上海某社区医院家庭医生签约服务现状分析

Current situation of family doctor contractual service of a community hospital in Shanghai

随着医疗服务的改革,社区医院家庭医生签约模式得到广泛应用。本研究分析制约签约的相关因素,为社区医院家庭医生签约服务提供参考。选取2017-01-01—2018-12-31上海市浦东新区南码头社区卫生服务中心38950名签约居民信息,对各类重点人群的签约情况、参保性质和签约方式及组合内签约情况进行统计分析。2017年签约人数占总签约人数的16.03%,2018年签约人数占总人数的83.97%,≥60岁老年人占总人数的60.56%。签约形式以门诊签约为主,2年平均占比为84%;医生上门入户签约占比最少,2年平均占比为3.69%,2年不同形式签约的人数构成差异有统计学意义,χ~2=792.07,P<0.05。≥65岁老年人、高血压与糖尿病患者以及精神病患者签约率>70%;在组合签约中,三级医院签约率低于二级医院。≥60岁年龄段人数最多,占总签约人数的近1/3;南码头社区家庭医生签约居民中,女性的签约率高于男性。从签约方式看,门诊签约是最主要的签约方式;重点人群签约方面,高血压与糖尿病患者签约率高,而孕产妇的签约率明显不足;组合内签约情况看,三级医院的选择上相较于二级医院更加分散。家庭医生签约还有很多需要完善和改进的地方,签约工作还有很大的提升空间。

With the reform of medical service,the model of community hospital family doctor contract has been widely used.In this study,the author analyzes the factors restricting the signing,and provid references for the signing service of family doctors in community hospitals.A total of 38950 residents of Community Health Service Center of NanMaTou,Pudong New District in Shanghai were selected from 2017-01-01 to 2018-12-31 to make a statistical analysis on the signing status,nature,signing methods and combination of the key groups.In 2017,16.03%of the total number of people signed contracts,83.97%of the total number of people signed contracts in 2018,and 60.56%of the total number of people signed contracts.The forms of signing are mainly outpatient service,accounting for 84%on average in 2 years,and doctors’door-to-door signing is accounting for 3.69%on average in 2 years.There were significant differences in the composition of different forms of contract signing in 2 years,χ~2=792.07,P<0.05.Among them,the signing rate of aged65,hypertension and diabetes patients and mental patients was>70%.In combination signing,the signing rate of tertiary hospitals is lower than that of secondary hospitals.≥60-year-old residents have the largest number,accounting for nearly 1/3 of the total number of people signing contracts.Among the residents signed by family doctors in south wharf community,the signing rate of females is higher than that of males.From the way of signing,outpatient signing is the main way of signing;The signing rate of hypertension and diabetes patients is high,while the signing rate of pregnant women is obviously insufficient.According to the situation of contract signing in the combination,the choice of tertiary hospitals is more dispersed than that of secondary hospitals.There are still many improvements to be made in the family doctor contract,and there is still much room for improvement in the contract.