云南省家庭医生签约服务开展现状研究

Current Status of Contracted Family Doctor Services in Yunnan Province

背景家庭医生签约服务是强化基层医疗卫生服务网络功能,深化医药卫生体制改革的重要任务,也是落实分级诊疗制度,促进人民群众健康的重要途径,了解云南省家庭医生签约服务存在的问题,对推动云南省家庭医生签约服务有序开展具有重要意义。目的了解云南省家庭医生签约服务存在的问题。方法采用定量研究和定性研究相结合的方法。定量研究分3部分:第1部分从2017年11—12月医改专题书面调研中选取“家庭医生签约服务”部分进行分析;第2部分对2016年《云南省年卫生统计资料》和《2017云南省统计年鉴》进行分析;第3部分采用多阶段分层抽样法选取云南省213名居民进行问卷调查(2018年5月),自行设计调查问卷,主要包括调查对象基本情况和对家庭医生签约服务的知晓情况。定性研究选取4名负责家庭医生签约服务的管理者、36名具体从事家庭医生签约服务工作的工作人员进行访谈。结果卫生统计资料显示,2016年云南省全科医生数4737名,每万人口全科医生数0.99名(不足1名);每千人口执业(助理)医师数为0.56名,除昆明市外,其余州(市)均低于全国水平。问卷调查结果显示,居民家庭医生签约服务信息的知晓渠道主要是医生告知(65.3%)、电视和广播(64.8%)、宣传栏(54.5%)、微信和微博(50.7%);群众对家庭医生签约服务知晓程度较低,213名被调查对象中,只有13名(6.1%)表示对家庭医生签约服务全部了解,63名(29.6%)表示了解小部分。定性访谈显示家庭医生签约服务方面存在的主要问题为:家庭医生签约服务宣传效果不理想,群众知晓率低;家庭医生签约服务工作压力大;信息化建设薄弱,工作效率低;配套措施不完善。结论云南省全科医生数整体偏低,且职称、学历偏低;居民对家庭医生签约服务知晓率较低。建议加大全科医生和执业(助理)医师培养,加强家庭医生签约服务政策宣传,加快基层医疗卫生机构信息化建设,完善相关配套措施,促进云南省家庭医生签约服务的有序开展。

Background Family doctor contract service is an important task to strengthen the function of primary health care service network,deepen the reform of medical and health system,and also an important way to establish the hierarchical diagnosis and treatment system and promote the health of people.Understanding problems existing in the family doctor contract service in Yunnan Province is of great significance to promote its orderly development.Objective To investigate the problems in family doctor contract service in Yunnan Province.Methods A combination of quantitative and qualitative research methods was used.Quantitative research was divided into three parts:the first part was about the analysis of the data collected from the"family doctor contract service"from the written investigation of the medical reform from November to December 2017;the second part was about the analysis of the data from Health Statistics Materials of Yunnan Province in 2016 and 2017 Statistics Yearbook of Yunnan Province;the third part was the analysis of the results conducted with a self-designed questionnaire by using a multi-stage stratified sampling in May,2018.We selected 213 residents to survey their basic situation and knowledge of family doctor contract service in May 2018.The qualitative research was based on individual interviews with 4 leaders who were responsible for family doctor contract service and 36 staff engaged in family doctor contract service.Results Health statistics materials indicated there were 4737 general practitioners in Yunnan Province in 2016,with the number of general practitioner per 10000 population of only 0.99;practicing(assistant)physicians per 1000 population was only 0.56,which was lower than the national level,except for Kunming.Questionnaire results indicated the access that residents received information on contract service were mainly doctor informed(65.3%),television and radio broadcast(64.8%),billboards(54.5%),WeChat and Weibo(50.7%);public awareness of family doctor contract service was low.Only 13(6.1%)out of the 213 respondents said they had full knowledge of family doctor contract service,and 63(29.6%)said they just knew some.Qualitative interviews showed there were 4 problems in family doctor contract service:poor publication of family doctor contract service,low awareness rate among the public;high pressure from family doctor contract service;weak information technology,low work efficiency;and poor supporting measures.Conclusion The number of general practitioners in primary health institutions in Yunnan Province is low,and the professional and education level of practicing(assistant)physicians are also at a low level;residents'awareness of family doctor contract service is low.It is recommended to increase the training of general practitioners and practicing(assistant)physicians,strengthen the publication of family doctor contract service,speed up the informationization of primary health institutions,and improve related supporting measures,to promote the orderly development of family doctor contract service in Yunnan Province.