贫困慢性非传染性疾病患者家庭医生签约服务进展分析

Analysis on the Progress of Contracted Family Doctor Seryice for the Poor with Chronic Diseases

目的:探讨家庭医生签约服务对贫困慢性非传染性疾病(以下简称慢病)患者的规范管理效果,为推进贫困慢病患者家庭医生签约服务提供参考。方法:基于全国健康扶贫动态管理系统的监测数据,对2019年建档立卡贫困慢病患者的家庭医生签约服务实施进展、管理效果进行描述性分析。结果:健康扶贫促进贫困患者家庭医生签约服务的快速覆盖,签约率达92.39%,重点慢病患者签约率为96.95%。贫困重点慢病患者管理逐步规范,高血压、糖尿病患者规范管理率分别与血压、血糖控制率显著正相关(相关系数分别为0.710、0.754)。贫困慢病患者门诊自付医疗费用明显减轻。结论:贫困地区全科医生短缺成为拓展家庭医生签约服务的瓶颈,建议加快全科医生培养,并借助医共体提升家庭医生团队的服务能力;结合慢病医保支付方式改革,建立慢病全程健康管理服务模式;拓展签约服务费的筹资渠道,逐步丰富家庭医生签约服务内涵。

Objective:To explore the effect of contracted family doctor service on the poor patients with chronic diseases,and to provide references for promoting contracted family doctor service for the poor with chronic diseases.Methods:Based on the monitoring data of the National Health Poverty Alleviation Dynamic Management System,descriptive analysis was conducted on the progress and effect of contracted family doctor service for the poor with chronic diseases who had been registered in 2019.Results:Health Poverty Alleviation Project rapidly promoted the coverage of contracted family doctor service for poor patients,with the signing rate of 92.39%.The signing rate of main chronic diseases was 96.95%.The health management for poor patients with chronic diseases became standard gradually.The standardized management rates of hypertension and diabetes patients were positively correlated with blood pressure control rate and blood glucose control rate(correlation coefficient was 0.710,0.754)respectively.The out of pocket expenses of poor outpatients with chronic diseases were reduced significantly.Conclusion:The shortage of general practitioners in poverty-stricken areas became the bottleneck of expanding contracted family doctor service.It is necessary to speed up general practitioners training and improve the service ability of family doctor team with the help of medical community.A whole process health management mode for patients with chronic diseases should be established connected to the payment reform of medical insurance.The financing resource of contracted service fee should be expanded in order to enrich the contracted services of family doctors gradually.