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目的全面了解乌鲁木齐市社区卫生服务中心医务人员及社区居民对全科医师签约制服务意愿及影响因素,为开展和推广适合我区的全科医师签约制服务模式提供有力依据。方法通过整群抽样方法从乌鲁木齐市7个区59个社区卫生服务中心中随机抽取5个符合标准的社区卫生服务中心,分别以303名社区医务人员和3 762名社区居民为研究对象,进行问卷调查。结果 (1)303名医务人员中,对签约服务的知晓率为88.0%;64.4%的医务人员愿意开展签约制服务。多因素分析发现对签约制服务知晓情况、参加健康管理师职业技能培训、带教经历、是否能够节约人力、提高居民就医依从性和是否能够密切医患关系是影响社区医务人员对全科医师签约制服务意愿的主要因素;(2)社区居民3 762名,46.0%知晓此项服务,80.6%愿意开展此项服务。族别、是否具有医保、是否患有慢性疾病、是否知晓什么是全科医师签约制服务、是否会选择相对固定的全科医师、是否能够接受以全科医师为核心的社区首诊和是否有上级医疗中心的转诊经历7个指标是影响社区居民签约全科医师服务需求的主要因素。结论社区医务人员及所辖居民对签约制服务意愿尚可,医务人员对全科医师签约制服务效果乐观,政策支持、技能培训及资源配置是影响医务人员的主要因素,就医机构受限、签约益处知晓度低及对全科医师信任度低是影响社区居民的主要因素。
Objective To comprehensively understand the willingness and influence factors of medical staffs and community residents in community health service centers of Urumqi on the contract service system of general practitioners and provide a strong evidence for carrying out and promoting the general contractor mode of service for general practitioners in our district. Methods A total of five community health service centers were selected randomly from 59 community health service centers in 7 districts of Urumqi by cluster sampling method. 303 community health workers and 3 762 community residents were selected as the research subjects, respectively. Questionnaires survey. Results (1) Among the 303 medical staffs, the awareness rate of signing service was 88.0%; 64.4% of medical staffs were willing to carry out contract service. Multivariate analysis found that the contracting system services to know the situation, to participate in health management division vocational skills training, teaching experience, whether it can save manpower, improve resident compliance and whether the doctor-patient relationship is affecting the community medical staff to general practitioners signed (2) 3,762 community residents, 46.0% knew the service, and 80.6% were willing to carry out the service. Ethnicity, whether they have health insurance, whether they have chronic diseases, whether they know what a GP is contracting for, whether they choose a relatively regular general practitioner, whether they can receive consultation with community-based GPs and whether they have The referral experience of the superior medical center 7 indicators are the main factors affecting the community resident contracted general practitioner service needs. Conclusion Community medical staffs and residents under their jurisdiction are willing to sign service contract. Medical staffs are optimistic about the contract service effect of general practitioners. Policy support, skill training and resource allocation are the main factors affecting medical staffs. Medical institutions are limited and contracted Low awareness of the benefits and low trust of the GP are the main factors affecting the community residents.