南京市家庭医生“签而不约”问题研究

Investigation of the Family Doctor"No Reservation after Signing Up"in Nanjing

目的对南京市家庭医生"签而不约"问题现状进行调研,为家庭医生签约服务制度的改进和完善提供合理的优化途径。方法通过问卷调研和实地采访的方式,在南京市8个区随机抽样16家社区卫生服务中心,共抽样公众400人,家庭医生50人,收集家庭医生"签而不约"问题的基本信息。结果需方:调查样本的签约率为27.25%,且具有老年化(χ~2=12.606,P=0.006)、慢性病(χ~2=30.331,P<0.05)、就医流向(χ~2=13.788,P=0.003)倾向性;32.75%受访者对签约不满意,家庭医生回访频率与被调查者的满意度间差异有统计学意义(χ~2=60.00,P<0.05)。供方:整体的签约人数/月随访数≈8.14,收入(χ~2=18.683,P<0.05)对被调查者的满意度影响有统计学意义。结论供需双方在服务项目、改善面要求、制度认知上整体不匹配,供需结构性矛盾突出。建议在增加服务内容、提高薪资待遇、加大宣传力度、完善培训机制方面进一步完善家庭医生服务体系。

Objective To provide a reasonable way to optimize and improve the service system of family doctors’signing on the investigation on the status of"No reservation after signing up"of family doctors in Nanjing.Methods By means of questionnaire survey and field visit,16 community health service centers were randomly sampled from 8 districts of Nanjing.A total of 400 people and 50 family doctors were sampled from the public to collect basic information on the issue of"No reservation after signing up"by family doctors.Result Demander:The contracting rate of the survey sample was 27.25%,and there was a tendency of aging(χ~2=12.606,P=0.006),chronic diseases(χ~2=30.331,P<0.05),and medical treatment flow direction(χ~2=13.788,P=0.003);32.75%of the respondents were not satisfied with the contract,and there was a significant difference between the frequency of return visits by family doctors and the respondents’satisfaction(χ~2=60.00,P<0.05).Supplier:The overall number of contract signers/monthly follow-up≈8.14,and income(χ~2=18.683,P<0.05)had a statistically significant impact on the satisfaction of the respondents.Conclusion Both suppliers and demanders do not match each other in terms of service items,improvement requirements and system cognition,and the structural contradiction between supply and demand is prominent.It is suggested to further improve the family doctor service system in terms of increasing service content,improving salary and treatment,increasing publicity and improving training mechanism.