目的 了解社区居民对家庭医生签约服务的认知与意愿.方法 于2013年12月采用多阶段随机抽样法,在上海市长宁区的10个街道/镇抽取社区居民3040例.采用本课题组研制的问卷对纳入居民进行调查,本文涉及的主要内容包括居民的社会人口学特征、对社区卫生服务中心与二/三级医院的认知、对家庭医生的认知、签约情况、未签约居民的签约意愿及影响因素,问卷有效回收2750份.另于2016年6月,对该3040例居民进行追踪调查,确定问卷有效回收的居民2004例.结果 2016年83.1%(1653/1989)的居民认为社区卫生服务中心与二/三级医院有区别,居民对二者的区别认知与2013年比较,差异有统计学意义(P<0.05);其中,2016年28.7%(474/1653)的居民认为二者间的区别在于二/三级医院技术水平高、社区卫生服务中心技术水平低,37.5%(620/1653)的居民认为二者间的区别在于二/三级医院主要治疗疑难病、社区卫生服务中心主要治疗常见病和多发病.2016年83.9% (1681/2004)的居民知晓家庭医生,67.1%(1345/2004)的居民知晓家庭医生签约服务,居民对家庭医生、家庭医生签约服务的知晓率高于2013年,差异有统计学意义(P<0.05).2016年居民签约率为32.5%(651/2004),高于2013年,差异有统计学意义(P<0.05);未签约居民中27.9%(374/1339)有签约意愿,影响未签约居民签约意愿的因素排在前3位的分别为无家庭医生签约服务需求(45.3%,437/965)、担心定点医疗(13.1%,126/965)、家庭医生技术水平较低(9.4%,91/965).结论 社区居民对社区卫生服务中心及家庭医生的了解程度较高,但认知深度缺乏,签约意愿有待提升.建议深化内涵宣传,改善供给侧的服务能力和水平,推行有价值的签约服务.%Objective To investigate community residents' awareness and willingness towards contractual services from family doctors. Methods In December 2013, using multistage random sampling, we selected 3 040 community residents from 10 neighborhoods/townships in Changning District, Shanghai, and surveyed them using a questionnaire designed by our research group for collecting the data about socio-demographic characteristics, awareness of community health service centers (CHSCs), awareness of family doctors, status of contract signing, as well as intention and associated factors of signing a contract with family doctors among those did not sign. Data were analyzed for 2 750 who returned responsive questionnaires. Then, in June 2016, we conducted a follow-up survey among these residents with the same questionnaire, among whom 2 004 responded validly. Results Compared with 2013, the awareness level of the difference between CHSCs and secondary /tertiary hospitals in the residents was differernt with 2016 (P<0.05). To be specific, higher proportion of residents (83.1%, 1 653/1 989) in 2016 knew that CHSCs are different from secondary /tertiary hospitals, among them, 28.7% (474/1 653) considered that the main difference between CHSCs and secondary/tertiary hospitals was levels of skills and techniques, and the latter had higher level; 37.5% (620/1 653) thought that the difference lay in their scope of treatment, i.e., the secondary/tertiary hospitals mainly treat difficult miscellaneous diseases while CHSCs mainly treat common and frequently-occurring diseases. In 2016, 83.9% (1 681/2 004) of residents knew family doctors, and 67.1% (1 345/2 004) knew that family doctors can provide contractual services, and both rates were higher compared with 2013 (P<0.05). The rate of signing contracts with family doctors was 32.5% (651/2 004) in 2016, which was also higher than that in 2013 (P<0.05). In 2016, 27.9% (374/1 339) of the unattached residents had the intention of signing, and the three leading factors that affected the willingness to sign include lack of demand for family doctor services (45.3%, 437/965), worrying that they could not access to the services delivered by other medical institutions after being attached to the designated medical institutions (13.1%, 126/965), and thought that the professional skills of family doctors were low (9.4%, 91/965). Conclusion Community residents have a good understanding of CHSCs and family doctors, but the level needs to be deepened and their willingness to sign contracts with family doctors needs to be improved. In view of this, family doctor services should be publicized intensively, capabilities of family doctors and standards of their services should be improved, and their valuable contractual services should be promoted.
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