银川市家庭医生服务签约居民续约意愿及影响因素分析

Willingness to renew residents and significant factors of residents signing family medical service in Yinchuan City

目的开展家庭医生签约服务对推进分级诊疗、提升基层医疗卫生服务水平及缓解居民"看病难、看病贵"问题具有重要意义。本研究探讨银川市家庭医生服务签约居民的续约意愿并分析其影响因素,为进一步推进家庭医生签约服务提供参考依据。方法2019年7-9月选择银川市3个社区卫生服务机构的480名签约居民作为调查对象,采用自行设计的调查问卷进行调查,分析签约居民续约意愿影响因素。结果共发放问卷480份,回收有效问卷456份,有效回收率为95%。签约居民有续签意愿者占71%。是否知道家庭医生的姓名及坐诊时间(χ^2=7.314,P=0.007)、是否知道家庭医生的联系方式(χ^2=11.416,P=0.001)、家庭医生签约服务是否可以提高就医便捷性(χ^2=5.970,P=0.015)、是否享受过家庭医生上门服务(χ^2=8.673,P=0.003)、认为家庭医生是否比非家庭医生工作更仔细(χ^2=9.503,P=0.002)、对基层医疗卫生服务机构的医药收费是否满意(χ^2=9.641,P=0.002)、对家庭医生服务的内容是否满意(χ^2=21.962,P<0.001)、家庭医生的诊疗技术水平是否满意(χ^2=26.137,P<0.001)及对家庭医生的信任度评价(χ^2=15.456,P<0.001)与签约居民续签意愿有关联。Logistic回归分析结果显示,从住所到最近社区卫生服务机构花费的时间(OR=0.555,95%CI为0.330~0.934,P=0.027)、是否满意家庭医生的诊疗技术水平(OR=1.969,95%CI为1.189~3.259,P=0.008)、对家庭医生的信任度(OR=1.737,95%CI为1.091~2.768,P=0.020)是影响签约居民续签意愿的主要因素。结论银川市家庭医生服务签约居民续签意愿相对较高。从住所到最近的社区卫生服务机构花费的时间、对家庭医生诊疗技术水平的满意度及对家庭医生的信任度是签约居民续签意愿的影响因素。

OBJECTIVE Carrying out family doctor contracting services is of great significance to promote hierarchical diagnosis and treatment,improve the level of primary medical care and health services,and alleviate the problem of"difficult and expensive medical treatment"for residents.This study explores the willingness of residents to sign a contract for family doctor services in Yinchuan City and analyzes their influencing factors,so as to provide a reference for further promoting family doctor contract services.METHODS From July to September in 2019,a total of 480 contracted residents of 3 community health service institutions in Yinchuan were selected as the survey objects,and a self-designed questionnaire was used for the survey,and the influencing factors of residents’willingness to renew their contracts were analyzed.RESULTS A total of 480 questionnaires were distributed and 456 valid questionnaires were recovered,with an effective recovery rate of 95%.71%of the residents who signed the contract were willing to renew.Do you know the name and time of the family doctor(χ^2=7.314,P=0.007),do you know the contact information of the family doctor(χ^2=11.416,P=0.001),whether the family doctor signing service can improve the convenience of medical treatment(χ^2=5.970,P=0.015),Have you ever visited a family doctor’s home service(χ^2=8.673,P=0.003),Do you think that family doctors work more carefully than non-family doctors(χ^2=9.503,P=0.002).whether you are satisfied with the medical fees(χ^2=9.641,P=0.002),whether you are satisfied with the content of the services provided by family doctors(χ^2=21.962,P<0.001),whether you are satisfied with the technical level of diagnosis and treatment of family doctors(χ^2=26.137,P<0.001),the trust evaluation of family doctors(χ^2=15.456,P<0.001)is related to the willingness of signing residents to renew their visas.Logistic regression analysis showed that the time spent from the residence to the nearest community health service(OR=0.555,95%CI:0.330-0.934,P=0.027),and whether they were satisfied with the level of diagnosis and treatment skills of family doctors(OR=1.969,95%CI:1.189-3.259,P=0.008),and trust in family doctors(OR=1.737,95%CI:1.091-2.768,P=0.020)are the main factors affecting the willingness of contracted residents to renew.CONCLUSIONS Residents of Yinchuan City Family Doctor Services contract renewal are relatively willing.The time spent from the residence to the nearest community health service,satisfaction with the family doctor’s diagnosis and treatment skills,and trust in the family doctor are the factors that influence the willingness of the contracted residents to renew.