全科医疗特征功能的评价、影响因素分析及政策涵义

目的:全科医疗特征功能是构成基础保健高绩效的基础,是区别于专科医疗的核心所在。本研究将测量全科医疗特征功能,剖析其影响因素,探讨问题原因,为制定强化全科医疗特征功能政策提供依据。方法:使用本土化的基础保健测量工具PCAT-AE,选择8家社区卫生服务中心和深圳市港大医院全科医疗门诊部作为调查机构。采用面对面、一对一形式的问卷调查方法,共调查1 712名病人,有效问卷1 645份。结果:全科医疗特征功能总分49.0分,首诊利用(69.8)、连续性(63.1)和文化胜任力(51.2)维度得分相对较高,可及性(40.8)和以社区为导向(31.0)维度得分相对较低。全科医疗特征功能得分受人口社会学特征、健康特征和服务利用等多种因素影响,特征功能对病人的满意度起积极作用(OR1)。结论:国内全科医疗特征功能得分较低,与国外相比差距较大。可以从病人个体、组织和系统三个层面,全面强化全科医疗特征功能。

Evaluation, determinants and policy implications of the general practice attributes

Objective: The general practice attributes constitute a basis for the high primary care performance. In this paper, the general practice attributes are measured, their influencing factors are analyzed, the causes of existing problems are explored, and suggestions are straight forwarded to strengthen the general practice function. Methods: In this study, a PCAT-AE modified Chinese edition was adopted. The research was conducted into 8 community health centers and the general outpatient clinic of the University of Hong Kong, Shenzhen Hospital. They were eligible adult patients who could communicate properly and had visited the same general practitioners at least three times. One-to-one interviews were conducted and a total of 1712 patients participated in the survey, a number of which 1645 effective samples were considered for analysis. Results: The total general practice attributes score was 49.0. The first-contact score of 69.8, continuity score being 63.1 and the cultural competence score of 51.2 were relatively high. The scores for the access (40.8) and community orientation (31.0) were relatively low. The general practice attribute scores were influenced by the social demographic and health characteristics, and the health care service utilization. Also, the general practice core attributes were positively related to the patient satisfaction (OR>1). Conclusion: Comparing to the numbers in the developed countries, the general practice attribute scores were still low in China. Therefore, to strengthen the general practice function, works could be done at the individual, organization and system levels.