上海市闵行区卫生服务供需方对家庭医生责任制服务的认知情况调查研究

doi:10.3969/j.issn.1007-9572.2018.00.182

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摘要目的　了解目前上海市闵行区社区居民和社区卫生服务中心家庭医生对家庭医生责任制服务的认知情况，为上海市在医疗卫生改革中进一步完善、推广家庭医生责任制服务提供参考。方法　2015年4—6月，选取闵行区13家社区卫生服务中心家庭医生400名（供方），采用方便抽样法抽取闵行区13家社区卫生服务中心的社区居民700名（需方）进行问卷调查，调查内容包括双方基本信息、签约情况、认为家庭医生责任制服务最需要改善的方面，社区居民对家庭医生责任制服务的知晓情况、就诊意愿、对家庭医生责任制服务的主观需求情况，家庭医生对就诊对象了解情况、对家庭医生责任制服务落实情况。结果　社区居民中共发放问卷700份，回收有效问卷657份，有效回收率93.9%；家庭医生中共发放问卷400份，回收有效问卷363份，有效回收率90.8%。在社区居民中，知晓社区卫生服务中心开展家庭医生责任制服务432名（65.8%）。在家庭医生提供的所有服务中，社区居民需求排名前3项为健康体检，计划免疫、妇幼保健、精神卫生、传染病控制等公共卫生服务，健康教育与健康咨询服务。家庭医生提供服务排名前3项为：慢性病建卡及随访管理、家庭病床及上门服务、双向转诊服务。在已签约的216名社区居民中，选择签约的家庭医生就诊率为50.0%（108名）；家庭医生对于就诊对象是否为自己签约对象的了解率为78.2%（284/363）。居民和家庭医生认为目前服务中最需要改善的方面为家庭医生诊治水平、基本药物制度的药物种类和对于疑难杂症向专科医院的快速有序转诊。结论　供需方对于家庭医生责任制服务的认知情况存在一定差异。社区卫生服务中心的家庭医生队伍应不断提高服务能力，进一步满足居民日益增长的基本医疗卫生服务需求，保证居民健康，保障家庭医生责任制的顺利实现和正常运转。

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	王君燕
	吴燕
	汪曦
	许慧琳
	郭琪
	苏华林

关键词 ：社区卫生服务, 初级保健, 认知, 居民, 家庭医生责任制

Abstract：Objective　To investigate the perceptions of the family doctor responsibility system among community-dwelling patients and family doctors〔working in community health centers（CHCs）〕in Shanghai's Minhang District，providing a reference for further development of family doctor responsibility system（included in the healthcare reform） in Shanghai.Methods　From April to June 2015，we surveyed a total of 400 family doctors with a self-developed questionnaire for family doctors and a convenience sample of 700 community-dwelling residents from 13 CHCs in Shanghai's Minhang District with a self-developed questionnaire for community residents for collecting their characteristics，signing status and main items of family doctor responsibility system needing to be improved，community-dwelling patients' cognition of family doctor responsibility system service，willingness to visit and self-reported level of demands for family doctor responsibility system，and understanding of patients and implementation of family doctor responsibility system by family doctors.Results　657 community-dwelling patients and 363 family doctors responded positively to the survey.Among the community-dwelling patients，65.8%（n=432） knew that family doctor services were carried out in CHCs；the 3 service items needed most were physical examination，public health management，health education and consultation；the 3 service items used most frequently were chronic disease registration and follow-up management，home-based care（including bedside care） and dual referrals.Of those（n=216） who had signed contracts with family doctors，50.0%（108/216）contacted their contracted family doctor for medical care.78.2%（284/363）of the family doctors knew whether the patient they received was the contracted.Both groups thought that the main factors associated with the delivery of family doctor services were professional levels of family doctors，types of medicines covered by the China's Essential Medicine System and rapid and orderly referrals.Conclusion　Community-dwelling patients and family doctors have different views about residents' demands for family doctor services.Family doctor team from CHCs should increase their service capabilities，in order to satisfy residents' growing demand of basic healthcare for better health，and to ensure the development of contract responsibility system for family doctors.

Key words： Community health services Primary care Cognition Resident Family doctor responsibility system

基金资助:基金项目：2015年度上海市医院协会医院管理研究基金（2015050）

引用本文:

王君燕，吴燕，汪曦，许慧琳，郭琪，苏华林. 上海市闵行区卫生服务供需方对家庭医生责任制服务的认知情况调查研究[J]. 中国全科医学, 2018, 21(27): 3385-3388.
WANG Jun-yan1，WU Yan，WANG Xi，XU Hui-lin，GUO Qi，SU Hua-lin. Perception of the Contract Responsibility System for Family Doctors in Shanghai's Minhang District：Patient and Physician Perspectives. Chinese General Practice, 2018, 21(27): 3385-3388.

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