长沙市基于分级诊疗的契约式家庭医生制实施现状

目的 了解长沙市望城区契约式家庭医生制度的实施现状及影响因素.方法选取长沙市望城区6个实施家庭健康契约式服务的镇卫生院185例就诊患者和63名医务人员,就契约式家庭医生服务的发展现状和影响因素进行问卷调查.结果望城区居民对镇卫生院的总满意率为49.44%;对不同机构满意度差异情况进行分析,结果显示:在就医环境、服务态度和医疗设备设施上,6个镇卫生院满意度比较差异有统计学意义(P<0. 05);Logistic回归分析结果显示,候诊时间长短、诊疗价格、服务态度、病情解释、技术水平、诊疗效果是影响居民满意度的主要因素(P<0.05);发展前景,工作量和时间的分配,公平性,工作风险是影响医务人员满意度的因素(P<0.05).结论 望城区契约式家庭医生制度的实施过程中存在较多的困难和影响因素,可以从家庭医生岗位职责、家庭医生的绩效评价、医疗保险报销比例的分配等方面进行完善.

Implementation status quo of contractual family doctor system based on hierarchical diagnosis and treatment in Changsha City

Objective To investigate the implementation status quo of the contracted family doctor system in Wangcheng District of Changsha City. Methods Sixty-three health workers and 185 medical residents were selected from 6 township health centers in Wangcheng district which implementing the contracted family doctor system and performed the questionnaire survey on the implementation status quo of the contracted family doctor system and its influencing factors.. Implementation status of contracted family doctor system and its influencing factors were investigated by using questionnaires. Results The total satisfaction of the residents in Wangcheng District to township hospitals was 49.44%;the satisfaction differences to different institutions were analyzed,the results showed that the medical environment, service attitude and medical equipments had statistical difference among 6 township health center(P<0.05);Logistic regression analysis results showed that queuing time for consultation, medical price, service attitude, explain of disease state,technological level and medical effect were the main influence factors affecting the residents' satisfaction (P<0.05) ;the development prospects,distribution of workload and time, equity and work risk were the influence factors for the medical workers' satisfaction (P<0.05). Conclusion Many problems and influencing factors exist in the implementation process of the contracted family doctor system in Wangcheng District, which can be perfected in the aspects of the job responsibility of family doctors,performance assessment of family doctors and distribution of medical insurance reimbursement ratio.