京北山区家庭医生签约服务内容及模式探析

Analysis on the content and mode of family doctor contract service in the mountain area of northern Beijing

目的了解京北山区家庭医生签约服务开展情况及居民对签约服务的实际需求,为建立契合于山区居民的家庭医生签约服务模式提供依据。方法2019年9月,基于家庭医生签约服务相关政策要求,编制调查问卷和访谈提纲。选取北京市怀柔区北部山区的全部8个乡镇,按比例抽取每个乡镇卫生院的签约居民,共计583人进行问卷调查,同时选取16名居民进行个人深入访谈。对计数资料进行构成比、频数描述和顺位排列等分析,对定性访谈资料采用主题框架法进行内容分析。结果133名居民(22.8%)对家庭医生签约制度完全不了解,164人(28.1%)了解很少,其认知不足将影响其就医行为;有361名居民(61.9%)知晓自己已经与家庭医生签订协议书。居民签约主动性不足,对家庭医生签约服务需求以各类上门服务为主,对网络在线服务需求较低。结论山区居民与家庭医生之间“契约式服务”关系体现尚不明显。应积极探索适合山区特点的家庭医生签约服务模式和绩效考核模式,促进家庭医生签约服务的良性发展。

Objective To understand the development of family doctor contract service and the actual demand of local residents for contract service,so as to provide the basis for the establishment of family doctor contract service mode suitable for mountainous residents.Methods Based on the relevant policy requirements of family doctor contract service,a questionnaire and an interview outline were developed.A questionnaire survey was conducted among 583 residents of each township health center in all eight townships in the mountainous area north of Huairou District,and 16 residents were interviewed in depth in September 2019.The count data were analyzed by composition ratio,frequency description and ranking.The content analysis of qualitative interview data was carried out by topic frame method.Results 133 residents(22.8%)were unaware of the family doctor contract system at all,and 164(28.1%)knew a lttle about it.Residents'lack of awareness tend to afect their medical seeking belprvior.361 residents(61.9%)knew that they had signed agreements with family doctors.Residents were not active enough to sign contracts,and their demand for family doctor signing service was mainly for various kinds of door-to-door services,and the demand for online service was low.Conclusions The contract service relationship between residents and.farmily doctors in mountainous areas is not working as desired.We should actively explore the contract service mode and performance evaluation mode suitable for the characterstics of mountain areas,so as to promote:the healthy development of family doctor contract service.