中国广州全科医生政策试行阶段影响居民与全科医生签约意愿的因素:基于安德森卫生服务利用行为模型的横断面研究
Factors Influencing Residents' Willingness to Contract With General Practitioners in Guangzhou, China, During the GP Policy Trial Phase: A Cross-Sectional Study Based on Andersen's Behavioral Model of Health Services Use.
作者信息
Liu Zhongqi, Tan Yawen, Liang Haiqing, Gu Yijun, Wang Xiaowen, Hao Yuantao, Gu Jing, Hao Chun
机构信息
1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.
2 Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
出版信息
Inquiry. 2019 Jan-Dec;56:46958019845484. doi: 10.1177/0046958019845484.
This study aimed to investigate the current contract rate and residents' willingness to contract with general practitioner (GP) services in Guangzhou, China, during the policy trial phase, and also to explore the association of behavior contract and contract willingness with variables based on Andersen's Behavioral Model of Health Services Use (ABM). In total, 160 residents from community health centers (CHCs) and 202 residents from hospitals were recruited in this study. The outcome variables were behavior contract and contract willingness. Based on the framework of ABM, independent variables were categorized as predisposing factors, enabling factors, need factors, and CHC service utilization experiences. Univariate and multivariate logistic regression analysis models were applied to explore the associated factors. Out of 362 participants, 14.4% had contracted with GP services. For those who had not contracted with GP services, only 16.4% (51 out of 310) claimed they were willing to do so. The contract rate for community-based participants was significantly higher than that for hospital-based participants. Major reasons for not choosing to contract were perceiving no benefit from the service and concerns about the quality of CHCs. Community health center experiences and satisfaction were significantly associated with contracting among hospital-based participants. A need factor (diagnosed with hypertension or diabetes) and CHC service utilization experiences (have gotten services from the same doctor in CHCs) were significantly associated with contract willingness among CHC-based participants. Intervention to improve awareness of GP services may help to promote this service. Different intervention strategies should be used for varying resident populations.
本研究旨在调查中国广州在政策试行阶段全科医生(GP)服务的当前签约率及居民与全科医生服务签约的意愿,并基于安德森卫生服务利用行为模型(ABM)探讨行为签约及签约意愿与各变量之间的关联。本研究共招募了160名来自社区卫生服务中心(CHC)的居民和202名来自医院的居民。结果变量为行为签约和签约意愿。基于ABM框架,自变量分为 predisposing因素、促成因素、需求因素和社区卫生服务中心服务利用经历。采用单因素和多因素逻辑回归分析模型来探讨相关因素。在362名参与者中,14.4%的人已签约全科医生服务。对于那些尚未签约全科医生服务的人,只有16.4%(310人中的51人)表示愿意签约。社区参与者的签约率显著高于医院参与者。不选择签约的主要原因是认为该服务无益处以及对社区卫生服务中心质量的担忧。社区卫生服务中心经历和满意度与医院参与者的签约显著相关。一个需求因素(被诊断患有高血压或糖尿病)和社区卫生服务中心服务利用经历(在社区卫生服务中心接受过同一位医生的服务)与社区卫生服务中心参与者的签约意愿显著相关。提高对全科医生服务认识的干预措施可能有助于推广这项服务。应对不同居民群体采用不同的干预策略。