杭州市居民医养护一体化智慧医疗服务的签约影响因素分析

A survey on the smart medical service model in Hangzhou:signing behavior and associated factors

2016年7月19-26日采用自编的问卷对杭州市主城区1000名(签约者和未签约者各500名)18岁及以上的居民进行调查,分析医养护一体化智慧医疗服务签约行为的影响因素.签约组和未签约组性别、年龄差异无统计学意义;文化程度、自评健康状况、慢性病患病情况、就诊偏好以及医保类型差异有统计学意义.多因素logistic回归分析显示,文化程度(OR=1.226,95%CI:1.118~1.344)、慢性病患病情况(OR=1.854,95%CI:1.524~2.257)是签约与否的影响因素.未签约者中,272名(54.4%)从未听说过“医养护一体化服务”;228名“听说过医养护一体化服务”者中,前3位的未签约原因分别为:“了解具体内容,但觉得对自己不适用”(17.0%,61/359)、“对政策具体内容不了解”(16.7%,60/359)、“签约程序复杂”(15.0%,54/359).提示结合居民的文化程度和慢性病患病情况差异,针对性地运用多种健康传播策略、宣传政策具体内容、简化签约程序将有助于该服务的推广.

To analyze the associated factors of signing behavior of the smart medical service model in Hangzhou,500 residents aged 18 years and older who signed the smart medical service and 500 unsigned residents were randomly selected from 5 urban districts of Hangzhou city from 19 to 26,July 2016.The social-demographic characteristics,chronic disease,health-seeking behavior,kinds of medical insurance were investigated by face-to-face interview.The results showed that there were significant differences in educational level,self-rated health status,chronic disease,seeking behavior and type of medical insurance,while there were no significant differences in gender and age between the signed group and the non-signed group.Logistic regression analysis revealed that residents with higher education level(OR=1.226,95%CI:1.118-1.344,P<0.01)and having more chronic diseases(OR=1.854,95%CI:1.524-2.257,P<0.01)preferred to sign the service contract.The main reasons for unwillingness of signing contract were"the service was not suitable for me"(17.0%,61/359),"I didn't know the specific content of the service"(16.7%,60/359),"the signing procedure was complicated"(15.0%,54/359).In conclusion,different communication strategies should be adopted considering residents with different educational level and chronic diseases.And delivery of detailed information,simplification of signing process will promote to popularize this smart medical service.