“1+1+1”签约下居民的社区首诊意愿及影响因素研究

目的　了解“1+1+1”签约下居民的社区首诊意愿,并探讨其影响因素。方法　于2017年10—12月,采用多阶段随机抽样法在上海市浦东新区潍坊街道抽取社区居民600例。采用本课题组自行设计的问卷对纳入居民进行调查,主要内容包括居民的基本情况、对“1+1+1”签约的知晓和签约情况、在社区卫生服务机构的就诊情况、患病后首诊选择的医疗机构。共发放问卷600份,有效回收580份,问卷有效回收率为96.7%。结果　580例社区居民中,有社区首诊意愿的居民463例（79.8%）。不同性别、年龄、文化程度、婚姻状况、家庭人均月收入、医疗费用支付方式居民的社区首诊意愿比较,差异无统计学意义（P>0.05）;知晓“1+1+1”签约居民的社区首诊意愿高于不知晓的居民,已签约居民的社区首诊意愿高于未签约的居民,在社区卫生服务机构有固定就诊医生居民的社区首诊意愿高于无固定就诊医生的居民,对就诊社区卫生服务机构医生技能水平感到满意居民的社区首诊意愿高于一般/不满意的居民,差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示,是否签约、在社区卫生服务机构是否有固定就诊医生是居民社区首诊意愿的影响因素（P<0.05）。结论　“1+1+1”签约模式有助于提高居民的社区首诊意愿,进而促进有序就医格局的形成。

Willingness and Influencing Factors of Initial Diagnosis at Community Level in the Mode of "1+1+1" Hierarchical Medical System in Shanghai

Objective　To investigate the willingness and associated factors of initial diagnosis at the community level among residents in the mode of "1+1+1" hierarchical medical system.Methods　Six hundred community residents were selected by random sampling method in Weifang Community Health Service Center,Pudong New Area from October to December 2017.A structured questionnaire designed by our research team consisting of questions about demographic characteristics,awareness level and signing situation of the "1+1+1" hierarchical medical system,medical treatment in community health services and first choice of medical institutions was used.A total of 600 questionnaires were distributed and 580 were recovered,with an effective recovery rate of 96.7%.Results　Of the 580 participants,463 subjects（79.8%） had the willingness of having first diagnosis at the community level.There were no significant differences in willingness of first diagnosis at the community level among residents in terms of gender,age,education level,marital status,family average monthly income,medical insurance payment method（P>0.05）.Residents who were aware of "1+1+1" hierarchical medical system had significantly higher willingness of having initial diagnosis in community service centers than those who were unaware of（P<0.05）.Residents who signed the contract had the same higher willingness than those un-signed（P<0.05）.Higher willingness of initial diagnosis at community medical services occurred in communities with fixed doctors（P<0.05）.Residents who were satisfied with doctors' service had significantly higher willingness of having initial diagnosis in community medical services than those who were neutral/unsatisfied（P<0.05）.Multivariate Logistic regression analysis showed that choice of signing "1+1+1" and continuity of care are factors influencing the willingness of initial diagnosis at the community level（P<0.05）.Conclusion　The "1+1+1" signing mode can improve the willingness of residents to have their first diagnosis in the community medical services,which will promote an orderly medical pattern.