深圳市签约居民对家庭医生服务的评价及续签意愿研究

doi:10.12114/j.issn.1007-9572.2019.00.320

摘要/Abstract

摘要： 背景　近年来深圳市家庭医生签约服务开展已取得一定进展，但“签而不约”“服务不到位”等现象依然存在。居民作为服务的需求方，研究其对家庭医生服务的评价及续签意愿对促进签约服务的有效开展具有重要意义。目的　了解深圳市签约居民对家庭医生服务的评价及续签意愿，为推进家庭医生服务提供科学依据。方法　于2016年7月—2017年9月，采取多阶段分层随机抽样法，对深圳市宝安区3个社区健康服务中心的1 000例签约居民开展基本情况、家庭医生服务利用与评价、家庭医生续签意愿及原因等内容的问卷调查。共发放问卷1 000份，获得有效问卷900份，问卷有效回收率为90.0%。结果　900例调查对象中，807例（89.7%）签约居民满意家庭医生的服务，家庭医生服务态度平均得分为（92±8）分。820例（91.1%）签约居民表示愿意继续和家庭医生签约，其中729例（88.9%）签约居民愿意续签家庭医生的原因是认为签约家庭医生就诊更方便；80例（8.9%）不愿意续签的居民中，56例（70.0%）选择的原因是认为签约家庭医生没有用。χ2检验结果显示，是否熟悉家庭医生姓名及坐诊时间、家庭医生主动联系次数、家庭医生服务态度、是否认为家庭医生看病比非家庭医生更仔细、是否满意家庭医生工作及对家庭医生的信任度条目选项不同者的续签意愿不同，差异具有统计学意义（P<0.05）。结论　深圳市签约居民对医疗卫生服务评价较好，家庭医生服务续签意愿较高，建议加大宣传推广力度，提升家庭医生服务质量，完善家庭医生服务体系，进而促进家庭医生服务的长远发展。

关键词: 家庭医生签约服务, 签约居民, 续签意愿, 影响因素分析

Abstract: Background　In recent years，some progress has been made in the implementation of contracted family doctor services in Shenzhen，but the phenomena such as "some contracted residents make no appointments" and "some contractual services are unsatisfactory" still exist.To study the evaluation of family doctor services and intention of renewing the contract with the family doctor among the residents，the demand side of healthcare services，may greatly promote the effective development of such services.Objective　To explore the evaluation of family doctor services and intention of renewing the contract with the family doctor among contracted residents in Shenzhen，providing scientific evidence for facilitating the development of such services.Methods　This survey was conducted in a stratified multistage random sample of 1 000 contracted residents from three community health centers of Shenzhen's Baoan District during July 2016 to September 2017.A self-designed questionnaire was used in the survey，which consists of general personal characteristics，use and evaluation of family doctor services，and intention and reasons of renewing the contract.Altogether，900 of them returned responsive questionnaires，obtaining a response rate of 90.0%.Results　 Among the 900 respondents，807（89.7%） were satisfied with family doctor services.Family doctors' attitude toward residents during delivering services was evaluated as（92±8） points on average.820（91.1%） of the respondents were willing to renew the contract with a family doctor because they thought they could obtain healthcare more conveniently.Among the 80 cases who were not willing to renew the contract，56（70.0%） thought the contractual services were ineffective.Chi-square analysis showed that the intention of renewing the contract differed significantly by the level of familiarity with the family doctor's name and consultation time，number of the family doctor taking the initiative to contact the patient，level of satisfaction with the attitude of the family doctor during delivering healthcare services，whether the family doctor is more careful than other types of doctors during delivering healthcare services，level of satisfaction with family doctor services，and level of trust in the family doctor（P<0.05）．Conclusion　 Family doctor services obtained high appraisals from the contracted residents of Shenzhen.And most of these residents intended to renew the contract.To promote the sustainable development of family doctor services，it is suggested to strengthen the publicity and promotion of such services，increase the level of quality of such services，and improve the family doctor system.

Key words: Contracted family doctor services, Contracted residents, Willingness for contract renewal, Root cause analysis

刘建新,乔岩,甘勇,等. 深圳市签约居民对家庭医生服务的评价及续签意愿研究[J]. 中国全科医学, 2020, 23(1): 40-44. DOI: 10.12114/j.issn.1007-9572.2019.00.320.
LIU Jianxin,QIAO Yan,GAN Yong, et al. Evaluation of Family Doctor Services and Intention of Renewing the Contract with the Family Doctor among Contracted Residents in Shenzhen　[J]. Chinese General Practice, 2020, 23(1): 40-44. DOI: 10.12114/j.issn.1007-9572.2019.00.320.

参考文献

［1］李秋粟，黄文昊，苗春霞，等．徐州市城区居民签约家庭医生意愿及影响因素研究［J］．中国卫生资源，2018，21（3）：262-266．DOI：10.13688/j.cnki.chr.2018.17879.
LI Q L，HUANG W H，MIAO C X，et al．Study on urban residents' willingness of family doctor contract and its influencing factors in Xuzhou［J］．Chinese Health Resource，2018，21（3）：262-266．DOI：10.13688/j.cnki.chr.2018.17879.
［2］HONARVAR B，LANKARANI B，KAZEMI M，et al．Five years after implementation of urban family physician program in Fars Province of Iran：are people's knowledge and practice satisfactory? ［J］．Int J Prev Med，2018，9（9）：41．DOI：10.4103/ijpvm.IJPVM32917.
［3］芦炜，张宜民，梁鸿，等．家庭医生签约服务与医保支付联动改革的理论基础及政策价值分析［J］．中国卫生政策研究，2016，9（8）：3-9．DOI：10.3969/j.issn.1674-2982.2016.08.002.
LU W，ZHANG Y M，LIANG H，et al．The theoretical basis and policy value analysis for the linkage reform between the family doctor service contract and medicare payment［J］．Chinese Journal of Health Policy，2016，9（8）：3-9．DOI：10.3969/j.issn.1674-2982.2016.08.002.
［4］刘利群.推进家庭医生签约服务　加强分级诊疗制度建设［J］．中国全科医学，2018，21（1）：1-4．DOI：10.3969/j.issn.1007-9572.2018.01.001.
LIU L Q.Promoting contracted services of family doctors to strengthen the construction of hierarchical medical system［J］．Chinese General Practice，2018，21（1）：1-4．DOI：10.3969/j.issn.1007-9572.2018.01.001.
［5］HATMI Z N，MALEKPOUR M．Family physicians in Iran：success despite challenges［J］．The Lancet，2010，376（9752）：1541．DOI：10.1016/S0140-6736（10）62030-2.
［6］闫德文.社区医生2型糖尿病管理流程与分级诊疗规范（深圳专家共识）［J］．全科医学临床与教育，2018，16（5）：484-488．DOI：10.13558/j.cnki.issn1672-3686.2018.05.002.
YAN D W．Expert consensus for the management and hierarchical medical care of type 2 diabetes in primary hospitals，Shenzhen［J］．Clinical Education of General Practice，2018，16（5）：484-488．DOI：10.13558/j.cnki.issn1672-3686.2018.05.002.
［7］何旭文，刘国莲，王丽，等．银川市兴庆区家庭医生签约服务现状及影响因素分析［J］．基层医学论坛，2019，23（9）：1199-1201．DOI：10.19435/j.1672-1721.2019.09.008.
HE X W，LIU G L，WANG L，et al．Analysis of the status and influencing factors about signing family doctor service in Xingqing District of Yinchuan［J］．The Medical Forum，2019，23（9）：1199-1201．DOI：10.19435/j.1672-1721.2019.09.008.
［8］纪瑞云.北京市居民与社区医务人员对家庭医生式服务的认知及签约情况研究［D］．合肥：安徽医科大学，2015.
［9］牛玉敬.广州市试点地区家庭医生式服务现况及影响因素研究［D］．广州：南方医科大学，2016.
［10］葛高琪，唐楠，陈兆杰，等．陕西省试点地区居民对家庭医生签约服务与双向转诊的知晓情况和满意度研究［J］．中国全科医学，2017，20（28）：3493-3497．DOI：10.3969/j.issn.1007-9572.2017.28.009.
GE G Q，TANG N，CHEN Z J，et al．Residents' awareness and satisfaction of family doctor services and two-way referral in two pilot towns of Shaanxi Province［J］．Chinese General Practice，2017，20（28）：3493-3497．DOI：10.3969/j.issn.1007-9572.2017.28.009.
［11］王良晨，葛敏，江萍，等．社区居民对家庭医生签约服务的认知与意愿研究［J］．中国全科医学，2018，21（4）：401-406．DOI：10.3969/j.issn.1007-9572.2018.04.006.
WANG L C，GE M，JIANG P，et al．Community residents' awareness and willingness towards contractual services from family doctors［J］．Chinese General Practice，2018，21（4）：401-406．DOI：10.3969/j.issn.1007-9572.2018.04.006.
［12］刘彩茵，江冬冬，王全．家庭医生服务签约居民的续签意愿及影响因素研究［J］．中国全科医学，2018，21（25）：3073-3078．DOI：10.12114/j.issn.1007-9572.2018.25.009.
LIU C Y，JIANG D D，WANG Q．Intention and associated factors of renewing the contract with family doctors［J］．Chinese General Practice，2018，21（25）：3073-3078．DOI：10.12114/j.issn.1007-9572.2018.25.009.
［13］赵建功，张向东，王敏，等．北京市西城区家庭医生式服务签约居民续约意愿及影响因素研究［J］．中国全科医学，2015，18（28）：3417-3422．DOI：10.3969/j.issn.1007-9572.2015.28.009.
ZHAO J G，ZHANG X D，WANG M，et al．Residents' willingness for renewing the contract of family doctor service in Xicheng District of Beijing and its influencing factors［J］．Chinese General Practice，2015，18（28）：3417-3422．DOI：10.3969/j.issn.1007-9572.2015.28.009.
［14］国家卫生健康委员会.国家卫生健康委办公厅关于做好2019年家庭医生签约服务工作的通知［Z］．2019.
［15］KOLSEK M．Implementing electronic medical record in family practice in Slovenia and other former Yugoslav Republics：barriers and requirements［J］．Srpski Arhiv Za Celokupno Lekarstvo，2009，137（11/12）：664-669．DOI：10.2298/SARH0912664K.
［16］TOH N，PAWLOVICH J，GRZYBOWSKI S．Telehealth and patient-doctor relationships in rural and remote communities［J］．Can Fam Physician，2016，62（12）：961-963.
［17］张向东，赵京，兰丽娜，等．北京市社区卫生家庭医生式服务模式及激励机制探讨［J］．中国全科医学，2014，17（7）：766-769．DOI：10.3969/j.issn.1007-9572.2014.07.009.
ZHANG X D，ZHAO J，LAN L N，et al．Service mode and incentive mechanism about community family doctor service system in Beijing［J］．Chinese General Practice，2014，17（7）：766-769．DOI：10.3969/j.issn.1007-9572.2014.07.009.

[1]	郝爱华, 曾韦霖, 李观海, 夏英华, 陈亮. 基于全科医生视角的家庭医生团队签约现状调查研究[J]. 中国全科医学, 2023, 26(34): 4261-4268.
[2]	郭亚红, 郭浩乾, 宁艳花, 姜婷, 李美曼, 吕兄兄, 孔维娟, 刘海燕. 基于家庭医生签约服务构建老年人"互联网+"家庭护理管理模式[J]. 中国全科医学, 2023, 26(23): 2876-2881.
[3]	赵琳琳, 邵爽, 罗琪, 陈小垒, 杜娟. 国内家庭医生团队医防融合实践策略研究[J]. 中国全科医学, 2023, 26(22): 2715-2719.
[4]	徐佳玙, 颜骅, 方军波, 王海琴, 郭佩, 沈福来, 王形松. 基于标化工作量的社区卫生服务机构家庭医生团队工作开展现状研究[J]. 中国全科医学, 2023, 26(13): 1641-1647.
[5]	孟文奇, 柳松艺, 姜晓利, 彭海波, 李子鑫, 于倩倩, 尹文强, 孙葵, 陈钟鸣, 郭洪伟. 基于扎根理论的家庭医生签约服务效果影响机制研究[J]. 中国全科医学, 2023, 26(10): 1192-1197.
[6]	周其如, 李举双, 郝春, 汪永刚, 沈睿, 朱敏贤, 程新. 预约诊疗服务对家庭医生签约服务结果质量的影响[J]. 中国全科医学, 2023, 26(10): 1198-1204.
[7]	马志强, 吴香兰. 基于信任源模型的全科医疗服务医患信任问题及对策建议[J]. 中国全科医学, 2023, 26(10): 1172-1178.
[8]	徐萍萍, 赵静, 李春晓, 李林峰, 刘森元. 我国中央层面家庭医生签约服务政策量化评价：基于PMC指数模型[J]. 中国全科医学, 2023, 26(04): 440-446.
[9]	李心言, 韩优莉. 家庭医生签约服务中引入竞争机制的影响及其启示[J]. 中国全科医学, 2023, 26(04): 447-452,459.
[10]	马志强, 张宝丽, 郭乐. 签约服务情境下全科医生岗位胜任力自评量表的开发与信效度检验[J]. 中国全科医学, 2023, 26(04): 477-485.
[11]	马志强, 郭乐, 李钊, 葛柏麟. 签约服务情境下基于扎根理论的全科医生胜任力模型构建研究[J]. 中国全科医学, 2023, 26(04): 460-466,485.
[12]	刘智敏, 冯磊. 家庭医生签约服务协议的内容分析及优化路径探索[J]. 中国全科医学, 2023, 26(04): 453-459.
[13]	柳松艺, 孟文奇, 彭海波, 姜晓利, 李子鑫, 于倩倩, 尹文强, 陈钟鸣, 孙葵, 郭洪伟. 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[J]. 中国全科医学, 2022, 25(34): 4312-4317.
[14]	姚岗, 张诚, 徐健, 潘文雷, 陈晨, 朱敏, 王朝昕, 黄蛟灵. 中青年楼宇人群对家庭医生签约服务的需求及影响因素研究[J]. 中国全科医学, 2022, 25(22): 2773-2781.
[15]	徐健, 姚岗, 潘文雷, 戴芳芳, 黄倩, 刘蕊, 李欣, 周良, 黄蛟灵. 中青年楼宇人群的家庭医生签约服务需求满足状况及影响因素研究[J]. 中国全科医学, 2022, 25(22): 2782-2789.