邻里中心卫生单元对开展家庭医生服务的影响研究

Influence of Neighborhood Center Health Unit on the Development of Family Doctor Services

目的探讨邻里中心卫生单元对开展家庭医生服务的影响。方法采用简单随机抽样法,在上海市闵行区马桥社区卫生服务中心下设的"吉祥坊"邻里中心卫生单元、旗忠社区卫生服务站、邻松社区卫生服务站分别抽取2017年1—9月的门诊就诊居民830、270、560例。采用本课题组自行设计的问卷,对居民进行面对面入户调查,调查时间为2017年10—11月,主要内容为居民的基本情况、对家庭医生签约服务的利用情况、就诊满意度。结果共回收有效问卷1 600份,问卷有效回收率为96.39%。其中,邻里中心卫生单元就诊居民800例(邻里中心卫生单元组),社区卫生服务站就诊居民800例(社区卫生服务站组),两组性别、年龄等基本情况间无差异(P>0.05)。在签约及就诊方面,邻里中心卫生单元组居民的"1+1+1"签约率、社区首诊率、预约转诊率高于社区卫生服务站组(P<0.05),两组居民"1+1+1"组合内就诊率、因病住院率、大病及时转诊率间无差异(P>0.05);在健康管理服务利用方面,邻里中心卫生单元组居民接受健康评估、开具延伸处方、通过社区筛查发现疾病、依从性好的比例高于社区卫生服务站组(P<0.05),两组居民开具慢性病延伸处方比例间无差异(P>0.05);在中医药和康复服务利用方面,邻里中心卫生单元组居民接受过中医药和康复服务的比例高于社区卫生服务站组(P<0.05)。在就诊满意度方面,邻里中心卫生单元组居民对医生诊疗水平、医生服务态度、中医药和康复服务、预约转诊、开具延伸处方、自检项目的满意度评分及总体满意度评分高于社区卫生服务站组,对排队等候时间的满意度评分低于社区卫生服务站组(P<0.05);两组居民对上门诊疗、健康体检的满意度评分间无差异(P>0.05)。结论邻里中心卫生单元的设立可拉近家庭医生与居民的距离,有效提升居民的就诊满意度,有利于家庭医生制度的落实和分级诊疗制度的形成。

Objective To investigate the influence of neighborhood center health unit on the development of family doctor services.Methods By use of simple random sampling,we enrolled 1 660 residents who received outpatient care from 3 subordinate institutions of Minhang District Maqiao Community Health Center located in Shanghai(830,270,560 from Jixiangfang Neighborhood Center Health Unit,Qizhong Community Health Station,Linsong Community Health Station,respectively)during January to September,2017.Then,from October to November 2017,we conducted a face-toface household survey with a questionnaire developed by our research team,for collecting the demographic characteristics,use of the contracted family doctor services and satisfaction with care.Results A total of 1 600 residents returned responsive questionnaires,with a response rate of 96.39%,including 800 from Jixiangfang Neighborhood Center Health Unit(neighborhood center health unit group),800 from other two community health stations(community health station group).Both groups had similar distribution of sex and age and other general demographic characteristics(P>0.05).In terms of signing a contract with family doctors and healthcare-seeking status,neighborhood center health unit group demonstrated higher rates of signing the"1+1+1"type of contract with family doctors,initial consultation in community healthcare settings,receiving upward referrals after making an appointment by the family doctor compared with community health station group(P<0.05),but the rates of healthcare-seeking in the health institutions designated in the"1+1+1"type of contract,illness-related hospitalization,and timely referral due to a serious illness were similar in both groups(P>0.05).With regard to use of health management services,neighborhood center health unit group showed higher rates of receiving health assessment,receiving prescriptions that can be extended,receiving disease screening,and good adherence(P<0.05),but the rate of receiving prescriptions for chronic disease that can be extended was similar in both groups(P>0.05).In regard to use of Chinese medicine and rehabilitation services,neighborhood center health unit group showed a higher rate of receiving such services than the community health station group(P<0.05).In respect of satisfaction with health-seeking,neighborhood center health unit group presented higher mean scores of satisfaction with health-seeking,physicians'professional management,physicians'attitude toward patients during healthcare delivery,Chinese medicine and rehabilitation services,upward referrals after making an appointment by the family doctor,prescription services that can be extended,and self-examinations and lower mean scores of satisfaction with the waiting time for healthcare(P<0.05),but the scores of satisfaction with home-based care and physical examination were similar in both groups(P>0.05).Conclusion The establishment of neighborhood center health unit is convenient to seek healthcare,which also can effectively improve the level of residents'satisfaction with healthcare-seeking,and promote the implementation of family doctor system and hierarchical medical system.