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目的:探讨签约服务对基层医疗卫生机构高血压患者管理效果和满意度的影响。方法:使用项目组自行设计的调查问卷,对10省20家基层医疗卫生机构就诊的签约和未签约高血压患者进行现况调查。结果:40~50岁、公费医疗、“小”病就医在社区卫生服务机构和乡镇卫生院、签约的调查对象自报血压控制效果更好(P<0.05)。参加城镇居民医疗保险、“小”病就医首选社区卫生服务机构和签约的患者对医务人员的满意度更高(P<0.05)。在评价签约和血压控制效果及满意度之间关系的有序多分类logistic回归方程中,校正了年龄、性别、文化程度、医疗保险方式、“小”病就医首选机构等因素的影响之后,签约是血压控制效果的独立影响因素,OR=3.007(95%CI:2.572-3.517),同样校正了上述因素的影响之后,签约与满意度呈正关联,OR=1.814(95%CI:1.563-2.105)。结论:签约是社区高血压患者血压控制效果和就诊满意度的独立影响因素,签约患者血压控制效果和就诊满意度均高于非签约患者。
Objective: To explore the impact of contract service on the management and satisfaction of hypertensive patients in primary health care institutions. Methods: Using questionnaires designed by the project team, the status quo of contracted and unsigned hypertension patients in 20 primary health care institutions in 10 provinces was investigated. Results: 40-50 years old, public medical care, “small” illness medical treatment in community health service agencies and township hospitals, contracted subjects reported self-reported blood pressure control effect is better (P <0.05). Participate in the urban medical insurance, “small ” medical treatment preferred community health service agencies and contracted patients were more satisfied with the medical staff (P <0.05). In an ordered multi-class logistic regression equation that evaluated the relationship between contracting and blood pressure control effects and satisfaction, adjusted for factors such as age, gender, educational level, medical insurance, and preferred agency for medical attention (OR = 3.007, 95% CI: 2.572-3.517). After the above factors were also corrected, the contract was positively correlated with the satisfaction, OR = 1.814 (95% CI: 1.563- 2.105). CONCLUSIONS: Signing is an independent influencing factor of blood pressure control and satisfaction in community hypertension patients. The contracted patients’ blood pressure control effect and satisfaction are higher than non-contracted patients.