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家庭医生制度对患者在基层医疗机构中使用全科医生的影响——来自中国杭州的证据。

The impact of family doctor system on patients' utilisation of general practitioner in primary care facilities-Evidence from Hangzhou, China.

机构信息

School of Urban and Environmental Science, Central China Normal University, Wuhan, Hubei, China.

School of Data Sciences, Zhejiang University of Finance and Economics, Hangzhou, Zhejiang, China.

出版信息

Int J Health Plann Manage. 2022 Nov;37(6):3089-3102. doi: 10.1002/hpm.3540. Epub 2022 Jul 7.

DOI:10.1002/hpm.3540
PMID:35801256
Abstract

OBJECTIVE

This study aims to examine whether participating in the contracted family doctor system increases patients' utilisation of primary care general practitioner for multiple disease outcomes in China.

METHODS

Binary logistic regression models were estimated using data collected from 372 community residents in nine selected districts of Hangzhou, China.

RESULTS

Findings revealed that (1) for patients with influenza, diabetes, upper respiratory infection, and gingivitis, those who participated in the contracted family doctor system were approximately 4.3 times, 98.4%, 92.5%, and 52.8% more likely to choose primary care general practitioners (GP) for their initial diagnosis, respectively, as compared with their counterparts who did not have contracted family doctors; (2) For patients with stroke or cerebrovascular disease and cholecystitis or cholelithiasis, those who had contracted family doctors were 1.111 times and 80.6% more likely to choose primary care GP for their subsequent disease maintenance, respectively, as compared to their counterparts without contracted family doctors.

CONCLUSION

Our findings indicate that the contracted family doctor system not only increases the utilisation of primary care GP for patients with many chronic conditions but also promotes the overall completion of China's hierarchical medical system in the long run. Policy implications were provided to help policymakers actively construct and develop the contracted family doctor system to promote the hierarchical medical system in China.

摘要

目的

本研究旨在考察参与签约家庭医生制度是否会增加患者对初级保健全科医生的利用,从而改善多种疾病结局。

方法

使用中国杭州市九个选定区的 372 名社区居民的数据,采用二元逻辑回归模型进行估计。

结果

研究结果显示:(1)对于流感、糖尿病、上呼吸道感染和牙龈炎患者,与没有签约家庭医生的患者相比,签约家庭医生的患者选择初级保健全科医生(GP)进行初始诊断的可能性分别高出约 4.3 倍、98.4%、92.5%和 52.8%;(2)对于中风或脑血管疾病和胆囊炎或胆结石患者,签约家庭医生的患者选择初级保健 GP 进行后续疾病维持治疗的可能性分别高出 1.111 倍和 80.6%。

结论

本研究结果表明,签约家庭医生制度不仅增加了慢性病患者对初级保健 GP 的利用,而且从长期来看,也促进了中国分级医疗制度的整体完成。本研究为政策制定者提供了政策建议,以帮助他们积极构建和发展签约家庭医生制度,促进中国分级医疗制度的发展。

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