Objective To explore the awareness and utilization of the contractual services among residents signing a contract with a family doctor. Methods The enrolled residents were from 10 neighborhoods/townships in Changning District of Shanghai, all of them signed a contract with a family doctor and were responsive to a previous study carried out by us. Using a questionnaire developed by our research group, we conducted two rounds of survey (one was in December 2013 and the other in June 2016) among them for collecting information concerning awareness and utilization of contractual services from family doctors. Data were analyzed for those who returned responsive questionnaires in 2013 (591 cases), 2016 (651 cases), respectively. Results In 2016, 34 (5.8%), 172 (29.6%) of the residents were "well-informed" "relatively informed" of the family doctor contractual service package, respectively, which was difference with that of 2013 (P<0.05). Compared with 2013, the awareness rates of 4 items included in the contractual service package (telephone-based consultation, personalized health assessment, guidance for healthy/subhealthy populations, and preventive treatment of disease by Chinese medicine) in the residents in 2016 were much lower (P<0.05), while those of other 4 items included in the package (outpatient appointment, return visits for down-referrals,post-discharge follow-up and health check-up) showed little changes (P>0.05). In 2016, of the residents, 77.5% (464/599) sought medical care in community health service centers (CHSCs) after signing the contract, 55.9% (333/596) visited their contracted family doctor, 35.7% (214/600) made regular appointments before visiting, and 27.0% (161/597) willing to be referred to the hospital by their contracted family doctor. The distribution of visited medical institutions after signing a contract with a family doctor, visiting the contracted family doctor, making appointments before visiting and willing to be referred to hospital by the contracted family doctor among the residents in 2016 were significantly different from those of 2013 (P<0.05). Conclusion The contracted residents showed poor awareness of contractual services from family doctors, but relatively good medical adherence. Furthermore, the utilization rate of appointment and referral services among them need to be improved.%目的 了解签约居民对家庭医生签约服务的认知与利用情况.方法 分别于2013年12月、2016年6月,在前期调查基础上,对上海市长宁区10个街道/镇的签约居民进行问卷调查.问卷由本课题组研制,主要调查签约居民对家庭医生签约服务的认知与利用情况.2013年和2016年分别回收有效问卷591、651份.结果 2016年表示对家庭医生签约服务包"非常了解""比较了解"的签约居民数分别为34例(5.8%)、172例(29.6%),认知情况与2013年比较,差异有统计学意义(P<0.05).2016年签约居民对家庭医生签约服务包中电话咨询、个性化健康评估、健康/亚健康人群指导、中医治未病的知晓率低于2013年,差异有统计学意义(P<0.05);对预约门诊、下转回访、出院随访、健康体检的知晓率与2013年比较,差异无统计学意义(P>0.05).2016年77.5%(464/599)的居民签约后选择到社区医院就诊;2016年居民签约后的就诊医疗机构选择情况与2013年比较,差异有统计学意义(P<0.05).2016年55.9%(333/596)的签约居民会选择签约家庭医生就诊,35.7%(214/600)的签约居民就诊前经常预约,27.0%(161/597)的签约居民愿意通过家庭医生转诊;2016年签约居民选择签约家庭医生就诊、就诊前预约、愿意通过家庭医生转诊情况与2013年比较,差异有统计学意义(P<0.05).结论 签约居民对家庭医生签约服务的认知仍较模糊,但就诊依从性相对较好,对预约、转诊服务的利用率有待提高.
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