湖北省家庭医生签约服务开展现状研究

目的　了解湖北省试点城市家庭医生签约服务的实施现状，发现存在的问题并提出针对性的建议。方法　在文献研究的基础上自行设计调查表，于2017年7—8月调查湖北省武汉、襄阳、宜昌3个城市的14个社区卫生服务中心的基本情况、人员构成、收支情况、基本公共卫生服务工作量、所需人员数、居民签约现状、家庭医生团队建设情况等。结果　大部分（8/14）社区卫生服务中心由政府举办，各社区卫生服务中心服务人口数为2.25万~13.57万人，服务面积为2.00~33.50 km2。14个社区卫生服务中心均下辖一定数量的居委会，4个社区卫生服务中心无下辖社区卫生服务站，大部分（9/14）社区卫生服务中心无所辖行政村。14个社区卫生服务中心在岗人数为22~129人，其中武汉市2个社区卫生服务中心有编制人员达到在岗人员的一半以上，而襄阳市与宜昌市的社区卫生服务中心均存在在编人员少的问题。各社区卫生服务中心以卫生技术人员为主，全科医生数量普遍较少。劳动街、庞公、施营、定中门街、南苑、西坝6个社区卫生服务中心总支出超过总收入，处于“亏损”状态。14个社区卫生服务中心共有全科医生128人，服务人口81.39万人，平均每个全科医生的服务人口数达到了6 359人。根据2016年公共卫生服务工作量以及人均年参与公共卫生服务的有效时间测算结果来看，大公桥、万寿桥、南苑、西陵、西坝5个社区卫生服务中心从事基本公共卫生服务应有卫生技术人员数为271人，而实际上只有156人，各个社区卫生服务中心均存在人员超负荷工作的情况。宜昌市和襄阳市12个社区卫生服务中心中有9个居民签约率为30.00%~35.00%，而老年人、高血压患者、糖尿病患者的签约率在60%及以上的仅有6、7、9个。14个社区卫生服务中心中仅有6个能够给每个团队配备全科医生，平均每个家庭医生团队有3.8人。结论　湖北省试点城市家庭医生签约率不高，主要问题为社区医务人员不足，需加强社区人才队伍建设，增强服务能力，促进家庭医生签约服务的顺利进行。

Current Situation of Family Doctor Signing Service in Hubei Province

Objective　To understand the implementation status quo of family doctor signing service in pilot cities of Hubei，so as to find out the existing problems and put forward corresponding suggestions.Methods　The questionnaire was designed on the basis of literature research.The basic situation，personnel composition，income and expenditure，workload of basic public health services，number of required personnel，status of residents' contract signing and team building of family doctors in 14 community health service centers in Wuhan，Xiangyang and Yichang，Hubei were investigated from July to August 2017.Results　Most community health service centers （8/14） were run by the government.The number of people serving in the community health service centers rangeed from 22 500 to 135 700，with a service area of 2.00-33.50 km2.All 14 community health service centers had a certain number of neighborhood committees，4 of which had no community health service stations，and most community health service centers （9/14） had no administrative villages under their jurisdiction.There were about 22 to 129 people employed in the 14 community health service centers，2 of which had more than half of staff with budgeted posts.However，there was a shortage of staff in community health service centers in both Xiangyang and Yichang.The majority of staff in community health service centers were health and technical personnel，with few general practitioners.The total expenditure of six community health service centers in Laodong Street，Panggong，Shiying，Dingzhongmen Street，Nanyuan and Xiba exceeded the total revenue and were in a state of deficit.There were 128 general practitioners in 14 community health service centers，serving 813 900 people，with an average of 6 359 per general practitioner.According to the workload of public health service in 2016 and the effective time of participating in public health service per capita per year，271 health technicians should be engaged in basic public health service in five community health service centers in Dagongqiao，Wanshouqiao，Nanyuan，Xiling and Xiba.However，there were only 156 health technicians in each community.All community health service centers were overloaded.Nine out of twelve community health service centers in Yichang and Xiangyang reached the signing rate of 30.00%-35.00%.While only 6，7 and 9 service centers had 60% or over of signing rate for the elderly，patients with hypertension and patients with diabetics，respectively.Only 6 out of 14 community health service centers were able to provide general practitioners to each team，with an average of 3.8 family doctors per team.Conclusion　The main problem of signing service in pilot cities of Hubei is the shortage of medical staff in communities.It is necessary to expand community talent team to enhance service ability and promote the smooth progress of family doctor signing service.