多种家庭医生服务模式管理效果评价

Management Effectiveness Evaluation of Three Models of Family Doctor Services

目的比较上海市徐汇区三种家庭医生服务模式的优劣。方法随机抽样调查选取三种模式[依托中心门诊的服务模式（模式1对照组）、采取以居委为依托划块管理的户籍制家庭医生服务模式（模式2）、以服务站为依托的家庭医生服务模式（模式3）]的社区卫生服务中心下的10个居委，评价2011年1～12月三种不同模式下的卫生人力成本、区域卫生服务均衡性、服务效果。结果三种模式互为补充，各具优势，但在服务相同人口的情况下三种模式投入相同的卫生人力成本．以模式2得到的服务效果较好、区域卫生服务均衡性更好。如：基本医疗服务满意率、居民家庭医生知晓率、高血压、糖尿病控制率、签约率、年均居民选择签约家庭医生就诊率、门诊预约复诊成功率模式2均好于其他两个模式，而家庭医生签约率、高血压、糖尿病管理率及家庭医生健康管理评估率在各个居委的分布均衡性也好于另外两个模式。结论模式2卫生服务更均等化，效果更优，是本中心今后家庭医生服务模式发展的方向。

Objective This study was designed to survey and analyze the advantages and weaknesses of three models of fami- ly doctor services in Xuhui District. Methods Random sampling survey was conducted in 10 neighborhood committees served by our Community Health Service Center to compare three selected models of family doctor services, including central clinic-based service（Model 1 as control）, neighborhood committee-based service as per designated residential blocks in accordance with household registration system （ Model 2）, and service station-based family doctor service （ Model 3 ）. These three models were com- pared during the period from January to December 2011 in terms of health workforce cost, regional health service balance, and service effectiveness. Results The three models were complementary with unique advantages. However, given the same health workforce cost and serving the same population, Model 2 provided better outcome and more balanced regional health services, evi-denced by satisfaction rate for basic medical service, awareness rate of neighborhood family doctor, control rate of hypertension and diabetes mellitus, proportion of the residents who have signed an service agreement, average annual percentage of the residents （who have signed an agreement with a family doctor） visiting his/her family doctor, and rate of successful outpatient appoint- ment. Model 2 also gave better service balance among different neighborhood committees than the other two models in terms of proportion of the residents who have signed an agreement with a family doctor, management rate of hypertension and diabetes mel-litus, and assessment rate of family doctor＇ s health mnagement. Conclusion Neighborhood committee-based family doctor serv-ice as per designated residential blocks （Model 2 ） was better in terms of heahh service balance and effectiveness. It may be future direction of the family doctor services in our Community Health Service Center.