科创承载型功能社区家庭医生服务需求及其影响因素研究

Needs of Family Doctor Services and Associated Factors in Functional Communities Bearing Science Innovation

背景上海市作为国家科技创新中心重要承载区,除了满足创新创业的政策支持、创业环境、资金投入等需求外,满足各类人才在健康保健等方面的延伸需求对于促进“产城融合”至关重要。发展功能社区卫生服务是完善功能配套、促进“产城融合”的关键环节,但当前功能社区服务存在短板,无法为“产城融合”提供支撑,亟须突破。目的 分析科创承载型功能社区人群多样化的健康服务需求,并为家庭医生健康服务在功能社区的拓展提供建议。方法 2019年3—11月,通过对上海市科创承载型功能社区进行分层随机抽样调查,共发放1 500份问卷,获得功能社区人群基本情况及生活方式、心理健康状况、卫生服务需求与利用等相关数据,了解功能社区人群的健康状况、卫生服务需求与利用情况,并分析功能社区家庭医生服务需求的影响因素;并参考文献研究结果,对比与其他类型功能社区人群的主要健康问题与卫生服务需求的差异。结果 共回收有效问卷1 487份(99.13%),其中调查对象两周患病率〔5.92%(88/1 487)〕、慢性病患病率〔5.98%(89/1 487)〕较低;功能社区人群健康服务主观需求主要是常见疾病处理(1 251人,84.13%)、健康管理(858人,57.70%)、健康体检(699人,47.01%)、健康咨询(586人,39.41%)、心理咨询(470人,31.61%)。功能社区人群家庭医生签约服务知晓率为57.03%(848/1 487),45.73%(680/1 487)有签约意愿,且性别、年龄、文化程度、自我感觉健康状况、慢性病患病情况对家庭医生签约意愿产生影响(P<0.05);就诊意愿调查中,患病后想去的卫生机构前3位分别是市级医院(620人,41.69%)、区级医院(404人,27.17%)、门诊部(所)/卫生室/卫生服务站(153人,10.29%),其中质量(734人,25.41%)、距离(732人,25.34%)和有可信赖的医生(391人,13.48%)是主要影响因素;卫生服务实际利用情况与就诊意愿基本一致。结论在科创承载型功能社区中开展健康保健服务具现实意义和可操作性。不同类型功能社区卫生服务需求可能存在差异,应针对不同需求提供差异化的健康服务方案,并吸取其他类型功能社区健康服务发展的优秀经验。建议从明确覆盖人群与服务内容、丰富供给方式、优化筹资来源、加强统筹协调等角度完善功能社区家庭医生服务的推进工作。

Background For Shanghai,an important bearing area of the National Science and Technology Innovation Center,Shanghai,it is essential to meet the extended needs of various talents in healthcare and other aspects to promote the industry-city integration besides meeting the needs of policy support for innovation and entrepreneurship,entrepreneurial environment,capital investment,etc.The development of functional community health services is a key link to improve functional facilities and promote the industry-city integration.However,the current functional community services are limited and cannot provide support for the integration,and need a breakthrough urgently.Objective To analyze the diversified health service needs of people in functional communities bearing science innovation,providing suggestions for the expansion of family doctor services in functional communities.Methods Data were collected through a stratified cluster sampling survey carried out with 1500 individuals selected from Shanghai's functional communities bearing science innovation from March to November 2019 using a self-developed questionnaire,including general demographic information,lifestyle,mental health status,health service demand and utilization.The health status,health service demand and utilization were analyzed,and factors associated with health service demand were explored.Then the health problems and health service demand in this population were compared to those of populations in other types of functional communities reported in other studies.Results A total of 1487 cases(99.13%)who returned responsive questionnaires were finally included.The two-week morbidity〔5.92%(88/1487)〕and chronic disease prevalence〔5.98%(89/1487)〕were relatively low.The subjective health service needs in functional communities were mainly common disease treatment〔84.13%(1251/1487)〕,health management〔57.70%(858/1487)〕,physical examination〔47.01%(699/1487)〕,health consultation〔39.41%(586/1487)〕,psychological consultation〔31.61%(470/1487)〕.The rates of knowing and intending to contract family doctor services were 57.03%(848/1487),and 45.73%(680/1487),respectively.The intention to contract family doctor services differed significantly by gender,age,education level,physical condition,and chronic disease prevalence(P<0.05).In terms of preferred healthcare institutions,the top three were municipal hospitals〔41.69%(620/1487)〕,district hospitals〔27.17%(404/1487)〕,outpatient department(clinic)/community health clinic/health station〔10.29%(153/1487)〕.Healthcare quality〔25.41%(734/1487)〕,distance between home and the healthcare institution〔25.34%(732/1487)〕and reliable doctors working at the healthcare institution〔13.48%(391/1487)〕were main factors associated with the choice of healthcare institution.The actual utilization of health services was basically consistent with the healthcareseeking intention.Conclusion It is practical and operable to deliver healthcare services to functional communities bearing science innovation.The needs of community health services may differ across different types of functional communities,so service provision should be based on the specific conditions of the community,with experiences of other types of functional communities as a reference.To promote family doctor services in functional communities,it is recommended to determine the coverage population and service scope,enrich the ways of provision,optimize funding sources,and strengthen overall planning and coordination.