重庆市巴南区慢病人群家庭医生签约服务影响因素分析

Analysis of factors influencing attitude towards family physician contract services among chronic patients in Banan District,Chongqing

目的探析重庆市巴南区高血压、2型糖尿病患者这2类重点人群的家庭医生签约影响因素,旨在为推进及改善该区家庭医生签约服务提供理论基础与实证依据。方法采用单纯随机抽样法,从重庆市巴南区抽取高血压、2型糖尿病患者共590名作为调查对象,采用问卷调查的方式收集调查对象对家庭医生签约服务的真实需求和建议,采用统计描述、单因素分析、多因素Logistic回归分析家庭医生签约服务的影响因素。结果590名调查对象中已签约对象492名(83.39%),未签约对象98名(16.61%)。不同年龄段、自评健康状况、婚姻状况以及居住地到签约医院步行所需时间、首诊医院、签约服务知晓情况不同的调查对象的签约率比较,差异均有统计学意义(P<0.05),其中,46~59岁年龄段调查对象签约率最高(96.8%),自评健康状况为差的调查对象签约率最高(92.3%),居住地到签约医院步行所需时间<30 min的调查对象签约率更高(87.6%),首诊医院为家庭医生签约医院的调查对象签约率最高(89.9%),知晓签约服务的调查对象签约率更高(93.8%)。Logistic回归分析结果显示:年龄、文化程度、医保支付主要方式、是否知晓签约服务、居住地到签约医院步行所需时间是调查对象家庭医生服务签约情况的影响因素(P<0.05)。结论年龄、文化程度、医保支付主要方式、签约服务知晓情况、居住地到签约医院步行所需时间是高血压、2型糖尿病这2类重点人群家庭医生签约的影响因素。今后应开展形式多样的家庭医生签约服务政策宣传,创新开展针对性、个性化签约服务,探索出台相关报销政策,多管齐下吸引更多重点人群参与签约服务。

Objective To analyze the factors influencing the attitude towards family physician contract services among the two key populations(hypertension and type 2 diabetes patients)in Banan District of Chongqing City,so as to provide a theoretical basis and empirical evidence for promoting and improving family physician contract services in the district.Methods A simple random sampling method was used to collect a total of 590 patients with hypertension or type 2 diabetes from Banan District,Chongqing City.A questionnaire survey was conducted to collect the real needs and suggestions regarding family physician contract services.Statistical description,single factor analysis and multi-factor logistic regression analysis were used to identify the influencing factors of attitude towards family physician contract services.Results Among the 590 surveyed subjects,492(83.39%)had a contracted family physician and 98(16.61%)did not.Comparing the signing rates of subjects of different age,self-assessed health status,time required to reach the contracted hospital,hospital of first visit and knowledge of contract services,the differences were all statistically significant(P<0.05).Among all subjects,patients with the highest signing rates are those aged 46-59 years(96.8%),with poor self-assessed health status(92.3%),first visiting a hospital providing family physician contract services(89.9%),living in a place less than 30 mins away from the contracted hospital(87.6%)and having a knowledge of the services(93.8%).Logistic regression analysis results showed that age,education level,main payment method of medical insurance,awareness of family physician contract services and time required to reach the contracted hospital are the factors influencing whether a subject has a contracted family physician(P<0.05).Conclusion Age,education level,main payment methods of medical insurance,awareness of family physician contract services and time required to reach the contracted hospital are the factors influencing hypertension and type 2 diabetes patients′decision to sign a contract with family physicians.In the future,more forms of publicity should be carried out,targeted and personalized contract services should be developed,relevant reimbursement policies should be explored,and a multi-pronged approach should be taken to attract more key populations to participate in family physician contract services.