上海市闸北区全科医生对家庭医生制认知和接受度调查

General Practitioners' Recognition and Acceptance to Family Doctors System in Zhabei District,Shanghai

目的了解上海市闸北区全科医生对家庭医生制的认知和接受度情况,为上海市进一步推广家庭医生服务提供参考依据。方法选取2013年7月闸北区所有9家社区卫生服务中心,以调查当日在岗的全科医生作为调查对象,共118名。依据闸北区家庭医生制试点机构的调研结果自行设计问卷,内容包括调查对象基本信息、政府推行家庭医生制知晓情况、对胜任家庭医生制服务项目的自我评价、对家庭医生制服务特色的认识、对家庭医生制服务与激励机制的反映、推行家庭医生制对自身产生的最大压力的反映。结果共发放问卷118份,回收118份,回收率为100.0%;有效问卷117份,有效率为99.2%。调查对象中男42名(35.9%),女75名(64.1%)。12名(10.2%)全科医生正确回答上海市政府在2013年开始推广家庭医生制,70名(59.8%)全科医生正确回答上海市在2020年将全面实现家庭医生制。全科医生对家庭医生制主要服务项目"转诊上级医院、健康咨询、疾病健康管理、预约门诊"知晓率均高达90%以上,对"增加慢病药物种类"知晓率为59.8%(70/117)。15.4%(18/117)的全科医生认为自身临床医疗水平完全能够满足家庭医生制服务需求,11.1%(13/117)认为自身基本公共卫生业务水平完全能够满足家庭医生制服务需求。全科医生对承担家庭医生制的服务是否认为有必要再提高自身业务水平,17.9%(21/117)认为完全有必要,54.7%(64/117)认为有必要。55.5%(65/117)的全科医生认为提高业务水平需要技能培训。71.8%(84/117)的全科医生愿意上门服务。38.5%(45/117)的全科医生认为转诊上级医院绿色通道畅通。60.7%(71/117)的全科医生认为家庭医生制将承担"社区诊断"服务项目可行。40.2%(47/117)的全科医生认为可以对签约居民实施个性化健康管理。57.3%(67/117)的全科医生认为签约居民适合服务人数为<500名。96.6%(113/117)认为提高家庭医生积极性的最佳方法是经济奖励。90.6%(106/117)的家庭医生认为家庭医生制健康发展关键措施是提高待遇。全科医生认为推行家庭医生制对自身产生的最大压力居前三位的分别是:服务量增大(78.6%,92/117),付出与收益不等(75.2%,88/117),上门服务(40.2%,47/117)。结论现阶段闸北区全科医生对家庭医生制的认知和接受度较好,但仍有三大问题影响进一步推广家庭医生服务,主要体现在社区首诊制、技能培训以及健康管理的切实开展。

Objective To know GPs＇ recognition and acceptance to the family doctor system in Zhabei District and provide references for further promotion of the family doctor service in Shanghai. Methods 118 general practitioners on the post on the same day with the investigation in all the 9 community health service centers during July, 2013 were selected as the re- search subjects. They were investigated by self - designed questionnaire according to the investigation result in the experimental units about their basic condition, awareness of family doctor system carried out by government, self evaluation of qualification for the service items, understanding of the service features of the system, reflection of the service and incentive mechanism and the biggest pressure in front of thero- Results 118 questionnaires were sent out, receiving 118 questionnaires with 100. 0% recovery rate. There were 117 valid questionnaires with an effective rate of 99. 2%. Among the 117, 42 were males （35.9%） and 75 were females （64. 1% ） ; 12 （ 10. 2% ） knew in 2013 Shanghai government began to extend the system; 70 （59. 8% ） knew that in 2020 Shanghai would fully realize the system; over 90% knew family doctors＇ main services ＂ referral to upper hospitals, health consultation, disease management and appointment out- patient clinic＂; 59.8% （70/117） knew ＂ addition of chronic medicine types＂ . 15.4% （18/117） thought their clinical medical skill could absolutely satisfy the service requirements; for the item of the necessity of improving their skill if they took the responsibility of family doctors, 17.9% （21/117） chose ＂ absolutely necessary＂ and 54. 7% （64/117） chose ＂ necessary＂ ; 55.5% （65/117） thought they needed technical training to improve professional level; 71.8% （84/117） agreed home service; 38.5% （45/117） thought the green pathway of the referral to upper hospitals smooth and effective; 60. 7% （71/117） thought it was feasible to undertake the service of ＂ community diagnosis＂; 40. 2% （47/117） thought it was possible to implement individualized health management to the signed citi- zens. 57.3% （67/117） thought the number of each family doctor service object should be controlled under 500 people. 96. 6% （113/117） thought the financial award was the best way to improve family doctors＇ enthusiasm. 90. 6% （106/117） believed the key measure to the in - depth development of family doctor system was to improve the treatment. They listed the top three pressures： increasing amount of services （78.6%, 92/117）, the inequality of pay and benefits （75.2%, 88/117）, and door - to - door service （40. 2%, 47/117） . Conclusion Currently Zhabei District GPs＇ awareness and acceptance of family doctor system is better, but there are three major issues affecting the further promotion of the family doctor service, mainly manifested in the community first contact care, skills training and practical development in health management.