Study On The Association Between Rural Family Doctor Contract Service And Health-related Quality Of Life In Shandong Province,China

Background:In order to protect the health of the people effectively,China began to explore the reform of family doctor contract service mode.The model takes the general practitioner as the core member of the family doctor team,and the main task is to provide the family health care service.Although the family doctor contract service started late in China,it has almost achieved full coverage throughout the all country including rural areas.In addition,On the basis of the improvement of the signing rate,Shandong provincial health commission proposed in 2018 to set a reasonable and clear target,focus on the implementation of family doctor contract service of the signed population,improving the quality and effect,and enhancing the residents' perception.Since the implementation of the family doctor contract service system,domestic scholars have carried out some studies on the effects of family doctor contract service,especially on the improvement of the management and treatment of certain diseases.As a comprehensive indicator to describe health status,the reliability and validity of health-related quality of life(HRQOL)has been verified by relevant studies.Objectives:The aim of the study is to describe the status of implementation of family doctor contract services in rural areas and the status quo of the health-related quality of life of the rural residents in Shandong province,China.And to study the associations between family doctor contract services and the health-related quality of life of rural residents.According to the latent class analysis,we can further explore the influence of family doctor contract services to the health-related quality of rural residents.So as to provide the basis for the development of rural family doctor contract service and improve the health-related quality of life of rural residentsMethods:This study adopted the multi-stage random sampling method and used the questionnaire "questionnaire on basic medical services for rural residents in Shandong province" made by our research group.The questionnaire mainly included the basic family information,the health status and health-related behaviors of the respondents,the status quo of family doctor contract service and the services demand.EpiData 3.1 and double entry were used for data entry,and Stata 14.0 and Mplus7.0 were used for statistical analysis.The adoption rate or component ratio(%)was used to describe the classification variables,and the mean and standard deviation were used to describe the counting data.In univariate analysis,Wilcoxon rank sum test,kruskal-wallis H test and univariate Tobit regression(counting data)were used for non-normal data,while chi-square test was used for latent class univariate analysis.In the multivariable analysis,the classified data were analyzed by multivariate disorderly logistics regression analysis,while the counting data were analyzed by Tobit regression analysis.Results:The average health utility value of health-related quality of life of rural residents in Shandong province was 0.89±0.15,the contracted residents was 0.91±0.13,and that of uncontracted residents was 0.88±0.16,with significant differences(P<0.01).According to the latent class model,the health status of rural residents can be divided into three categories,named as "healthy group","psychological anxiety group" and "unhealthy group",accounting for 30.25%,58.03%and 11.72%,respectively.Compared with the healthy group,the results showed that the unhealthy risk of the family doctors contracted residents was 0.544 times higher than that of the uncontracted residents,and the difference was significant(P<0.01),while the effect of family doctor contract services on the psychological anxiety group was not significant.The study also found that in addition to family doctor contract service,age(P<0.01),the educational level(P<0.01),marital status(P=0.038),occupation(P<0.05),whether they are in poor economy status(P<0.01),chronic disease(P<0.01),health service utilization in two weeks(P<0.01),and drinking status(P<0.01)also have a significant impact on the health-related quality of life of rural residents.Conclusions and suggestions:The health-related quality of life of rural residents who contracted family doctors is different from that of uncontracted residents in Shandong province.And the total rural population divided into three categories according to latent class models,namely the healthy group,unhealthy group and psychological depression group,found that the family doctor contract service make the health-related quality of life of health group and unhealthy group significantly different,but it has no significant impact on that of healthy group and psychological depression group.Therefore,in order to better implement the family doctor contract service in rural areas and improve the health-related quality of life of rural residents,measures should include:1)clarify the connotation of family doctor contract service and improve the policy awareness rate in rural residents;2)improve the utilization level of family doctor contract services and prevent "signing but not using";3)take multiple measures to strengthen the team of family doctors and improve the capacity of primary health services;4)increase the input of medical funds and perfect the incentive mechanism and assessment mechanism;5)pay equal attention to the physical and mental health of rural residents.