我国家庭医生签约率及相关因素meta分析

周珊; 王金霞; 李娜; 马力

doi:10.16766/j.cnki.issn.1674-4152.004299

我国家庭医生签约率及相关因素meta分析

doi: 10.16766/j.cnki.issn.1674-4152.004299

周珊^{1, 2},
王金霞¹,
李娜²,
马力^2, ,

1.
首都医科大学全科医学与继续教育学院, 北京 100069
2.
首都医科大学附属北京天坛医院全科医疗科, 北京 100070

基金项目:

2022年度首都全科医学研究专项 22QK13

高层次公共卫生技术人才建设项目学科带头人-02-09

详细信息

通讯作者:
马力，E-mail：mali_ttyy@126.com

中图分类号: R197.61 R499
计量
- 文章访问数: 21
- HTML全文浏览量: 8
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2025-05-22
- 网络出版日期: 2026-03-13

A meta-analysis of the prevalence and influencing factors of family doctor contract service in China

ZHOU Shan^{1, 2},
WANG Jinxia¹,
LI Na²,
MA Li^{2
, ,}

1.
School of Practice and Continuing Education, Capital Medical University, Beijing 100069, China

摘要

摘要: 目的探讨我国家庭医生签约率及影响因素，为优化签约服务提供依据。方法系统检索2018—2023年知网、万方、维普、PubMed和Web of Science数据库，由2名研究者独立筛选文献、提取数据，采用JBI质量评价标准和Stata 17.0进行meta分析。结果纳入18篇横断面研究。我国家庭医生签约率为54.37%(95% CI：41.81%~66.66%)，城市为63.60%，农村为40.80%。年龄较大(OR=1.029, 95% CI：1.012~1.047，P＜0.001)、无业(OR=1.517, 95% CI：1.046~2.223，P=0.025)、患慢性病(OR=1.709, 95% CI：1.636~1.786，P＜0.001)、经济状况较差(OR=3.177, 95% CI：2.552~3.955，P＜0.001)、有医保(OR=1.994, 95% CI：1.687~2.354，P＜0.001)、知晓签约服务(OR=8.174, 95% CI：7.106~9.412，P＜0.001)为主要影响因素。结论签约率与2035年目标值尚存差距，农村地区更为显著。需结合地方实际制定政策，优化服务，助力社区卫生管理。
- 社区卫生服务中心 /
- 家庭医生签约 /
- meta分析
Abstract: Objective To evaluate the current signing rate and key determinants of family doctor contracted services in China, offering insights for policy formulation and service optimization. Methods A comprehensive systematic review was conducted across databases including CNKI, Wanfang, VIP, PubMed, and Web of Science, covering cross-sectional studies published from 2018 to 2023. Two researchers independently screened the literature, extracted data. The studies meeting inclusion criteria were assessed using the JBI quality evaluation framework and analyzed with Stata 17.0. Results A total of 18 cross-sectional studies were included. The pooled signing rate of family doctor contracted services in China was 54.37% (95% CI: 41.81%-66.66%), with rates of 63.60% in urban areas and 40.80% in rural areas. The main influencing factors included advanced age (OR=1.029, 95% CI: 1.012-1.047, P < 0.001), unemployment (OR=1.517, 95% CI: 1.046-2.223, P=0.025), chronic illness (OR=1.709, 95% CI: 1.636-1.786, P < 0.001), poor economic status (OR=3.177, 95% CI: 2.552-3.955, P < 0.001), health insurance coverage (OR=1.994, 95% CI: 1.687-2.354, P < 0.001), and awareness of the service (OR=8.174, 95% CI: 7.106-9.412, P < 0.001). Conclusion Despite progress, the signing rate of family doctor contract service remains below the 2035 target, with a significant gap in rural areas. Policies tailored to local contexts are essential to optimize services and promote community health management.
- Community health service center /
- Family doctor contract service /
- Meta-analysis

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图 1 文献检索流程图

Figure 1. Literature screening flow chart

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图 2 家庭医生签约率Meta分析森林图

Figure 2. Forest plot for the rate of family doctor contract service

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图 3 家庭医生签约率的漏斗图

Figure 3. Funnel plot of studies on prevalence of family doctor contract service

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表 1 纳入文献基本情况表

Table 1. Characteristics of the studies included in the meta-analysis

第一作者	年份(年)	调查时间(年/月)	抽样方法	地区	样本量(人)	研究对象	签约率(%)	评分	影响因素
SHANG X^[10]	2019	2017/10—12	1	浙江	3 871	居民	50.43	8	①②④⑥⑨
LV B^[11]	2023	2021/7—8	2	北京	1 814	居民(≥60岁)	21.55	8	①④
刘慧^[12]	2023	2021/6—12	1	成都	2 148	居民(≥60岁)	47.30	8	①④⑦
柯思思^[13]	2022	2019/7—2020/1	1	武汉	10 253	居民	25.52	7	①②③④⑤⑦
格桑卓玛^[14]	2023	-	1	西藏	4 705	居民	39.21	7	②④⑤⑥⑦⑧
潘菁^[15]	2023	-	1	泰安	3 896	居民(≥60岁)	82.67	7	①③④⑤⑥
郭红英^[16]	2019	-	2	佛山	1 992	社区就诊者	52.16	7	④
刘春光^[17]	2022	2020	1	山东	1 966	农村居民(≥60岁)	86.93	7	⑦⑧⑨
唐静^[18]	2021	2017/9—11	1	盐城	1 480	农村居民(≥60岁)	26.01	7	④⑥⑧
YANG S^[19]	2021	-	1	山东	1 395	农村居民(≥60岁)	28.17	7	③④⑤⑧⑨
吴舒窈^[20]	2020	2019/2—3	2	上海	993	社区就诊者	73.31	7	-
郑晓辉^[21]	2022	2019/6—12	2	广州	952	社区就诊者	60.50	7	-
范阳东^[22]	2021	2019/11—12	2	广州	600	居民	59.00	7	②③④
何俊曦^[23]	2019	-	1	福建	720	农村居民	15.28	7	①②③
董婷婷^[24]	2020	-	1	重庆	590	重点人群	83.39	7	①②⑤⑦⑨
孙倩^[25]	2022	2020/10—2021/1	1	潍坊	505	居民	57.43	7	⑤⑥⑦
巫云辉^[26]	2021	2021/5—6	1	深圳	382	社区就诊者	59.95	7	-
陈奕君^[27]	2018	2017/9—12	1	甘肃	2 515	重点人群	52.51	7	④⑧
吴瑶琴^[28]	2020	-	1	江苏	9 450	居民	17.35	6	①④⑥
王俊杰^[29]	2022	-	1	河南	8 441	居民(≥60岁)	67.60	6	①②③④⑤⑥⑧
张翠萍^[30]	2020	2019/9—12	1	潍坊	2 001	居民	30.58	6	④⑤⑧⑨
王荣英^[31]	2018	2016/12—2017/1	1	石家庄	1 031	社区就诊者	86.42	6	-
黄蛟灵^[32]	2018	2015/12—2016/1	1	上海	614	居民	65.31	6	②⑧
白润娟^[33]	2022	-	2	兰州	812	社区就诊者	61.8	6	-
注：抽样方法，1=随机抽样，2=非随机抽样；影响因素，①=年龄，②=文化程度，③=职业，④=患慢性病，⑤=居住地，⑥=经济状况，⑦=有医疗保险，⑧=健康自评状况，⑨=知晓家庭医生签约；“-”表示无此项内容。

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表 2 中国家庭医生签约率的亚组分析

Table 2. Subgroup analysis for the rate of family doctor contract service

亚组	纳入研究数	异质性检验		效应模型	OR(95% CI)
亚组	纳入研究数	P值	I²值(%)	效应模型	OR(95% CI)
抽样来源
城市	11^{[10, 13, 20-25, 28, 31-32]}	＜0.001	99.834	随机	63.6(47.5~78.3)
农村	6^{[12, 15, 17-19, 29]}	＜0.001	99.902	随机	40.8(16.7~67.5)
抽样方法
随机抽样	15^{[10, 12-15, 17-19, 23-25, 28-29, 31-32]}	＜0.001	99.897	随机	52.3(38.5~66.0)
非随机抽样	3^[20-22]	＜0.001	＜0.001	随机	64.5(54.9~73.5)
年龄
≥60岁	6^{[12, 15, 17-19, 29]}	＜0.001	99.846	随机	57.5(38.5~75.4)
全年龄段	12^{[10, 13, 14, 20-25, 28, 31-32]}	＜0.001	99.811	随机	52.8(39.8~65.6)

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表 3 影响家庭医生签约因素的meta分析

Table 3. Results of meta-analysis of influencing factors of family doctor contract service

影响因素	纳入研究数	异质性检验		效应模型	meta分析
影响因素	纳入研究数	P值	I²(%)	效应模型	OR(95% CI)	Z值	P值
年龄大	8^{[10, 12, 13, 15, 23, 24, 29, 32]}	＜0.001	87.1	①	1.029(1.012~1.047)	3.379	＜0.001
文化程度	9^{[10, 13, 14, 22-24, 29, 32]}	＜0.001	95.3	①	1.145(0.752~1.742)	0.631	0.528
职业
在业、离退休	4^{[13, 19, 22, 29]}	＜0.001	93.1	①	1.665(0.486~2.123)	0.041	0.968
无业	3^{[15, 23, 29]}	0.089	58.7	①	1.517(1.046~2.223)	2.195	0.025
患有慢性病	10^{[10, 12-15, 18, 19, 22, 29, 30]}	＜0.001	92.3	①	1.709(1.636~1.786)	23.765	＜0.001
居住地
城镇、市中心	4^{[13-15, 25]}	＜0.001	98.6	①	0.932(0.861~1.020)	-1.500	0.134
距离卫生服务中心远	2^{[24, 29]}	＜0.001	98.0	①	0.308(0.073~1.289)	-1.613	0.107
经济情况
较好	3^{[10, 14, 25]}	0.006	80.4	①	0.935(0.599~1.461)	-0.295	0.768
较差	3^{[15, 18, 29]}	0.365	0.8	②	3.177(2.552~3.955)	10.355	0.001
有医疗保险	5^{[12, 13, 17, 24, 25]}	0.051	57.6	①	1.994(1.687~2.354)	8.120	＜0.001
自评健康状况
较好	3^{[14, 17, 29]}	＜0.001	97.6	①	0.856(0.445~1.647)	-0.467	0.641
较差	2^{[18, 19]}	0.253	23.4	②	0.726(0.522~1.017)	-1.859	0.063
知晓家庭医生签约	4^{[10, 17, 19, 32]}	＜0.001	96.3	①	8.174(7.106~9.412)	29.365	＜0.001
注：效应模型，①=随机，②=固定。

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