Wang Shuo, Cheng Feng, Xu Junfang
School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Vanke School of Public Health, Tsinghua University, Beijing, China.
J Family Med Prim Care. 2024 May;13(5):1887-1893. doi: 10.4103/jfmpc.jfmpc_1724_23. Epub 2024 May 24.
Family doctor contract service (FDCS) is a vital part of China's primary health care system. This study aims to explore whether contracting with FDCS affects residents' utilization of and satisfaction with primary health care.
A structured questionnaire was employed to collect data in January 2022. The questionnaire mainly included the following three parts: the social-demographic characteristics, health-related information, and utilization of and satisfaction with primary health care. Propensity score matching (PSM) was used to adjust for social-demographic differences between participants who contracted with a family doctor and those who did not. For the matched population, we used the Chi-square test to examine the differences in the utilization of and satisfaction with primary health care between contracted and non-contracted participants. Moreover, multiple logistic regression and linear regression were used to explore the influencing factors of the utilization of and satisfaction with primary health care.
A total of 10,850 people were investigated and 10,419 participants were incorporated into the data analysis. After matching, there were no significant differences in most of the matching variables between the contracted and non-contracted groups ( > 0.05). The utilization rate was significantly higher among the contracted population than of the non-contracted (96.3% vs 92.6%, < 0.001). The quality of services (e.g., good service attitude, high medical level, and a trusted family doctor) was more likely to be cited as the main reasons for the contracted people to utilize primary health care than for the non-contracted. The contracted people were also significantly more satisfied than the non-contracted in all terms of satisfaction. Moreover, people who contracted with a family doctor were more likely to use primary health care with OR = 1.979 (95% CI, 1.511-2.593).
The contracted people were more likely to utilize and be satisfied with primary health care than the non-contracted. In addition, the contracted people tended to use primary health care because of the quality of services rather than because of the close distance or short waiting time. Therefore, it is important to further promote the high quality of FDCS to ensure residents' sense of gain and improve their satisfaction.
家庭医生签约服务是中国基层医疗卫生服务体系的重要组成部分。本研究旨在探讨签约家庭医生服务是否会影响居民对基层医疗卫生服务的利用及满意度。
于2022年1月采用结构化问卷收集数据。问卷主要包括以下三个部分：社会人口学特征、健康相关信息以及对基层医疗卫生服务的利用情况和满意度。采用倾向得分匹配法（PSM）对签约家庭医生的参与者和未签约者之间的社会人口学差异进行调整。对于匹配后的人群，我们使用卡方检验来检验签约和未签约参与者在基层医疗卫生服务利用情况和满意度方面的差异。此外，还使用多元逻辑回归和线性回归来探讨基层医疗卫生服务利用情况和满意度的影响因素。
共调查10850人，10419名参与者纳入数据分析。匹配后，签约组和未签约组在大多数匹配变量上无显著差异（>0.05）。签约人群的利用率显著高于未签约人群（96.3%对92.6%，<0.001）。与未签约者相比，签约者更有可能将服务质量（如服务态度好、医疗水平高、有值得信赖的家庭医生）作为利用基层医疗卫生服务的主要原因。在所有满意度方面，签约者也显著比未签约者更满意。此外，签约家庭医生的人使用基层医疗卫生服务的可能性更大，比值比（OR）=1.979（95%可信区间，1.511-2.593）。
签约者比未签约者更有可能利用基层医疗卫生服务并对其感到满意。此外，签约者倾向于因服务质量而非距离近或等待时间短而使用基层医疗卫生服务。因此，进一步提升家庭医生签约服务质量对于确保居民获得感、提高满意度具有重要意义。
