基于感知质量评价的农村家庭医生签约服务技术性研究

Technicality of Contracted Family Doctor Services in Rural Areas Using Perceived Quality Framework

背景随着老年人群、慢性病患者被纳入重点签约对象,家庭医生在提升老年慢性病人群的疾病管理水平和生活质量上发挥着越来越重要的作用,但目前缺少对其服务提供的技术性评价研究。目的研究农村家庭医生为慢性病患者提供的签约服务技术性现状及其影响因素,为进一步提升家庭医生签约服务技术水平提供依据。方法于2019年7月,采用典型抽样与分层整群抽样相结合的方法,抽取江苏南部、中部、北部农村地区的老年慢性病患者开展基本信息、签约服务质量评价、健康行为等内容的问卷调查,本文主要分析农村老年慢性病患者对家庭医生签约服务技术质量感知情况。结果 1 728例签约患者中,316例(18.29%)的技术性维度总体感知评分较低。技术性维度3个条目(诊疗技术水平、用药服务、控制疾病发展)评分较低者分别占比17.19%(297例)、13.31%(230例)、10.82%(187例)。多因素Logistic回归分析结果显示,患者所在地区、性别、慢性病用药方案主要来源、是否会首选在家庭医生处看小病是患者对家庭医生签约服务技术性感知的影响因素(P<0.05)。结论农村家庭医生签约服务总体技术水平有待提高,医生诊疗技术有较大提升空间;女性、苏南地区患者、慢性病用药方案主要来源于村级的患者、一定会在家庭医生处看小病的患者感知评分更高。建议以提升苏中、苏北地区技术水平为优先,以提高家庭医生诊疗技术为重点,通过完善财政转移支付制度、创新签约服务模式、加强家庭医生人才队伍建设等举措,全面提升家庭医生签约服务技术水平。

Background The elderly and chronic disease patients have been included in the key contracting population.Family doctors play an ever-growing role in improving their quality of life via enhancing disease management.However,there is a lack of technicality analyses of contracted services by them.Objective To study the technicality and influencing factors of contracted family doctor services provided by rural family doctors for patients with chronic diseases,providing a basis for improving the technicality level of such services.Methods In July 2019,a combination of typical sampling and stratified cluster sampling was used for selecting contracted rural elderly chronic disease patients from southern,central and northern Jiangsu to participate in a questionnaire survey involving socio-demographic characteristics,quality evaluation of contracted services,healthy behaviors.Multivariate Logistic regression analysis was used to explore the influencing factors of patients’perception of technicality level of the services.This paper mainly analyzes the perception of rural elderly patients with chronic diseases on the technical quality of family doctor contract service.Results Of all the 1728 contracted patients,316(18.29%)gave a lower overall perception score for the technical dimensions.Diagnosis and treatment technology level,medication service and disease control development were the three technical dimensions,and the lower ones accounted for 17.19%(297 cases),13.31%(230 cases)and 10.82%(187 cases)respectively.Logistic regression analysis showed that sex,geographical location,whether preferring the care for a minor illness delivered by a family doctor,and the main source of medication schemes were associated with patients’perception of technicality level of the services(P<0.05).ConclusionIn short,the overall technicality level of contracted rural family doctor services,especially the diagnostic and treatment level of family doctors,should be improved.Women,southern Jiangsu,using a medication scheme prescribed by doctors working at a village clinic,and always seeing a family doctor for a minor illness may be associated with higher perception of technicality level of contracted family doctor services.To further improve the technicality of the services,we put forward the following suggestions:priority should be given to central and northern Jiangsu,with a focus on improving the diagnostic and treatment level of family doctors;enhancing the intergovernmental transfer system;innovating the contracting forms;strengthening the future family doctor workforce.