基于患者服务体验的中国初级卫生保健服务测量与评价研究

摘要： 背景 患者服务体验是衡量初级卫生保健服务质量的重要方面，其测量与评价是非常重要的工作，但我国的患者体验研究起步较晚，针对基层就诊患者的研究相对更少。 

目的 了解基层医疗卫生机构就诊患者的服务体验，以此反映中国初级卫生保健服务开展情况。 

方法 于2023年3-4月，采用完全随机抽样法在12个国家基层卫生健康综合试验区（简称试验区）各抽取3个乡镇/街道，由培训合格的调查员在相应乡镇/街道的乡镇卫生院/社区卫生服务中心门诊大厅和住院病房采用拦截方式对患者进行问卷调查，主要调查工具为简版全科医疗核心特征功能患者体验（ASPC）量表，实际调查36家机构、1 157例患者。

 结果 基层就诊患者的首诊/第一线照护、服务可及性、医患关系连续性、综合性服务、协调性服务维度得分分别为（69.5±20.5）、（74.1±20.1）、（72.0±20.7）、（75.1±21.0）、（68.5±21.7）分，ASPC量表总得分为（71.8±17.3）分。不同年龄、文化程度、职业状况、家庭医生签约情况、患慢性病情况、试验区患者的首诊/第一线照护、服务可及性、医患关系连续性、综合性服务、协调性服务维度得分及ASPC量表总得分比较，差异有统计学意义（P<0.05）。多元线性回归分析结果显示，年龄、职业状况、家庭医生签约情况、试验区是患者首诊/第一线照护维度得分的影响因素（P<0.05），职业状况、家庭医生签约情况、试验区是就诊患者其他4个维度得分及量表总得分的影响因素（P<0.05）。调整其他因素的影响后，失业患者的5个维度得分及量表总得分均低于在业患者（P<0.05）；已签约家庭医生患者的5个维度得分及量表总得分均高于未签约患者（P<0.05）；长汀县、习水县就诊患者的ASPC量表总得分高于介休市（P<0.05），海盐县、泸县、东方市就诊患者的ASPC量表总得分低于介休市（P<0.05），濉溪县、寿光市、郏县、新源县、密云区、上思县就诊患者的ASPC量表总得分与介休市相比，差异无统计学意义（P>0.05）。 结论 ASPC量表得分能反映我国初级卫生保健服务现状；家庭医生签约实施提升了患者在基层医疗卫生机构首诊、服务可及性、医患关系连续性、综合性和协调性等方面的体验。试点地区提供初级卫生保健服务的能力和质量各不相同，不同试验区基层就诊患者体验得分差异与"以患者为中心"和便民举措有关。

关键词: 基层医疗卫生服务, 初级卫生保健, 卫生保健质量, 全科医疗核心特征功能, 家庭医生签约服务, 患者体验

Abstract:

Background

Patients' experience as an important aspect of measuring and evaluating the quality of primary healthcare services, it's important to measure and evaluate it. However, the research about patients' experience in China started late, and there are even fewer studies focusing about patients who visit to the primary health care institutions.

Objective

To reflect the progress of primary healthcare services in China by measuring and evaluating patients' experience which from the primary health care institutions.

Methods

From March to April 2023, a patient questionnaire survey was conducted by trained and qualified investigators using an intercept method on patients of township health centers/community health service centers in 3 sample townships/streets in 12 national comprehensive primary health care pilot zones (hereinafter referred to as "the pilot zones"). The main survey tool was the Assessment Survey of Primary Care (ASPC) scale. In fact, 36 institutions and 1 157 patients were surveyed.

Results

The scores for the dimensions of the first visit/first line care, service accessibility, continuity of the patient relationship, comprehensive services, and coordinated services for the patients surveyed who received primary healthcare services were (69.5±20.5), (74.1±20.1), (72.0±20.7), (75.1±21.0), and (68.5±21.7) respectively, with the total score of the ASPC scale being (71.8±17.3). There were statistically significant differences (P<0.05) between patients of different ages, literacy levels, employment statuses, whether they were signed up or not with prationers, and whether they were with chronic diseases as well as in the different pilot zones in all dimension scores and in total scores. The results of the multivariate linear regression analysis show that age, employment statuses, signed up or not with prationers, and different pilot zones are the influencing factors for the scores of the first visit/first line care in patient (P<0.05), while employment statuses, signed up or not with prationers and different pilot zones are the influencing factors for the scores of the other four dimensions and the total score of the scale (P<0.05). After adjusting for other factors, the scores on the five dimensions and the total score of the ASPC scale were all lower in unemployed patients than in employed patients (P<0.05). The scores on the five dimensions and the total score of the ASPC scale were all higher in patients who had signed up with prationers than in those who had not (P<0.05). The total score of the ASPC scale was higher in patients from Changting County, Xishui County than in those from Jiexiu City (P<0.05), while it was lower in patients from Haiyan County, Lu County, Dongfang City than in those from Jiexiu City (P<0.05). The total score of the ASPC scale was not statistically significant in patients from Suixi County, Shouguang City, Jiaxian County, Xinyuan County, Miyun District, and Shangsi County compared with those from Jiexiu City (P>0.05) .

Conclusion

The scores of ASPC reflect the current situation of primary health care services in China. The implementation of the family doctor contract service enhances the patient's experience of the first visit to the primary health care institutions, accessibility of services, continuity of the doctor-patient relationship, comprehensive services, and coordinated services. The capacity and quality of primary health service delivery varies across the pilot zones. The difference in the experience score of primary outpatients in different experimental areas is related to "patient-centered" and convenience measures.

Key words: Primary health services, Primary health care, Quality of health care, General practice core characteristic functions, Contracted family doctor services, Patient experience

中图分类号: R 197

引用本文：

林春梅,李思思,张艳春,等. 基于患者服务体验的中国初级卫生保健服务测量与评价研究[J]. 中国全科医学, 2025, 28(13): 1553-1559. DOI: 10.12114/j.issn.1007-9572.2024.0275.

LIN Chunmei,LI Sisi,ZHANG Yanchun, et al. Evaluation and Measurement of Primary Health Services Based on Patients' Experience in China[J]. Chinese General Practice, 2025, 28(13): 1553-1559. DOI: 10.12114/j.issn.1007-9572.2024.0275.

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