广州市试点地区家庭医生签约和续约现况及影响因素研究

Status and influencing factors of contracting and renewing on family doctor service in pilot areas in Guangzhou

目的通过对广州市家庭医生式服务试点地区非签约居民、签约居民及家庭医生进行调查，了解家庭医生服务现况，发现存在的问题及影响因素。方法2016年1月抽取广州市6个典型社区的社区卫生服务中心（或乡镇卫生院）为调研点，通过随机抽样的方式，选取调查期间来就诊的居民和社区全体家庭医生为调查对象。采用EpiData双录入数据，使用SPSS20．0软件进行统计分析。结果非签约居民对家庭医生的签约意愿率为66．0％，去除混杂因素后，二元logistic回归分析显示，性别和是否需要家庭医生对自己（及家庭）进行健康管理是签约意愿的影响因素。94．6％的签约居民有续约意愿，去除混杂因素后，二元logistic回归分析显示，影响续约意愿的因素包括整体满意度和签约家庭医生有无必要。结论家庭医生式服务顺利发展，仍需突破诸多瓶颈，而提高签约意愿率和续约意愿率是家庭医生制度可持续发展的基础。

Objective To learn the current status of family doctor service at pilot communities in Guangzhou, and discover existing problems and influencing factors by investigating the residents who have contracted such service, those have not and the family doctors. Methods This study chose typical community health centers of six communities in Guangzhou in January 2016. In random sampling, residents who visited doctors during the survey and all the family doctors were surveyed. EpiData was used to doubly input data, with SPSS 20.0 for statistical analysis. Results 66. 0% of those residents who have not contracted the service are willing to contract a family doctor. According to the binary logistic regression analysis after eliminating the interference factors, there are two factors affecting their willingness ： gender and whether needing a family doctor for themselves and their family for health management. According to the binary logistic regression analysis after eliminating the interference factors, the influencing factors of renewing contract arc overall satisfaction and necessity for signing family doctors. Conclusions The smooth development of the family doctor service is faced with many bottlenecks, while improving willingness to contract and renew contract to family doctors are the cornerstone for sustainability of the family doctor