医联体全科团队对居民家庭医生签约意愿的影响研究

The Influence of General Practice Alliance on the Residents' Willingness to Sign a Family Physician

目的建立三级综合医院全科团队参与下的家庭医生服务模式,探讨其对社区居民家庭医生签约意愿的影响。方法选取2017-05-01至2017-06-30温州市2家社区卫生服务中心(梧田社区卫生服务中心、南浦社区卫生服务中心)辖区内的居民为调查对象,采用单纯随机抽样方法共抽取社区居民560人。采用随机数字表法分成社区家庭医生组(单纯社区家庭医生签约服务模式)与医联体全科团队组(三级综合医院全科团队参与的家庭医生签约服务模式),对两组居民家庭医生签约意愿进行调查,调查内容包括:调查对象的基本情况,对家庭医生签约知晓度、签约意愿及其影响因素。结果共发放问卷560份,回收有效问卷540份,有效回收率为96.4%。两组居民性别、年龄、平均月收入、文化程度、医保类型比较,差异无统计学意义(P>0.05)。两组居民对家庭医生签约知晓度比较,差异无统计学意义(P>0.05);医联体全科团队组居民的签约意愿高于社区家庭医生组(P<0.05)。社区家庭医生组居民就医可接受距离、就医行程时间短于医联体全科团队组(P<0.05);社区家庭医生组居民担心误诊漏诊、延误病情、用药不规范、转诊不方便发生率高于医联体全科团队组(P<0.05);两组居民担心服务态度不好发生率比较,差异无统计学意义(P>0.05)。结论三级综合医院全科团队参与下的家庭医生签约服务模式有助于提高居民对基层卫生服务能力的认可度,提高其签约意愿,可有效推动家庭医生签约服务,引导居民分层就医、优化医疗资源利用。

Objective To establish a family doctor service model under the direction of the general hospital team at a tertiary hospital and discuss the impact on community resident of family doctors'willingness to sign contracts.Methods The residents of two community health service centers(Wutian Community Health Service Center,Nanpu Community Health Service Center)in Wenzhou City were selected to participate in the study between 2017-05-01 and 2017-06-30,and 560 people were recruited from the community using a simple random sampling method.The participants were randomly divided into the community family doctor group(simple community family doctor contracted service model)and the medical general team group(three-tier hospital general team participation family doctor service model)to investigate the willingness of the two groups of residents and family doctors to sign contracts.The survey included the following:the basic situation of the surveyed subjects;the knowledge of family doctor-style services;the willingness to sign contracts;and the factors that influence the signing of contracts.Results A total of 560 questionnaires were distributed and 540 valid questionnaires were returned,the effective recovery rate was 96.4%.There were no significant differences between the two groups with respect to gender,age,average monthly income,education level,and type of medical insurance(P>0.05).There was no significant difference in the degree of knowledge of family doctors signing up between the two groups(P>0.05).The willingness to sign contracts for family doctors in the medical general team group was higher than the community family doctor group(P<0.05).The acceptable distance to the community family doctor group was believed to be shorter than the medical general team,while the medical travel time that the community family doctor group accepted was shorter than the medical general team(P<0.05).The surveyed people in the community family doctor group had more concerns about misdiagnoses,missed diagnoses,non-indicated medications,and inconvenience of the referral rate than the medicial general team group(P<0.05).There was no significant difference in the incidence of bad service attitudes between the two groups(P>0.05).Conclusion The family doctor service model under the direction of the general hospital team in a tertiary hospital helps to increase community residents'recognition of primary health service capabilities,effectively promote family doctor signing services,guide residents to stratify medicial treatment,and optimize the use of medical resources.