中山市大涌镇青岗社区家庭医生服务签约情况及有效签约方式探讨

Current Situation of Family Doctor Services in Qinggang Community of Dayong Town, Zhongshan City and the Effective Methods of Signing a Contract with Family Doctors

目的探索中山市大涌镇青岗社区家庭医生服务最有效的签约方式,促进家庭医生服务在中山市的推广与发展。方法 2015年10月—2016年3月对中山市大涌镇青岗社区内的65岁以上老年人、育龄妇女、0~6岁儿童,重症精神病患者以及残疾人共996人在自愿、免费的签约原则上进行家庭医生服务签约。签约方式包括集体签约、门诊签约以及下户签约。在居民进行家庭医生服务签约的同时对签约居民进行问卷调查,调查内容包括签约后的首诊率、对家庭医生服务的知晓率和满意度。统计3种签约方式的签约效率。结果签约居民255人,签约率为25.6%,其中集体签约22.7%(58/225)、门诊签约61.2%(156/255)、下户签约16.1%(41/255)。门诊签约的首诊率、知晓率和满意度均高于集体签约、下户签约(P<0.05)。门诊签约和集体签约平均耗时基本相同,分别是15 min/人和10 min/人,而下户签约平均耗时为30 min/人。结论门诊签约是中山市大涌镇青岗社区家庭医生服务最有效的签约方式。

Objective To explore the most effective contract-signing methods of family doctor services in Qinggang community of Dayong town,Zhongshan city in order to further promote the sustainable development of family doctor service system in Zhongshan. Methods A total of 996 residents from Qinggang community of Dayong town,Zhongshan city,including the elder who were over 65 years old,women of childbearing age,children aged 0-6 years old,severe psychotic patients and disabled people,were invited to sign a contract with family doctors on a free and voluntary contracting principle from October 2015 to March2016. There were three methods to sign a contract with family doctors,including collective contract,outpatient contract and signing a contract in the houses of residents. At the same time,a questionnaire was used to investigate the rate of receiving initial diagnosis at community health institutions,and residents＇ awareness rate and satisfaction rate of family doctor services. Statistics on the efficiency of 3 kinds of contract signing methods. Results A total of 255 residents signed the contract with family doctors and the contract-signing rate was 25. 6%. The signing rate of collective contract was 22. 7%（ 58/225）; the signing rate of outpatient contract was 61. 2%（ 156/255）; and the signing rate of signing a contract in the houses of residents was 16. 1%（ 41/255）.Residents who signed the outpatient contract had a higher rate of receiving initial diagnosis at community health institutions as well as residents＇ awareness rate and satisfaction rate than those who sighed the contracts through the other two methods（ P 0. 05）. As for the contract efficiency,it took 15 minutes per people to sign the outpatient contract and 10 minutes per people to sign the collective contract,while it took 30 minutes per people to sign a contract in the houses of residents. Conclusion The outpatient contract is the most effective way to sign a contract with family doctors in Qinggang community of Dayong town,Zhongshan city.