成都市家庭医生服务现状的定性研究

目的 本研究针对成都市基层医疗卫生服务机构，调查分析了家庭医生服务开展现况、存在的问题，以及家医服务平台的建设情况并提出了改进建议。方法 本研究共抽取了成都市六个基层社区卫生服务机构，对每家机构的1名管理人员和1个家庭医生团队分别进行深入访谈和专题小组访谈，调查时间为2020年12月—2021年2月。结果 成都市双向转诊取得一定成效，但下转难情况依然突出；有偿签约效果不好，居民就诊观念需转变；基层卫生技术人员不足，家医服务增加了日常工作量；家医信息化平台存在诸多问题，功能亟需改善；家医的绩效考核制度有一定激励作用，但仍需完善；基层卫生投入不足，家医政策落地难。结论 规范分级诊疗秩序，畅通双向转诊通道；加强官方媒体宣传力度，转变居民就诊观念；提升基层职业吸引力，培养优质人才；加强信息化建设，完善家庭医生信息化服务平台；健全家庭医生绩效考核制度，调动工作积极性；完善家医配套政策与措施，强化基层机构服务能力。

Qualitative research on the current situation of family doctor service in Chengdu

Objective To investigate and analyze the current situation of family doctor service development, problems, and the construction of the family doctor service platform for primary health care service providers in Chengdu, to put forward suggestions for improvement. Methods A total of six primary community health service institutions in Chengdu were selected for this study, and in-depth and focus group interviews were conducted with one manager and one family doctor team from each institution, respectively, from December 2020 to February 2021. Results Two-way referrals in Chengdu have been effective, but the situation of difficult downward referrals is still prominent. Paid contracting is not effective, and residents’ attitudes toward medical care need to be changed. There are not enough grassroots health technicians, and family medicine services have increased daily workload. The information platform of family medicine has many problems, and its functions need to be improved. The performance assessment system of family medicine has some incentive effect, but still needs to be improved. There is insufficient investment in grassroots health, and it is difficult to implement family medicine policies. Conclusion We need to standardize the order of graded diagnosis and treatment, and smooth two-way referrals; strengthen the publicity of the official media to change the residents’ perception on medical treatment; enhance the attractiveness of grassroots occupations and cultivate high-quality talents; strengthen the construction of information technology and improve the information service platform of family doctors; improve the family doctors’ performance appraisal system to mobilize work enthusiasm; improve supporting policies and measures for family doctors, and strengthen the service capabilities of grassroots institutions.