基于供方视角的家庭医生签约及双向转诊制度执行效果调查

Effect of contracted family doctor services and two-way referral system based on the supplier perspective

目的评价陕西省试点地区家庭医生签约服务与双向转诊相结合的运行效果,为实施和推广分级诊疗制度提供依据。方法2019年3-5月,采用便利抽样法以陕西省汉中市南郑区圣水镇、黄官镇中心卫生院及其下属村卫生室263名医务人员作为调查对象,设计调查问卷了解其工作现状、自评能力及其对家庭医生签约与双向转诊运行效果的评价等。结果:担任家庭医生的工作量占调查对象总工作量的5%~90%,其中签约人数超过600人者占47.4%,60.1%认为自身能力不足;转诊上级医院、慢性病管理、疾病健康管理为家庭医生服务中频数最高的项目;影响医务人员上门服务意愿的因素有:年龄、工作年限、职称、工作时间、家庭医生工作量、签约人数等;多数调查对象认为该制度可提高基层卫生服务利用率及居民健康管理依从性。结论家庭医生签约结合双向转诊可缓解就医难问题,今后应继续调动居民签约积极性,加快全职家庭医生培养速度,进而推动分级诊疗政策的实施。

Objective To evaluate the operation effect of the combination of contracted family doctor services and two-way referral system in the pilot area of Shaanxi Province,and to provide a basis for the implementation and promotion of the hierarchical medical system.Methods From March to May 2019,convenience sampling was used to select 263 medical staff from township hospitals and the affiliated village clinics in Shengshui Town,Huangguan Town of Nanzheng District,Hanzhong City,Shaanxi Province as subjects included in the survey.A questionnaire survey was designed and carried out to investigate the medical staff’s status of work,self-assessment competence and evaluation on the combined effect of contracted family doctor services and two-way referral system.Results The workload of the surveyed as a family doctor accounted for 5%to 90%of the total workload.47.4%of the doctors signed more than 600 residents,and 60.1%of the medical staff said that their ability could not meet the needs for family doctors.Services with the highest frequencies were referral to higher level hospital,chronic disease management,and disease and health management.The influencing factors of medical staff’s on-site service willingness were age,years of working,professional title,working hours,workload of family doctors,and number of contractors.Most respondents thought that the system could improve the utilization rate of primary health services and residents'compliance with health management.Conclusions The combination of contracted family doctor services and two-way referral system can alleviate the difficulty in seeking medical advice.In the future,we need to further arouse the residents’enthusiasm to sign contracts,accelerate the training of full-time family doctors,and then promote the implementation of hierarchical medical policies.