签约居民对家庭医生签约服务连续性的评价及其影响因素研究

Contracted Residents'Evaluation for Continuity of Contracted Family Doctor Services and Influencing Factors

背景家庭医生签约服务自2016年全面推行以来,已取得阶段性成效,进一步的工作开展需要“质”“量”并重,重点提高居民的服务获得感和满意度,而目前居民对家庭医生签约服务连续性的评价尚不明确。目的了解签约居民对家庭医生签约服务连续性的评价,探讨其影响因素并提出改进策略。方法于2021年1月,采用多阶段分层随机抽样法在山东省菏泽市抽取9所社区卫生服务机构和9所乡镇卫生院的1193例签约居民。采用汉化版基本医疗质量评估量表(PCAT)的连续性维度对纳入居民展开入户调查,量表共包含15个条目。比较不同特征签约居民的PCAT连续性维度得分,采用多元线性回归分析签约居民PCAT连续性维度得分的影响因素。结果共回收有效问卷1098份,问卷有效回收率为92.04%。其中,签约社区卫生服务机构的居民541例(49.27%),签约乡镇卫生院的居民557例(50.73%)。签约居民的PCAT连续性维度平均得分为(3.38±0.51)分。得分最高的条目是“D5您的家庭医生是否耐心听您叙述病情”,为(3.64±0.59)分;得分最低的条目是“D15如果很容易给您换一个家庭医生,您是否愿意”,为(2.98±0.92)分。多元线性回归分析结果显示,签约机构类型、年龄、受教育程度、婚姻状况、职业、是否患慢性病是签约居民PCAT连续性维度得分的影响因素(P<0.05)。结论签约居民对家庭医生签约服务的连续性评价总体较好,医患双方建立了长久、稳定的联系。在开展家庭医生签约服务时,应关注签约居民的年龄、受教育程度、婚姻状况、职业及慢性病患病情况,以针对性提供其所需要的家庭医生签约服务,提高其对家庭医生签约服务的评价。

Background Since the full implementation of contracted family doctor services in 2016,we have achieved phased results.Further work needs to be paid equal attention to"quality"and"quantity",focusing on improving the residents'sense of service access and satisfaction,however,at present,the residents'evaluation of contracted family doctor services is not clear.Objective To investigate the contracted residents'evaluation for the continuity of family doctor contract,explore its influencing factors,and propose improvement strategies.Methods This study used a multi-stage stratified random sampling method to select 1193 contracted residents from 9 community health service institutions and 9 township health centers in Heze City,Shandong Province in January 2021.A household survey was conducted on the included residents by using the continuity dimension of the Chinese version of the Primary Care Assessment Tools(PCAT),which contains 15 items.We compared the PCAT-continuity dimension scores of contracted residents with different characteristics,and used multiple linear regression to analyze the factors influencing the PCAT-continuity dimension scores of contracted residents.Results A total of 1098 valid questionnaires were collected,with a valid response rate of 92.04%.541(49.27%)of them were contracted to community health service institutions and 557(50.73%)of them were contracted to township health centers.The average score of the PCAT-continuity dimension of the contracted residents was(3.38±0.51).The item with the highest score was"Does your family doctor listen to you patiently",with a score of(3.64±0.59).The item with the lowest score was"Would you be willing to change your family doctor if it was easy to do so",with a score of(2.98±0.92).Multiple linear regression analysis showed that the type of contract organization,age,education,marital status,occupation,and chronic diseases were the factors that influence the PCAT-continuity dimension score of contracted residents(P<0.05).Conclusion The contracted residents had an overall good evaluation on the continuity of contracted family doctor services,and the long and stable doctor-patient relationship had been established.Township health centers are better than community health service institutions.To further improve the contracted residents'evaluation of contracted family doctor services,we need to pay more attention to the type of contracting institution,the age,education level,marital status,occupation of contracted residents and their chronic diseases.