“1+1+1”家庭医生签约管理在儿童保健中应用的效果

Evaluation of the effect of “1+1+1” type of contracted family doctor services in child health care

目的:探讨上海市“1+1+1”家庭医生签约管理在儿童保健中的应用效果。方法:选取2019年3月1日至2020年3月1日在上海市华泾镇社区卫生服务中心儿童保健门诊进行体检,已办理好上海市医保卡,并建立儿童档案的186例辖区常住儿童作为研究对象,其中已完成上海市“1+1+1”签约的93例儿童作为研究组,平均年龄(5.33±3.16)岁,其中男性46例(49.46%),女性47例(50.54%)。未签约的93例儿童作为对照组,平均年龄(5.20±3.28)岁,其中男性48例(51.61%),女性45例(48.39%)。对对照组儿童延用原有的诊疗措施和常规体检,并给予相应指导。对研究组儿童除了进行常规体检外,还提供以下签约服务:健康指导、双向转诊、出院随访、线上线下结合等,每次体检完成后按照儿童的发育情况制定个体化指导干预方案。结果:干预后,研究组的体检依从性及满意度均明显提高(P <0.05);研究组儿童营养性疾病的患病率明显低于对照组(7.53%比20.43%,P <0.05);研究组有7例患儿因患社区卫生服务中心无法处理的疾病均通过转诊至上级医院。结论:“1+1+1”家庭医生签约管理的方式可提高家长体检依从性及满意度,能降低营养性疾病发生率的同时为患儿提供双向转诊服务。

Objective: To evaluate the application effect of “1+1+1” type of contracted services delivered by a family doctor team in Shanghai child health care. Methods: From March 1, 2019 to March 1, 2020 186 who received the physical examination at the child health clinic of Huajing Community Health Service Center, and had Shanghai medical insurance card and children’s files in the jurisdiction were selected as the research objects. The children who had completed the “1+1+1” contract were taken as the research group with 93 cases, the average age was(5.33 ± 3.16) years, including 46 males(49.46%)and 47 females(50.54%). and the children who had not signed were taken as the control group with 93 cases, and the average age was(5.20±3.28) years, including 48 males(51.61%) and 45 females(48.39%). Children in the control group continued to use the original diagnosis and treatment, carried out routine physical examination, and gave corresponding guidance. In addition to routine physical examination, children in the research group were provided the following services: health guidance, bi-directional referral services, discharge follow-up service, online and offline combination services, and after each physical examination, an individualized guidance and intervention program was formulated according to the children’s development. Results: After the intervention, the compliance and satisfaction of parents in the research group were significantly improved(P<0.05);the prevalence of nutritional diseases in children in the research group was significantly lower than that in the control group(7.53% vs 20.43%,P<0.05);in the research group, 7 children suffering from diseases that could not be handled by the community health service center were transferred to the superior hospital. Conclusions: The “1+1+1” type of contracted services delivered by a family doctor team can improve the compliance and satisfaction of parents, can reduce the incidence of nutritional diseases, and can provide bi-directional referral services for sick children.