家庭医生服务签约居民的续签意愿及影响因素研究

目的　了解家庭医生服务签约居民的续签意愿并探讨其影响因素，为推动家庭医生签约服务提供参考。方法　采用随机抽样法，在宜昌市开展家庭医生签约服务工作的21家社区卫生服务中心（乡镇卫生院），抽取于2017年9—12月在社区卫生服务中心就诊且已签约家庭医生服务的750例居民为研究对象。采用自行设计的调查问卷进行调查，主要内容有：居民的一般情况，对基层医疗卫生机构开展签约服务的知晓、认知、利用及满意度情况，居民的续签意愿。共发放问卷750份，回收有效问卷735份，问卷的有效回收率为98.0%。结果　735例居民中，有续签意愿者占85.9%（631/735）。年龄、健康状况、从家步行至最近基层医疗卫生机构需要花费的时间、对基层首诊的看法（是否赞成基层首诊）不同的居民续签意愿比较，差异有统计学意义（P<0.05）。对家庭医生签约服务的知晓情况（是否知道自己的家庭医生），认知情况（是否信任家庭医生，认为家庭医生签约服务是否必要，认为家庭医生签约服务是否能降低发病率、医疗费用及提高就医便捷性），利用情况（是否享受到上门服务、电话随访、免费体检及建立健康档案），满意度情况（对家庭医生医疗水平、家庭医生服务态度及总体情况是否满意）不同的居民续签意愿比较，差异有统计学意义（P<0.05）。多因素逐步Logistic回归结果显示，居民年龄、是否赞成基层首诊、是否信任家庭医生、认为家庭医生签约服务是否必要、对家庭医生医疗水平的满意度、对总体情况的满意度是居民续签意愿的影响因素，差异有统计学意义（P<0.05）。结论　宜昌市家庭医生服务签约居民的续签意愿较高，居民年龄、是否赞成基层首诊、是否信任家庭医生、认为家庭医生签约服务是否必要、对家庭医生医疗水平的满意度、对总体情况的满意度是居民续签意愿的影响因素。

Intention and Associated Factors of Renewing the Contract with Family Doctors

Objective　To investigate the intention and associated factors of renewing the contract with family doctors，providing a reference for promoting the development of contracted family doctor services（CFDS）.Methods　By random sampling，from 21 community health centers（township hospitals）offering CFDS in Yichang，we enrolled 750 residents who received the medical services including the CFDS during September to December 2017.A self-designed questionnaire survey was conducted with them for collecting the demographic data，awareness，perception and utilization of CFDS，level of satisfaction with CFDS and the intention of renewing the contact with family doctors.Totaled 735 returned responsive questionnaires，with a response rate of 98.0%（735/750）.Results　Among the 735 residents，85.9% （631/735）intended to renew the contract with family doctors.The intention of renewing the contract with family doctors differed significantly by age，health status，level of supporting initial treatment in primary care settings，the time needed to walk to the grassroots medical institution nearest to home（P<0.05）.Moreover，it varied obviously by the level of awareness of CFDS（including knowing one's own contracted family doctor or not），level of perception of CFDS（including level of trust in family doctors，level of perceived necessity of CFDS，whether the CFDS can reduce the incidence of diseases，medical costs and improve the convenience in seeking healthcare or not），level of utilization of CFDS（including home-based care，telephone-based follow-up，free physical examinations，and building health records），level of satisfaction with CFDS（including satisfaction with the professional capabilities，service attitude and overall quality of family doctors）（P<0.05）.Multivariate stepwise Logistic regression analysis showed that residents' intention of renewing the contract with family doctors was associated with age，level of supporting initial treatment in primary care settings，level of trust in family doctors，level of perceived necessity of CFDS，levels of satisfaction with the professional capabilities and overall quality of family doctors （P<0.05）.Conclusion　On the whole，the level of intention of renewing the contract with family doctors was high in Yichang's residents，which was associated with age，level of supporting initial treatment in primary care settings，level of trust in family doctors，level of perceived necessity of CFDS，and levels of professional capabilities and overall qualities of family doctors.