农村居民对家庭医生“签约首诊”忠诚度的影响因素分析

盛清; 蔡利强; 王朝昕

doi:10.16766/j.cnki.issn.1674-4152.003804

农村居民对家庭医生“签约首诊”忠诚度的影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003804

1.
上海市闵行区江川社区卫生服务中心全科，上海 200240
2.
上海市浦东新区大团社区卫生服务中心全科，上海 201311
3.
海南医科大学管理学院，海南海口 570100

基金项目:

国家重点研发计划项目 2022YFC3601505

上海市浦东新区科技发展基金民生科研专项 PKJ2020-Y70

详细信息

通讯作者:
蔡利强，E-mail：13671544803@163.com

中图分类号: R197.61 R192.3
计量
- 文章访问数: 16
- HTML全文浏览量: 7
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-05-15
- 网络出版日期: 2025-01-20

Analysis on the factors influencing the loyalty of rural residents to family doctors' "contract first consultation"

1.
Department of General practice, Jiangchuan Community Health Care Center of Minhang District, Shanghai 200240, China

摘要

摘要: 目的运用服务营销中“顾客忠诚度”的理论，将“签约首诊服务”作为“重要产品”，调查和分析农村居民对家庭医生签约首诊服务忠诚度的影响因素，提高家庭医生签约服务的利用率。方法采用随机抽样方法，选取上海市浦东新区6家农村社区的1 000名居民为调查对象。于2021年5—9月，使用改良美国顾客满意度指数(ASCI)模型和SERVQUAL服务质量评价量表，运用半结构访谈法自行设计签约居民对家庭医生签约首诊服务忠诚度的问卷调查表。收集调查问卷分析差异和影响家庭医生签约首诊服务忠诚度的因素。结果家庭医生签约首诊服务忠诚度的8个维度期望值和实际值间差异均有统计学意义。家庭医生签约服务忠诚度的58个条目中期望值和实际值的均值差值在1.0以上的共6个，58个条目期望值与实际值差异均有统计学意义。回归模型发现各个维度的期望值均显著提高了签约居民的满意度，期望值比实际值更能影响满意度。结论浦东新区农村社区卫生服务中心在硬件设施、家庭医生服务态度、医患沟通等方面，签约居民认可程度比较高，在药品供给和医疗辅助技术方面存在短板。建议适度增加社区卫生服务中心自主管理权限，完善和综合医院“上下对接”药品使用制度，探索“全科+专科”综合性的人才培养模式，提高家庭医生签约服务的积极性和主动性。
- 农村社区 /
- 签约首诊 /
- 忠诚度 /
- 影响因素 /
- 策略研究
Abstract: Objective Using the theory of "customer loyalty" in service marketing, taking "contracted first visit service" as an "important product", investigate and analyze the influencing factors of rural residents' loyalty to family doctor contracted first visit service, and improve the utilization rate of family doctor contracted service. Methods A random sampling method was employed to select 1 000 residents from six rural communities in the Pudong New Area of Shanghai as the subjects of the survey subjects. From May to September 2021, an enhanced American customer satisfaction index (ASCI) model and the SERVQUAL service quality evaluation scale were employed to develop a questionnaire survey on the loyalty of contracted residents to the initial visit service of family doctors using semi-structured interview approach. The survey questionnaires were collated for analysis of the discrepancies and factors influencing the loyalty of family doctors to register for initial visit services. Results A statistically significant discrepancy exists between the anticipated and observed values of the 8 dimensions that affect influence the loyalty of family doctors to the initial consultation service. A total of 58 items were identified as influencing the loyalty of family doctors to contract services. Of these, 6 items exhibited a mean difference of 1.0 or more between their expected and actual values. Furthermore, the differences between the expected and actual values were statistically significant for all 58 items. The regression model revealed that the anticipated values for each dimension had a notable influence on the satisfaction of contracted residents. Furthermore, the anticipated values exerted a more pronounced effect on satisfaction than the actual values. Conclusion The Pudong New Area Rural Community Health Service Center is perceived to have a relatively high level of recognition among contracted residents in terms of the availability of hardware facilities, the quality of family doctor services, and the communication between doctors and patients. Nevertheless, deficiencies exist in the provision of pharmaceuticals and medical technology. It is recommended that the self-management authority of community health service centers be moderately increased, that the drug use system with general hospitals be improved with a view to enhancing its "top-down coordination", that a comprehensive talent training model of "general practice+specialty" be explored, and that the enthusiasm and initiative of family doctors to sign contracts for services be enhanced.
- Rural communities /
- Sign the contract for the first visit /
- Loyalty /
- Influencing factors /
- Operational research

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图 1 美国顾客满意度指数模型

Figure 1. American customer satisfaction index model

下载: 全尺寸图片幻灯片

图 2 服务质量测量模型

Figure 2. Quality of service measurement model

下载: 全尺寸图片幻灯片

图 3 签约居民对家庭医生签约首诊服务忠诚度的影响因素框架

Figure 3. A framework of influencing factors on the loyalty of residents to family doctors' first-visit services

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表 1 1 000名农村签约居民基本情况

Table 1. Baseline characteristics of 1 000 rural residents on contract

项目	例数(%)	项目	例数(%)
性别		职业
男性	460(46.00)	农民	356(35.60)
女性	540(54.00)	职工	241(24.10)
年龄(岁)		个体经营	61(6.10)
＜45	185(18.50)	退休	342(34.20)
45~59	272(27.20)	婚姻状态
≥60	543(54.30)	未婚	24(2.40)
慢性病		已婚	853(85.30)
无	416(41.60)	离婚	38(3.80)
有, 不服药	50(5.00)	丧偶	85(8.50)
有, 偶尔服药	94(9.40)	是否签约
有, 长期服药	440(44.00)	是	994(99.40)
学历		不知道	6(0.60)
大学及以上	129(12.90)	了解家庭医生么
高中	131(13.10)	不了解	7(0.70)
初中	370(37.00)	了解	993(99.30)
小学及以下	370(37.00)

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表 2 家庭医生签约首诊服务忠诚度8个维度期望值和实际值比较(x±s, 分)

Table 2. Comparison of expected value and actual value of 8 dimensions of family doctors' first-visit service loyalty (x±s, points)

项目	期望值	实际值	t值	P值
A 有形性	31.98±2.59	26.64±2.77	44.579	＜0.001
B 可靠性	45.68±3.56	37.06±3.85	51.915	＜0.001
C 响应性	32.08±3.13	25.61±2.78	48.914	＜0.001
D 保证性	27.57±2.61	22.25±2.37	47.737	＜0.001
E 移情性	36.76±3.15	29.72±3.36	48.436	＜0.001
F 感知价值	32.10±2.78	25.81±2.95	49.091	＜0.001
G 顾客满意	23.23±2.10	18.81±2.31	44.835	＜0.001
H 顾客抱怨	36.47±3.50	28.72±3.48	49.691	＜0.001

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表 3 家庭医生签约首诊服务忠诚度的影响因素分析

Table 3. Analysis of influencing factors of family doctor's contract service loyalty

项目	维度	β	β'	SE	t值	P值
期望值	有形性	0.359	0.331	0.029	12.446	＜0.001
	可靠性	0.241	0.206	0.021	11.340	＜0.001
	响应性	0.177	0.201	0.025	7.068	＜0.001
	保证性	0.260	0.236	0.030	8.726	＜0.001
	移情性	0.235	0.208	0.024	9.603	＜0.001
	感知价值	0.347	0.366	0.027	13.005	＜0.001
	顾客满意	0.363	0.314	0.037	9.922	＜0.001
	顾客抱怨	0.292	0.252	0.021	13.941	＜0.001
实际值	有形性	0.047	0.042	0.029	1.610	0.108
	可靠性	0.033	0.039	0.021	1.599	0.110
	响应性	0.234	0.248	0.028	8.284	＜0.001
	保证性	0.203	0.233	0.033	6.059	＜0.001
	移情性	-0.009	-0.033	0.024	-0.367	0.714
	感知价值	0.015	0.073	0.027	0.547	0.585
	顾客满意	0.152	0.177	0.034	4.434	＜0.001
	顾客抱怨	-0.169	-0.130	0.334	-0.504	0.614
注：连续性变量，均以实际值赋值。

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