糖尿病患者选择家庭医生作为慢病管理服务供方的决策影响因素

目的 了解社区糖尿病管理现状,明确患者选择家庭医生作为疾病管理服务供方的决策影响因素,为做实家庭医生签约服务提供建议。 方法 2018年5月,采用简单随机抽样法抽取上海市某社区确诊糖尿病患者500例。自行设计问卷,以Likert 5级评分法,从7个维度30个条目,调查患者选择家庭医生作为疾病管理供方的决策影响因素;从6个维度22个条目,调查患者不选择家庭医生的影响因素。 结果 对符合入选标准的500名患者,选择家庭医生作为疾病管理服务供方影响程度最大的5个项目分别是:服务态度好(影响因素评价均值1.17);家属陪同和照顾方便(均值1.15);对医生熟识并了解自身情况(均值1.08);慢性病病情稳定(均值1.07);离家近,利用方便(均值1.06)。不选择家庭医生的因素中,影响程度最大的前5个项目分别是:不提供专家门诊(影响因素评价均值0.96);担心一次就诊不能解决问题(均值0.87);医保报销比例无显著变化(均值0.80);报销政策没有规定首选社区(0.77);社区医疗设备不能满足需求(均值0.76): 结论 家庭医生服务因距离和时间可及、费用低廉、服务较好等优势,是居民选择慢性病管理服务提供方的主要因素,但医疗技术、设备、药品和当前卫生政策因素对居民优先选择家庭医生提供慢性病管理服务尚有一定程度的制约。 

Influencing factors of decision-making for diabetic patients to choose family doctors as providers of chronic disease management services

Objective To investigate the current situation of diabetes management in community, to clarify the decision-making factors of patients choosing family doctors as disease management service providers, and to provide suggestions for the implementation of family doctors' contracted services. Methods In May 2018, a simple random sampling method was used to select 500 diabetes patients diagnosed in a community in Shanghai. The questionnaire was designed by ourselves. With Likert's 5-level scoring method, 30 items from 7 dimensions were used to investigate the decision-making influencing factors of patients choosing family doctors as disease management providers, and 22 items from 6 dimensions were used to investigate that of patients not choosing family doctors. Results For 500 patients who met the inclusion criteria, the five items that had the greatest impact on the selection of family doctors as disease management service providers were as follows:good service attitude(mean value of influencing factors evaluation is 1.17); family members are easy to accompany and take care of(mean value is 1.15); doctors are familiar with and understand the situation of patients(mean value is 1.08); chronic diseases are stable(mean value is 1.07); close to home, easy to use(mean 1.06). Among the factors that didn't choose family doctors, the top five items that had the greatest influence were as follows:not providing expert outpatient service(the average value of influencing factor evaluation is 0.96); worrying that one visit can't solve the problem(the average value is 0.87); no significant change in the proportion of medical insurance payment(the average value is 0.80); reimbursement policy does not specify preferred community(the average value is 0.77); community medical equipment can't meet the demand(the average value is 0.76). Conclusion Due to the advantages of distance and time, low cost and good service, family doctor service is the main factor for residents to choose providers of chronic disease management services. However, medical technology, equipment, drug supply and current health policy factors still have certain constraints on residents to choose family doctors to provide chronic disease management services preferentially.