新疆城市社区卫生服务机构“2+X”家庭医生团队预测及运行研究

背景　家庭医生团队作为签约服务的提供主体，基于目前的人力资源现状，如何科学地组建家庭医生团队是进一步推广家庭医生签约服务的关键。目的　预测“2+X”家庭医生团队发展情况，探索新疆城市社区卫生服务机构家庭医生签约服务运行情况，为加快推进家庭医生签约服务提供科学依据。方法　2011—2017年新疆城镇人口、城市社区卫生服务机构执业（助理）医师及注册护士数据来源于2012—2018年《新疆统计年鉴》。2018年新疆城镇人口数来源于新疆维吾尔自治区2018年国民经济和社会发展统计公报。本研究于2019年进行，依据2011—2017年上述数据，采用灰色预测模型GM（1，1），预估2019—2025年新疆城镇人口数及2018—2025年家庭医生团队相关卫生技术（卫技）人员数。计算2011—2025年新疆城市社区卫生服务机构“2+X”家庭医生团队数量情况。观察每3 000服务人口的标准下和每2 000服务人口的标准下，家庭医生团队服务人口数及“2+X”家庭医生团队服务人口覆盖率。结果　预测2019—2025年新疆城镇人口数逐年增长，从2019年1 317.39万人增至2025年1 706.42万人；执业（助理）医师数逐年增长，由2019年的3 083人增至2025年3 268人；注册护士数逐年增长，由2019年3 256人增至2025年3 940人。以“2+X”家庭医生团队模式最低配置标准组建家庭医生团队，预测2018—2025年“2+X”家庭医生团队数量逐渐增多，且2025年理论上新疆城市社区卫生服务机构卫技人员能够组建3 268个团队。2011—2016年注册护士数低于职业（助理）医师数，直到2017年有所改善，医师与护士比达1∶1.02，并一直保持上升趋势，但增长趋势较慢，预测2020年可达1∶1.08，2025年可达1∶1.21。由灰色模型GM（1，1）的预测结果可知，2011—2025年新疆城镇人口数总体呈上升趋势。以每3 000服务人口数的家庭医生团队服务标准，“2+X”家庭医生团队服务人口覆盖率均在70%以上，最高达到82%；以每2 000服务人口数的家庭医生团队服务标准，2018年“2+X”家庭医生团队服务人口覆盖率为48%，理论上到2025年，“2+X”家庭医生团队服务人口覆盖率为38%。结论　2018—2025年“2+X”家庭医生团队数量逐渐增多，但依据每个家庭医生团队服务2 000人口的标准，未来新疆城市社区卫生服务机构医护需求量很大，距实现辖区服务人口全覆盖目标仍有一定的距离，需加强家庭医生团队人才培养，组建提高型家庭医生团队，实现“家家拥有家庭医生，人人享有基本医疗卫生服务”。

Development Prediction and Operation Research of"2+X"-type Family Doctor Team in Xinjiang's Urban Community Health Organizations

Background Family doctor team is a main provider of contracted family doctor services.And how to scientifically establish a family doctor team using available human resources is the key to further promote such services.Objective To predict the development and operation of"2+X"-type family doctor team(consisting mainly of family doctors and nurses in combination with re-employed specialists retired from the secondary hospital,temporarily employed specialists,pharmacists,health managers and other healthcare workers)in urban community health institutions in Xijiang,to provide a scientific basis for accelerating the development of contracted family doctor services.Methods This study was conducted in 2019.The number of urban population,practicing(assistant)physicians and registered nurses working at urban community health institutions in Xinjiang of from 2011 to 2017 were obtained from 7 volumes of Xinjiang Statistical Yearbook(2012—2018).The urban population of Xinjiang in 2018 was derived from the 2018 Xinjiang Uygur Autonomous Region Statistical Bulletin on National Economic And Social Development.Based on the above-mentioned data from 2011 to 2017,a Grey Prediction Model GM(1,1)was developed and adopted to estimate the urban population from 2019 to 2025 and the number of healthcare workers in family doctor teams from 2018 to 2025 in Xinjiang.And the number of"2+X"-type family doctor teams in urban community health institutions from 2011 to 2025 was also calculated.And the number of people and coverage of services delivered by"2+X"-type family doctor teams were estimated based on presumed ratios of 2000,and 3000 people to one family doctor,respectively.Results It is predicted that during 2019—2025,the urban population of Xinjiang would gradually increase from 13.1739 million in 2019 to 17.0642 million in 2025.The number of practicing(assistant)physicians would increase year by year,from 3083 in 2019 to 3268 in 2025.The number of registered nurses would also increase year by year,from 3256 in 2019 to 3940 in 2025.Theoretically,the number of"2+X"-type family doctor teams(presumed to be developed based on the lowest eligibility criteria)wound increase in 2018—2025,and the teams established by urban community health organizations would number 3268 in 2025.From 2011 to 2016,the number of registered nurses was lower than that of practicing(assistant)physicians.Until 2017,the ratio of doctors to nurses improved,which reached 1∶1.02,and was rising,with a slow speed.The ratio was predicted to reach 1∶1.08 in 2020 and 1∶1.21 in 2025.According to the prediction results of GM(1,1),the urban population of Xinjiang would be on the rise from 2011 to 2025.The coverage of services delivered by"2+X"-type family doctor teams wound be over 70%,reaching 82%up most,in 2018,estimated based on a presumed ratio of 3000 people to one family doctor,and wound be 48%estimated based on a presumed ratio of 2000 people to one family doctor.Theoretically,by 2025,the coverage would be 38%.Conclusion In Xinjiang,the predicted number of"2+X"-type family doctor teams wound increase gradually form 2018 to 2025,but there is still a big gap between the coverage of services provided by them estimated based on a presumed ratio of 2000 urban people to one family doctor and universal coverage.To meet the great demand of community-based healthcare services,and realize the goals of every family has a family doctor,and everyone enjoys essential healthcare services,the training for healthcare talents in family doctor teams should be strengthened,and high-quality family doctor teams should be established.