上海市徐汇区实行家庭医生首诊制可行性的横断面调查研究

Cross-sectional Survey Research of “Family Doctor First Option” Feasibility in Shanghai

目的了解上海市徐汇区社区医生及社区居民对上海市徐汇区实行家庭医生首诊制的态度及相应的意见建议。方法对2017年9—12月随机抽样上海市徐汇区12家社区卫生服务机构在职在岗的210名社区医生及250名社区居民进行自主设计的问卷调查。医生问卷由被调查者自行阅读理解后填写完成并由质控员审核;居民问卷采取在相关人员指导下面对面逐项询问完成并由质控员审核。后期统一的数据汇总、整理输录及验收另有两名成员负责。结果回收居民有效问卷240份;医生有效问卷206份。接受问卷调查的240名社区居民中,对于徐汇区实施家庭医生首诊制愿意接受的占62.5%(P<0.05)。考虑或愿意首诊社区的众多因素中,医保自负部分能减免占64.6%(P<0.05);各类处方药物齐全占62.5%(P<0.05);家庭医生个人素养及能力占57.9%(P<0.05)。接受问卷调查的206名社区医生中,同意开展家庭医生首诊制的占74.76%(P<0.05);认为家庭医生可以提供连续性、照顾性的医疗服务以及社区居民可以享受可及性、便捷性的医疗服务是目前最大的优势所在(76.2%)(P<0.05),其他包括能切实推进双向转诊、优先预约挂上级医疗系统专家号(59.7%)同样有利于首诊制在基层的开展(P<0.05)。限制家庭医生首诊制实施的众多因素中以有关的政策及措施未改变老百姓的就医模式(78.2%)、患者的不信任感(71.8%)为主(P<0.05)。结论上海市徐汇区在实施家庭医生首诊制方面具备成熟的社区医疗背景及民众基础,在居民主观需求导向方面及医生综合素养、主观能动性方面呈现出可以进一步推进的良性发展趋势。

OBJECTIVE To investigate Shanghai xuhui district community doctors and community residents“family doctor first option”subjective intention and the corresponding opinions and suggestions. METHODS On September 9-12, 2017 in 12 community health service institutions of Xuhui District the 210 community doctors and random sampling of 250 community residents in independent design of the questionnaire. The doctor questionnaire completed by respondents to fill out after reading comprehension and checking by quality engineer;to control the quality of questionnaire to guide the opposite item by item, interrogation to complete the questionnaire below. The data collect and is responsible for the acceptance of two other members. RESULTS It received 240 effective resident questionnaires ;and 206 doctorvalid questionnaires.. Among the questionnaire survey of 240 community residents in the Xuhui district ,62.5% willing to accept the implementation of the“family doctor first option”（P〈0.05）. Consider of many factors, or would like to first option community health care conceit part can deduct 64.6%（P〈0.05）omplete all kinds of prescription drugs accounted for 62.5%（P〈0.05）; Family doctors personal accomplishment and ability of 57.9%（P〈0.05）; ccept the questionnaire survey of 206 community doctors, agree to carry out“family doctor first option”accounted for 74.76%（P〈0.05）; hink family doctors could provide continuity, compassionate health services and community residents could enjoy the accessibility and convenience of medical service were the biggest advantage（76.2%）（P〈0.05）, Others include if can promote two-way referral, priority booking visit hang the superior medical system（59.7%）also was advantageous to the“first option” in the development of grassroots（P〈0.05）. Limit“family doctor first option”in the implementation of many factors to the relevant policies and measures did not change the ordinary medical model”（78.2%）, distrust of patients（71.8%）（P〈0.05）. CONCLUSION In Xuhui District,implementing system of family doctor first option had the mature community medical background and the foundation, and doctors in residents’subjective demand oriented comprehensive literacy, subjective initiative presents could further promote the development trend.