家庭医生签约服务联动改革对有序诊疗格局的作用效果研究

Effects of Coordinated Reform in the Delivery of Contractual Services by Family Doctors on the Orderly Diagnosis and Treatment Pattern

目的了解家庭医生签约服务联动改革对有序诊疗格局的作用效果,并针对存在的问题提出相应政策建议。方法根据2013—2016年上海市长宁区卫生计生委和上海市长宁区社管中心口径输出的统计报表和运行监测报告,计算并比较2013—2016年长宁区居民的签约率及签约居民的社区定点就诊率、家庭医生定点就诊率、预约门诊率、预约门诊履约率、转诊率、转诊到位率等。结果 2013—2016年长宁区居民的家庭医生签约率分别为23.3%、31.4%、43.1%、47.0%,2016年较2013年上升23.7个百分点。2013—2016年签约居民的社区定点就诊率分别为67.47%、68.35%、65.61%、64.75%,均值为66.55%;家庭医生定点就诊率分别为31.52%、35.16%、36.01%、32.54%,均值为33.81%。2013—2016年签约居民的预约门诊率分别为24.85%、38.71%、42.38%、41.65%,2016年较2013年上升16.80个百分点;预约门诊履约率分别为65.71%、75.85%、73.10%、85.05%,2016年较2013年上升19.34个百分点。2013—2016年长宁区签约居民通过家庭医生转诊率分别为1.16%、0.47%、0.95%、0.96%,2016年较2013年下降0.20个百分点;转诊到位率分别为57.35%、49.41%、45.65%、41.82%,2016年较2013年下降15.53个百分点。结论社区居民的家庭医生签约率稳步提升,有序诊疗格局初步形成,但居民的就诊依从性和转诊问题仍有待改善。建议加强深度宣传;健全人才培养机制;制定明确的转诊制度和转诊指南;提升各级医疗机构协同服务能力,加强信息系统和服务平台建设。

Objective To study the effect of the coordinated reform in the delivery of contractual services by family doctors on the orderly diagnosis and treatment pattern,and put forward targeted policy suggestions for the existing problems.Methods From the statistical reports and operational monitoring reports issued by Shanghai Changning District Health and Family Planning Commission and Shanghai Changning District Community Health Service Management Center during 2013-2016,we collected the data about signing a contract with a family doctor,seeking healthcare in the designated community health service center(CHSC),outpatient appointments and referrals among residents in Changning District,and calculated and comparatively analyzed the annual rates of signing contracts,seeking healthcare in the designated CHSC,visiting the contracted family doctor,making and implementing outpatient appointments,referred residents,successful referrals and so on during this period.Results From 2013 to 2016,among the residents,the annual rate of signing a contract with a family doctor was 23.3%,31.4%,43.1%and 47.0%,respectively,increasing by 23.7%percentage points in 2016 compared with 2013;the annual rate of seeking healthcare in the designated CHSC was 67.47%,68.35%,65.61%and 64.75%respectively,with a mean rate of 66.55%;the average annual rate of visiting the contacted family doctor was 31.52%,35.16%,36.01%and 32.54%respectively,with a mean rate of 33.81%;the annual rate of making outpatient appointments was 24.85%,38.71%,42.38%and 41.65%respectively,upping by 16.80 percentage points in 2016 compared to 2013;the annual rate of implementing outpatient appointments was 65.71%,75.85%,73.10%and 85.05%respectively,increasing by 19.34 percentage points in 2016 compared with 2013;the annual rate of residents referred by their contracted family doctor to hospital was 1.16%,0.47%,0.95%and 0.96%,respectively,dropping by 0.20 percentage points in 2016 compared with 2013;the annual rate of successful referrals was 57.35%,49.41%,45.65%and 41.82%respectively,downing by 15.53 percentage points in 2016 compared with 2013.Conclusion The rate of signing a contract with a family doctor among residents in Changning District has been steadily increasing,and the orderly diagnosis and treatment pattern has initially taken shape.However,their compliance to obtaining healthcare from the designated CHSC and contracted family doctor and referrals still need to be improved.Hence,publicity of information related to contractual services should be intensified;family doctor training system should be improved;systematic referral system and guidelines should be developed;coordinated capacities of medical institutions at all levels should be enhanced;the construction of community health information system and community health service platform should be strengthened.