Effectiveness of family doctor contracting services in alleviating healthcare access barriers of community residents
10.3760/cma.j.cn114798-20250215-00111
- VernacularTitle:家庭医生签约服务改善居民就医障碍的效果研究
- Author:
Zhao LIU
1
;
Weiying GU
;
Shuai LIU
Author Information
1. 上海市闵行区申鑫社区卫生服务中心全科，上海 201109
- Publication Type:Journal Article
- Keywords:
Physicians, family;
Home care services;
Health services accessibility;
Propensity score;
Marketing of health services
- From:
Chinese Journal of General Practitioners
2025;24(9):1075-1082
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the effectiveness of family doctor contracting services in alleviating healthcare access barriers of community residents.Methods:From January to February, 2025, a cross-sectional study was conducted among 1 188 patients attending general practice clinics in Shanghai Minhang District selected by combination of stratified sampling and simple random sampling. Patients were divided into two groups, 560 with family doctor contracting were designed as a study group and 628 without contrcting as a control group. The questionnaire based on the Andersen Health Behavior Model was used for the survey, and binary logistic regression was employed to analyze the influencing factors of family doctor contracting. The intervention effect of family doctor contract services on the healthcare access barriers of residents was analyzed by Medical Treatment Barrier Questionnaire with the counterfactual framework and the propensity score matching (PSM) method.Results:Among 1 188 participants, there were 472 males (39.73%) and 716 females (60.27%) aged 18-79 years. Multivariate analysis showed that factors influencing family doctor contracting were: predisposing factors including gender ( OR=1.593, 95% CI:1.007-2.518) and age ( OR=1.875, 95% CI:1.394-2.520); enabling factors including main source of medical care ( OR=0.407, 95% CI:0.252-0.658); need factors including household registration ( OR=4.060, 95% CI:2.554-6.453) and frequency of medical visits ( OR=5.947, 95% CI:4.321-8.184)(all P<0.05). The overall score of healthcare access barriers in the two groups was (76.42±26.87); that for study group was (55.35±12.54), and for the contract group was (95.22±21.81) ( P<0.05); the study group had better scores than contract group in 6 dimensions: unawareness, unavailability, inaccessibility, non-adaptability, unaffordability and unacceptability ( t=-27.97, -23.91, -28.45, -18.45, -13.15, -48.61, -38.02, all P<0.05). After propensity score matching (PSM), the study group had better scores in 4 dimensions: unawareness, inaccessibility, non-adaptability and unacceptability ( t=-4.22, -1.97, -2.70, -3.28, -3.21, all P<0.05). Conclusion:Family doctor contract services have a significant effect on improving residents′ subjective perception of access barriers to healthcare, especially in terms of information perception, resource accessibility, process adaptation, and psychological acceptance.
