家庭医生服务签约老年人续约意愿及影响因素

Willingness for renewing the contract of family doctor service among elderly people and its influencing factors in Haishu District of Ningbo City

目的了解宁波市海曙区家庭医生服务签约老年人的续约意愿及影响因素。方法采用分层随机抽样方法,选取海曙区4个基层医疗机构签约门诊管理的65岁及以上老年人为调查对象。于2018年6-8月,采用自行设计的调查问卷进行家庭医生服务续约意愿调查,对数据进行χ~2检验、多因素Logistic回归分析。结果 568名老年人中,有续签意愿者占86.09%(489/568)。多因素Logistic回归分析结果显示,有流感疫苗免疫史(OR=1.267, 95%CI=1.017~2.069)、≥3次/年签约门诊就诊史(OR=2.350, 95%CI=1.498~6.072)、对家庭医生满意(OR=2.801, 95%CI=1.574~4.983)、认为家庭医生签约服务能提高就医便捷性(OR=2.524, 95%CI=1.523~4.184)的老年人家庭医生服务续约意愿较高;此外,相对无慢性病患病史者,患有1种慢性病(OR=2.028, 95%CI=1.218~3.376)和2种及以上慢性病(OR=3.035, 95%CI=1.817~5.069)的老年人更愿意续约家庭医生服务。结论海曙区家庭医生服务签约老年人续约意愿较高,流感疫苗免疫史、签约门诊就诊史、对家庭医生满意度、家庭医生签约服务提高就医便捷性的认同度、慢性病患病史是老年人续签意愿的影响因素。

Objective To investigate the willingness among elderly people for renewing the contract of family doctor service in Haishu District and its influencing factors. Methods The stratified random sampling method was used to choose people over 65 years old who signed family doctor service agreement with four respective primary medical institutions of Haishu District for a self-designed questionnaire survey of willingness for renewing the contract of family doctor service. Factors influencing willingness were determined with χ~2 test and Logistic regression analysis. Results Among the 568 respondents, 86.09% would like to renew the contract of family doctor service. The multifactor Logistic regression analysis showed that the elderly people who were more willing to renew the family doctor service agreement were those who had an influenza vaccination history(OR=1.267, 95%CI=1.017~2.069), who visited the contracted outpatient more than 3 times/year(OR=2.350, 95%CI=1.498~6.072), who were satisfied with the service of family doctor(OR=2.801, 95%CI=1.574~4.983), and who believed that the contractual service of family doctors could improve the convenience of medical treatment(OR=2.524, 95%CI=1.523~4.184). Additionally, compared with the elderly with no chronic diseases, those who suffered from one chronic disease(OR=2.028, 95%CI=1.218~3.376), and who suffered from two or more chronic diseases(OR=3.035, 95%CI=1.817~5.069), had a higher willingness to renew the contract. Conclusions The willingness among elderly people for renewing the contract of family doctors service was high in Haishu District of Ningbo City. Influenza vaccination history, visits history of contracted outpatient, satisfaction with family doctor, recognition of the convenience of contractual service of family doctors, history of chronic diseases were influencing factors of renewing the contract of family doctor service.