【摘要】 目的:了解昆明市老年慢性病患者感知基层卫生服务质量,识别基层首诊和家庭医生签约影响因素,为提高基层卫生服务质量、进一步推进分级诊疗制度的落实提供决策依据。方法:通过分层抽样对801名老年慢性病患者进行问卷调查,了解感知基层卫生服务质量,运用logistic回归分析识别基层首诊和家庭医生签约影响因素。结果:感知基层卫生服务质量可靠性维度评价最低,城乡差距较大;学历、城乡分布、慢性病类型、慢性病共病和感知基层卫生服务质量的可靠性是老年慢性病患者基层首诊的影响因素(P<0.05);医保类型、感知基层卫生服务质量的关怀性和便利性以及慢性病类型是老年慢性病患者签约家庭医生的影响因素(P<0.05)。结论:基层卫生服务质量较差,基层卫生服务质量可靠性有待提高;昆明市老年慢性病患者的基层首诊率和家庭医生签约率整体较高;提升居民感知基层卫生服务质量,有助于进一步推进基层首诊和家庭医生签约。更多还原

【Abstract】 Objective: To understand the perception of grassroots health service quality of the elderly with chronic diseases in Kunming, to identify the influencing factors of first-visit at grassroots medical institution and family doctor contract service, so as to provide decision-making basis for improving grassroots health service quality and further implementing the hierarchical medical system. Methods: Through stratified sampling, 801 elderly patients with chronic diseases were conducted questionnaire survey to understand grassroots health service quality. Logistic regression analysis was used to identify the influencing factors of first-visit at grassroots medical institution and family doctor contract service. Results: The evaluation of the reliability dimension of the perception of grassroots health service quality was the lowest, and there was a large difference between the city and country. Education background, urban and rural distribution, the type of chronic diseases, multiple chronic conditions, and the reliability of the perception of grassroots health service quality were the influencing factors for first-visit at grassroots medical institution for elderly patients(P<0.05). The type of medical insurance, the care and convenience of the perception of grassroots health service quality, and the type of chronic diseases were the influencing factors of family doctor contract service for elderly patients(P<0.05). Conclusion: Rural grassroots health service quality is poor, and the reliability of grassroots health service quality needs to be improved.The rate of first-visit at grassroots medical institution and family doctor contract service for elderly patients with chronic diseases in Kunming is generally high. The perception of grassroots health service quality has been improved, which is helpful to further promote first-visit at grassroots medical institution and family doctor contract.更多还原