Page 98 - 2022-22-中国全科医学

http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn ·2783·

6.Tenth People's Hospital of Tongji University，Shanghai 200072，China
7.Department of Rehabilitation，Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine，Shanghai
200092，China
8.School of Public Health，Shanghai Jiao Tong University School of Medicine，Shanghai 200025，China
*
Corresponding author：HUANG Jiaoling，Associate researcher；E-mail：jiaoling_huang@sina.com
【Abstract】 Background Shanghai is gradually expanding the supply of family doctor contract service to building
functional communities，but the prevalence of met needs of such services in young and middle-aged office building occupants is
still unknown，and relevant studies on the prevalence and associated factors could inform the development and improvement of
policies regarding building-based family doctor services. Objective To explore the prevalence of met needs for contracted family
doctor services and associated factors in young and middle-aged office building occupants. Methods A questionnaire survey was
implemented from December 2019 to December 2020 in the setting of office buildings selected by typical sampling from Hongkou
District，Pudong New District and Jing'an District of Shanghai. Among the young and middle-aged occupants（n=2 272，
18-59 years old） selected from the buildings by use of cluster random sampling to attend the survey，1 137 with an experience
of using contracted family doctor services were determined as the participants. The survey involved four aspects，including
sociodemographic and economic characteristics，health status，understanding level of contracted family doctor services，and met
needs of these services（containing essential and personalized service needs assessed using a 5-point Likert scale）. Multinomial
and ordinal Logistic regression was used to analyze factors associated with met needs of contracted family doctor services. Results
The prevalence of having needs of essential family doctor services considerably/completely met was 39.61%（425/1 073）. And
that of having needs of personalized family doctor services considerably/completely met was 39.01%（419/1 074）. Multinomial
and ordinal Logistic regression analysis revealed that registered place of household（Shanghai or not），occupation，annual
income，self-rated health，understanding of the "1+1+1" type of contracted family doctor services，level of trust in family
doctors，and evaluation of family doctors' service capabilities were associated with met needs of essential family doctor services
（P<0.05）. Sex，annual income，chronic disease prevalence， understanding of the "1+1+1" type of contracted family doctor
services and the composition of a family doctor team，as well as evaluation of family doctors' service capabilities were associated
with met needs of personalized family doctor services（P<0.05）. Conclusion The prevalence of self-reported met needs of
essential or personalized family doctor services in the young and middle-aged office building occupants was about 40%，which
was associated with sociodemographic and economic characteristics，health status，understanding level of contracted family
doctor services，and self-assessed family doctors' service capabilities. It is recommended to improve the publicity of the system of
contracting family doctor services，customize personalized service plans according to the characteristics and differentiated needs
of the population，improve the family doctor's service capabilities and enrich the services.
【Key words】 Contracted family doctor services；Young and middle-aged office building occupants；Health services
needs and demand；Root cause analysis；Shanghai

家庭医生签约服务是深化医药卫生体制改革的重要 策、提高楼宇人群家庭医生签约服务效率和服务质量提
“抓手” ［1］ 。近年来，上海市针对居民的健康状况和 供依据。
需求，制定了不同类型的个性化签约服务内容，并将服 1 对象与方法
务范围逐步拓展至辖区内的学校、企业园区及办公楼宇 1.1 研究对象 于 2019 年 12 月至 2020 年 12 月，采
等功能社区 ［2］ 。上海市部分地区于 2018 年 6 月率先试 用典型抽样法在上海市虹口区、浦东新区、静安区各选
点了基于“楼宇健康驿站”的家庭医生签约服务模式 ［3］ 。 取 8 个楼宇，然后采用整群随机抽样法抽取 18~59 岁的
有研究显示，截至 2018 年底，上海市中青年楼宇人群 中青年楼宇人群开展线上、线下相结合的问卷调查，最
的签约率相对较低 ［4］ 。但值得注意的是，该人群具有 终回收有效问卷 2 272 份。具体抽样和调查方法见本课
较为个性化的家庭医生签约服务需求 ［5］ 。受限于家庭 题组其他研究 ［6］ 。本研究以其中利用过家庭医生服务
医生楼宇服务的开展时间，当前针对其开展现况的研究 的 1 137 例（50.04%）中青年人为研究对象。
相对较少，家庭医生楼宇服务是否能够满足中青年楼宇 1.2 研究方法 调查问卷由课题组自行设计，与本研
人群的需求尚未可知。因此，本文调查了上海市中青年 究有关的调查内容包括：（1）社会人口与经济学特征，
楼宇人群的家庭医生签约服务需求满足状况并分析其影 如性别、年龄、户籍、受教育程度、婚姻状况、职业类别、
响因素，旨在为制定楼宇人群家庭医生签约服务相关政 年收入、社会医疗保障情况；（2）健康状况，如自评