城市社区卫生技术人员对全科医生团队建设与管理现状评价

Interdisciplinary family doctor team building and its management in urban community health service： perspectives from primary health workers

目的从社区卫生技术人员的视角评价我国全科医生团队建设与管理现状。方法2016年3月1—31日，对12个省24家中国社区卫生协会培训基地全体卫生技术人员765人进行问卷调查，分析社区卫生技术人员对全科医生团队的认识情况、团队建设和管理现状评价，比较不同地区、不同岗位社区卫生技术人员对全科医生团队建设和管理的满意度。结果共发出调查问卷765份，收到有效调查问卷738份，问卷有效率96．5％。70．73％（522／738）的社区卫生技术人员对全科医生团队的工作表示支持，对全科医生团队建设与管理的总体满意度为48．61％（2870／5904），其中，对“团队绩效考核与激励工作”“团队被赋予的自主权”“团队成员职责分工合理性”和“团队成员配置合理性”的满意度较低，分别为32．25％（238／738）、40．92％（302／738）、44．44％（328／738）、48．78％（360／738）。不同地区、不同岗位社区卫生技术人员对全科医生团队服务的总体满意度差异均有统计学意义（χ^2分别为176．86，57．17，均P〈0．05）。其中，西部地区和公共卫生岗位社区卫生技术人员对全科医生团队服务的满意度低，分别为35．65％（636／1784）和43．91％（534／1216）。结论目前我国社区卫生技术人员支持全科医生团队，但全科医生团队组成及职责分工尚不完善，团队激励和竞争机制有待强化。西部地区和公共卫生岗位的社区卫生技术人员对全科医生团队建设和管理满意度相对较低，应该重点予以关注。

Objective To survey the perspectives from primary health workers on the building and management of interdisciplinary family doctor team in urban community health service. Methods Primary health workers from 24 community health centers of 14 provinces were selected to participate in a questionnaire survey on March 2016. The attitude and satisfaction of participants with interdisciplinary family doctor team in urban community health setting were surveyed and analyzed. Results There were 765 questionnaires were distributed and 738 valid ones were returned with a retrieve rate of 96.5%. The survey showed that 70.73 % （522/738） of participants supported the interdisciplinary family doctor teamwork, while the overall satisfaction with items regarding its building and management was 48.61% （2 870/5 904）. Participants were mostly dissatisfied with performance appraisal and incentive mechanism （ 32. 25% ） , autonomy of team （ 40.92% ） , job division of team members （ 44.44% ） and rationality of professional allocation in the team （48.78%）. There were significant differences in overall satisfaction rate among primary health workers in different positions and from different regions （ χ^2 = 176.86 and 57.17, both P 〈 0. 05 ）. The overall satisfaction of participants in western regions was only 35.65% （636/1 784） and that of public health workers was 43.91% （534/1 216）. Conclusion Currently, the building and management of interdisciplinary family doctor team in urban community health service are in a initial stage, although its importance has been recognized. Team composition, responsibility of various team members and effective incentive mechanism should be further improved, and more attention should be paid to western regions and for public health workers.