基层医务人员对《残疾人家庭医生签约服务指导手册》可行性评价的质性研究

Primary Care Workers’Opinions on the Feasibility of the Manual on Contracted Family Doctor Services for Persons with Disabilities:a Qualitative Study

背景 2018年中国残疾人联合会康复部与国家卫生健康委员会基层卫生司联合牵头编写了《残疾人家庭医生签约服务指导手册》(《手册》)并在全国范围推广,以便切实提高全国基层医疗卫生机构残疾人家庭医生团队的服务能力。目的调查《手册》对家庭医生团队要求的服务内容在基层实践工作中的可行性、实用性,以期为《手册》内容的进一步完善提供参考。方法于2019年10月,通过质性研究中的现象学研究,对首都医科大学附属复兴医院月坛社区卫生服务中心参与残疾人家庭医生签约服务的9例医生、6例护士进行半结构化访谈,访谈录音整理成书面文字形式,编码提炼主题,并与受访者核对所提炼主题的准确性。结果 15例受访者均表示《手册》中要求家庭医生团队提供的常见病及多发病诊治、基本公共卫生服务、优先门诊转诊及转介服务等内容可以完成,但9/15的受访者表示上门服务缺乏可持续性;受访者均表示《手册》对实际工作有指导作用;13/15的受访者表示《手册》中延伸服务的部分内容尚需充实以满足实际工作需要。结论《手册》具有可行性,能够起到指导残疾人家庭医生签约服务实践的作用;残疾人家庭医生团队成员对残疾人康复相关知识、信息的需求量大,手册需要增加相应的内容;服务内容需要根据各地的实际情况分别进行完善。

Background In 2018,the Rehabilitation Department of the China Disabled Persons’Federation and Department of Primary Health,the National Health Commission of the People’s Republic of China complied the Manual on Contracted Family Doctor Services for Persons with Disabilities(hereinafter referred to as the Manual),and promoted its nationwide use,so as to effectively improve the serving ability of family doctor teams in domestic primary care for persons with disabilities.Objective To investigate the feasibility and practicability of the Manual in primary practice,to provide a reference for its further improvement.Methods A qualitative study was implemented in October 2019 using a phenomenology approach.Semi-structured interviews were conducted among 9 doctors and 6 nurses with an experience of delivering contracted family doctor services for persons with disabilities from Yuetan Community Health Center,Fuxing Hospital,Capital Medical University.The interviews were recorded,transcribed and coded,with themes were summarized,and verified by the interviewees.Results All the 15 interviewees expressed that they could provide the services by a family doctor team required in the Manual,such as managing common diseases and frequently occurring diseases,essential public health services,priority outpatient referral services,and referral services.And the Manual offered guidance for them in practice.But 9 of them said that home services were not sustainable.13 said that part of the extended services in the Manual needed to be enriched to meet actual needs.ConclusionThe Manual is feasible,and it can provide guidance for contracted family doctor services for persons with disabilities.As members in the family doctor team need a large amount of knowledge related to the rehabilitation of disabled people,so corresponding contents need to be added.And the Manual needs to be improved according to the actual local situation.