我国居民签约家庭医生意愿率的Meta分析

Rate of Residents Intending to Sign a Health Service Contract with the Family Doctor in China:a Meta-analysis

背景2016年我国开始在医联体内推行家庭医生签约服务制度,期望改变基层医疗卫生服务模式,提升基层服务能力。目前,我国居民签约家庭医生的意愿不清,了解当前居民签约家庭医生的意愿情况,分析其影响因素,有利于我国家庭医生签约制度的推行。目的系统评价我国居民签约家庭医生的意愿率,分析其影响因素。方法计算机检索中国知网、万方数据知识服务平台、维普网、PubMed、EMbase、The Cochrane Library等数据库,收集我国居民签约家庭医生意愿相关的文献,检索时限为2009-01-01至2018-06-01。由2名研究者独立筛选文献并提取数据,对纳入研究偏倚风险进行评价。采用Stata 12.0统计软件进行Meta分析。结果共纳入34篇文献,调查时间范围2011—2017年,包括32 326例居民,有签约意愿的居民人数为20 344例,签约意愿率为62.9%[95%CI(56.7%,68.6%)]。根据地区、调查时间、性别、民族、年龄、文化程度、职业、是否知晓家庭医生服务及健康状况进行亚组分析,结果显示,民族、是否了解家庭医生服务是影响居民签约意愿的因素(P<0.05)。居民不愿签约的原因主要有:(1)不了解家庭医生服务;(2)不信任全科医生的能力;(3)怕自己就医受限;(4)担心社区设备差或药品受限;(5)不清楚签约的好处;(6)担心签约费用;(7)医生服务的态度差;(8)没有需求。结论我国居民签约家庭医生意愿率为62.9%,民族、是否了解家庭医生服务是影响居民签约意愿的因素。

Background In 2016,China began to promote the implementation of the contracted family doctor services by the member institutions of the regional medical consortium,aiming to improve the service delivery patterns and service capabilities of primary healthcare facilities.At present,the status of residents'intention of signing a health service contract with the family doctor is not unclear.And examining their intention and associated factors is favorable for the development of the contracted family doctor services.Objective To systematically evaluate the rate of Chinese residents'intention of signing a health service contract with the family doctor and analyze the associated factors.Methods Articles about residents'intention of signing a health service contract with the family doctor in China published during January 1,2009 to June 1,2018 were retrieved via searches of the electronic databases of CNKI,Wanfang Data Knowledge Service Platform,VIP,PubMed,EMbase,and The Cochrane Library.Two reviewers independently screened literature,extracted data and assessed the risk of bias of the included studies.Meta-analysis was performed by using Stata 12.0.Results A total of 34 articles were included,involving 32 326 Chinese residents as the participants of surveys conducted during 2011 to 2017.The overall prevalence of signing a health service contract with the family doctor was 62.9%(20 344/32 326)〔95%CI(56.7%,68.6%)〕.To identify the associated factors for residents'intention of signing a health service contract with the family doctor,subgroup analyses on residential region,survey time,sex,minzu,age,educational level,occupation,awareness level of the family doctor services and health status were carried out and the results showed that minzu and awareness level of the family doctor services were associated with the intention of signing a health service contract with the family doctor(P<0.05).For the following reasons,residents did not want to sign the contract:(1)Knowing little about family doctor services;(2)Distrusting the professional capabilities of general practitioners;(3)Worrying about the problem of limited access to healthcare possibly brought by receiving the contracted family doctor services;(4)Worrying about the problem of unsatisfactory treatment devices or limited drugs in community-based healthcare settings designated in the contract;(5)Being unclear about the benefits of the contracted family doctor services;(6)Worrying about not being able to afford the contracted family doctor services;(7)Worrying about being served by the contracted family doctor with bad attitude;(8)Having no need of such services.Conclusion The rate of residents intending to sign a health service contract with the family doctor in China was 62.9%,which was influenced significantly by residents'minzu,and awareness level of the contracted family doctor services.