家庭医生签约服务能否促进转诊制度中的有序就诊？来自中国上海的一项前沿政策研究。
Can family doctor contracted services facilitate orderly visits in the referral system? A frontier policy study from Shanghai, China.
机构信息
School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Center for HTA, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China.
出版信息
Int J Health Plann Manage. 2022 Jan;37(1):403-416. doi: 10.1002/hpm.3346. Epub 2021 Oct 9.
BACKGROUND
China committed to establishing a family doctor (FD)-based referral system following the medical reform in 2009. This paper explored the effect of FD on establishing the anticipated system.
METHODS
Two waves of survey were conducted in Shanghai, China. 2754 and 1995 individuals were sampled in 2013 and 2016 respectively. We compared orderly visiting behaviour between contracted and non-contracted residents. Logistic regression models were performed to further test the effect of FD on orderly visits.
RESULTS
More contracted residents first-contacted community health service centres (CHSCs; 45.48%) than non-contracted residents (28.93%). Contracted residents were also more likely to refer to specialists via CHSCs than the non-contracted (9.84% vs. 2.60%). The odds ratio (OR) for first-contact at CHSCs by contract status was 1.569 in 2013, but increased to 1.675 in 2016. Being contracted with a FD was associated with referral behaviour, but the OR declined from 2.692 to 2.487 over years.
CONCLUSION
The survey from Shanghai showed that FD had a significant effect on attracting first-contact at CHSCs and referral via CHSCs; however, the effect on the latter decreased. The effectiveness of the FD role on referral behaviour requires a well-established referral system, which has not yet been completely achieved in China.
背景
中国在 2009 年医改后致力于建立家庭医生（FD）为基础的转诊制度。本文探讨了 FD 对建立预期系统的影响。
方法
在中国上海进行了两轮调查。2013 年和 2016 年分别抽取了 2754 名和 1995 名个体。我们比较了签约和未签约居民的有序就诊行为。采用逻辑回归模型进一步检验 FD 对有序就诊的影响。
结果
更多签约居民首先到社区卫生服务中心（CHSCs）就诊（45.48%），而非签约居民（28.93%）。签约居民也更有可能通过 CHSCs 转诊给专科医生，而非签约居民（9.84%对 2.60%）。2013 年，签约状态下首次到 CHSCs 就诊的优势比（OR）为 1.569，但到 2016 年上升至 1.675。与 FD 签约与转诊行为有关，但随着时间的推移，OR 从 2.692降至 2.487。
结论
上海的调查显示，FD 对吸引居民首先到 CHSCs 就诊和通过 CHSCs 转诊有显著影响；然而，对后者的影响有所下降。FD 在转诊行为方面的有效性需要一个完善的转诊制度，而这在中国尚未完全实现。
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