河南省老年人签约家庭医生现状及影响因素分析

目的 探讨河南省老年人签约家庭医生现状及影响因素，以提高河南省老年人家庭医生签约率。方法 采用的是多阶段分层整群随机抽样的方法选取河南省60岁及以上的老年人分析其家庭医生签约情况，采用χ2检验和多因素logistic回归模型来分析老年人签约家庭医生的影响因素。结果 本研究的共纳入8 441名老年人，家庭医生签约率为67.6%。多因素logistic回归结果显示，70～79岁（OR = 1.124，95%CI:1.009～1.254）、小学初中文化（OR = 1.232，95%CI:1.095～1.386）、无业（OR = 1.165，95%CI:1.019～1.333）、贫困户（OR = 3.305，95%CI:2.584～4.227）、身体与功能有问题（OR = 1.315，95%CI:1.189～1.454）、自评健康状况一般（OR = 1.364，95%CI:1.202～1.549）和良好（OR = 1.248，95%CI:1.052～1.481）、需要人照顾（OR = 1.220，95%CI:1.049～1.417）、高血压（OR = 1.194，95%CI:1.078～1.323）和糖尿病（OR = 1.264，95%CI:1.090～1.474）是签约家庭医生的积极因素；离退休（OR = 0.596，95%CI:0.501～0.711）和距离最近医疗单位≥1公里（OR = 0.610，95%CI:0.547～0.679）是签约家庭医生的阻碍因素。结论 河南省老年人家庭医生签约率较高；需要提高老年人对家庭医生签约服务的知晓度；根据影响因素制定更加个性化服务项目，以满足不同人群的各种需求。

Analysis on the current situation and influencing factors of family physician contracting service for the elderly in Henan Province

Objective To explore the current situation and influencing factors of contracting family physicians for the elderly in Henan Province in order to improve the contracting rate of family physicians for the elderly in Henan Province. Methods The multi-stage stratified cluster random sampling method was used to select the elderly aged 60 and over in Henan Province to analyze the signing of family physician. The influencing factors of elderly contracted family physician were analyzed by χ2 test and multivariate logistic regression model. Results A total of 8 441 elderly people were included in this study, and the family doctor contracting rate was 67.6%. The results of multifactorial logistic regression showed that 70-79 years old (OR=1.124, 95%CI: 1.009-1.254), junior or elementary school education (OR=1.232, 95%CI: 1.095-1.386), jobless (OR=1.165, 95%CI: 1.019-1.333), poor households (OR= 3.305, 95%CI: 2.584-4.227), having physical and functional problems (OR=1.315, 95%CI: 1.189-1.454), fair (OR=1.364, 95%CI: 1.202-1.549) and good (OR=1.248, 95%CI: 1.052-1.481) self-rated health status, and need for care (OR=1.220, 95%CI: 1.049-1.417), hypertension (OR=1.194, 95%CI: 1.078-1.323) and diabetes (OR=1.264, 95%CI: 1.090-1.474) were positive factors for signing up with a family doctor; being retired (OR=0.596, 95%CI: 0.501-0.711) and distance to the nearest medical institution ≥1 km (OR=0.610, 95%CI: 0.547-0.679) were deterrents to signing up with a family doctor. Conclusion The contracting rate of family doctors for elderly people in Henan Province is high. It is necessary to improve the awareness of family doctor contracting services among elderly people and to develop more personalized service programs according to the influencing factors to meet the various needs of different populations.