1.School of Medical Politics,Nanjing Medical University,Jiangsu Nanjing;2.Jiangsu Cancer Hospital,Jiangsu Nanjing
目的 评估农村地区签约家庭医生的慢性病患者主观幸福感水平,并探讨其主观幸福感的主要影响因素,为促进农村民生福祉与提升家庭医生的心理健康指导服务效果提供依据。 方法 采取分层抽样与典型抽样结合的方法抽取1740份样本,运用WHO-5幸福感指数量表研究农村签约家庭医生的慢性病患者的主观幸福感现状；采用logistics回归分析探讨农村签约家庭医生的慢性病患者主观幸福感的影响因素。 结果 调查对象主观幸福感呈非正态分布,中位数M=72.00,四分位数间距QR=20.00；有70人(4.0%)“可能抑郁”,208人(11.9%)“幸福感减弱”,1466人(84.1%)“感到幸福”。 调查对象所在地区、所患最主要慢性病的经济负担、家庭医生的心理健康指导工作开展频率、调查对象对家庭医生签约服务质量的评价以及自评健康状况的统计学结果具有显著性(P<0.05)：来自苏南、疾病负担较低、心理指导频率较多、签约服务质量较高、健康状况较好时,调查对象的主观幸福感水平较高。 结论 调查地区总体主观幸福感水平较高,相比城市,有待进一步提升。提示政府部门聚焦民生,落实健康政策与养老服务,保障人群健康；完善医疗保障体系建设,提升家庭医生签约服务质量,减轻农村慢性病患者疾病负担,针对性提升慢性病患者主观幸福感。
Objective Evaluating the subjective well-being of chronically ill patients with contracted family doctors in rural areas and exploring the main influencing factors of their subjective well-being, to supplement research in related fields, provide a basis for promoting rural people"s livelihood and welfare and improve the effectiveness of family doctors" mental health guidance services. Methods A combination of stratified sampling and typical sampling was used to extract 1,740 samples, and the WHO-5 well-being index was used to study the subjective well-being of chronically ill patients with contracted rural family doctors; logistics regression analysis was used to explore chronically ill patients with contracted rural family doctors Influencing factors of subjective well-being. Results The subjective well-being of the survey subjects was non-normally distributed, the median M=72.00, the interquartile range QR=20.00; 70 people (4.0%) were “probably depressed” and 208 people (11.9%) were “weakened” , 1466 people (84.1%) "feel happy". The area where the survey respondents are located, the economic burden of the most important chronic diseases, the mental health guidance of family doctors, the survey respondents’ evaluation of the quality of the family doctor’s contracted services, and the statistical results of their self-evaluated health status are significant (P<0.05): When from southern Jiangsu, the burden of disease is lower, the frequency of psychological guidance is more, the quality of contracted services is higher, and the health status is better, the subjective well-being of the survey respondents is higher. Conclusion The overall subjective well-being of the surveyed areas is relatively high,while compared with cities, it needs to be further improved. It reminds government departments to focus on people"s livelihood, implement health policies and elderly care services to protect the health of the population; improve the construction of the medical security system, improve the quality of contracted services by family doctors, reduce the disease burden of rural patients with chronic diseases, to improving the subjective well-being of patients with chronic diseases purposefully.