Chinese General Practice ›› 2019, Vol. 22 ›› Issue (7): 783-788.DOI: 10.12114/j.issn.1007-9572.2019.07.008

• Monographic Research • Previous Articles     Next Articles

Intention and Influencing Factors of Signing a Health Service Contract with the Family Doctor among Community-dwelling Residents in Yunnan Province 

  

  1. 1.School of Management and Economics,Kunming University of Science and Technology,Kunming 650093,China
    2.Party Committee Office,the First People's Hospital of Yunnan Province,Kunming 650093,China
    *Corresponding author:LI Wei,Chief physician,Doctoral supervisor;E-mail:lw13908701155@163.com
  • Published:2019-03-05 Online:2019-03-05

云南省社区居民家庭医生签约意愿及影响因素研究

  

  1. 1.650093云南省昆明市,昆明理工大学管理与经济学院 2.650093 云南省昆明市,云南省第一人民医院党办
    *通信作者:李伟,主任医师,博士生导师;E-mail:lw13908701155@163.com
  • 基金资助:
    基金项目:国家自然科学基金资助项目(71764014);中国教育部人文社会科学研究青年基金项目(17YJC880015);云南省科技厅计划重点项目(2016FA028)

Abstract: Background The implementation of the contracted services of family doctors in Yunnan Province started late.Understanding the intention and influencing factors of signing a health service contract with the family doctor in community-dwelling residents in this province,is conducive to further improving the utilization and effectiveness of such services,and enhancing the medical service coverage in a tangible way.Objective To explore the intention and influencing factors of signing a health service contract with the family doctor in community-dwelling residents in Yunnan Province,and based on this,to put forward suggestions for promoting the residents' contract signing rate.Methods By geographical and economic stratification,two districts and one county from 13 districts (counties) in Kunming City,Yunnan Province were selected.Then by typical sampling,Hongyun Community,Qianwei Community and Gucheng County were selected from Wuhua District,Xishan District,Jinning District,respectively.Then,by convenience sampling,the family members of 90 households were selected from each of the communities and participated in a survey conducted between July and September 2017.A self-designed questionnaire was used in the survey,which mainly included basic personal characteristics,health seeking behavior,and the intention of signing a health service contract with the family doctor.Of the 1 412 residents,1 318 returned responsive questionnaires,achieving a response rate of 93.3%.Results Of the 1 318 respondents,1 187 (90.1%) intended to sign a health contract with the family doctor.The intention of signing a health contract with the family doctor differed significantly among the respondents by age,educational level,type of medial insurance,annual income,living environment(urban or rural area),chronic illness,initially consulted institution,waiting time for consultation in a community health center,and time needed to get to the nearby community health center(P<0.05).Multivariate Logistic regression analysis showed that the type of medical insurance,living area(urban or rural),chronic diseases,waiting time for consultation in a community health center,time needed to get to the nearby community health center were significantly associated with respondents' intention of signing a health service contract with the family doctor(P<0.05).Conclusion The prevalence of intention to sign a health service contact with the family doctor is high among community-dwelling residents in Yunnan Province.Having medical insurance, living in urban areas, suffering from at least one chronic illness, access to consultation after waiting for no more than half an hour, and getting to the nearby community health center within half an hour are associated with higher level of intention of signing a health service contract with the family doctor.

Key words: Contracted services of family doctors, Community residents, Intention of signing a contract, Root cause analysis, Yunnan

摘要: 背景 云南省的家庭医生签约服务工作起步较晚,了解社区居民的签约意愿及影响因素,有利于进一步促进家庭医生服务的利用与开展成效,切实提高医疗服务的覆盖率。目的 了解云南省社区居民的家庭医生签约意愿,并进一步探讨影响其签约意愿的因素,为推动家庭医生签约服务开展提供建议。方法 采用分层抽样法,根据云南省昆明市13个区(县)的地理位置和经济发展状况,选取2个区1个县;采用典型抽样法,分别从每个区(县)中选取1个社区,依次为五华区的红云社区、西山区的前卫社区、晋宁区古城镇;采用方便抽样法,在每个社区中抽取90户家庭,以符合条件的家庭成员为研究对象。于2017年7—9月,采用自行设计的问卷进行调查,主要内容为居民的基本情况、就诊行为及签约意愿等。共发放问卷1 412份,回收有效问卷1 318份,有效回收率为93.3%。结果 1 318例居民中,有签约意愿者1 187例(90.1%)。不同年龄、受教育程度、医疗保险类型、个人年收入、城乡环境、患慢性病情况、选择社区首诊情况、在社区卫生服务中心候诊时间、到社区卫生服务中心花费时间的居民家庭医生签约意愿比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,医疗保险类型、城乡环境、患慢性病情况、在社区卫生服务中心候诊时间、到社区卫生服务中心花费时间是居民家庭医生签约意愿的影响因素(P<0.05)。结论 云南省社区居民的家庭医生签约意愿较高,参保城镇居民医疗保险、居住在城区、患慢性病、在社区卫生服务中心候诊时间≤0.5 h、到社区卫生服务中心花费时间≤0.5 h的居民具有更高的签约意愿。

关键词: 家庭医生签约服务, 社区居民, 签约意愿, 影响因素分析, 云南