基于社区健康管理的上海市家庭医生制度发展战略与策略

Study on the development strategy and tactics of the family doctors system in Shanghai city based on the community health management

目的:为进一步了解目前上海市居民对家庭医生制度的认知和愿景,并深入分析成因,为上海市医改提出政策建议,特进行该研究。方法:随机整群分层抽取上海市中心地区(徐汇区)、上海市城乡结合区(闵行区)、上海市郊区(金山区),每个地区研究800名门诊(住院)居民(医院和社区卫生服务中心各400人),共计2400人,回收问卷2082份,问卷回收率为86.75%。结果:1)上海市居民首选社区医院情况:门诊患者65.40%首选社区医院,20.80%首选三级医院;住院患者57.40%首选社区医院,27.80%首选三级医院。60～74岁人群首选社区医院达72.00%,≥75岁老人高达73.00%,门诊患者、高龄者、退休人员和新型农村合作医疗人员首选社区医院比例较高。2)上海市居民首选社区医院原因分析:门诊患者选择社区医院的主要原因是价格便宜和交通方便,住院患者选择社区医院的主要原因是价格便宜和服务态度;在年龄方面,不管是那个年龄组,都认为选择社区医院出于价格便宜和交通方便的原因。其他项目的人群也基本如此,选择社区医院的原因主要是价格便宜、交通方便、就医流程便捷。3)居民对健康管理、家庭保健的需求较高。4)社区居民对家庭医生制度政策的认知较差。结论:上海市家庭医生制度发展势头较好,要因势利导,制定相关政策,保证家庭医生制度的顺利实现,社区健康管理更是当务之急。

Objective： To further understand the cognition and vision of resident in Shanghai for family medical system, to deeply analyze the factors and status of family medical system and bring up the policy suggestion for Shanghai medicine reform. Method： With random sampling and whole sampling and layering sampling, 2082 samples （86.75%） were taken from Xu Hui, Min Hang and Jin Shan districts. Results： 1） The situation of community first diagnosis in Shanghai residents was that 65.40% outpatients chose the community hospital and 20.8% the third class hospital, 57.4% inpatients chose the community hospital as their first diagnosis and 27.8% the third class hospital. 2） Analysis of the factors of community first diagnosis in Shanghai residents： the reasons for choosing community hospital as fist diagnosis were cheaper price and traffic convenience for outpatients, and cheaper price and better service attitude for inpatients. 3） The residents have higher need in health management and family care . 4） The residents have poor cognition to family medical system in Shanghai. Conclusion： The situation of the development of family medical system in Shanghai is better. It is important to establish policy and guarantee the realization of family doctor system in Shanghai. Community health management is also an urgent matter of the moment。