| Objective:To investigate the current implement status of the family physician among the outpaients of the community health care centers in shanghai, and to explore the predisposing, enabling and reinforcing factors of signing family physician. In order to provide policy suggestions for promoting signing rate of family physician among community residents.Materials and methods:Community-based study was employed through cross-sectional epidemiology survey. On the principle of convenience sampling, we investigated residents from 5 community health centers of 5 districts. A carefully developed questionnaire was then completed by the participants independently. The questionnaire covered information on demographics, health situation, health seeking behavior, satisfactory, signing status and the implementing situation of family physician. T-test, Chi-square test, and multivariate logistic analysis were conducted for quantitative data with SPSS 18.0.Content analysis was conducted for qualitative data using SWOT.Results:(1) All the 5 community health centers provided the family physician service, in which the main service included basic medical services, health management, health record, medical guidance, health education and family sick bed service. A small part of the center provided two-directioned referral system, but the implementation was limited. The way to sign contract mainly through outpatient, home visiting and community activities.(2) The total of 1021 questionnaires were issued and 959 valid questionnaires were collected. The valid response rate is 93.9% The average age was 59.91±14.30 years. The rate of signing was 30.2%, while the rate of willing to contract with family physicians was 69.6%.About 90.3% participants had heard of family physician,however only 12.8% participants knew enough about the family physicians.(3) The characteristics of the signing people:a)The average age of the signing respondents was 65.35±11.72 years old, in which were more women (67.9%), workers and professionals, people with middle or high schools or technical secondary school or technical school degree (67.4%).The main health care type was the worker health care (63.1%), the rate of signing respondents with the proportion of residents’ health care (35.0%) was higher than the unsigned respondents. b) The self-rated health status scores of the signing respondents (2.92±0.733) was lower than the unsigned respondents (3.08±0.763).87.24% contractor suffered the chronic diseases. The number of illnesses and taking medicine among signing respondents were both higher than that among the unsigned respondents, the difference was statistically significant (P<0.001). The signing respondents pay more attention to health knowledge compared to the unsigned respondents. c) There was no resource difference between the signing and the unsigned respondents; The preferred hospital in signing respondents was the community health service centers. The satisfaction degree in the signing respondents was higher than the unsigned respondents. (t=-5.824, P<0.001).d) The awareness rate of family physicians among signing group was higher than that among unsigned group (x2=79.663, P<0.001); 14.0% contractor thought the family doctor helped a lot, which had no statistically significant difference between the signing and the unsigned respondents.(4) People Older than 70 years (OR=2.35,95%CI:1.26-4.36) and long-term medication personnel (OR=2.53,95%CI:1.51-4.24) had more chance signing contract with family physician. After controlling for demographics and health situation using multiple logistic regression analysis, the firstly treatment in the community (OR=2.37,95%CI: 1.42-3.97),high understanding of family physician services, (OR=6.14,95%CI: 3.42-11.03),willing to sign with family physicians were predisposing factors, urban resident basic medical insurance (OR=1.65,95% CI:1.17-2.34) and living in an pilot were enabling factors, while the community satisfaction (OR=1.84,95%CI: 1.30-2.60),pharmaceuticals Satisfaction (OR=1.77,95%CI:1.25-2.51)and signing cases around (OR=4.60,95%CI:3.00-7.05) were reinforcing factors.Conclusion:The family physician system is still at exploring stage in shanghai, with different implementation situation in different district. The services provided by family physicians included basic medical services and public health services. The family physician services attracted old people, high medical needs people and residents who often visited the community health center. Health counseling, diagnosis and treatment, outpatient appointment, pharmaceutical benefits and health management were the mainly services the residents expected.Firstly treatment institution, awareness of family physician services, health care type,, community medical treatment satisfaction, pharmaceuticals satisfaction,signing situation around them and policy had an influence on residents signing with family physicians.Besides, the contents provided by family physician services & the family doctor and implement situation will influence signing status.it still needs further study. |
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