摘要
背景家庭医生签约服务是改进基层医疗卫生资源配置及医疗服务质量的重要途径,目前我国总体签约率稳步提升,但服务内容落实及质量有待加强,缺乏系统权威的签约可及性和综合性评价途径。目的研究农村家庭医生对慢性病患者的签约服务可及性和综合性的现状及其影响因素。方法 2019年7月在江苏省通过典型抽样和多阶段分层抽样选取1 814例老年慢性病签约患者进行调查,调查问卷包括基本信息、家庭医生签约服务质量评估、健康行为等部分,本文主要分析农村地区家庭医生签约可及性与综合性水平。结果共有1 728例(95.26%)调查对象纳入本研究,其中1 510例(87.38%)对家庭医生签约服务可及性感知程度较高,1 497例(86.63%)对综合性服务感知程度较高。二元Logistic回归分析结果显示,地区、慢性病用药方案主要来源和服务承诺兑现情况是调查对象签约服务综合性感知的影响因素(P<0.05),地区、慢性病用药方案主要来源和服务承诺兑现情况是调查对象签约服务可及性感知的影响因素(P<0.05)。结论农村家庭医生签约服务可及性和综合性总体水平较高,综合性维度中的心理服务的感知程度较低;苏北患者、慢性病用药方案主要来源于村卫生室的患者、家庭医生签约服务承诺兑现情况较好的患者对家庭医生签约服务的综合性和可及性感知评分较高。提示地区政府基于不同因素的影响,改进签约模式,加强签约服务内容落实程度,提高基本药物可及性,有针对地提升签约服务可及性和综合性。
Background China has launched family doctor services as a key action to improve the allocation of primary care resources and quality of healthcare services.Currently,the rate of contracting is increasing stably,but there is a lack of systematic and authoritative evaluation of the accessibility and comprehensiveness of such services,which is significantly associated with further improvement of the implementation and quality of the services.Objective To study the accessibility and comprehensiveness of contracted rural family doctor services for chronic disease patients and associated factors.Methods In July 2019,1814 elderly patients with chronic diseases were selected by typical sampling and multi-stage stratified sampling in Jiangsu Province to attend a questionnaire survey for investigating their essential socio-demographic characteristics,quality assessment of contracted family doctor services,and health behaviors.This paper mainly analyzes the accessibility and comprehensive level of family doctors in rural areas.Results A total of 1728(95.26%)cases were included for analysis,of whom 1510(87.38%)rated the accessibility of contracted family doctor services relatively high,and 1497(86.63%)had a relatively high level perception of comprehensiveness of the services.The Logistic regression analysis indicated that patients’geographical location,medication option,and doctors’fulfillment of service commitments were associated with patients’perception of comprehensiveness of the services(P<0.05).Patients’geographical location,medication option,and doctors’fulfillment of service commitments were associated with patients’perception of accessibility of the services(P<0.05).Conclusion On the whole,the levels of accessibility and comprehensiveness of contracted rural family services were relatively high,but the perceived evaluation level of psychological services in comprehensiveness dimension was low.Furthermore,those who lived in northern Jiangsu,uesd medication prescribed by doctors working at a village clinic,and received services from doctors with good fulfillment of service commitments rated the comprehensiveness and accessibility of contracted family doctor services relatively high.Our analysis suggested that the local government should improve the accessibility and comprehensiveness of the services by improving contracting modes,service implementation and accessibility of essential medicines according to local associated factors.
作者
韩相如
秦才欣
吴怡
田蓝岚
王屹亭
钱东福
HAN Xiangru;QIN Caixin;WU Yi;TIAN Lanlan;WANG Yiting;QIAN Dongfu(School of Health Policy&Management,Nanjing Medical University,Nanjing 211166,China;Center for Global Health/Institute of Healthy Jiangsu Development,Nanjing Medical University,Nanjing 211166,China)
出处
《中国全科医学》
CAS
北大核心
2021年第19期2428-2434,共7页
Chinese General Practice
基金
国家自然科学基金面上项目(71874085)。
关键词
家庭医生签约服务
可及性
综合性
农村卫生
感知质量评价
影响因素分析
Contracted family doctor services
Accessibility
Comprehensiveness
Rural health
Evaluation of perceived quality
Root cause analysis
