Factors Influencing the Demand for Long-term Family Doctor Contract in Community Health Service Centers

Abstract

Background The number of patients with chronic diseases in the community of China is increasing annually. Family doctor contract service is an important way to promote people's health in China, and long-term family doctor contract will help to improve the continuity of health management and the treatment outcomes. Analyzing patient demand for long-term family doctor contract is critical to the advancement of family medicine services in China. Objective To investigate the demand for long-term family doctor contract among community patients in Beijing Chaoyang Distrct and analyze its influencing factors, so as to provide a theoretical basis for achieving high quality family medicine services. Methods Using continuous enrollment, 500 patients who were enrolled in family doctor contract service at Baliqiao community health service center, Taiyanggong community health service center and Jiangtai community health service center in Chaoyang District, Beijing from January 2020 to January 2021 were included as the study subjects and categorized into the agreement group (those willing to sign long-term contracts) and the refusal group (those unwilling to sign long-term contracts). Data on patient demographics, chronic diseases, educational level, income status, medical expenses, health status, distance from home to the community health service center, compliance, living arrangements, and other indicators were collected through online system retrieval of health records and supplemented by questionnaire surveys from January 2020 to January 2021. From January to March 2021, a questionnaire survey was conducted to collect general information, service quality evaluation, and willingness to sign long-term family doctor contracts. The SERVQUAL scale was designed based on literature retrieval, expert consultation, and preliminary open-ended questionnaire survey results to evaluate the quality of family doctor services. Scores were assigned for expected quality, perceived quality, and importance, ranging from 1 to 5. Expectation scores and perception scores were used to calculate the service quality (SQ) score, and the latter was used to correct importance and calculate the corrected SQ (cSQ) score. Multivariate Logistic regression analysis was used to explore the influencing factors of the demand for long-term family doctor contract services. Results A total of 500 questionnaires were distributed, and 423 were collected, including WeChat platform (73, 17.2%), offline questionnaire (190, 44.9%) and telephone interview (160, 37.8%), the validity rate was 84.6%. Among the respondents, 283 belonged to the agreement group (66.9%), and 140 belonged to the refusal group (33.1%). The average score for the SERVQUAL scale was -0.54, with perceived and expected average scores of 3.98 and 4.52, respectively. Statistically significant differences were observed in the cSQ scores and average scores for each dimension between the two groups (P<0.05). The results of multivariate Logistic regression analysis showed that distance from home to the community health service center (OR=1.077, 95%CI=1.013-1.145, P=0.018), compliance (OR=0.291, 95%CI=0.137-0.617, P=0.001), living alone (OR=4.132, 95%CI=1.997-8.550, P<0.001), and cSQ (OR=0.983, 95%CI=0.980-0.986, P<0.001) were independent influencing factors for patients' willingness to sign long-term family doctor contracts. Conclusion The corrected family doctor service quality, distance from home to community health service center, living arrangements, and compliance are independent factors influencing patients' willingness to sign long-term family doctor contracts. The SERVQUAL scale can effectively evaluate family doctor service quality and aids in developing strategies for improving family doctor services.

Keywords

• community health services|family doctor contract|health management|root cause analysis