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目的在对信任积累的长期性与阶段性特质分析的基础上,从居民对社区卫生服务的初始信任、持续信任、推荐信任三个阶段找出影响居民对社区卫生服务信任的因素,为更好地发展社区卫生服务提供依据。方法 2016年9—11月,在杭州市6个主城区选取10家社区卫生服务中心,采用定额抽样的方法,拦截就诊或者附近居住的18~70岁的居民进行问卷调查。一般描述性统计分析居民对社区卫生服务信任的基本情况,秩和检验法分析不同信任阶段影响居民对社区卫生服务机构信任的因素,P<0.05为差异有统计学意义。结果初始信任阶段,社区卫生服务机构的声誉、居民获得信息的质量、医保制度的保障、双向转诊制的保障、居民个人的信任倾向对居民产生影响。持续信任阶段,社区卫生服务机构的环境、内部管理、信息公开化、候诊时间、诊疗能力对居民产生影响。推荐信任阶段,居民推荐他人就诊的方式、推荐路径、推荐个数对居民产生影响。结论初始信任阶段加强宣传,给居民提供高质量的信息,促使居民去社区卫生服务机构就诊。持续信任阶段要优化社区卫生服务机构的环境,减少排队等待的时间,提升诊疗能力,为居民提供舒适、高效的就诊体验。推荐信任阶段,鼓励居民推荐他人去社区卫生服务机构就诊,采取措施调动居民推荐的积极性。
Based on the analysis of the long-term and staged traits of trust accumulation, we found out the factors influencing the residents’ trust in community health services from the initial trust of residents to community health services, the sustained trust and the recommendation of trust. Provide basis for the development of community health services. Methods From September to November 2016, 10 community health service centers were selected in 6 main urban districts of Hangzhou. Quarantine sampling was used to intercept the 18 to 70-year-old residents who were visiting or living nearby. General descriptive statistical analysis of residents’ basic situation of community health service trust, rank sum test analysis of different trust stages affect residents trust community health service agencies, P <0.05 for the difference was statistically significant. Results The initial trust stage, the reputation of community health service agencies, the quality of residents’ access to information, the protection of the health insurance system and the guarantee of two-way referral system and the trust tendency of residents have an impact on residents. In the continuous trust phase, the community health service agencies have an impact on the residents’ environment, internal management, information disclosure, waiting time and diagnosis and treatment ability. Recommended trust stage, residents recommend other people’s way of treatment, recommended path, the recommended number of residents have an impact. Conclusion The initial trust stage to strengthen publicity, to provide residents with high-quality information, to promote residents to community health service agencies. The continuous trust phase should optimize the environment of community health service agencies, reduce the waiting time for queuing up, enhance the ability of diagnosis and treatment, and provide residents with a comfortable and efficient visiting experience. Recommending the trust phase, encourage residents to recommend others to community health service agencies, take measures to mobilize the residents recommended enthusiasm.