Page 89 - 2022-22-中国全科医学

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1.Chengxiang Community Health Center，Taicang 215400，China
2.Shaxi Town Zhitang Health Center，Taicang 215400，China
3.High-tech Zone Community Health Center，Taicang 215400，China
4.Jing'an District Jiangning Community Health Center，Shanghai 200040，China
5.Pudong New District Weifang Community Health Center，Shanghai 200122，China
6.School of Public Health，Shanghai Jiao Tong University School of Medicine，Shanghai 200025，China
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Corresponding author：HUANG Jiaoling，Associate researcher；E-mail：jiaoling_huang@sina.com
【Abstract】 Background For building a healthy China，it is essential to expand the coverage of family doctor
services. In young and middle-aged office building occupants，the rate of contracting family doctor services is low. Shanghai has
taken the lead in exploring building-based family doctor services，and providing on-demand health management services. So it is
particularly meaningful to study the health needs in young and middle-aged office building occupants. Objective To investigate
the needs and associated factors of contracted family doctor services among young and middle-aged office building occupants
in Shanghai. Methods A questionnaire survey was conducted from December 2019 to December 2020 with a cluster random
sample of young and middle-aged office building occupants（aged 18-59 years） selected from representative office buildings in
Shanghai's Hongkou District，Pudong New District，and Jing'an District of Shanghai for understanding their sociodemographic
characteristics，health and healthcare-seeking conditions，knowledge of family doctor services，and needs of essential and
personalized family doctor services. Multiple Logistic regression analysis was used to analyze the factors affecting the needs of
family doctor services. Results In all，2 366 cases attended the survey，and 2 272 of them（96.03%） who completed the
survey effectively were included for analysis. Among them，87.65%（1 874/2 138） had general，moderate or strong needs
for essential family doctor services，and 70.59%（1 452/2 057） had needs for personalized family doctor services. Multiple
Logistic regression analysis indicated that age，education level，self-assessed social class，understanding of one's own health，
self-assessed health status，chronic disease prevalence，mental health status，preferred healthcare setting for treating common
diseases，treatment experience in a community health institution，understanding of and degree of trust in a family doctor，and
understanding of building-based family doctor services and the specific scope of the services were associated with the needs of
essential family doctor services（P<0.05）. Education level，social health insurance，commonly used drugs，chronic disease
prevalence，preferred healthcare setting for treating common diseases，treatment experience in a community health institution，
understanding of building-based family doctor services，and understanding of the scope of building-based family doctor services
were associated with the needs of personalized family doctor services（P<0.05）. Conclusion The contracted family doctor
services were in high demand in young and middle-aged office building occupants. Improving health literacy in this population，
modifying publicity strategies regarding the services，and improving the capabilities of the family doctor team and primary medical
institutions，may be conducive to increasing the rate of contracting family doctor services in this group.
【Key words】 Contracted family doctor services；Young and middle-aged office building occupants；Health services
needs and demand；Root cause analysis；Shanghai

“十四五”规划提出，为全面推进“健康中国”建 提高该类人群的家庭医生签约率提供参考 ［6］ 。
设，深化医药卫生体制改革，要求稳步扩大城乡家庭医 1 对象与方法
生签约服务覆盖范围，提升签约服务质量 ［1］ 。2016 年， 1.1 研究对象 本研究于 2019 年 12 月至 2020 年 12
国务院医改办发布的《关于推进家庭医生签约服务的指 月开展，研究地点为上海市楼宇聚集较多的虹口区、
导意见》指出，家庭医生团队要采取多种服务形式，增 浦东新区、静安区，研究对象为在以上 3 个区域工作
强签约服务吸引力 ［2］ 。上海市家庭医生签约服务覆盖 的 18~59 岁中青年人群。具体抽样方法为：（1）确
率达 45% 以上，但大部分签约居民为老年人，中青年 定 3 个区域的典型楼宇，选取依据为该区域带有办公
人群的覆盖率不高 ［3］ 。上海市从 2012 年起探索将健康 功能的标志性建筑，每个区域选取 8 个楼宇作为抽样
服务送进楼宇企业的服务模式 ［4］ ，到 2020 年将楼宇人 地点；（2）采用整群随机抽样的方式抽取楼宇内中青
群纳入社区卫生健康管理范围 ［5］ ，以推进家庭医生签 年人，即根据楼宇实际情况随机选取每个楼宇调查的
约服务、解决楼宇白领人群健康问题，但目前针对楼宇 楼层，所在楼层以单位为整体开展问卷调查。根据公
2
2
人群家庭医生签约服务需求的研究较为匮乏。本文旨在 式 n=μ ×P×（1-P）/（r×P） ，计算得到虹口区、
探讨上海市中青年楼宇人群对家庭医生签约服务中基本 浦东新区、静安区 3 个区域最低样本量分别为 272、
服务和个性化服务的需求，并分析其影响因素，从而为 182、266。其中，μ 表示置信度所对应的 Z 统计量（双