医方视角下的京郊家庭医生式服务现况及问题探析

Research on Current Situation and Problems of Family Doctor Service in Beijing Suburbs from Medical Perspective

目的了解京郊家庭医生式服务现状及其存在问题,并给予相应的对策建议。方法本研究于2016年9—10月进行,在北京市抽取密云、怀柔两个远郊区县的10个社区卫生服务中心,对其在岗社区医务人员进行问卷调查。结果共发放问卷200份,回收有效问卷185份,问卷有效回收率为92.5%。社区医务人员所在机构已建立家医服务团队的有160人(占86.5%)、已建立家医服务工作制度及职责的有167人(占90.3%)、医务人员认为目前机构开展的家医服务的内容全面的有55人(占29.7%);认为目前社区医务人员数量能满足辖区居民的家医服务需求的有26人(占14.0%),认为技术水平能满足居民需求的有55人(占29.7%);所在机构对于开展家医服务有激励措施的有52人(占28.1%)。机构所采取的激励方式主要为口头激励,认为这些激励方式能调动医务人员积极性的有25人(占48.1%);不愿意成为家医服务团队一员的有58人(占31.4%),主要原因为工作开展难度大、现有工作量大,社区医务人员认为适合远郊区县居民的服务方式主要是预约服务、电话咨询、坐诊。结论目前北京市远郊区县家医服务运行中仍存在较多阻碍,为更好地实现家医服务的全覆盖,特此提出以下对策:制定符合地域特色的家医服务内容及模式;完善多层兼顾的家庭医生人才培养机制;探索行之有效的家医服务激励机制。

Objective To understand the status quo and problems of family doctor service in Beijing suburbs and to give corresponding countermeasures and suggestions. Methods The survey was conducted from September, 2016 to October, 2016 in Beijing, and 10 community health service centers in two suburban districts of Miyun and Huairou were surveyed. Results A total of 200 questionnaires were issued and 185 valid questionnaires were recovered. The effective rate of the questionnaire was 92.5%. And 160 people （86.5%） whose organization have established family doctor service teams, 167 people （90.3%） have established medical service work systems and responsibilities, and the current institutions to carry out the comprehensive family doctor service 55 people （29.7%） ; At present, there are 26 people （ 14% ） who can meet the needs of residents＇ medical service in the community, and the technical level can meet the needs of residents of 55 people （29.7%） ; there were 52 people （28.1%） in the institution who had incentives to carry out the home medical service, the main motivation mode is oral motivation, which were 25 （48.1% ） of these incentives to mobilize the enthu- siasm of medical staff; 58 （31.4%） were reluctant to become involved a medical service team. The main reason is that the work is difficult to carry out and the existing workload is great, community medical staff considered suitable for sub- urbs residents service is the main way of booking services, telephone consultation, and in clinic. Conclusion At pres- ent, there are still many obstacles to the operation of the family doctor service in the suburbs of Beijing. In order to better realize the full coverage of the family doctor service, the following countermeasures are put forward ： to make the content and mode of family doctor service according to local characteristics ; to improve the training mechanism of family doctors ; and to explore effective family doctor service incentive mechanism.