The impact of family doctor contracting on the utilization of community health services for functional building population
-
摘要:
目的 分析功能楼宇人群社区卫生服务利用的影响因素，探明家庭医生签约服务对社区卫生服务利用的影响机制。 方法 于2024年3—4月，采用典型抽样法在上海市浦东新区潍坊社区卫生服务中心辖区内选择3个功能楼宇，使用整群随机抽样法抽取396名功能楼宇人群进行调研。问卷包括社会人口学变量，医疗保障和健康状况，近6个月的社区卫生服务和家庭医生签约服务利用情况。采用单因素分析和logistic回归模型分析社区卫生服务利用影响因素，建立结构方程模型分析家庭医生签约服务对社区卫生服务利用提升的机制。 结果 功能楼宇人群6个月社区卫生服务利用水平为32.83%(130/396)，常规家庭医生签约服务利用率为20.71%(82/396)，功能楼宇家庭医生签约服务利用率为18.69%(74/396)。婚姻情况、自觉健康水平、患有慢性病、了解家庭医生制度、了解家庭医生的团队组成、信任家庭医生和有利用常规家庭医生签约服务均是社区卫生服务利用水平的影响因素(P < 0.05)。结构方程模型提示常规家庭医生签约服务利用对功能楼宇家庭医生签约服务利用、社区卫生服务利用均有驱动作用，功能楼宇家庭医生签约服务利用对常规家庭医生签约服务利用有驱动作用(P < 0.05)。 结论 家庭医生签约服务利用对于社区卫生服务的利用具有直接驱动作用，提高家庭医生知晓率及居民对家庭医生的信任感是继续提升服务利用的基石。 Abstract:Objective To analyze the influencing factors of community health service utilization among functional building populations, and explore the impact mechanism of family doctor contract services on community health service utilization. Methods From March to April 2024, three functional buildings in the district of Weifang Community Health Service Center in Pudong New Area of Shanghai were selected by typical sampling method, and 396 people in functional buildings were selected by cluster random sampling method for investigation. The questionnaire included sociodemographic variables, medical security and health status, utilization of community health services in the last 6 months, and utilization of contracted services by family doctors. Univariate analysis and logistic regression model were used to analyze the influencing factors of community health service utilization, and a structural equation model was established to analyze the mechanism of family doctor contract service to improve the utilization of community health service. Results The utilization level of community health services in functional buildings within 6 months was 32.83% (130/396), the utilization rate of contracted services by conventional family doctors was 20.71% (82/396), and the utilization rate of contracted services by family doctors in functional buildings was 18.69% (74/396). Marital status, perceived health level, chronic disease, understanding of family doctor system, understanding of family doctor team composition, trust in family doctor and use of regular family doctor contract service were all influencing factors on community health consumption level (P < 0.05). The structural equation model indicated that the utilization of contracted services by conventional family doctors in functional buildings had a driving effect on both the utilization of contracted services by family doctors in functional buildings and the utilization of community health services, and the utilization of contracted services by family doctors in functional buildings had a driving effect on the utilization of contracted services by conventional family doctors (P < 0.05). Conclusion The utilization of contracted services by family doctors has a direct driving effect on the utilization of community health services. Improving the awareness rate of family doctors and improving residents ' trust in family doctors is the cornerstone of further improving the utilization of services. -
图 1 功能楼宇人群社区卫生服务利用的结构方程模型
Figure 1. Structural equation model of community health service utilization for population in functional buildings
表 1 功能楼宇人群社区卫生服务利用情况[人(%)]
Table 1. Utilization of community health services for people in functional buildings [person (%)]
项目 人数(%) 无利用(n=266) 有利用(n=130) χ2值 P值 性别 0.623 0.430 男性 194(48.99) 134(69.07) 60(30.93) 女性 202(51.01) 132(65.35) 70(34.65) 年龄段(岁) 9.446 0.051 18~25 24(6.06) 20(83.33) 4(16.67) 26~30 38(9.60) 30(78.95) 8(21.05) 31~40 108(27.27) 68(62.96) 40(37.04) 41~50 170(42.93) 106(62.35) 64(37.65) 51~60 56(14.14) 42(75.00) 14(25.00) 婚姻状况 24.818 ＜0.001 未婚 72(18.18) 62(86.11) 10(13.89) 已婚 304(76.77) 198(65.13) 106(34.87) 离异 20(5.05) 6(30.00) 14(70.00) 学历 9.455 0.051 初中及以下 26(6.57) 14(53.85) 12(46.15) 高中/中专 72(18.18) 46(63.89) 26(36.11) 大学专科 76(19.19) 60(78.95) 16(21.05) 大学本科 186(46.97) 126(67.74) 60(32.26) 研究生及以上 36(9.09) 20(55.56) 16(44.44) 居住情况 2.137 0.343 与配偶共同居住 280(70.71) 182(65.00) 98(35.00) 独居 48(12.12) 34(70.83) 14(29.17) 与朋友/室友共同居住 68(17.17) 50(73.53) 18(26.47) 医疗保障类型 0.693 0.707 城镇职工保险 334(84.34) 226(67.66) 108(32.34) 城镇居民保险 54(13.64) 34(62.96) 20(37.04) 商业保险或自费 8(2.02) 6(75.00) 2(25.00) 自觉健康水平 9.956 0.019 非常好 66(16.67) 54(81.82) 12(18.28) 较好 168(42.42) 114(67.86) 54(32.14) 一般 144(36.36) 88(61.11) 56(38.89) 不太好 18(4.55) 10(55.56) 8(44.44) 慢病种类 15.309 0.002 无 276(69.70) 202(73.19) 74(26.81) 1种 88(22.22) 46(52.27) 42(47.73) 2种 24(6.06) 14(58.33) 10(41.67) 3种及以上 8(2.02) 4(50.00) 4(50.00) 是否已签约家庭医生 35.334 ＜0.001 未签约 268(67.68) 206(76.87) 62(23.13) 签约 128(32.32) 60(46.88) 68(53.12) 是否了解“上海市1+1+1家庭医生签约制度”中“1+1+1” 31.944 ＜0.001 完全不了解 168(42.42) 122(72.62) 46(27.38) 不太了解 122(30.81) 92(75.41) 30(24.59) 一般了解 62(15.66) 38(61.29) 24(38.71) 比较了解 32(8.08) 10(31.25) 22(68.75) 常了解 12(3.03) 4(33.33) 8(66.67) 是否了解家庭医生的团队由哪些人员组成 32.205 ＜0.001 完全不了解 174(43.94) 130(74.71) 44(25.29) 不太了解 130(32.83) 96(73.85) 34(26.15) 一般了解 58(14.65) 28(48.28) 30(51.72) 比较了解 22(5.56) 8(36.36) 14(63.64) 非常了解 12(3.03) 4(33.33) 8(66.67) 对家庭医生信任程度打分 41.092 ＜0.001 不信任 12(3.03) 10(83.33) 2(16.67) 比较不信任 20(5.05) 16(80.00) 4(20.00) 一般 228(57.58) 176(77.19) 52(22.81) 比较信任 102(25.76) 52(50.98) 50(49.02) 很信任 34(8.59) 12(35.29) 22(64.71) 对家庭医生的能力水平打分 24.543 ＜0.001 不好 8(2.02) 4(50.00) 4(50.00) 不太好 12(3.03) 8(66.67) 4(33.33) 一般 238(60.10) 182(76.47) 56(23.53) 比较好 114(28.79) 60(52.63) 54(47.37) 很好 24(6.06) 12(50.00) 12(50.00) 常规家庭医生签约服务利用 106.523 ＜0.001 无利用 250(79.62) 64(20.38) 有利用 16(19.51) 66(80.49) 功能楼宇家庭医生签约服务利用 57.857 ＜0.001 无利用 244(75.78) 78(24.22) 有利用 22(29.73) 52(70.27) 
下载: 导出CSV
表 2 变量赋值情况
Table 2. Variable assignment
自变量 赋值方法 婚姻状态 未婚/离异/丧偶=1；已婚=2 自觉健康水平 不大好=1；一般=2；较好=3；非常好=4 慢病种类 无=1；1种=2；2种=3；3种及以上=4 是否已签约家庭医生 是=0；否=1 是否了解“上海市1+1+1家庭医生签约制度”中“1+1+1” 是=0；否=1 是否了解家庭医生的团队由哪些人员组成 非常了解=5；比较了解=4；一般=3，不太了解=2，不了解=1 对家庭医生信任程度打分 非常信任=5；比较信任=4；一般=3，不太信任=2，不信任=1 对家庭医生的能力水平进行打分 非常好=5；比较好=4；一般=3，不太好=2，不好=1 常规家庭医生签约服务利用 是=1；否=0 功能楼宇家庭医生签约服务利用 是=1；否=0
下载: 导出CSV
表 3 功能楼宇人群对社区卫生服务影响因素的logistic分析
Table 3. Logistic analysis of influencing factors of community health services in functional building populations
变量 B SE Waldχ2 P值 OR(95% CI) 婚姻状态 0.850 0.504 2.109 0.028 3.034(1.129~8.153) 自觉健康水平 -0.620 0.910 4.453 0.007 0.086(0.015~0.513) 慢病种类 1.200 1.000 4.027 0.004 17.271(2.434~122.566) 了解家庭医生制度 0.950 1.062 2.144 0.047 0.121(0.015~0.970) 了解家庭医生团队组成 0.720 0.978 5.601 0.001 5.170(2.033~13.151) 对家庭医生的信任 1.103 0.854 3.402 0.009 9.167(1.720~48.851) 常规家庭医生签约服务利用 1.510 0.547 8.713 ＜0.001 18.376(6.290~53.687)
下载: 导出CSV
表 4 结构方程路径关系假设检验
Table 4. Hypothesis testing of the path relationship of structural equations
路径 Effect SE CR P值 中间变量←常规家庭医生签约服务利用 -0.083 0.040 -2.066 0.039 中间变量←功能楼宇家庭医生签约服务利用 -0.061 0.031 -1.984 0.047 社区卫生服务利用←常规家庭医生签约服务利用 0.530 0.070 7.559 ＜0.001 社区卫生服务利用←功能楼宇家庭医生签约服务利用 0.042 0.072 0.590 0.556 社区卫生服务利用←中间变量 -0.355 0.259 -1.372 0.170 常规家庭医生签约服务利用↔功能楼宇家庭医生签约服务利用 0.108 0.010 11.201 ＜0.001
下载: 导出CSV
-
[1] 卫生健康委财政部人力资源社会保障部医保局中医药局疾控局关于推进家庭医生签约服务高质量发展的指导意见[J]. 中华人民共和国国务院公报, 2022(19): 61-64.Guiding Opinions of the Health Commission, Ministry of Finance, Ministry of Human Resources and Social Security, Medical Insurance Bureau, Traditional Chinese Medicine Bureau, Disease Control Bureau on Promoting High Quality Development of Family Doctor Contract Services[J]. State Council Bulletin of the People's Republic of China, 2022(19): 61-64. [2] 彭涛, 滕黎. 医共体模式下家庭医生签约服务的困境与进路探析[J]. 南京医科大学学报(社会科学版), 2024, 24(2): 120-123.PENG T, TENG L. Analysis of the challenges and pathways of family doctor contract services under the medical community model[J]. Journal of Nanjing Medical University (Social Sciences Edition), 2024, 24(2): 120-123. [3] 白兰, 孙红, 肖雨龙. 南京市家庭医生签约服务现状及问题研究[J]. 卫生经济研究, 2024, 41(3): 32-35.BAI L, SUN H, XIAO Y L. Research on the current situation and problems of family doctor contract services in Nanjing city[J]. Health Economics Research, 2024, 41(3): 32-35. [4] 张娇. 供需视角下家庭医生签约服务偏好研究[D]. 济南: 山东大学, 2021.ZHANG J. Research on the preference of family doctor contract services from the perspective of supply and demand[D]. Jinan: Shandong University, 2021. [5] 李心怡, 张榕榕, 胡丹, 等. 我国家庭医生签约服务现状研究: 基于四省份的实地调研[J]. 中国卫生政策研究, 2020, 13(5): 39-44.LI X Y, ZHANG R R, HU D, et al. A Study on the current status of family doctor contract services in China: based on field research in four provinces[J]. Chinese Health Policy Research, 2020, 13(5): 39-44. [6] 汤真清, 汪铭涵, 石斌, 等. 上海市开展功能社区社区卫生服务的SWOT分析[J]. 上海医药, 2023, 44(10): 3-5, 38.TANG Z Q, WANG M H, SHI B, et al. SWOT analysis of functional community health services in Shanghai[J]. Shanghai Medical & Pharmaceutical Journal, 2023, 44(10): 3-5, 38. [7] WARREN S, CLAMAN D, MEYER B, et al. Acceptance of voice assistant technology in dental practice: a cross sectional study with dentists and validation using structural equation modeling[J]. PLOS Digital Health, 2024, 3(5): e0000510. DOI: 10.1371/journal.pdig.0000510. [8] 黄蛟灵, 崔雅琦, 郝雨, 等. 上海市北外滩街道中青年楼宇人群社区卫生服务利用分析[J]. 中华全科医学, 2021, 19(6): 975-978. doi: 10.16766/j.cnki.issn.1674-4152.001964HUANG J L, CUI Y Q, HAO Y, et al. Analysis of community health service utilization among young and middle aged building population in North Bund Street, Shanghai [J]. Chinese Journal of General Practice, 2021, 19(6): 975-978. doi: 10.16766/j.cnki.issn.1674-4152.001964 [9] 谭梅, 张雨婷, 张艳, 等. 基于安德森模型的老年人社区居家医养结合服务需求及影响因素分析[J]. 中华全科医学, 2023, 21(7): 1179-1183. doi: 10.16766/j.cnki.issn.1674-4152.003079TAN M, ZHANG Y T, ZHANG Y, et al. Analysis of demand and influencing factors for elderly community home care integrated services based on anderson model[J]. Chinese Journal of General Practice, 2023, 21(7): 1179-1183. doi: 10.16766/j.cnki.issn.1674-4152.003079 [10] 王洪兴, 汪洋, 王麒凯, 等. 社区糖尿病高危人群对中医"治未病"服务需求及利用的研究[J]. 中华全科医学, 2020, 18(5): 797-800. doi: 10.16766/j.cnki.issn.1674-4152.001360WANG H X, WANG Y, WANG Q K, et al. Research on the demand and utilization of the "prevention of disease" service of traditional Chinese medicine for high-risk groups of diabetes in communities[J]. Chinese Journal of General Practice, 2020, 18(5): 797-800. doi: 10.16766/j.cnki.issn.1674-4152.001360 [11] 相彤, 李文涛, 赵京伟, 等. 基于安德森模型的国内外基层医疗服务利用影响因素的系统综述[J]. 中华全科医学, 2023, 21(10): 1757-1761. doi: 10.16766/j.cnki.issn.1674-4152.003218XIANG T, LI W T, ZHAO J W, et al. A systematic review of factors influencing the utilization of primary healthcare services at home and abroad based on the Anderson model[J]. Chinese Journal of General Practice, 2023, 21(10): 1757-1761. doi: 10.16766/j.cnki.issn.1674-4152.003218 [12] 詹祥, 周颖, 许兴龙, 等. 居民社会资本对基本公共卫生服务利用的影响研究[J]. 中国卫生事业管理, 2023, 40(1): 34-37, 57.ZHAN X, ZHOU Y, XU X L, et al. Researches on the influence of residents' social capital on the utilization of basic public health services[J]. Chinese Health Service Management, 2023, 40(1): 34-37, 57. [13] 李紫璇, 严运楼. 基于灰色预测模型的我国社区卫生服务发展研究[J]. 中国医疗管理科学, 2021, 11(2): 17-22.LI Z X, YAN Y L. Prediction of the development of community health services in China based on a gray model[J]. Chinese Journal Of Medical Management Sciences, 2021, 11(2): 17-22. [14] 胡小璞, 候乐荣, 邵平, 等. 推广签约对社区卫生服务的利用及影响研究: 以杭州主城区为例[J]. 中国卫生事业管理, 2020, 37(7): 489-493, 507.HU X P, HOU L R, SHAO P, et al. Studying on the utilization of community health services and the influence from promoting contractual services sampled with main urban area of Hangzhou[J]. Chinese Health Service Management, 2020, 37(7): 489-493, 507. [15] 唐志红, 王朝昕, 蔡利强. 运用组织沟通理论解决家庭医生签约问题的策略研究[J]. 中华全科医学, 2023, 21(1): 97-99, 122. doi: 10.16766/j.cnki.issn.1674-4152.002821TANG Z H, WANG C X, CAI L Q. Using organisational communication theory to solve the problem of family doctors signing contract[J]. Chinese Journal of General Practice, 2023, 21(1): 97-99, 122. doi: 10.16766/j.cnki.issn.1674-4152.002821 [16] 饶雅舒, 王俊舟, 杨义, 等. 基于社会网络分析法的社区居民家庭医生签约服务利用研究[J]. 中华全科医学, 2023, 21(4): 632-636. doi: 10.16766/j.cnki.issn.1674-4152.002948RAO Y S, WANG J Z, YANG Y, et al. Utilization of community residents' family doctor contracted services based on social network analysis[J]. Chinese Journal of General Practice, 2023, 21(4): 632-636. doi: 10.16766/j.cnki.issn.1674-4152.002948 -
点击查看大图
图(1) / 表(4)
计量
- 文章访问数: 5
- HTML全文浏览量: 1
- PDF下载量: 0
- 被引次数: 0
