increased after knowing about the services. Age,employment status and medical insurance status are the factors associated with the needs for family doctor services. Therefore, in order to promote the development of family doctor system,strong policy support and publicity and targeted services developed for priority groups are necessary.