山东省农村家庭医生签约居民转诊意愿影响因素

Influencing factors of referral intention among rural residents with contracted family doctor service in Shandong province: a theory of planned behavior-based study

目的了解山东省农村家庭医生签约居民转诊意愿并探讨其影响因素,为促进家庭医生签约服务在山东省农村地区的顺利开展提供政策建议。方法于2018年5月在山东省采用随机数字表法随机抽取3个样本市进行问卷调查,并利用计划行为理论(TPB)建立理论分析模型。结果山东省826名家庭医生签约居民中,79.66%的居民表示愿意通过家庭医生转诊,二元logistic回归结果显示,对家庭医生的认知水平较高、认为家庭医生对家人的健康有帮助、首诊选择是村卫生室以及接受过家庭医生团队提供的服务的居民更愿意通过家庭医生转诊。结论居民的行为态度是影响居民转诊意愿的最大因素,其次是知觉行为控制因素。家庭医生签约服务中对于转诊工作的有效落实是完善分级诊疗卫生服务体系的有效途径。

Objective To examine the referral intention and its associates among residents with contracted family doctor services(CFDS) in rural Shandong and to provide evidences for developing policies to promote CFDS in rural region.Methods Using random sampling, we conducted a questionnaire survey among 826 residents with CFDS in rural regions of3 municipalities of Shandong province during May 2018. Based on the theory of planned behavior(TPB), we established theoretical analysis models to explore factors influencing the residents′ referral intention. Results Of the 826 participants,79.66% expressed their intention to have necessary medication in upper level hospitals referred by the family doctors providing contracted services. Binary logistic regression models demonstrated that the participants having high cognition on CFDS, considering CFDS being helpful for their family members′ healthcare, selecting village clinics first when needing outpatient medication, and having received CFDS were more likely to report the referral intention. Conclusion Behavioral attitude is the most important factor, followed by perceived behavior control, for referral intention among rural residents with contracted family doctor services and the implementation of family doctors-led referral is an effective way to improve the hierarchical medical services.