Article(id=1322608158682493848, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322608013010120712, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202504048, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1743696000000, receivedDateStr=2025-04-04, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793263957900, onlineDateStr=2026-10-29, pubDate=1762704000000, pubDateStr=2025-11-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793263957900, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793263957900, creator=13701087609, updateTime=1793263957900, updator=13701087609, issue=Issue{id=1322608013010120712, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='21', pageStart='3841', pageEnd='4032', issueExtLink='null', onlineDate='null', pubDate='1762704000000', pubDateStr='2025-11-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793263923169, creator='13701087609', updateTime=1793264266929, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322609454932149086, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322608013010120712, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322609454932149087, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322608013010120712, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3977, endPage=3982, ext={EN=ArticleExt(id=1322608158879626137, articleId=1322608158682493848, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Contracting status and satisfaction with family doctor contract services among community residents in Zhejiang Province, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the contracting status and satisfaction levels of community residents with family doctor contract services in Zhejiang Province, and to analyze the associated influencing factors.

Methods

A multi-stage stratified sampling method was used to randomly select seven community health service centers in Hangzhou, Wenzhou, and Zhoushan,Zhejiang Province. A cross-sectional questionnaire survey was conducted among individuals visiting these centers from January to March 2024. Analysis of factors influencing satisfaction levels with family doctor contract services was performed using an ordered logistic regression model.

Results

A total of 713 questionnaires were distributed, with 643 valid responses, yielding a response rate of 90.18%. Among the respondents, 373 had contracted family doctor contract services, resulting in a contracting rate of 58.01%. The main reasons for not contracting were having never heard of the family doctor contract service (40.00%) and considering it unnecessary (26.67%). The overall satisfaction score with family doctor services among the contracted population was 4.11 ± 1.16. Satisfaction was assessed across five dimensions showing statistically significant differences (H=20.182, P<0.001). Ordered logistic regression analysis revealed that individuals living with a spouse and/or children (OR=2.316, 95% CI:1.040-5.160) reported higher satisfaction levels with family doctor contract services. Conversely, lower satisfaction levels were observed among individuals with an annual household income of 200 000-<500 000 yuan (OR=0.242, 95% CI: 0.102-0.573), those with an annual household income of ≥500 000 yuan (OR=0.212, 95% CI: 0.074-0.605), those reporting moderate awareness of family doctor contract services (OR=0.282, 95% CI: 0.163-0.486), and those reporting good awareness (OR=0.011, 95% CI: 0.004-0.028).

Conclusion

Currently, the family doctor contracting rate and satisfaction among community residents in Zhejiang Province are relatively high, but there is still room for improvement. Further efforts are needed to enhance publicity, improve service quality, and increase both the contracting rate and satisfaction of residents.

, authors=Ling-yi WANG1, Han-xiao HU1, Lu-xuan HE2, Bi-yao LI2, Wang-zhe DU3, Jun-ji CHEN4, Yue WU1, authorsList=Ling-yi WANG, Han-xiao HU, Lu-xuan HE, Bi-yao LI, Wang-zhe DU, Jun-ji CHEN, Yue WU, authorCompany=null, correspAuthors=Yue WU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322608160393769892, articleId=1322608158682493848, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=浙江省社区居民家庭医生签约情况及满意度研究, columnId=1228016568014139551, journalTitle=现代预防医学, columnName=卫生政策与管理, runingTitle=null, highlight=null, articleAbstract=
目的

调查浙江省社区居民家庭医生签约情况和满意度,并分析其影响因素。

方法

采用多阶段分层抽样,随机选取浙江省杭州市、温州市、舟山市7所社区卫生服务中心,于2024年1—3月对社区卫生服务中心就诊人群进行现场问卷调查,采用有序logistic回归模型分析家庭医生签约服务满意度的影响因素。

结果

共发放问卷713份,回收有效问卷643份,回收率为90.18%。其中,373人签约家庭医生,签约率达58.01%,调查人群未签约主要原因是从未听说过庭医生签约服务(40.00%)、认为没有必要(26.67%)等。签约人群家庭医生服务的总体满意度得分为(4.11±1.16)分。五个维度得分差异存在统计学意义(H=20.182,P<0.001)。有序logistic回归显示:与伴侣和(或)孩子居住的人群(OR=2.316,95% CI:1.040~5.160)对家庭医生签约服务满意度较高;家庭年收入在20~<50万元(OR=0.242,95% CI:0.102~0.573)和≥50万元(OR=0.212,95% CI:0.074~0.605)、对家庭医生签约服务的认知一般(OR=0.282,95% CI:0.163~0.486)和了解(OR=0.011,95% CI:0.004~0.028)的人群满意度较低。

结论

目前浙江省社区居民家庭医生签约率与满意度较高,但存在一定提升空间。仍需加大宣传,提高服务水平,提升居民签约率和满意度。

, authors=王凌熠1, 胡涵笑1, 何露萱2, 李碧瑶2, 杜王哲3, 陈俊吉4, 吴玥1, authorsList=王凌熠, 胡涵笑, 何露萱, 李碧瑶, 杜王哲, 陈俊吉, 吴玥, authorCompany=null, correspAuthors=吴玥, authorNote=

王凌熠和胡涵笑为共同第一作者

王凌熠(2003—),女,本科,无职称,研究方向:健康管理;

胡涵笑(2004—),男,本科,无职称,研究方向:健康管理;

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吴玥,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=lLmmYXvxWU7OpRtSmz9hjw==, magXml=5pxPTRlJsfGVxv1SqI3B8Q==, pdfUrl=null, pdf=KcQXh2gxioj6teoBQ15x6g==, pdfFileSize=666218, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=MmW0TA06nk+7LreXoJ4lIw==, mapNumber=null, fund=null)}, authors=[Author(id=1322608162537059247, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1322608162604168113, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, authorId=1322608162537059247, language=EN, stringName=Ling-yi WANG, firstName=Ling-yi, middleName=null, lastName=WANG, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1322608162671276978, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, authorId=1322608162537059247, language=CN, stringName=王凌熠, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=1.浙江中医药大学公共卫生学院,浙江 杭州 310053, bio={"content":"

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(In Chinese), articleTitle=The development process and implementation of policies related to family doctor in China, refAbstract=null), Reference(id=1322608169495409638, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, doi=null, pmid=null, pmcid=null, year=2023, volume=44, issue=20, pageStart=47, pageEnd=50, url=null, language=null, rfNumber=[3], rfOrder=4, authorNames=张琳琳, 赵璇, 闫昌睿, journalName=医学与哲学, refType=null, unstructuredReference=张琳琳,赵璇,闫昌睿, 等. 家庭医生签约服务中医患信任困境及优化路径 [J]. 医学与哲学, 2023, 44 (20): 47-50., articleTitle=家庭医生签约服务中医患信任困境及优化路径, refAbstract=null), Reference(id=1322608171428983783, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, doi=null, pmid=null, pmcid=null, year=2023, volume=44, issue=20, pageStart=47, pageEnd=50, url=null, language=null, rfNumber=[3], rfOrder=5, authorNames=Zhang LL, Zhao X, Yan CR, journalName=Medicine &Philosophy, refType=null, unstructuredReference=Zhang LL, Zhao X, Yan CR, et al. 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(In Chinese), articleTitle=Prevalence of signing a contract to attend a family doctor team and associated factors of renewing the contract upon the termination date among medical workers, refAbstract=null), Reference(id=1322608171907134445, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, doi=null, pmid=null, pmcid=null, year=2022, volume=null, issue=19, pageStart=61, pageEnd=64, url=null, language=null, rfNumber=[7], rfOrder=11, authorNames=佚名, journalName=中华人民共和国国务院公报, refType=null, unstructuredReference=佚名. 卫生健康委 财政部 人力资源社会保障部 医保局 中医药局 疾控局关于推进家庭医生签约服务高质量发展的指导意见(国卫基层发〔2022〕10号) [J]. 中华人民共和国国务院公报, 2022, (19): 61-64., articleTitle=卫生健康委 财政部 人力资源社会保障部 医保局 中医药局 疾控局关于推进家庭医生签约服务高质量发展的指导意见(国卫基层发〔2022〕10号), refAbstract=null), Reference(id=1322608171982631918, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, doi=null, pmid=null, pmcid=null, year=2022, volume=null, issue=19, pageStart=61, pageEnd=64, url=null, language=null, rfNumber=[7], rfOrder=12, authorNames=Anonym , journalName=Gazette of the State Council of the People's Republic of China, refType=null, unstructuredReference=Anonym . 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Study on the current status and problems of family doctor contracted services in nanjing city [J]. Health Economics Research, 2024, 41 (3): 32-35. 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Study on the satisfaction of family doctors'contract services in Beijing——based on the patient's perspective [J]. Health Economics Research, 2022, 39 (1): 54-58. (In Chinese), articleTitle=Study on the satisfaction of family doctors'contract services in Beijing——based on the patient's perspective, refAbstract=null), Reference(id=1322608173438054400, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, doi=null, pmid=null, pmcid=null, year=2022, volume=36, issue=4, pageStart=30, pageEnd=33, url=null, language=null, rfNumber=[17], rfOrder=31, authorNames=张翠萍, 郭健美, 岳林琳, journalName=中国初级卫生保健, refType=null, unstructuredReference=张翠萍,郭健美,岳林琳, 等. 我国家庭医生签约服务研究现状及建议 [J]. 中国初级卫生保健, 2022, 36 (4): 30-33., articleTitle=我国家庭医生签约服务研究现状及建议, refAbstract=null), Reference(id=1322608173517746177, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, doi=null, pmid=null, pmcid=null, year=2022, volume=36, issue=4, pageStart=30, pageEnd=33, url=null, language=null, rfNumber=[17], rfOrder=32, authorNames=Zhang CP, Guo JM, Yue LL, journalName=Chinese Primary Health Care, refType=null, unstructuredReference=Zhang CP, Guo JM, Yue LL, et al. Research status and suggestion of family doctors' contracting services in China [J]. Chinese Primary Health Care, 2022, 36 (4): 30-33. (In Chinese), articleTitle=Research status and suggestion of family doctors' contracting services in China, refAbstract=null), Reference(id=1322608173580660738, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, doi=null, pmid=null, pmcid=null, year=2022, volume=19, issue=23, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[18], rfOrder=33, authorNames=Kwan C, Tam HC, journalName=International Journal of Environmental Research and Public Health, refType=null, unstructuredReference=Kwan C, Tam HC. "What if I die and no one notices?" A qualitative study exploring how living alone and in poverty impacts the health and Well-Being of older People in Hong Kong [J]. International Journal of Environmental Research and Public Health, 2022, 19 (23): 15856., articleTitle="What if I die and no one notices?" A qualitative study exploring how living alone and in poverty impacts the health and Well-Being of older People in Hong Kong, refAbstract=null), Reference(id=1322608173643575299, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, doi=null, pmid=null, pmcid=null, year=2020, volume=14, issue=1, pageStart=132, pageEnd=144, url=null, language=null, rfNumber=[19], rfOrder=34, authorNames=Alcántara C, Diaz SV, Cosenzo LG, journalName=Health Psychology Review, refType=null, unstructuredReference=Alcántara C, Diaz SV, Cosenzo LG, et al. Social determinants as moderators of the effectiveness of health behavior change interventions: scientific gaps and opportunities [J]. Health Psychology Review, 2020, 14 (1): 132-144., articleTitle=Social determinants as moderators of the effectiveness of health behavior change interventions: scientific gaps and opportunities, refAbstract=null), Reference(id=1322608173710684164, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, doi=null, pmid=null, pmcid=null, year=2025, volume=14, issue=3, pageStart=205, pageEnd=213, url=null, language=null, rfNumber=[20], rfOrder=35, authorNames=林雨涵, 吴舒湲, 郭晶, journalName=统计学与应用, refType=null, unstructuredReference=林雨涵,吴舒湲,郭晶, 等. 中国居民家庭医生签约服务利用率的Meta分析 [J]. 统计学与应用, 2025, 14 (3): 205-213., articleTitle=中国居民家庭医生签约服务利用率的Meta分析, refAbstract=null), Reference(id=1322608173798764549, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, doi=null, pmid=null, pmcid=null, year=2025, volume=14, issue=3, pageStart=205, pageEnd=213, url=null, language=null, rfNumber=[20], rfOrder=36, authorNames=Lin YH, Wu SY, Guo J, journalName=Statistics and Application, refType=null, unstructuredReference=Lin YH, Wu SY, Guo J, et al. Resident’s utilization of family doctor contract services in China: a Meta-Analysis [J]. Statistics and Application, 2025, 14 (3): 205-213. (In Chinese), articleTitle=Resident’s utilization of family doctor contract services in China: a Meta-Analysis, refAbstract=null)], funds=[Fund(id=1322608168501359583, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, awardId=2024ZL374, language=CN, fundingSource=浙江省中医药科技计划项目(2024ZL374), fundOrder=null, country=null), Fund(id=1322608168572662752, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, awardId=2024R410A024, language=CN, fundingSource=浙江省大学生科技创新活动计划项目(2024R410A024), fundOrder=null, country=null), Fund(id=1322608168643965921, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, awardId=2023JKZKTS13, language=CN, fundingSource=浙江中医药大学自然科学青年探索项目(2023JKZKTS13), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322608160620262309, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, xref=1., ext=[AuthorCompanyExt(id=1322608160628650918, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, companyId=1322608160620262309, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China), AuthorCompanyExt(id=1322608160637039527, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, companyId=1322608160620262309, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.浙江中医药大学公共卫生学院,浙江 杭州 310053)]), AuthorCompany(id=1322608162293789608, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, xref=2., ext=[AuthorCompanyExt(id=1322608162302178217, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, companyId=1322608162293789608, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.浙江中医药大学口腔医学院)]), AuthorCompany(id=1322608162369287082, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, xref=3., ext=[AuthorCompanyExt(id=1322608162377675691, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, companyId=1322608162369287082, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.浙江中医药大学第四临床医学院)]), AuthorCompany(id=1322608162461561772, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, xref=4., ext=[AuthorCompanyExt(id=1322608162469950381, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, companyId=1322608162461561772, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.浙江中医药大学第一临床医学院)])], figs=[ArticleFig(id=1322608167654110167, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, language=EN, label=Table 1, caption=

Variable assignment

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名称编码
性别1=男,2=女
年龄(岁)1=25~44,2= 45~64,3=≥65
婚姻状况1=未婚,2=已婚
居住地1=农村,2=城镇
居住情况1=与长辈居住或三代以上同住,2=与伴侣和(或)孩子共同居住,3=独居
职业1=学生,2=企业职工/商人,3=政府/事业单位人员,4=务农,5=其他
文化水平1=小学,2=初中,3=高中或中专,4=本科或大专,5=硕士及以上
家庭年收入(万元)1=0~<5,2= 5~<10,3= 10~<20,4=20~<50,5= ≥50
对家庭医生签约服务的认知情况1=不了解,2=一般,3=了解
是否患有慢性病0=否,1=是
一年内是否住院治疗0=否,1=是
是否定期参加体检0=否,1=是
自身健康评价0=不健康,1=健康
), ArticleFig(id=1322608167746384856, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, language=CN, label=表1, caption=

自变量赋值

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名称编码
性别1=男,2=女
年龄(岁)1=25~44,2= 45~64,3=≥65
婚姻状况1=未婚,2=已婚
居住地1=农村,2=城镇
居住情况1=与长辈居住或三代以上同住,2=与伴侣和(或)孩子共同居住,3=独居
职业1=学生,2=企业职工/商人,3=政府/事业单位人员,4=务农,5=其他
文化水平1=小学,2=初中,3=高中或中专,4=本科或大专,5=硕士及以上
家庭年收入(万元)1=0~<5,2= 5~<10,3= 10~<20,4=20~<50,5= ≥50
对家庭医生签约服务的认知情况1=不了解,2=一般,3=了解
是否患有慢性病0=否,1=是
一年内是否住院治疗0=否,1=是
是否定期参加体检0=否,1=是
自身健康评价0=不健康,1=健康
), ArticleFig(id=1322608167826076633, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, language=EN, label=Table 2, caption=

Baseline characteristics of participants (n=643)

, figureFileSmall=null, figureFileBig=null, tableContent=
人口特征分组调查人数[n(%)]签约人数签约率(%)χ2值P值
性别男278(42.23)18466.1913.445<0.001
女365(56.77)18951.78
年龄(岁)25~44296(46.03)12542.2360.980<0.001
45~64256(39.81)17467.97
≥6591(14.15)7481.32
婚姻状况未婚71(11.04)2636.6214.991<0.001
已婚572(88.96)34760.66
居住地农村267(41.52)17967.0415.291<0.001
城镇376(58.48)19451.60
居住情况与长辈居住或三代以上同住112(17.42)6053.572.4360.296
与伴侣和(或)孩子共同居住466(72.47)27959.87
独居65(10.11)3452.31
职业学生20(3.11)420.0034.985<0.001
企业职员/商人167(25.97)7444.31
政府/事业单位人员159(24.73)9962.26
务农71(11.04)5171.83
其他226(35.15)14564.16
文化水平小学98(15.24)7879.5927.851<0.001
初中89(13.84)5662.92
高中或中专115(17.88)6758.26
本科或大专269(41.84)13449.81
硕士及以上72(11.20)3852.78
家庭年收入(万元)0~<5103(16.02)7976.7044.463<0.001
5~<10169(26.28)11869.82
10~<20202(31.42)9949.01
20~<50122(18.97)5141.80
≥5047(7.31)2655.32
对家庭医生签约服务的认知情况不了解292(45.41)23981.85172.277<0.001
一般153(23.79)9058.82
了解198(30.79)4422.22
是否患慢性病否392(60.96)20752.8111.161<0.001
是251(39.04)16666.14
一年内住院治疗否562(87.40)32557.830.0590.807
是81(12.60)4859.26
是否定期参加体检否131(20.37)6348.096.6430.010
是512(79.63)31060.55
自身健康评价不健康377(58.63)22158.620.1400.708
健康266(41.37)15257.14
), ArticleFig(id=1322608167914157018, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, language=CN, label=表2, caption=

调查对象基本情况(n=643)

, figureFileSmall=null, figureFileBig=null, tableContent=
人口特征分组调查人数[n(%)]签约人数签约率(%)χ2值P值
性别男278(42.23)18466.1913.445<0.001
女365(56.77)18951.78
年龄(岁)25~44296(46.03)12542.2360.980<0.001
45~64256(39.81)17467.97
≥6591(14.15)7481.32
婚姻状况未婚71(11.04)2636.6214.991<0.001
已婚572(88.96)34760.66
居住地农村267(41.52)17967.0415.291<0.001
城镇376(58.48)19451.60
居住情况与长辈居住或三代以上同住112(17.42)6053.572.4360.296
与伴侣和(或)孩子共同居住466(72.47)27959.87
独居65(10.11)3452.31
职业学生20(3.11)420.0034.985<0.001
企业职员/商人167(25.97)7444.31
政府/事业单位人员159(24.73)9962.26
务农71(11.04)5171.83
其他226(35.15)14564.16
文化水平小学98(15.24)7879.5927.851<0.001
初中89(13.84)5662.92
高中或中专115(17.88)6758.26
本科或大专269(41.84)13449.81
硕士及以上72(11.20)3852.78
家庭年收入(万元)0~<5103(16.02)7976.7044.463<0.001
5~<10169(26.28)11869.82
10~<20202(31.42)9949.01
20~<50122(18.97)5141.80
≥5047(7.31)2655.32
对家庭医生签约服务的认知情况不了解292(45.41)23981.85172.277<0.001
一般153(23.79)9058.82
了解198(30.79)4422.22
是否患慢性病否392(60.96)20752.8111.161<0.001
是251(39.04)16666.14
一年内住院治疗否562(87.40)32557.830.0590.807
是81(12.60)4859.26
是否定期参加体检否131(20.37)6348.096.6430.010
是512(79.63)31060.55
自身健康评价不健康377(58.63)22158.620.1400.708
健康266(41.37)15257.14
), ArticleFig(id=1322608168002237403, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, language=EN, label=Table 3, caption=

Satisfaction score of family doctor contract services (n=336)

, figureFileSmall=null, figureFileBig=null, tableContent=
维度条目条目满意度得分(分,)Z/HP值维度满意度得分(分,)HP值
可靠性满足健康需求3.90±1.26-0.5090.6113.94±1.2220.182<0.001
有效控制病情3.98±1.17
响应性及时提供转诊服务4.14±1.100.1750.9164.15±1.11
快速取得联系并得到有效回复4.16±1.11
告知准确随访时间并按时随访4.15±1.12
保证性技术水平熟练4.11±1.17-0.0220.9834.11±1.17
健康教育形式多样4.12±1.16
共情性服务态度亲和4.18±1.130.0030.9984.17±1.13
结合个人实际情况4.18±1.13
注重隐私保护4.17±1.14
有形性设备携带齐全4.09±1.20-0.0740.9414.09±1.20
着装整洁专业4.10±1.19
), ArticleFig(id=1322608168090317788, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, language=CN, label=表3, caption=

家庭医生签约服务满意度得分(n=336)

, figureFileSmall=null, figureFileBig=null, tableContent=
维度条目条目满意度得分(分,)Z/HP值维度满意度得分(分,)HP值
可靠性满足健康需求3.90±1.26-0.5090.6113.94±1.2220.182<0.001
有效控制病情3.98±1.17
响应性及时提供转诊服务4.14±1.100.1750.9164.15±1.11
快速取得联系并得到有效回复4.16±1.11
告知准确随访时间并按时随访4.15±1.12
保证性技术水平熟练4.11±1.17-0.0220.9834.11±1.17
健康教育形式多样4.12±1.16
共情性服务态度亲和4.18±1.130.0030.9984.17±1.13
结合个人实际情况4.18±1.13
注重隐私保护4.17±1.14
有形性设备携带齐全4.09±1.20-0.0740.9414.09±1.20
着装整洁专业4.10±1.19
), ArticleFig(id=1322608168170009565, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, language=EN, label=Table 4, caption=

Ordered logistic regression analysis of factors influencing satisfaction with family doctor contract services

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素β Wald χ2值P值OR值(95% CI)
居住情况(ref:独居)
与长辈居住或三代以上同住0.7470.5092.1510.1422.111(0.778~5.726)
与伴侣和(或)子女共同居住0.8400.4084.2300.0402.316(1.040~5.160)
家庭年收入(万元)(ref:0~<5)
5~<100.1520.3260.2190.6401.164(0.615~2.206)
10~<200.2460.3390.5270.4681.279(0.658~2.487)
20~<50-1.4200.44010.4060.0010.242(0.102~0.573)
≥50-1.5500.5348.4250.0040.212(0.074~0.605)
对家庭医生签约服务的认知情况
(ref:不了解)
一般-1.2660.27820.754<0.0010.282(0.163~0.486)
了解-4.5400.49982.865<0.0010.011(0.004~0.028)
), ArticleFig(id=1322608168241312734, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608158682493848, language=CN, label=表4, caption=

家庭医生签约服务满意度影响因素的有序logistic回归结果

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素β Wald χ2值P值OR值(95% CI)
居住情况(ref:独居)
与长辈居住或三代以上同住0.7470.5092.1510.1422.111(0.778~5.726)
与伴侣和(或)子女共同居住0.8400.4084.2300.0402.316(1.040~5.160)
家庭年收入(万元)(ref:0~<5)
5~<100.1520.3260.2190.6401.164(0.615~2.206)
10~<200.2460.3390.5270.4681.279(0.658~2.487)
20~<50-1.4200.44010.4060.0010.242(0.102~0.573)
≥50-1.5500.5348.4250.0040.212(0.074~0.605)
对家庭医生签约服务的认知情况
(ref:不了解)
一般-1.2660.27820.754<0.0010.282(0.163~0.486)
了解-4.5400.49982.865<0.0010.011(0.004~0.028)
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浙江省社区居民家庭医生签约情况及满意度研究
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王凌熠 1 , 胡涵笑 1 , 何露萱 2 , 李碧瑶 2 , 杜王哲 3 , 陈俊吉 4 , 吴玥 1
现代预防医学 | 卫生政策与管理 2025,52(21): 3977-3982
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现代预防医学 |卫生政策与管理 2025 , 52 (21) : 3977 -3982
浙江省社区居民家庭医生签约情况及满意度研究
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王凌熠1, 胡涵笑1, 何露萱2, 李碧瑶2, 杜王哲3, 陈俊吉4, 吴玥1
作者信息
  • 1.浙江中医药大学公共卫生学院,浙江 杭州 310053
  • 2.浙江中医药大学口腔医学院
  • 3.浙江中医药大学第四临床医学院
  • 4.浙江中医药大学第一临床医学院
通讯作者:
吴玥,E-mail:
作者简介:

王凌熠和胡涵笑为共同第一作者

王凌熠(2003—),女,本科,无职称,研究方向:健康管理;

胡涵笑(2004—),男,本科,无职称,研究方向:健康管理;

Contracting status and satisfaction with family doctor contract services among community residents in Zhejiang Province
Ling-yi WANG1, Han-xiao HU1, Lu-xuan HE2, Bi-yao LI2, Wang-zhe DU3, Jun-ji CHEN4, Yue WU1
Affiliations
  • School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
出版时间: 2025-11-10 doi: 10.20043/j.cnki.MPM.202504048
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目的

调查浙江省社区居民家庭医生签约情况和满意度,并分析其影响因素。

方法

采用多阶段分层抽样,随机选取浙江省杭州市、温州市、舟山市7所社区卫生服务中心,于2024年1—3月对社区卫生服务中心就诊人群进行现场问卷调查,采用有序logistic回归模型分析家庭医生签约服务满意度的影响因素。

结果

共发放问卷713份,回收有效问卷643份,回收率为90.18%。其中,373人签约家庭医生,签约率达58.01%,调查人群未签约主要原因是从未听说过庭医生签约服务(40.00%)、认为没有必要(26.67%)等。签约人群家庭医生服务的总体满意度得分为(4.11±1.16)分。五个维度得分差异存在统计学意义(H=20.182,P<0.001)。有序logistic回归显示:与伴侣和(或)孩子居住的人群(OR=2.316,95% CI:1.040~5.160)对家庭医生签约服务满意度较高;家庭年收入在20~<50万元(OR=0.242,95% CI:0.102~0.573)和≥50万元(OR=0.212,95% CI:0.074~0.605)、对家庭医生签约服务的认知一般(OR=0.282,95% CI:0.163~0.486)和了解(OR=0.011,95% CI:0.004~0.028)的人群满意度较低。

结论

目前浙江省社区居民家庭医生签约率与满意度较高,但存在一定提升空间。仍需加大宣传,提高服务水平,提升居民签约率和满意度。

家庭医生  /  签约率  /  满意度
Objective

To investigate the contracting status and satisfaction levels of community residents with family doctor contract services in Zhejiang Province, and to analyze the associated influencing factors.

Methods

A multi-stage stratified sampling method was used to randomly select seven community health service centers in Hangzhou, Wenzhou, and Zhoushan,Zhejiang Province. A cross-sectional questionnaire survey was conducted among individuals visiting these centers from January to March 2024. Analysis of factors influencing satisfaction levels with family doctor contract services was performed using an ordered logistic regression model.

Results

A total of 713 questionnaires were distributed, with 643 valid responses, yielding a response rate of 90.18%. Among the respondents, 373 had contracted family doctor contract services, resulting in a contracting rate of 58.01%. The main reasons for not contracting were having never heard of the family doctor contract service (40.00%) and considering it unnecessary (26.67%). The overall satisfaction score with family doctor services among the contracted population was 4.11 ± 1.16. Satisfaction was assessed across five dimensions showing statistically significant differences (H=20.182, P<0.001). Ordered logistic regression analysis revealed that individuals living with a spouse and/or children (OR=2.316, 95% CI:1.040-5.160) reported higher satisfaction levels with family doctor contract services. Conversely, lower satisfaction levels were observed among individuals with an annual household income of 200 000-<500 000 yuan (OR=0.242, 95% CI: 0.102-0.573), those with an annual household income of ≥500 000 yuan (OR=0.212, 95% CI: 0.074-0.605), those reporting moderate awareness of family doctor contract services (OR=0.282, 95% CI: 0.163-0.486), and those reporting good awareness (OR=0.011, 95% CI: 0.004-0.028).

Conclusion

Currently, the family doctor contracting rate and satisfaction among community residents in Zhejiang Province are relatively high, but there is still room for improvement. Further efforts are needed to enhance publicity, improve service quality, and increase both the contracting rate and satisfaction of residents.

Family doctor  /  Contracting rate  /  Satisfaction
王凌熠, 胡涵笑, 何露萱, 李碧瑶, 杜王哲, 陈俊吉, 吴玥. 浙江省社区居民家庭医生签约情况及满意度研究. 现代预防医学, 2025 , 52 (21) : 3977 -3982 . DOI: 10.20043/j.cnki.MPM.202504048
Ling-yi WANG, Han-xiao HU, Lu-xuan HE, Bi-yao LI, Wang-zhe DU, Jun-ji CHEN, Yue WU. Contracting status and satisfaction with family doctor contract services among community residents in Zhejiang Province[J]. Modern Preventive Medicine, 2025 , 52 (21) : 3977 -3982 . DOI: 10.20043/j.cnki.MPM.202504048
家庭医生签约服务是以全科医生为核心,以家庭医生服务团队为支撑,通过签约方式与居民建立长期、稳定的服务关系,为签约居民提供基本医疗、公共卫生和约定的健康管理服务[1]。在 “强基层”“大健康”背景下,家庭医生签约服务作为基层医疗卫生服务的重要组成部分,对我国推进分级诊疗制度、建立合理就医秩序具有重要作用[2]。2016年家庭医生签约服务在我国正式全面推行,截至2023年,全国已组建超过42万个家庭医生团队。但目前家庭医生签约服务还存在人群认识不到位[3],服务供给不足[4]等问题;导致家庭医生签约服务出现“怕被签约”“签而不约”等现象[5]。
2022年3月国家卫健委等六部门发布《关于推进家庭医生签约服务高质量发展的指导意见》,明确家庭医生服务内涵,进一步推动家庭医生服务体系建设。基于上述背景,本研究以浙江省为例,调查当前浙江省家庭医生签约现状及其满意度,并分析其影响因素,为更好推进浙江省家庭医生签约服务发展,实现医疗资源的优化配置提供参考依据。
选取2024年1—3月浙江省杭州市、温州市、舟山市7所社区卫生服务中心当天就诊人群为研究对象。纳入标准:(1)年龄:≥25周岁;(2)自愿参加并能积极配合。排除标准:没有自我认知和判断能力、配合度低的调查者。本研究获得浙江中医药大学生物医学伦理委员会审批(20210305-1),所有调查对象均签署知情同意书。
采用多阶段分层抽样方法,依据人均GDP高、中、低分层,随机抽取杭州市西湖区和余杭区,温州市龙港市以及舟山市定海区和嵊泗县的社区卫生服务中心(卫生院)为调查地点。
根据样本量计算公式,假定签约率为50%,容许误差d为0.05,计算样本量为385人。考虑存在非响应情况(如问卷未完全填写或回收率低),研究实际发放713份,回收有效问卷643份,回收率为90.18%。
参考《国家卫生服务调查》,结合浙江省实际情况设计调查问卷,于2024年1—3月,开展线下面对面问卷调查。问卷内容主要包括:(1)个人基本情况:性别、年龄、婚姻状况、职业、文化水平、婚姻状况、家庭年收入等。(2)健康状况:是否患有慢性病、一年内是否住院治疗、是否定期参加体检、自身健康评价等。(3)对家庭医生签约服务的认知情况。认知情况涵盖三个方面,包括服务内容、服务形式、服务价格。(4)家庭医生签约情况:以签约率表示,签约率(%)=(签约人数÷总人数)×100%。(5)对家庭医生签约服务的满意度。满意度涵盖可靠性、响应性、保证性、共情性、有形性五个维度,共12个条目。问卷中,认知情况与满意度的评分方式一致,均采用Likert 5级量表(1~5分),通过计算各条目平均得分评估总体水平,得分越高表示认知或满意程度越高。经信度检验,两者的Cronbach α系数分别为0.988和0.987,均大于0.8,表明问卷具有良好的内部一致性和较高信度。
问卷设计参考已有文献,并结合专家论证意见进行修订,以确保问卷内容的科学合理。所有调查人员均接受统一培训,确保调查过程规范一致。问卷填写完后由专人负责审核与整理,确保问卷的效性。
采用SPSS 27.0软件进行统计分析,计量资料以()表示,计数资料以率或构成比表示,采用χ2检验或秩和检验进行组间比较。其中,认知情况与满意度按照得分范围分为三类:1~2分为“不了解”或“不满意”,>2~<4分为“一般”,4~5分为“了解”或“满意”。针对家庭医生签约服务满意度(1=不满意,2=一般,3=满意),采用有序logistic回归模型分析其影响因素,自变量编码见表1。检验水准α=0.05。
调查人群男女比例接近1∶1,年龄主要集中在25~64岁,占85.84%,已婚为主,占88.96%。居住在城镇的人占58.48%,主要与伴侣和(或)孩子居住的人占72.47%。60.96%的人未患慢性病,79.63%的人每年参加体检,41.37%的人自评健康状况较好。见表2。
调查人群有373人签约家庭医生服务,签约率为58.01%。有270人未签约,其中108人(40.00%)从未听说过家庭医生签约服务、72人(26.67%)认为没有必要、54人(20.00%)认为签约途径不明或流程繁琐、35人(12.96%)认为服务内容单一、11人(4.07%)因政策条件限制、8人(2.96%)认为服务价格较高、2人(0.74%)担心个人信息泄露隐患等。
签约人群中有336人获得家庭医生签约服务,满意度得分为(4.11±1.16)分。五个维度中可靠性、响应性、保证性、共情性、有形性的满意度得分分别为(3.94±1.22)、(4.15±1.11)、(4.11±1.71)、(4.17±1.13)和(4.09±1.20)分,差异存在统计学意义。见表3。
采用有序 logistic 回归模型对家庭医生签约服务满意度的影响因素进行分析。单因素结果显示,居住情况、文化水平、家庭年收入、对家庭医生签约服务的认知情况、是否患有慢性病、是否定期参加体检等与满意度有关(P<0.1)。将上述变量纳入多因素回归模型后,居住情况、家庭年收入以及对家庭医生签约服务的认知情况是影响满意度的主要因素。与独居相比,与伴侣和(或)子女共同居住者满意度较高;家庭年收入高于20万元、对家庭医生认知情况较好的人群对家庭医生服务满意度较低。见表4。
自2016年起,我国依托社区卫生服务中心,逐步推行家庭医生签约服务制度[6]。国家明确提出,到2035年社区居民签约服务覆盖率应达到75%以上,重点人群,包括老年人、慢性病患者等,签约率应达到85%以上[7]。浙江省也提出到2025年全人群签约率达到45%以上[8]。本研究结果显示,浙江省基层社区卫生服务中心就诊人群的家庭医生签约率为58.01%,表明目前已基本达到浙江省阶段性目标。重点人群签约率较高,如65岁及以上老年人签约率81.32%,慢性病人群签约率66.14%,与政策中要求优先覆盖重点人群相符。
调查显示,未签约家庭医生的主要原因是从未听说过该项服务,占比达40.00%,与宋佳丽等[9]研究结果一致,可见认知不足是影响签约的关键因素。仅有30.79%的居民对家庭签约医生服务表示了解,认知程度不高,可能与家庭医生服务覆盖范围有限、宣传方式单一等有关。目前部分地区仍处于试点阶段,服务体系尚不完善。尽管一些地区正积极探索契合本地医疗实际的家庭医生服务模式[10-11],但目前仍以重点人群为主,依赖线下宣传,居民整体知晓率有待进一步提高[12]。
26.67%的调查对象认为签约没有必要,部分慢性病患者亦持此观点。一方面反映出居民对家庭医生服务的接受度和信任度有待提升[13];另一方面,当前家庭医生签约服务尚未突出自身优势,服务内容主要集中于基本医疗,难以有效改变居民依赖大医院就诊的习惯[14]。因此,未来应在团队建设与服务质量等方面应持续优化,逐步构建便捷高效的家庭医生服务体系[15]。
研究还对家庭医生签约服务满意度开展了调查,结果显示,总体满意度为(4.11±1.16)分,处于较高水平,但略低于赵静等[16]对北京市的研究结果,可能与地区间发展水平的差异有关。在满意度的五个维度中,共情性、有形性、响应性和保证性得分较高,反映出居民普遍认可家庭医生团队的服务态度、隐私保护、设备配备和规范着装以及转诊服务、咨询回复速度和健康宣教等。然而,在可靠性维度上,满意度得分相对较低。部分居民认为家庭医生服务未能满足其健康管理需求,疾病控制效果不明显。主要原因可能与医疗资源不足有关,尤其是基层医生数量短缺,是制约家庭医生服务效力的重要因素[17]。为此,应加快全科医生队伍建设,提升基层医疗服务能力;同时积极引入社会力量,如志愿者等,支持家庭医生团队建设。事实上,家庭医生签约服务的一大优势在于其连续性,通过定期家庭访视和电话随访,及时掌握居民需求并开展针对性健康管理,可增强居民对家庭医生的信任,提升满意度。
研究还发现,与伴侣和(或)子女共同居住的人群满意度显著高于独居人群,可能由于其具备较强的家庭支持,更易配合服务并获得良好体验;而独居人群情感和照护需求较高,服务预期与实际供给之间的落差可能导致满意度偏低[18]。家庭年收入高、对家庭医生签约服务认知情况较好的人群,满意度反而较低。可能原因在于这类人群健康意识较强、服务期望较高,更倾向于追求专业性更强、资源更丰富的医疗服务[19]。而现阶段家庭医生签约服务,服务内容相对基础,人员和设备配置有限,难以满足其较高的医疗服务需求[20]。
本研究还存在一定局限性。第一,调查人群是社区卫生服务中心的就诊人群,其家庭医生签约率可能高于一般社区居民,影响结果的代表性与外推性。第二,研究采用现场问卷调查,可能存在信息偏倚,如被调查者因社会期望而影响答题的准确性。
综上所述,浙江省家庭医生签约服务已取得一定成效,签约率基本达到既定目标,居民整体满意度较高。但不同人群在服务认知、签约行为和满意度方面仍存在差异,整体签约服务尚有优化空间。未来应进一步加强宣传,优化服务内容与流程,提升服务可及性与居民获得感,持续推动家庭医生签约服务的高质量发展。
  • 浙江省中医药科技计划项目(2024ZL374)
  • 浙江省大学生科技创新活动计划项目(2024R410A024)
  • 浙江中医药大学自然科学青年探索项目(2023JKZKTS13)
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2025年第52卷第21期
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doi: 10.20043/j.cnki.MPM.202504048
  • 接收时间:2025-04-04
  • 首发时间:2026-10-29
  • 出版时间:2025-11-10
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  • 收稿日期:2025-04-04
基金
浙江省中医药科技计划项目(2024ZL374)
浙江省大学生科技创新活动计划项目(2024R410A024)
浙江中医药大学自然科学青年探索项目(2023JKZKTS13)
作者信息
    1.浙江中医药大学公共卫生学院,浙江 杭州 310053
    2.浙江中医药大学口腔医学院
    3.浙江中医药大学第四临床医学院
    4.浙江中医药大学第一临床医学院

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2种不同金属材料的力学参数
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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