我国家庭医生签约服务现状研究——基于四省份的实地调研

目的:了解我国部分典型地区家庭医生签约服务状况,为提升家庭医生服务供给能力提出政策建议。方法:采用典型抽样法在青海、甘肃、安徽、浙江共选取7家基层医疗卫生机构,对13名机构负责人、23名家庭医生服务团队成员进行面对面半结构式访谈,运用主题框架法对访谈资料进行分析。结果:不同地区在家庭医生服务团队组建、服务模式上存在差异。基本医疗、公共卫生、健康管理、资源协调、政策宣传等服务是家庭医生的主要工作内容。当前,家庭医生签约服务面临职责不清、工作量大、物质激励不足、职业发展受限、居民主动性不强等共性问题。中西部地区在人力资源、技术支撑、服务条件等方面面临更大挑战。结论:建议优先明确家庭医生职责要求和签约服务规范,并优化薪酬待遇、职业发展等方面的保障机制。对于中西部地区,还需进一步加大家庭医生培养力度,提高家庭医生服务能力,强化签约服务技术支撑。

Research on the current situation of family doctor contract service in China: Based on field research in 4 provinces

Objective:To understand the development of family doctor services and existing problems in typical areas of different provinces in China, and to put forward policy suggestions for improving the family doctors contract services. Methods:A total of 7 primary health care institutions were selected from Qinghai, Gansu, Anhui and Zhejiang provinces by typical sampling method, and face-to-face semi-structured interviews were conducted with 13 directors and 23 family doctor service team members. The thematic framework method is used to analyze the interview data. Results:There are differences in the establishment and service mode of family doctor service teams in different areas. Basic medical service, public health service, health management service, resource coordination service and policy publicity service are the main service contents of family doctors. At present, the family doctor service is faced with some common problems, such as unclear responsibilities, heavy workload, insufficient material incentives, limited career development and weak initiative of residents.The central and western regions are facing greater challenges in human resources, technical support and service conditions. Conclusion:It is recommended to give priority to clarifying the duty requirements of family doctors and the standard of contracted services, and optimize the guarantee mechanism of remuneration and career development.For the central and western regions, it is necessary to further strengthen the training of family doctors, improve the service competency, and strengthen technical support.