中国全科医学2026，Vol.29Issue(17)：2303-2311,9.DOI:10.12114/j.issn.1007-9572.2025.0325
信任视角下患者持续基层首诊意愿的驱动机制研究
Research on the Driving Mechanism of Patients'Willingness to Continue Primary Diagnosis from the Perspective of Trust
摘要
Abstract
Background Primary medical first consultation plays an important role in the rational utilization of medical services and alleviating the contradiction between supply and demand of medical resources.However,the rate of primary medical first consultation in China is lower than the policy expectations,and it is very important to guide patients to primary care.Therefore,it is of great significance to conduct an in-depth exploration of the driving mechanism of patients'willingness for primary medical first consultation.Objective Based on the family doctor contract service scenario,a theoretical model of"expectation confirmation-patient trust-sustained willingness to first visit at the grassroots level"was constructed based on the expectation confirmation theory.Through empirical research,this paper verifies the social psychological mechanism of patients'willingness to continue grassroots first diagnosis,reveals the path of patient trust,and provides theoretical basis and practical enlightenment for improving patients'willingness to continue grassroots first diagnosis.Methods Taking a community health service center in Chengdu as the research site,a questionnaire survey was conducted on the patients served by the center in March 2024,including four parts:general information questionnaire,expectation confirmation,patient trust,and medical seeking willingness at the grassroots level.Independent sample t-test and one-way analysis of variance were used to study the differences in patients'trust between groups,and the structural equation model was used to verify the theoretical hypothesis and mediating effect.Results A total of 318 questionnaires were collected for the survey,of which 288(90.6%)were valid.The average expection confirmation score for patients was(3.99±0.74)points,with 208 cases(72.2%)exhibiting high expected confirmation.The average patient trust score was(4.13±0.61)points,with the three dimensions of technical trust,service trust,and emotional trust averaging(4.18±0.65),(3.60±1.02),and(4.35±0.64)points respectively.Patients who were adults,aged 60 years or older,had hypertension/diabetes,had signed up with a family doctor,and had high expectations demonstrated higher trust in primary care(P<0.05).Patients who did not have a designated doctor showed lower trust in primary care(P<0.05).Patient trust had a complete mediating effect between expectation confirmation and the willingness to seek initial treatment at primary care facilities(P<0.05).Conclusion Patient trust has a significant full mediating effect between expectation confirmation and willingness to continue primary care.It is the starting point to cultivate patients'trust by providing patients with super-expected experience through targeted demand satisfaction,so as to improve patients'expectation confirmation.Taking public health services as an opportunity to establish emotional trust,relying on the improvement of diagnosis and treatment ability and the optimization of referral services to establish technical trust and service trust may be the key path to enhance the first diagnosis of patients'willingness at the grassroots level.关键词
基层首诊/患者信任/期望确认/就诊意愿/结构方程模型Key words
Primary medical first consultation/Patient trust/Expectation confirmation/Medical seeking willingness/Structural equation model分类
医药卫生引用本文复制引用
肖蕾,缪星雨,刘兴雨,胡馨怡,张松,吴颖敏..信任视角下患者持续基层首诊意愿的驱动机制研究[J].中国全科医学,2026,29(17):2303-2311,9.基金项目
四川应用心理研究中心资助项目(CSXL-23310) （CSXL-23310）
