分级诊疗背景下山东省居民基层首诊意愿影响因素研究

Research on Influencing Factors of Residents'Willingness of First-visit at Grassroots Medical Institution Under the Background of Hierarchical Medical System in Shandong Province

目的:了解山东省居民现阶段基层首诊意愿,分析其影响因素,为促进分级诊疗制度的运行提供参考。方法:采用多阶段系统抽样方法,对山东省16地市2965名居民进行问卷调查,通过卡方检验和logistic回归进行数据分析。结果:1922人(64.8%)选择基层首诊,281人(9.5%)不会选择基层首诊,另外有762人(25.7%)表示不确定。学历、收入、是否有基层医疗机构、是否赞同分级诊疗和是否有基层就诊经历是居民基层首诊意愿的影响因素(P<0.05)。结论:是否有基层就诊经历是居民首诊意愿的重要影响因素,政府应通过加大对基层医疗的财政投入、加强分级诊疗宣传力度、完善家庭医生签约服务等手段,引导居民前往基层就诊。

Objective: To investigate the current situation and the influence factors of residents’ willingness of first-visit at grassroots medical institution, and to provide a reference for promoting the operation of hierarchical medical system. Methods: Multi-stage systematic sampling was used to investigate 2965 residents in 16 cities of Shandong province. Chi-square test and logistic model were used to analyze the data. Results: 1922 residents(64.8%) chose to go to grassroots medical institutions for first-visit and 281(9.5%) chose not, and another 762 people(25.7%) said that they could not make sure whether to go in the future. Education background, income, whether having grassroots medical institutions, whether agreeing hierarchical medical system and whether having grassroots diagnosis experience were the influence factors of their willingness of first-visit at grassroots medical institution. Conclusion: Whether the residents have the experience of grassroots diagnosis is the important influence factor of their willingness of first-visit at grassroots medical institution. The government should guide the residents to grassroots institutions for diagnosis by increasing the financial investment to grassroots health care, strengthening the propaganda of hierarchical medical system and improving the family doctors’ contracting services.