家庭医生签约服务模式下农村基层医务人员工作内容比较研究

A Comparative study on the workload of rural primary healthcare personnel under the family doctor contract service mode

目的:了解家庭医生签约服务模式下农村基层医务人员的工作内容和职责分工现状,为进一步完善职责分工和签约服务模式提供依据。方法:2019年7月采用典型抽样、分层抽样和方便抽样相结合的方法,选取江苏省3个县(区)18个乡镇参与家庭医生签约服务的乡镇卫生院医生、护士、公卫医生、村卫生室医生进行问卷调查;采用描述性分析、卡方检验进行分析。结果:家庭医生签约服务模式下,乡镇卫生院医生主要参与疾病诊疗护理(91.8%)、健康教育(67.6%)、转诊服务(50.5%)、慢性病患者健康管理(50.5%)等工作;护士主要参与疾病诊疗护理(85.0%)、健康教育(61.5%)工作;公卫医生主要参与预防接种(65.9%)、老年人健康管理(51.2%)、慢性病患者健康管理(51.2%)工作;村卫生室医生主要参与医疗服务和绝大部分公共卫生服务项目。结论:家庭医生签约服务模式下农村基层医务人员的工作任务范围广,既参与医疗服务又参与公共卫生服务,促进了医防融合,但存在护士公共卫生服务职能未充分发挥、公卫医生对自身工作职责不清、村卫生室医生工作负担较重等问题。

Objective:To understand the work content of rural primary healthcare personnel under the mode of family doctor contract service and the status of division of responsibilities,so as to provide a basis for further improving the functional division of duties and responsibilities and contracted service model as well.Methods:In July 2019,a sampling method combining typical sampling,stratified sampling and convenience sampling were used to select doctors,nurses,public health doctors at township health centers and doctors at village clinics who participated in the family doctor contract service from 18 townships in three counties(districts)of Jiangsu Province for the questionnaire survey which included the basic information and workload.Descriptive statistical analysis and chi-square test were employed for data analysis.Results:Under family doctor contract service mode,doctors at township health centers were mainly involved in disease diagnosis and treatment(91.8%),health education(67.6%),referral services(50.5%),and health management of chronic disease patients(50.5%);nurses at township health centers mainly participated in disease diagnosis and treatment(85.0%),health education(61.5%);public health doctors at township health centers were mainly involved in vaccination(65.9%),elderly health management(51.2%),and chronic disease health management(51.2%);and doctors at village clinics mostly practiced in medical services and public health services.Conclusion:Under the family doctor contract service mode,rural primary healthcare personnel have a wide range of tasks.They not only participate in medical services but also in public health services,which promotes the integration of medical and prevention.However,there are problems such as insufficient public health service functions of nurses in township health centers,unclear duties and responsibilities for public health doctors,and heavy workload for doctors in the village clinics.