重庆市居民家庭医生签约服务需求与签约现状研究

背景　重庆市家庭医生签约服务从2011年开始,2016年全面推开,政府通过完善制度、保障经费和人员、规范服务形式和内容等措施来促使家庭医生签约服务有序化、规范化、优质化,但目前关于重庆市居民家庭医生签约服务需求和签约现状的研究仍比较缺乏。目的　了解重庆市居民对家庭医生签约服务的需求和签约现状,为政府制定相关政策提供建议。方法　于2018年3—5月采用多阶段抽样法选取重庆市北碚、彭水、巴南、永川、梁平、合川、沙坪坝、秀山、黔江、垫江、大足、开州12个区（县）的2 400例居民为研究对象,采用自行设计的调查问卷进行调查。调查内容包括：居民基本情况、居民对家庭医生签约服务需求情况、家庭医生签约服务签约情况。共发放问卷2 400份,回收有效问卷2 342份,问卷有效回收率为97.58%。结果　2 342例居民中有2 153例（91.93%）居民对家庭医生签约服务有总体需求。2 342例居民中已签约的有1 358例（57.98%）,未签约的有984例（42.02%）。不同性别、居住地、文化程度、家庭月收入居民家庭医生签约服务需求比较,差异无统计学意义（P>0.05）;不同年龄、职业居民家庭医生签约服务需求比较,差异有统计学意义（P<0.05）。对家庭医生签约服务“非常需要”排序前5位的条目是常见病多发病的及时诊治（43.42%,1 017/2 342）、孕妇/儿童/老年人体格检查与健康评估（34.93%,818/2 342）、定期体格检查/健康评估（33.69%,789/2 342）、家庭医生出诊（32.96%,772/2 342）、已经确诊的慢性病管理（32.45%,260/2 342）。健康状况、对家庭医生签约服务认知情况、以往就医/签约情况、对家庭医生签约服务需求情况不同的居民签约率比较,差异有统计学意义（P<0.05）。结论　重庆市居民对家庭医生签约服务的需求较大,但签约率较低,需求最大的是常见病多发病的及时诊治。居民健康状况、对家庭医生签约服务认知情况、以往就医/签约情况、对家庭医生签约服务需求都会影响居民是否签约家庭医生。政府应该加大对家庭医生签约服务的普及和宣传力度,有针对性地制定重点人群签约服务包,促进家庭医生签约服务有序进行。

Implementation Status and Residents' Needs Analysis of Contracted Family Doctor Services in Chongqing City

Background　The contracting service of family doctors in Chongqing has been fully implemented since 2011 and fully lunched in 2016. The government has improved the system,guaranteed funds and personnel, standardized service forms and contents to promote the orderly, standardized and high-quality contracting service of family doctors. However, there is still a lack of research on the demand and status of contracting service of family doctors in Chongqing.Objective　To investigate the implementation status and residents' needs of contracted family doctor services in Chongqing,putting forward evidence-based suggestions for policy-making institutions.Methods　From March to May 2018,we conducted a survey in a convenient sample of 2 400 residents who received healthcare from primary healthcare institutions selected from 12 districts/counties（Beibei,Pengshui,Banan,Yongchuan,Liangping,Hechuan,Shapingba,Xiushan,Qianjiang,Dianjiang,Dazu,Kaizhou） of Chongqing City by use of multistage sampling with a self-designed questionnaire consisting of basic demographic characteristics,needs of contracted family doctor services,and status of signing a contract with the family doctors.Of the 2 400 questionnaires distributed,2 342 returned were responsive,achieving a response rate of 97.58%．Results　Of the 2 342 respondents,2 153 （91.93%） had needs for contracted family doctor services,including 1 358 （57.98%） who had signed a contract with the family doctors,and 984 （42.02%） who had not.The status of needs for contracted family doctor services differed significantly by age and occupation （P<0.05）,but not by sex,living area,educational level and average monthly household income （P<0.05）．The top five items in the list of "badly needed" family doctor services were prompt diagnosis and treatment of common diseases and frequently-occurring diseases （43.42%,1 017/2 342）,physical examination and health assessment of pregnant women/children/the elderly （34.93%,818/2 342）,regular physical examination/health assessment （33.69%,789/2 342）,visits of family doctors paid to patients （32.96%,772/2 342） and management of chronic diseases （32.45%,260/2 342）．The rate of signing a contract with the family doctors varied obviously by health status,awareness and status of needs of contracted family doctor services,medical treatment history/history of signing a contract with the family doctors （P<0.05）．Conclusion　The contracted family doctor services are needed by a large majority of Chongqing residents,in particular,prompt diagnosis and treatment of common diseases and frequently-occurring diseases are mostly needed.Residents' health status,awareness level of contracted family doctor services,and past healthcare-seeking habits,as well as healthcare quality are associated factors for the status of signing a contract with the family doctors.Therefore,the family doctor system should be publicized more intensively to increase its popularity,and targeted service packages should be developed for key populations in order to promote the implementation of contracted family doctor services in an orderly way.