■实施家庭医生签约服务是加强基层医疗服务和执行分级诊疗制度的关键措施。实现各机构之间的服务协调既是合同服务的基本目标,也是合同服务的核心要素。
■该研究旨在评估居民的评估,并确定与山东省不同地区基层医疗机构内卫生服务协调有关的因素。调查结果旨在作为加强这些机构提供的协调服务的参考。
■本研究采用多阶段分层随机抽样的方法,选取了山东省三个经济水平不同的地级市。在每个城市,三个县(区)采用相同的方法随机抽样。在每个县(区)内,随机抽取3个实施家庭医生签约服务的社区卫生服务中心和乡镇卫生院。使用研究小组制定的修订后的初级保健评估工具量表(PCAT)的协调维度,对签约居民进行了面对面的问卷调查。采用单因素方差分析和多元线性回归等方法进行数据分析。
■样本包括3859名签约居民。基层医疗机构协调维度得分平均为3.41±0.18,转诊服务子维度得分平均为3.60±0.58,信息系统子维度得分平均为3.34±0.65。转诊服务子维度的总分超过信息系统子维度的总分。回归结果表明,该市的经济地位,签约机构的类型,性别,教育,婚姻状况,收入,职业,健康状况,养老保险缴费状况对基层医疗机构协同服务得分有显著影响(p<0.05)。
■山东省基层医疗机构的协调需要进一步优化。继续努力的重点应该是完善转诊制度,加快信息基础设施建设,提高基层医疗机构的服务水平,培养居民的信任。这些措施旨在推进分级诊疗和双向转诊制度的实施。
UNASSIGNED: The implementation of family doctor contract service is a pivotal measure to enhance primary medical services and execute the hierarchical diagnosis and treatment system. Achieving service
coordination among various institutions is both a fundamental objective and a central element of contract services.
UNASSIGNED: The study aims to assess residents\' evaluations and determining factors related to the coordination of health services within primary medical institutions across different regions of Shandong Province. The findings intend to serve as a reference for enhancing the
coordination services offered by these institutions.
UNASSIGNED: The study employed a multi-stage stratified random sampling method to select three prefecture-level cities in Shandong Province with different economic levels. Within each city, three counties (districts) were randomly sampled using the same method. Within each county (district), three community health service centers and township health centers implementing family doctor contract services were selected randomly. Face-to-face questionnaire surveys were conducted with contracted residents using the
coordination dimension of the revised Primary Care Assessment Tools Scale (PCAT) developed by the research team. Data analysis was conducted using such methods as one-way analysis of variance and multiple linear regression.
UNASSIGNED: The sample included 3,859 contracted residents. The
coordination dimension score of primary medical institutions averaged 3.41 ± 0.18, with the referral service sub-dimension scoring 3.60 ± 0.58 and the information system sub-dimension scoring 3.34 ± 0.65. The overall score of the referral service sub-dimension surpassed that of the information system sub-dimension. Regression results indicated that the city\'s economic status, the type of contracted institutions, gender, education, marital status, income, occupation, health status, and endowment insurance payment status significantly influenced the coordinated service score of primary medical institutions (p < 0.05).
UNASSIGNED: The
coordination of primary medical institutions in Shandong Province warrants further optimization. Continued efforts should focus on refining the referral system, expediting information infrastructure development, enhancing the service standards of primary medical institutions, and fostering resident trust. These measures aim to advance the implementation of the hierarchical diagnosis and treatment and two-way referral system.