中国全科医学2018，Vol.21Issue(4)：407-410,4.DOI:10.3969/j.issn.1007-9572.2018.04.007
家庭医生签约服务对社区居民就诊行为的影响研究
Effects of Contractual Services from Family Doctors on the Healthcare-seeking Behavior among Community Residents
摘要
Abstract
Objective To investigate the effects of contractual services from family doctors on the healthcare-seeking behavior among community residents. Methods In December 2013, by multistage cluster random sampling, we selected 3 040 community residents from 10 neighborhoods/townships in Changning District of Shanghai and surveyed them using a questionnaire developed by our research group for collecting the data mainly about the medical institution visited last time, reasons for choosing this medical institution, and the referral in community health service centers (CHSCs). Analysis was limited to the 2 750 who returned responsive questionnaires. Then, in June 2016, we conducted a follow-up survey among these 3 040 residents with the same questionnaire, among whom 2 004 responded effectively. Results The percentage of contracted residents visited CHSCs the last time for 2013 and 2016 was 51.4%(213/414), 40.7%(209/514), respectively, indicating that in 2016 it decreased significantly (P<0.05). Both in 2013 and 2016, the percentages of contracted residents visited CHSCs the last time were much higher compared with those uncontracted (P<0.05). The three leading reasons for contracted residents seeking healthcare in CHSCs in 2016 were easy to access medical services (27.7%, 180/649 ), light illness (13.4%, 87/649) and low cost (11.6%, 75/649 ). The rate of contracted residents who were referred from the community health service center to hospital in 2013 and 2016 was 7.6% (45/589), 11.9%(77/649), respectively, demonstrating that in 2016 it increased significantly (P<0.05). Both in 2013 and 2016, the percentages of contracted residents who were referred from the community health service center to hospital were much higher compared with those uncontracted (P<0.05). In 2016, 46.7% (36/77) of the contracted residents were referred to hospital by their contracted family doctor, 83.3%(40/48) of those uncontracted were referred by the general outpatient doctor, which showed that the referral way between these two groups was significantly different (P<0.05). Conclusion The healthcare-seeking behavior was improved in the contracted community residents, but the rate of referral in primary care was low, and the hierarchical diagnosis and treatment pattern should be developed further.关键词
家庭医生签约服务/就诊行为/居民Key words
Family doctor contractual services/Healthcare-seeking behavior/Residents分类
医药卫生引用本文复制引用
刘姗姗,葛敏,江萍,朱敏杰,梁鸿,黄蛟灵,方帅,赵德余,张宜民..家庭医生签约服务对社区居民就诊行为的影响研究[J].中国全科医学,2018,21(4):407-410,4.基金项目
国家自然科学基金资助项目(71403171) （71403171）
上海市浦东新区卫生和计划生育委员会学科带头人计划项目(PWRd2014-13) （PWRd2014-13）
上海市浦东新区卫生、计生科技项目(PW2016A-3) （PW2016A-3）
