医联体服务模式下慢性病患者社区首诊意愿分析

Willingness to Have the Initial Diagnosis in Community Health Service Centers of Patients with Chronic Diseases in Medical Integration Model

目的通过了解医联体服务模式下慢性病患者社区首诊意愿及其影响因素,为进一步提高医联体建设成效、完善分级诊疗服务体系建设提供参考意见。方法 2016年6月,采用多阶段抽样方法,从北京朝阳医院医联体和清华大学附属北京市垂杨柳医院医联体中,抽取4所社区卫生服务中心(以下简称社区)内的341例慢性病患者进行调查。采用自行编制的调查问卷对慢性病患者进行面对面访谈式调查。问卷内容主要包括人口学特征、社区首诊意愿及相关情况、对医联体的了解情况。采用多因素Logistic回归分析分析慢性病患者社区首诊意愿的影响因素。结果共发放问卷341份,回收问卷341份,回收率100.0%,剔除回答问题前后逻辑不一致的问卷,有效问卷320份,有效回收率93.8%。66.6%(213/320)的慢性病患者有社区首诊意愿。57.8%(185/320)的慢性病患者对医联体了解。不同职业、受教育程度、医疗保险类型、慢性病对生活影响程度的慢性病患者社区首诊意愿比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,受教育程度、职业、医疗保险类型是慢性病患者社区首诊意愿的影响因素(P<0.05)。结论大部分慢性病患者社区首诊意愿较高,且慢性病患者受教育程度、职业、医疗保险类型是其社区首诊意愿的影响因素。因此,社区应逐步加大慢性病规范管理的力度,引导慢性病患者逐步回归社区,条件成熟时建立慢性病社区首诊制度。

Objective To further improve the effectiveness of medical integration model and to promote the construction of hierarchical medical system through analyzing the willingness to have the initial diagnosis in community health service centers of patients with chronic diseases and its influencing factors in medical integration model. Methods Using the multistage sampling method,341 patients with chronic diseases from four selected community health service centers in Beijing Chao-yang Hospital medical integration and Beijing Chuiyangliu Hospital Affiliated to Tsinghua University medical integration in June 2016. A self-designed questionnaire was used to conduct face-to-face interview with patients. The contents of the questionnaire were mainly demographic characteristics,patients＇ willingness to have the initial diagnosis in community health service centers,and patients＇ knowledge of the medical integration model. Multivariate Logistic regression analysis was used to analyze the factors influencing the willingness to have the initial diagnosis in community health service centers among patients with chronic diseases. Results A total of 341 questionnaires were distributed and all of them were recollected. The recovery rate was100. 0%. Eliminating the questionnaires with inconsistent logic,320 questionnaires were effective and the effective recovery rate was 93. 8%. In addition,66. 6%（ 213/320） of patients showed a willingness to have the initial diagnosis in community health service centers and 57. 8%（ 185/320） of patients had a certain knowledge of the medical integration model. There were significant differences among patients with chronic diseases in different education level,occupations,medical insurance types,and different chronic diseases（ P〈 0. 05）. Multivariate Logistics regression analysis showed that the education level,occupations and medical insurance type were factors influencing the willingness to have the initial diagnosis in community health service centers among patients with chronic diseases（ P〈 0. 05）. Conclusion Most patients have a high willingness to have the initial diagnosis in community health service centers, and the education level, occupations and medical insurance type are influencing factors. Therefore,the community health service centers should strength the management of chronic diseases and guide the patients with chronic diseases to return to community health service centers gradually,with the establishment of the initial diagnosis system of chronic diseases when the time comes.