医联体背景下社区居民首诊意愿调查研究

Survey on the willingness of residents to choose community health service centers as their initial doctor visits under the united health system

目的了解医联体背景下居民社区首诊意愿,分析影响因素,提出应对策略,为促进社区首诊的真正落实提供参考。方法于2018年4~5月,采用多阶段抽样的方法,从阜阳市3区5县中各随机抽取1个区2个县,再从抽取的每个县(区)随机抽取4个社区,对抽取的每个社区按东、南、西、北、中五个位置各随机抽取5~8名居民进行问卷调查。结果68.20%(281/412)的居民愿意选择社区首诊,其原因有就诊方便、手续简单、医保定点单位等,分别占87.90%、43.77%和37.72%(χ^2=970.560,P<0.01);31.80%(131/412)的居民不愿意选择社区首诊,其原因有诊疗设备落后、技术水平低、就诊环境差等,分别占63.36%、51.15%和29.01%(χ^2=316.063,P<0.01)。Logistic回归分析显示年龄、职业、步行至社区卫生服务(community health sewice,CHS)机构时间、提供的CHS整体改善情况等4个因素可能是居民社区首诊意愿的影响因素,"50~59岁"年龄组(OR=3.19,95%CI:0.88~11.54)、从事商业和服务业(OR=1.63,95%CI:0.77~3.47)、步行至CHS机构时间<10 min(OR=0.70,95%CI:0.42~1.19)和认为提供的CHS整体基本没变化(OR=1.82,95%CI:0.22~15.44)的居民更愿意选择社区首诊。结论阜阳市居民社区首诊意愿较高,但仍有近1/3的居民不愿意接受社区首诊。为促进社区首诊制度的真正贯彻落实,需要在健康宣传与引导、硬件建设、人才培养与引进、医联体建设等方面加大力度。

Objective To understand the willingness of residents to choose community health service centers as their initial doctor visits under the united health system,and to analyze the influencing factors.Methods During April and May in 2018,a total of 412 residents were randomly selected from 12 communities of 3 districts and 5 counties in Fuyang City using multi-stage sampling method and a questionnaire survey was conducted.SPSS 22.0 software was used for data process.χ^2 test and binary logistic regression analysis were performed to determine the influencing factors.Results 68.20%(281/412)of the residents showed their willingness to go to the local community health service centers for their initial doctor visits due to the convenience(87.90%),simple procedure(43.77%)and medical insurance designated visiting sites(37.72%).While,31.80%(131/412)of the residents were unwilling to go because of outdated medical equipments(63.36%),lower level of medical practice(51.15%)and poor environment(29.00%).Binary logistic regression analysis showed that age,occupation,walking distance to community health service centers and the overall improvement of the service centers were major influencing factors of residents′willingness to choose community health service centers.Residents in age group of 50-59(OR=3.19,95%CI=0.88-11.54),doing business and working in service industry(OR=1.63,95%CI=0.77-3.47),being close to community health service center(less than 10 min of walking)(OR=0.70,95%CI=0.42-1.19)and claiming improved or unchanged services(OR=1.82,95%CI=0.22-15.44)were more likely to go to community health service centers as their first choices of doctor visits.Conclusions Almost two-thirds of the residents in Fuyang are willing to go to community health service centers as their first choices of doctor visits.Age,occupation,walking distance and the overall improvement of the service centers are major influencing factors.