“1+1+1”医疗机构组合签约影响因素研究

  目的  探索居民签约“1+1+1”医疗机构组合签约的影响因素，了解政策推进过程中存在的障碍，并提出针对性的改进建议和措施。  方法  采用随机数字表法，对上海市黄浦区淮海中路卫生服务中心2018年门诊就诊居民按照签约和未签约分别进行抽样，共获取有效样本1 204例，签约和未签约各602例。通过问卷调查采集其人口社会学信息、健康状况、就医状况、家庭医生签约知晓情况。数据分析采用SPSS 24.0统计学软件进行。  结果  单因素分析结果显示，职业、是否离退休、文化程度、婚姻情况、高血脂、脑卒中、心脏疾病、肾脏疾病、骨质疏松、其他疾病、是否需要长期服药、配药需求、康复护理需求、其他需求、是否知晓签约服务方面不同的居民，其家庭医生签约情况的差异有统计学意义(均P < 0.05)；签约和未签约居民的年龄、受教育年限差异有统计学意义(均P < 0.05)。多因素分析结果显示，职业、是否离退休、文化程度、婚姻情况、高血脂、骨质疏松、是否需要长期用药、是否知晓签约服务是家庭医生签约率的独立影响因素(均P < 0.05)；“没需求”是居民不考虑签约的主要原因。  结论  要促进落实“1+1+1”医疗机构组合签约政策，建立长期稳定的签约关系，需进一步加大政策的宣传力度、以社区居民的需求为立足点提供健康服务。 

Study on the influencing factors of "1+1+1" type of contracted family doctor services

  Objective  To explore the influencing factors of "1+1+1" type of contracted family doctor services, to understand the obstacles in the process of policy promotion, and to put forward the targeted suggestions and measures for improvement.  Methods  The random number table method was used to sample residents in the outpatient clinics of Huaihai Middle Road Health Service Center in Huangpu District, Shanghai in 2018 according to signed and unsigned contracts. A total of 1 204 valid samples were obtained, which include 602 residents contracting family doctor and 602 residents without contracting family doctor. Their demographic sociology information, health status, medical treatment status, family doctor contract awareness status were collected through questionnaire survey. Data analysis was performed in SPSS 24.0.  Results  The results of single factor analysis showed that residents with different situation showed statistically significant differences in family doctors' contracting status (all P < 0.05), such as occupation, whether to retire, education level, marital status, hyperlipidemia, stroke, heart disease, kidney disease, osteoporosis, other diseases, the need for long-term medication, dispensing needs, rehabilitation care needs, other care needs and knowledge of family doctor contract. There was a statistically significant difference in the age and years of education between contracted and unsigned residents (all P < 0.05). Multi-factor analysis results showed that occupation, retirement or not, education, marital status, hyperlipidemia, osteoporosis, needs for long-term medication, knowledge of family doctor contract were the independent factors affecting signing rate with family doctors (all P < 0.05). "No demand" was the main reason why residents did not consider signing contracts.  Conclusion  To promote the implementation of "1+1+1" medical institution combination contracting policy and establish a long-term and stable contracting relationship are necessary to further strengthen the propaganda of the policy, and provide health services based on the needs of community resident.