Utilization of community residents' family doctor contracted services based on social network analysis
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摘要:
目的 分析社区居民家庭医生服务的利用现状，为优化家庭医生服务提供建议。 方法 对成都市6个主城区在社区卫生服务中心就诊的605名居民展开问卷调查，有效问卷590份，采用logistic回归分析服务利用的影响因素。运用UCINET 6.0软件分析中心度及密度，并绘制可视化结构图。 结果 调查对象中女性占63.73%，年龄为(51.14±19.81)岁，244人(41.36%)签约了家庭医生服务，其中88.11%为免费；签约居民EQ-5D总体健康状况得分为(80.49±11.97)分，患1种和2种及以上慢性病者分别占43.00%和27.50%。医生、护士的度数中心度分别为0.988和0.943，提供服务较多；健康档案管理的度数中心度为0.963，利用良好；logistic回归显示：行动有问题(OR=8.524，95% CI：2.089~34.788)、为家庭医生签约付费(OR=2.877，95% CI：1.247~6.635)的居民家庭医生服务利用更优，家庭前一年总收入为10 001~80 000元的居民与收入150 001元及以上者相比，利用更差。 结论 医生护士发挥显著作用，中医人员等参与度不足，健康档案管理利用情况良好，双向转诊利用严重不足。通过合理付费、重点关注行动不便的居民，促进社区居民家庭医生服务利用。 Abstract:Objective To analyze the utilization status of community residents ' family doctor services and provide suggestions for optimizing family doctor services. Methods A questionnaire survey was conducted on 605 residents in the community health service centers in 6 main urban areas of Chengdu, and 590 valid questionnaires were collected. Logistic regression was used to analyze the factors affecting service utilization. UCINET 6.0 software was used to analyze centrality and density, and a visual structure diagram was drawn. Results Among the survey respondents, women accounted for 63.73%, the age was (51.14±19.81) years old, and 244 (41.36%) had signed up for family doctor services, 88.11% of which were free. The EQ-5D overall health score of the contracted residents was (80.49±11.97) points, and the contracted residents with one and two or more chronic diseases accounted for 43.00% and 27.50% respectively. The degree centrality of doctors and nurses were 0.988 and 0.943 respectively, providing more services. The degree centrality of health record management was 0.963, which was well utilized. Logistic regression showed that residents who had problems with their actions (OR=8.524, 95% CI: 2.089-34.788) and those who contracted and paid for family doctors (OR=2.877, 95% CI: 1.247-6.635) used the services of family doctors better. Residents with an income of 10 001 to 80 000 yuan had worse utilization than those with an income of 150 001 yuan and above. Conclusion Doctors and nurses play a prominent role, and the participation of traditional Chinese medicine personnel is insufficient. The utilization of health records management is good, and the utilization of two-way referrals is seriously insufficient. The utilization of family doctor services of community residents will be promoted by paying reasonable fees and focusing on residents with limited mobility. -
Key words:
- Family doctor /
- Social network analysis /
- Resident utilization /
- Centrality
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图 1 家庭医生团队成员服务提供服务度数中心度的可视化结构图
Figure 1. The visual structural diagram of the degree services provided by members in the family doctor team
图 2 居民利用签约服务内容利用度数中心度的可视化结构图
Figure 2. The visual structural diagram of the utilization degree of family doctor services
表 1 社区居民基本情况(n=590)
Table 1. Basic information of community residents(n=590)
人口学信息 人(%) 人口学信息 人(%) 性别 职业 男性 214(36.27) 机关、企事业单位负责人 19(3.22) 女性 376(63.73) 专业技术人员 38(6.44) 学历 办事人员和有关人员 26(4.41) 文盲 31(5.25) 商业/服务业人员 62(10.51) 小学 88(14.92) 司机/工人 10(1.69) 初中 123(20.85) 个体户 29(4.92) 高中/技校/中专 118(20.00) 私营企业主 13(2.20) 大专 89(15.08) 离退休 286(48.47) 本科 127(21.53) 自由职业者 35(5.93) 硕士及以上 14(2.37) 失业/无业 47(7.97) 前一年总收入 在校学生 25(4.24) 10 000元及以下 39(6.61) 医疗费用支出 10 001~30 000元 84(14.24) 2 000元及以下 233(39.49) 30 001~80 000元 184(31.19) 2 001~4 999元 144(24.41) 80 001~150 000元 144(24.41) 5 000~9 999元 91(15.42) 150 001元及以上 139(23.56) 10 000元及以上 122(20.68) 
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表 2 签约居民自评健康状况(n=244)
Table 2. Self-evaluation health status of residents that have been signed(n=244)
居民健康自评 人数 构成比(%) 行动 无问题 232 95.08 行动有些不便 12 4.92 自我照顾 无问题 240 98.36 在洗澡、穿衣方面有些问题 4 1.64 从事日常活动 无问题 239 97.95 从事日常活动有些问题 5 2.05 身体疼痛或不舒服 没有任何疼痛或不舒服 172 70.49 有些疼痛或不舒服 72 29.51 焦虑或沮丧 不觉得焦虑和沮丧 203 83.20 觉得中度焦虑和沮丧 36 14.75 觉得极度焦虑和沮丧 5 2.05
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表 3 家庭医生团队成员服务提供的中心度
Table 3. The degree of the family doctor team that provide the service
中心度 医生 护士 医技人员 中医人员 后勤人员 其他工作人员 度数中心度 0.988 0.943 0.795 0.389 0.311 0.275 接近中心度 1.012 0.930 0.736 0.468 0.437 0.424 中间中心度 0.384 0.309 0.187 0.035 0.022 0.017
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表 4 家庭医生服务提供及利用情况的密度
Table 4. The density of the provision and utilization of family doctor services
社区卫生服务中心 各项家庭医生服务利用 家庭医生团队成员服务提供 A中心 0.335 0.723 B中心 0.323 0.507 C中心 0.324 0.675 D中心 0.395 0.641 E中心 0.494 0.585 F中心 0.424 0.583
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表 5 家庭医生签约服务居民利用情况的中心度
Table 5. The degree of the utilization of family doctor services
中心度 健康档案管理 健康教育 面对面随访、随访评估 疫苗接种 分类干预 母婴访视 康复训练 双向转诊 度数中心度 0.963 0.730 0.693 0.295 0.254 0.066 0.045 0 接近中心度 0.935 0.662 0.632 0.429 0.415 0.361 0.356 0 中间中心度 0.532 0.211 0.201 0.036 0.021 0.002 0 0.012
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表 6 家庭医生服务居民利用情况单因素分析
Table 6. Single factor analysis of residents' utilization of contracted services from family doctors
调查内容 人数 利用情况 χ2值 P值 较差 较好 家庭前一年总收入 10 000元及以下 9 7(77.78) 2(22.22) 16.240 0.003 10 001~30 000元 35 31(88.57) 4(11.43) 30 001~80 000元 81 57(70.37) 24(29.63) 80 001~150 000元 56 32(57.14) 24(42.86) 150 001元及以上 63 33(52.38) 30(47.62) 有行动方面的问题 否 232 157(67.67) 75(32.33) 9.204 0.002 是 12 3(25.00) 9(75.00) 为家庭医生签约服务付费情况 否 215 148(68.84) 67(31.16) 8.534 0.003 是 29 12(41.38) 17(58.62)
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表 7 家庭医生服务居民利用情况多因素分析
Table 7. Multi-factor analysis on the utilization of family doctors ' services among residents
自变量 类别及赋值 B SE Waldχ2 P值 OR(95% CI) 为家庭医生签约服务付费况 否=1 是=2 1.057 0.426 6.143 0.013 2.877(1.247~6.635) 有无行动方面的问题 否=1 是=2 2.143 0.718 8.918 0.003 8.524(2.089~34.788) 家庭前一年总收入 150 001元及以上=1 80 001~150 000元=2 -0.193 0.383 0.254 0.614 0.825(0.390~1.745) 30 001~80 000元=3 -0.866 0.370 5.466 0.019 0.421(0.204~0.869) 10 001~30 000元=4 -1.926 0.605 10.130 0.001 0.146(0.044~0.477) 10 000元及以下=5 -1.078 0.853 1.596 0.206 0.340(0.064~1.812) 注：因变量为家庭医生服务居民利用，较好=1，较差=0。
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