西部地区家庭医生签约服务推广中医务人员自身影响因素研究

Influencing Factors of Medical Staff in the Promotion of Contracted Family Doctor Services in Western Regions

背景医务人员作为服务的提供方,研究其自身对家庭医生所需条件的认知对从供方角度促进家庭医生签约服务的开展具有重要意义。目的了解西部地区各级医疗卫生体系中医务人员对于推进家庭医生签约服务项目发展所需自身条件的认知,为更好地推行家庭医生式服务、细化系统工作提供参考。方法于2019年3—5月,采用多阶段抽样方法,使用自行设计的调查问卷,对南充、绵阳、重庆等地区60所医疗机构在岗的医务人员进行现场自填式问卷和网络自填式问卷调查。调查内容包括医务人员基本情况、推进家庭医生签约服务发展所需的自身条件、医务人员参与家庭医生签约服务项目的现状和意愿。采取统计描述、因子效度检验、Logistic回归分析对调查数据进行分析。结果1797例医务人员中,男221例(12.30%),女1576例(87.70%);编制内1347例(74.96%),编制外450例(25.04%)。Logistic回归分析显示,影响医务人员参与家庭医生签约服务现状的因素有职业素养、家庭环境、生活态度、额外职业素养(P<0.05);影响医务人员参与家庭医生签约服务意愿的因素有职业素养、家庭环境、额外职业素养(P<0.05)。结论从供方的角度,通过对工作时间超负荷的医务人员提供补偿、提升医务人员职业素养、提高医务人员家庭对家庭医生工作的支持,有助于不断完善家庭医生签约制度的发展。

Background As medical service providers,medical staff’s cognition of the requirements for family doctors is of great significance to promote the contracted family doctor services from the perspective of the supplier.Objective To understand the cognition of medical staff in the medical and health system at all levels in Western China on the conditions necessary to promote the development of the contracted family doctor service project,in order to provide a reference for the better implementation and detailed system work of family doctor services.Methods Using a multi-stage sampling method,a self-designed questionnaire survey was conducted among medical staff in 60 medical institutions in Nanchong,Mianyang and Chongqing from March to May in 2019 through the on-site and online self-administered questionnaire.The questionnaire included the basic information of medical staff,the internal conditions required for the development of contracted family doctor service project,and the situation and willingness of medical staff to participate in the project.After the data was sorted,statistical description,factor validity test and Logistic regression analysis were used to analyze the survey data.Results Among the 1797 medical staff,221(12.30%)were male,1576(87.70%)were female,1347(74.96%)were in the establishment,and 450(25.04%)were out of the establishment.Logistic regression analysis showed that factors affecting the participation of medical staff in contracted family doctor services currently included occupational quality factors,family environmental factors,life attitude and additional occupational quality factors(P<0.05).Factors affecting the willingness of medical staff to participate in contracted family doctor services were occupational quality factors,family environmental factors,and additional occupational quality factors(P<0.05).Conclusion From the perspective of the supplier,the development of contracted family doctor service project could be continuously improved through providing compensation for medical staff who are overloaded with working hours,improving the occupational quality of medical staff,and improving the support of medical staff families to the work of family doctors.