School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China.
Beijing Tiantan Hospital, Capital Medical University, No.119 South of the Fourth Ring Road, Fengtai District, Beijing, 100070, China.
BMC Public Health. 2023 Aug 12;23(1):1540. doi: 10.1186/s12889-023-16438-5.
China's family doctor contracting service is an important part of deepening the reform of the healthcare systems, aiming to further develop chronic disease management services, enhance the capacity of primary health care services and improve the health of residents. The purpose of this study was to explore the influence of multiple chronic conditions in the elderly on family doctor contracting and whether socioeconomic status played a moderating role.
A cross-sectional survey was conducted in Beijing, China. A total of 1814 elderly people over 60 years old were included in this study using a whole-group sampling method. The univariate analysis and logistic regression analysis was used to analyze the data.
21.72% of the elderly signed up with family doctors. The multiple chronic conditions was a factor influencing the elderly to sign up with family doctors (OR = 1.44, 95%CI = 1.28-1.61), and the higher the degree of multiple chronic conditions, the stronger willingness to sign up. Socioeconomic status positively moderates the effect of multiple chronic conditions on signing. Also, physical activity intensity (OR = 1.25, 95%CI = 1.03-1.54) and willingness to first visit primary care facilities (OR = 1.38, 95%CI = 1.25-1.54) influenced the elderly to sign up with family doctors.
The elderly with a high degree of multiple chronic conditions, high activity intensity, and a strong willingness to first visit primary care facilities were more likely to sign up with family doctors. The health literacy of the elderly should be further improved, and publicity on the family doctor contracting service policies for the elderly with lower socioeconomic status should be strengthened to guide them to sign up with family doctors. At the same time, the service capacity of primary care facilities should be further improved to meet the health needs of the elderly.
中国的家庭医生签约服务是深化医疗卫生体制改革的重要组成部分，旨在进一步发展慢性病管理服务，增强基层医疗卫生服务能力，提高居民健康水平。本研究旨在探讨老年人多重慢性病对家庭医生签约的影响，以及社会经济地位是否起调节作用。
本研究采用整群抽样方法，在北京进行了一项横断面调查。共纳入 1814 名 60 岁以上的老年人。采用单因素分析和逻辑回归分析对数据进行分析。
21.72%的老年人签约了家庭医生。多重慢性病是影响老年人签约家庭医生的因素（OR=1.44，95%CI=1.28-1.61），多重慢性病程度越高，签约意愿越强。社会经济地位对多重慢性病对签约的影响起正向调节作用。同时，身体活动强度（OR=1.25，95%CI=1.03-1.54）和愿意首先就诊于基层医疗机构（OR=1.38，95%CI=1.25-1.54）也影响老年人签约家庭医生。
多重慢性病程度高、身体活动强度高、愿意首先就诊于基层医疗机构的老年人更有可能签约家庭医生。应进一步提高老年人的健康素养，加强对社会经济地位较低的老年人家庭医生签约服务政策的宣传，引导他们签约家庭医生。同时，应进一步提高基层医疗机构的服务能力，满足老年人的健康需求。
