上海市社区居民基层首诊意愿及影响因素研究

Analysis on the Current Situation and Influence Factors of Residents’Intention to Have First Consultations in Primary Health Care Institution in Shanghai

目的:了解上海市社区居民基层首诊意愿现状,分析社区居民首诊意愿的影响因素。方法:按比例从上海市分层随机抽取50家社区卫生服务中心,采用自行设计调查问卷便利抽取社区卫生服务中心附近居民开展调查。采用二元logistic回归分析居民首诊意愿的影响因素。结果:共发放2501份问卷,有效回收2443份,有效回收率为97.68%。签约居民比非签约居民首诊更倾向选择社区卫生服务中心,差异有统计学意义(OR=2.90,P<0.001)。居民的户籍、健康自评得分、婚姻状况和医疗机构特点均会影响首诊意愿。结论:上海市居民社区首诊意愿较高,签约居民的社区首诊意愿高于未签约居民。积极提升家庭医生服务质量,整合医疗资源,优化就诊流程,有利于将患者留在社区,实现分级诊疗。

OBJECTIVE To investigate the current situation and analysis influence factors of residents’intention to have first consultations in primary health care in Shanghai.METHODS In June 2019,a self-designed questionnaire was used to conduct surveys of residents in Shanghai.Using stratified random sampling method to analyze the influencing factors of first consultations among residents based on logistic regressional analysis.RESULT 2501 questionnaires were send out,and 2443 questionnaires were effectively received.The response rate of this survey was 97.68%.Contracted residents were more likely to have their first consultations in primary healthcare institutions than non-contracted residents(OR=2.90,P<0.001).The residents’own factors like census register seat,self-rated health,marital status and the characteristics of medical institutions also have an influence.CONCLUSION The rate of residents’willingness to seek their first counseling from primary healthcare institution in Shanghai was high,and residents who contracted with family doctors were more willing to seek their first counseling from primary healthcare than those non-contracted.Actively improving the service quality of family doctors,integrating medical resources and optimizing medical treatment process were conducive to keeping patients in the community and promoting the hierarchical medical system.