基于深度访谈法的太原市家庭医生签约服务政策研究

背景　近年来,太原市家庭医生签约工作正逐步开展,但在就医过程中“看病难、看病贵”问题凸显。为规范医疗秩序,合理就医,了解家庭医生签约政策现状具有重要意义。目的　了解太原市家庭医生签约政策在制定和运行过程中存在的问题,并为其更好地发展提供对策和建议。方法　采用方便抽样方法,在太原市3个城区（迎泽区、小店区、晋源区）的社区卫生服务站各选择1个家庭医生团队（共17例访谈对象）;另选择太原市卫生健康委基层处4例工作人员为研究对象。采用深度访谈方法,于2019年4-6月对21例研究对象进行访谈。访谈的主要内容包括：太原市家庭医生签约政策文件的进展,家庭医生签约政策制定过程中的指标、合同条目和目标,签约服务过程中存在的问题。最后对访谈资料进行整理归纳,总结主题。结果　通过对访谈资料进行分析,共提炼出6个主题：签约率虚高与服务利用率低之间的矛盾;签约率虚高与合同信息不透明之间的矛盾;新旧政策衔接差,政策权威性不足;出现“签而不约”问题;诊疗秩序不规范;家庭医生数量不足。结论　建议通过建立有效签约机制、规范服务合同内容、合理配置新旧政策、规范分级诊疗秩序和大力培养优质人才的方式解决家庭医生签约过程中存在的问题与矛盾。

Analysis of the Status Quo of Policies on Contracted Family Doctor Services in Taiyuan Based on In-depth Interview

Background　In recent years,the contracted family doctor service in Taiyuan has been gradually carried out,but the problems of "difficult to see a doctor and too expensive to have medical service" are highlighted in the process of medical treatment.In order to standardize the medical order and make patients seek medical treatment reasonably,it is of great significance to study the status quo of policies on contracted family doctor service.Objective　To understand the problems existing in the formulation and implementation of policies on contracted family doctor service in Taiyuan,in order to provide countermeasures and suggestions for its better development.Methods　Using the convenient sampling method,one family doctor team（17 cases in total） was selected from each of community health service centers in three urban districts（Yingze District,Xiaodian District and Jinyuan District） in Taiyuan,and 4 staff members from the Grassroots Division of Taiyuan Health and Family Planning Commission were selected as the research objects.Using the in-depth interview,21 cases were interviewed from April to June in 2019.The main contents of the interview were the progress of policy documents of contracted family doctor service in Taiyuan,indicators,contract items and goals in the process of formulating the contracted family doctor service policy,and problems in the implementation of contracted family doctor service.Finally,the interview materials were summarized to extract themes.Results　Through the analysis of the interview data,six themes were extracted.They were the contradiction between the virtual high signing rate and the low service utilization rate,the contradiction between the virtual high signing rate and the unclear contract information,the poor connection between the new and old policies and the lack of policy authority,the problems of "signing but not visiting",the irregular diagnosis and treatment order,and the insufficient number of family doctors.Conclusion　It is suggested to solve the problems and contradictions in the implementation process of contracted family doctor service by establishing an effective signing mechanism,standardizing the content of service contracts,rationally allocating the old and new policies,standardizing the hierarchical diagnosis and treatment order,and cultivating high-quality talents.