医患共同决策对老年慢性病共病患者家庭医生签约服务质量的影响

The influence of shared decision making on the quality of family doctor contracted service for Multimorbidity among the elderly population

目的:深入剖析医患共同决策水平对老年慢性病共病患者家庭医生签约服务质量的作用路径,为推动慢性病健康管理、改善患者就医体验感和签约服务质量提供参考。方法:在武汉市和贵阳市采取多阶段随机抽样方法对599名老年慢性病共病患者及其对应的63名签约医生开展问卷调查,借助分层回归模型分析医患共同决策水平对签约服务质量的作用路径。结果:我国中西部地区老年慢性病共病患者的医患共同决策得分为32.07±6.46,家庭医生签约服务质量得分为95.20±8.73,其中经济性和纵向连续性维度得分较低。分层回归模型分析结果显示医患共同决策水平对签约服务质量产生正向影响(β=0.369,P<0.05),家庭医生对签约患者的信任程度起到正向调节作用(β=0.548,P<0.05)。结论:我国中西部地区老年慢性病共病患者的医患共同决策水平和家庭医生签约服务质量均处于中等水平且有待提升,医患共同决策显著提升签约服务质量,对签约患者的信任程度强化共同决策对服务质量的正向效应。今后应加强医患共同决策、规范慢性病患者转诊服务、强化医患沟通信任,切实提升家庭医生签约服务质量。

Objective:To deeply analyze the effect path of shared decision making(SDM)level on the quality of family doctor contracted service for multimorbidity among the elderly population,and to provide reference for promoting the health management of chronic diseases,improving the patient s medical experience and the quality of contracted service.Methods:A multi-stage random sampling method was used to conduct a questionnaire survey on 599 elderly patients with multimorbidity and their corresponding 63 contracted doctors in Wuhan and Guiyang.The hierarchical regression model was used to analyze the effect of SDM level on the quality of contracted services.Results:The score of SDM in elderly patients with multimorbidity in the central and western regions of China was 32.07±6.46,and the score of family doctor contracted service quality was 95.20±8.73,among which the scores of economy and vertical continuity were lower.The results of hierarchical regression model analysis showed that the level of SDM had a positive impact on the quality of contracted services(β=0.369,P<0.05),and family doctors had a positive moderating effect on the degree of trust in contracted patients(β=0.548,P<0.05).Conclusion:The level of SDM and the quality of contract service for elderly patients with multimorbidity in the central and western regions of China are at a medium level and still need to be improved.Shared decision-making significantly improves the quality of contracted service.The degree of trust in contracted patients strengthens the positive effect of SDM on service quality.In the future,we should strengthen the SDM,standardize the referral service of patients with chronic diseases,strengthen the communication and trust between doctors and patients,and effectively improve the quality of family doctor contracted service.