医联体内基层医疗卫生机构人员对核心医院全科医生参与家庭医生签约服务认识情况的调查

Perception on the participation in family doctor contract services of general practitioners in core hospitals of integrated care organization among medical staff in primary health care institutions

目的调研医联体内基层医疗卫生机构人员对医联体核心医院全科医生参与家庭医生签约(家医签约)服务的认识情况。方法该研究为横断面调查。采用典型抽样法抽取北京市丰台区、密云区为调查现场,2023年11—12月对医联体覆盖的共33家社区卫生服务中心进行家医签约工作的管理人员和医务人员进行线上问卷调查。主要调查医联体核心医院全科医学科建设及参与基层医疗工作情况、核心医院参与家医签约工作情况,以及基层医生对核心医院全科医生参与家医签约服务的态度、需求、问题与建议等。结果共回收问卷234份,有效问卷211份,问卷回收有效率90.17%。其中女性147名(69.67%),年龄≤35岁者110名(52.13%)。71.56%(151/211)的基层医疗卫生机构人员知道医联体核心医院参与家医签约服务工作,签约地点多为社区卫生服务中心(92.05%,139/151),参与原因主要为医院工作安排(60.93%,92/151),参与形式主要是作为团队成员加入家庭医生团队(57.62%,87/151)。48.82%(103/211)的基层医疗卫生机构人员认为综合医院医生应该参与家医签约服务,希望参与的工作排前3位的分别是作为联络基层和综合医院的纽带负责安排转诊等工作(46.45%,98/211)、作为团队成员参与(43.13%,91/211)和作为专家指导复杂问题处理(33.65%,71/211),最大的担心在于综合医院医生不能保证时间和精力因而影响工作(45.97%,97/211)。建议采取的措施排前3位的分别为绩效支持(78.20%,165/211)、政策支持(72.04%,152/211)和配备更多的人员(58.77%,124/211)。结论目前医联体核心医院全科医生到基层参与家医签约服务工作开展不理想,基层医疗卫生机构人员对相关情况的认识程度不一,可建立多层面机制推进工作进展。

Objective:To investigate the perception on the participation in family doctor contract services of general practitioners in core hospitals of integrated medical organizations among medical staff in primary health care institutions.Methods:It was a cross-sectional study.An online survey was conducted from November to December 2023 among managers and medical staff of 33 community medical service centers in Fengtai District and Miyun District of Beijing selected by typical sampling method.The contents of survey included the setting up of general practice in the core hospital of the integrated medical organizations and its participation in the primary medical services,the participation of the core hospitals of the integrated medical organization in the family medical contract service,and the attitude,demand,problems and suggestions of the general practitioners in core hospitals of the integrated medical organization on the family medical contract service.Results:A total of 234 questionnaires were collected,and 211 were valid with an effective rate of 90.17%.Among the respondents,147 were women(69.67%),and 110 were under the age of 35(52.13%).Results showed that 151(71.56%)of the respondents knew that the core hospitals of the integrated medical organization participated in the family doctor contract services,the main service sites were community health service centers(92.05%,139/151),and the main reason for participation was the arrangement by hospitals(60.93%,92/151),and joining the family doctor team(57.62%,87/151);48.82%(103/211)of the respondents believed that doctors in general hospitals should participate in contracted family medical services,the top three reasons for participating were the link role for referral arrangements(46.45%,98/211),participation as a team member(43.13%,91/211)and providing guidance and consultation of medical service(33.65%,71/211).The major concern for doctors in general hospitals was the balance of time and energy management between contract service and hospital work(45.97%,97/211).The top three recommended measures were performance support(78.20%,165/211),policy support(72.04%,152/211)and more staffing(58.77%,124/211).Conclusion:At present,the participation of general practitioners from the core hospitals of the integrated medical organization in family doctor contract services at the primary healthcare institutions is less satisfactory,and there are some perception bias among medical personnel in the primary health care institutions.It is necessary to establish a multi-level mechanism measures to promote this work.