基于多水平模型的家庭医生签约影响因素研究OA

Objective To assess the willingness of rural residents in Shandong Province to engage with family doctors and to explore associated determinants,thereby providing policy recommendations for the successful implementation of family doctor contracted services in rural areas of Shandong Province.Methods A question-naire survey was conducted in six randomly selected counties in Shandong Province,employing a multi-level gener-alized hierarchical linear model to explore influencing factors.Results Among 2978 residents in Shandong Prov-ince who were approached for family doctor contracting,27.73％had engaged in such contracts.Regression ana-lyses results revealed that at the individual level,rural residents with higher education(high school and above:OR=1.71,P=0.001),regular physical exercise(OR=1.40,P=0.001),presence of multiple chronic disea-ses(OR=1.53,P=0.006)were more willing to contract with family doctors;at the village level,clinics with higher degrees of informatization had higher signing rates;and at the town level,health centers with sufficient a-vailability of essential medications(OR=1.53,P=0.032),higher degree of informatization(OR=1.28,P=0.005),and with doctors having family doctor training(OR=3.19,P=0.002)and central hospitals(OR=1.92,P＜0.001)had greater signing probabilities.Conclusions It is recommended to enhance publicity of fami-ly doctor contracted services among residents,improve their health literacy,achieve equitable allocation of health-care resources,elevate overall standards of primary healthcare services,and encourage rational healthcare-seeking behaviors among residents,so as to augment family doctor signing rates and operational efficiency.