| Objective Based on the policy background of the general practitioner(GP)system,this study took the patients of community health service institutions as the research object and measured the continuity of GP services from three dimensions: information continuity(IC),management continuity(MC),and relationship continuity(RC).Meanwhile,This study focused on the main influencing factors of continuity of GP services by collecting basic personal information of patients,patients' attitudes on GP services and medical service behaviors and willingness.It aims to provide targeted strategies and recommendations for further improving the continuity of community health services.Methods We took Hangzhou as an example in this study.Through a multi-stage random sampling method,eight community health service centers were randomly selected from four jurisdictions in the main urban area of Hangzhou,and a certain number of patients were randomly intercepted in community health institutions to conduct a questionnaire survey.The questionnaire we adopted was divided into two parts.A self-designed questionnaire was first part,which mainly includes the general demographic characteristics of the patient,the patient's knowledge and attitude toward GP services,and the patient's behavior and willingness to seek treatment.The second part is the continuity scale developed based on continuous health service measurement theory.SPSS 20.0 was used for statistical analysis of sample data.Statistical analysis methods included statistical description,T test,analysis of variance,Pearson correlation analysis,and multiple linear regressions.Results 1.The scores of information continuity,management continuity and relationship continuity in general practitioner services evaluated by patients in Hangzhou were 50.74±17.18,61.61±18.07,and 63.57±17.40,respectively,and the overall continuity score was 57.73±15.31.2.In terms of general demographic characteristics of patients,chronic disease and the distance to the community health service have differences in scores of patients on information continuity,and it has statistical significance.Patients' ages,education levels,income,marital status,and distance to community health service have statistically different scores on management continuity.There was a statistically significant difference on scores of relationship continuity among patients of different ages and chronic diseases.The differences in scores on comprehensive continuity between age,education level,chronic disease,and distance to community health service were statistically significant.In terms of the patient's cognitive attitudes(knowing the family doctor,knowing the contract service,knowing the preferential services,the rationality of the community's first consultation,confidence for the technical level,and the degree of health improvement),Except factor whether known family doctors or not has no statistical significance in scores of management continuity,there are statistically significant differences in other factors in terms of IC,MC,RC,and comprehensive continuity.In terms of patients' behavior and willingness to treat(whether signing,knowing contracted doctors,whether they are willing to sign or renew visas,whether to choose a regular doctor,whether to accept a referral,the choice of the first consultation institution,the number of community visits,the cost of sub-standard consultations,and acceptance Number of preventive health services),Except factor knowing whether the difference between the contracted physician or not and whether received the referral or not was not statistically significant on score in the management continuity,the other factors have statistically difference on information continuity,management continuity,relationship continuity,and comprehensive continuity.3.The correlation analysis results show that the correlation coefficients between information continuity,management continuity and relationship continuity are 0.625 and 0.615,respectively.The correlation coefficient between management continuity and relationship continuity was 0.719.All correlation coefficients were statistically significant.4.The results of multiple linear regression showed that among the factors that affected the score of information continuity,the household registration,education level,rationality of the first consultation in the community,improvement of their own health,whether they signed the contract,whether they are aware of contracted physicians,and willingness to sign contracts,the choice of fixed physician,first choice of clinic and the number of preventive care services was statistically significant(p<0.05).Among the factors influencing management continuity scores,the patients' age,income,chronic diseases,and distance to community health service was statistically significant(p<0.05).Meanwhile,the impact on the management continuity was statistically significant for the trust of GPs,the improvement of their own health awareness,whether they signed contracts,whether they were aware of the contracted physicians,and the choice of first clinic and the times of preventive health services(p<0.05).Among the factors influencing relationship continuity,the household registration,chronic diseases,rationality on first consultation,trust on GP technology,improvement of their own health status,whether they were aware of contracted physicians,willingness to sign contracts,and whether they chose the fixed physicians and times of visits to the community was statistically significant(p<0.05).Factors of comprehensive continuity,the patient's household registration,education level,income,chronic diseases,and distance to community health service had statistically significant effects on comprehensive continuity(p<0.05).Meanwhile,the rationality of the first consultation,the trust on GPs,the improvement of their own health status,whether they sign contracts,whether they are aware of contracted physicians,whether they are willing to sign contracts,whether they choose to fix their physicians,first consultation institution and the number of preventive health services had a statistically significant impact on the score of comprehensive continuity(p<0.05).Conclusion 1.Based on the evaluation on continuity of health services,it can be found that the patients do not have a high score for the continuity of GP services in Hangzhou.Among different dimensions of continuity,the information continuity assessment is low,and the continuity of management and the relationship are higher.2.Through hypothesis testing,it can be found that the age,education level,household monthly income,chronic disease,and distance have different scores in the continuity of care and its three dimensions.Patient's knowledge of GPs,signing services,and preferential services enjoyed after signing contracts,rationality of first consultation system,the trust on GPs technology,and improvement of their own health have different scores in continuity of health care and its three dimensions.In terms of behavior and willingness factors,signing contract or not,knowing doctor they signed,willingness to sign,whether to select a fixed physician,whether receive referral services,first choice of clinic,the number of visits to a community health facility,cost,and the times of preventive care have different scores in continuity of health care and its three dimensions.3.Through correlation analysis,it can be concluded that the three dimensions of information continuity,management continuity,and relationship continuity are positively related to each other.4.Based on the results of multiple linear regression analysis,patient's household registration,education level,rationality of first-diagnosis,improvement of their own health,signing contracts,knowing whether contracted physicians,signing contract,choices of fixed physicians,first choice of clinics,and the number of preventive health services has an impact on the evaluation of the information continuity.With respect to management continuity,patient's age,income,presence or absence of chronic diseases,distance to community health facilities,trust on technology of GP and improvement of their own health and whether they are contracted,whether they are aware of contracting physicians,first choice of clinics,and The number of preventive care affected its scores.Concerning the continuity of the relationship,the household registration,chronic diseases,the rationality on the first diagnosis,the trust on the technology of GP,the improvement their own health,whether they are aware of the contracted physician,the willingness to sign up,whether to choose the fixed physician and the number of visits to community institutions have an significant impact on this dimension.The main contributing factors of comprehensive continuity mainly included the patient's household registration,education level,income,chronic diseases,understanding of the first-diagnosis,the trust on general practitioners,and improvement of their own health,signing contracts not.Knowing contracted physicians,the willingness to sign up,whether to choose a fixed physician,first choice of clinic and the times of preventive health care services. |
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