上海市中心城区居民社区预约就诊现况及影响因素研究

背景　预约就诊对缩短患者非医疗等候时间、提高患者满意度有明显效果。然而，社区预约接受度不高的现象普遍存在，设计适合社区卫生服务中心的预约就诊制度亟待解决。目的　分析社区居民预约就诊服务利用现况及其影响因素，为社区预约就诊服务的改进提供依据。方法　于2019年2-3月，基于便利性原则在上海市黄浦区10个街道社区卫生服务中心门诊和站点门诊，对1 000例就诊居民进行问卷调查。问卷内容包括个人基本信息、健康及就医状况、家庭医生签约知晓和利用状况、社区预约就诊服务知晓和利用状况。采用多因素逐步Logistic回归分析预约就诊行为的影响因素。结果　共发放问卷1 000份，回收有效问卷993份，问卷有效回收率99.3%。993例被调查居民中，患病726例（73.1%）；857例（86.3%）知晓社区家庭医生签约服务，主要通过社区医院了解服务〔88.4%（758/857）〕。857例知晓社区家庭医生签约服务居民中，728例（84.9%）和家庭医生签约，698例（95.9%）知道签约的家庭医生是谁。993例被调查居民中，46.0%（457/993）知道社区开展预约就诊服务，其中，48.4%（221/457）使用过全科预约就诊服务，54.3%（248/457）使用过非全科预约就诊服务。多因素逐步Logistic回归分析结果显示，知晓签约医生是谁会增加全科预约就诊行为，而有其他慢性病（除了高血压、糖尿病、心脑血管疾病、骨关节病、呼吸系统疾病外）、对医生服务态度评价一般或比较好或非常好（相比于非常不好）、通过电视知晓家庭医生签约服务，会减少全科预约就诊行为（P<0.05）；知晓家庭医生签约和签约家庭医生会增加居民非全科预约就诊行为，通过社区医院知道家庭医生签约服务、对接诊医生态度评价一般或比较好或非常好（相比于非常不好）会减少非全科预约就诊行为（P<0.05）。结论　要改善社区预约就诊现况，需要重点从有长期慢性病随访或管理需求的居民入手，以夯实家庭医生签约服务为手段，并兼顾其他居民的家庭医生签约服务宣传；在非全科预约就诊方面，还额外需要从优化门诊流程、控制等候时长等方面入手，通过践行分时段预约及便利的远程预约和解约方式，改进就诊患者的服务体验。

Prevalence and Associated Factors of Use of Appointment-based Community Health Services in Residents from a Central District of Shanghai

Background　Visiting the doctor with an advanced appointment may reduce the treatment waiting time and improve patient satisfaction significantly. However，low acceptance of making an appointment in community care is a common phenomenon. Thus，it is urgent to design an appointment system suitable for the community health center. Objective　To investigate the prevalence and associated factors of residents' use of appointment-based community health services，providing evidence for the improvement of such services. Methods　From February to March 2019，a questionnaire survey was conducted in a convenience sample of 1 000 residents who received outpatient services from 10 subdistrict community health centers and stations in Shanghai's Huangpu District for collecting data about their demographics，health and healthcare-seeking status，awareness and use of contracted family doctor services and appointment-based community health services. Stepwise multivariate logistic regression was used to analyze the associated factors of use of appointment-based community health services. Results　993（99.3%） cases who returned responsive questionnaires were included for analysis. Of these respondents，73.1%（726/993） had at least one illness；86.3%（857/993） knew contracted family doctor services，mainly acquired related information from the community hospital〔88.4%（758/857）〕，and 84.9% （728/857） of them had a contracted family doctor，and 95.9%（698/728） knew their contracted doctor. Nearly half of the respondents〔46.0%（457/993）〕 knew the community hospital delivering appointment-based health services，and 48.4%（221/457）of them had used appointment-based general medical services，and 54.3%（248/457）had used appointment-based non-general medical services. Multivariate logistic regression analysis found that knowing the contacted family doctor was associated with increased rate of using appointment-based general medical services（P<0.05），while having chronic diseases except hypertension，diabetes，cardiovascular diseases，osteoarthropathy，and respiratory diseases，evaluating the doctor's attitude as fair or good or very good（compared with very bad），and knowing contacted family doctor services via watching TV were associated with decreased rate of using such services（P<0.05）. Knowing contracted family doctor services and the contracted family doctor were associated with increased rate of using appointment-based non-general medical services（P<0.05），while evaluating the doctor's attitude as fair or good or very good（compared with very bad），and knowing contracted family doctor services through the community hospital were associated with decreased rate of using such services（P<0.05）. Conclusion　To improve the use of appointment-based community health services in residents，we put forward the following suggestions：promoting the use of contracted family doctor services by strengthening the publicity of these services among residents，especially those with chronic diseases needing long-term follow-up or management；improving the experience of seeking appointment-based non-general medical services by optimizing the outpatient procedure，and controlling the treatment waiting time via offering conveniences for making an appointment at a chosen time，and making or cancelling a remote appointment.