高校社区居民家庭医生服务签约意愿及影响因素的调查

Survey on the willingness to sign a contract of family physician service and its influencing factors among university community residents

目的了解西北某高校社区居民的家庭医生服务签约意愿及相关影响因素,为更好地发展社区医疗保健提供参考。方法随机抽取821名西北某高校医院(社区卫生中心)及其所在社区的患者和居民以及该高校2个学院的教师作为研究对象,采用自制问卷进行调查,并对数据进行统计分析。结果调查对象中愿意通过签约方式与家庭医生保持相对固定就诊关系者419人(51.0%),不愿意签约者216人(26.3%),对是否签约持犹豫态度者97人(11.8%),认为无所谓者89人(10.9%)。不同性别、不同年龄组、不同文化程度及不同职业调查对象的家庭医生服务签约意愿比较,差异均有统计学意义(χ2=15.842,65.516,30.557,92.135;P<0.05),且随着年龄的增长,调查对象中愿意签约家庭医生服务者比例越高。在"选择家庭医生最看重的因素"一题中,有296人(36.1%)最看重与签约医生的熟悉程度,有247人(30.1%)最看重签约医生的医疗水平;在"家庭医生服务签约意愿影响因素"一题中,分别有317人(38.6%)、305人(37.1%)、125人(15.3%)、49人(6.0%)及25人(3.0%)选择了"担心延误治疗""怀疑社区诊疗能力""担心误诊""影响自由选择就医地点""担心费用太高"。68.1%的调查对象赞同家庭医生签约服务应收取必要的医疗费用即签约相关费用,453名(55.2%)调查对象可接受的签约相关费用为20~50元/年。结论社区居民对家庭医生制度的认可度还需提高,同时社区卫生服务中心应进一步思考和探索家庭医生签约服务的内容和运行模式,以提升服务质量,完善服务内容,进而提升家庭医生的整体素质和业务能力。

Objective To investigate the willingness to sign a contract of family physician service and its influencing factors among university community residents in northwest China,so as to provide insights into how to improve community healthcare.Methods A total of 821 participants were randomly selected from patients of a university hospital（community health center）,community residents,and faculty members of two colleges of this university.A self-designed questionnaire was used in this study,and statistical analysis was performed.Results Totally 419 participants（51.0%）were willing to sign a contract in order to maintain a relatively fixed relationship with their family physician,216（26.3%）expressed their unwillingness,97（11.8%）were hesitate to sign such a contract,and 89（10.9%）thought＂it doesn′t really matter＂.The willingness to sign a contract of family physician service varied significantly with gender,age,educational background,and occupation（χ2=15.842,65.516,30.557,and 92.135,respectively;all P0.05）.The proportion of willing participants increased with age.As for＂the most important factor in selecting family physician＂,296 participants（36.1%）chose＂familiarity with the contracted physician＂,and 247（30.1%）chose＂competency of the contracted physician＂.In terms of＂the influencing factor on the willingness to sign a contract of family physician service＂,317（38.6%）,305（37.1%）,125（15.3%）,49（6.0%）and 25（3.0%）chose＂ worry about possible treatment delay＂,＂ uncertain about family physician＇s competency＂,＂ worry about misdiagnosis＂,＂ may affect the free choice of medical centers＂,and＂ worry about high cost＂,respectively.About 68.1% of participants agreed that＂contract-related charge is reasonable for family physician contracted service,and 453（55.2%）believed that the acceptable standard for contract-related charge was 20-50 RMB per year.Conclusion It is important to enhance the acceptance of family physician system among community residents.Meanwhile,community health centers should further explore the contents and running mode of family physician contracted service,which may help to improve the quality and coverage of service as well as the professional competency of family physicians.