加强机制建设推动 综合医院参与家庭医生签约

陈思雨; 马力

doi:10.16766/j.cnki.issn.1674-4152.003824

加强机制建设推动综合医院参与家庭医生签约

doi: 10.16766/j.cnki.issn.1674-4152.003824

陈思雨,
马力^,

首都医科大学附属北京天坛医院全科医疗科，北京 100070

基金项目:

北京市高层次公共卫生技术人才建设项目学科带头人-02-09

详细信息

通讯作者:
马力，E-mail: mali_ttyy@126.com

中图分类号: R499 R192.3
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- 文章访问数: 39
- HTML全文浏览量: 15
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-03-27
- 网络出版日期: 2025-02-13

Strengthen the mechanism to encourage general hospitals to participate in the family doctor contract service

CHEN Siyu,
MA Li^,

Department of General Practice, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

摘要

摘要: 充分发动综合医院全科医生的力量，不断增加签约服务的供给能力和内涵建设，是新时代家庭医生签约服务高质量发展的必然要求，也是综合医院全科医学科的重要工作内容之一。政策大力倡导以二、三级医院全科医生为突破点直接参与家庭医生签约，但综合医院全科医学科本身面临着人员不足、工作职责不清晰、学科定位不清晰、学科竞争力不足、发展前景不明确等问题，目前主要通过加入基层医疗卫生机构家医团队，承担技术指导、双向转诊衔接等职责，普遍未在基层医疗卫生机构以家庭医生的身份开展家庭医生签约服务。面对综合医院全科医生到基层参与家庭医生签约服务工作普遍存在着动力不足、身份不明、支持与保障不足等问题，本文从综合医院全科医生参与家庭医生签约的政策环境与社会环境、现状、相关机制入手，建议完善宣传引导机制、签约服务工作机制、人才培养机制等相关机制建设，同时加强宣传与引导增强对综合医院全科医生参与家庭医生签约政策的认可度，以需求为导向制定相关工作机制和工作规范，提供政策支持与工作保障，从政策和实践层面不断提高认识、制定规范，为促进相关政策的落地提供支持与保障，对综合医院全科医生深入参与家庭医生签约工作提供思路，以不断推动家庭医生签约服务高质量发展、提升居民卫生健康获得感。
- 综合医院 /
- 全科医生 /
- 家庭医生 /
- 签约服务
Abstract: The advancement of high-quality contracted family doctor services is an inevitable consequence of the need to fully mobilize the strength of general practitioners in order to continuously increase the supply capacity and connotation construction of contracted services in the new era. This is also one of the important work contents of the general practice department of general hospitals. The policy strongly advocates that general practitioners in secondary and tertiary hospitals should be directly involved in the signing service of family doctors. However, the general practice department of the general hospital itself is confronted with a number of challenges, including a shortage of personnel, a lack of clarity regarding job responsibilities, an uncertain disciplinary positioning, a lack of competitiveness in disciplines, and an unclear development trajectory. Presently, the primary role of general practitioners in secondary and tertiary hospitals is to join the family medical team of primary medical and health institutions, assuming technical guidance, two-way referral and other responsibilities. They do not generally carry out family doctor contract services as family doctors in primary medical and health institutions. Presently, several issues persist, including inadequate motivation, uncertain identity, and insufficient support and assurance. This paper commences with an examination of the policy environment, social environment, current situation, and pertinent mechanisms of general practitioners participating in the signing of family doctors. It then proceeds to propose the following suggestions. It is recommended that improvements be made to the construction of publicity and guidance mechanisms, signing service mechanisms, talent training mechanisms and other related mechanisms. First and foremost, it is imperative to enhance the publicity and guidance measures to reinforce the recognition of general practitioners ' involvement in family doctor signing policies. Furthermore, the formulation of pertinent operational mechanisms and standards based on demand is essential. This should be accompanied by the provision of policy support and the assurance of work guarantees, with a view to fostering continuous improvement in awareness and the formulation of norms at the level of policy and practice. This will ensure the necessary support and guarantees for the implementation of relevant policies. Furthermore, it offers suggestions for general practitioners in general hospitals to engage extensively in the contractual work of family doctors, thereby facilitating the continuous advancement of high-quality family doctor contractual services and enhancing residents ' perception of the value derived from healthcare.
- General hospital /
- General practitioner /
- Family physician /
- Contract service

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表 1 国家卫生健康委员会家庭医生签约相关文件汇总

Table 1. The compilation of documents on family doctor contracting by the National Health Commission

发布时间	文件	涉及内容
2023年2月	关于强化“五个拓展”扎实推进家庭医生签约服务高质量发展的实施意见(新卫基层卫生发〔2022〕3号)	基层医疗卫生机构向二、三级医院拓展，通过多种途径壮大签约服务队伍，提高健康管理服务质量；由全科向专科拓展，扩充家庭医生队伍，加强“一站式”全专结合服务；组织专科医生以“1+N”形式包联家庭医生团队，至少每年一次面对面随访；二级以上医疗机构应通过调整绩效分配调动签约服务人员积极性。
2022年3月	关于推进家庭医生签约服务高质量发展的指导意见(国卫基层发〔2022〕10号)	鼓励各类符合条件的医生到基层医疗卫生机构加入家庭医生队伍，积极开展不同形式的签约服务。家庭医生以个人或组建团队为签约主体提供多种形式签约服务；专科医生通过直接参与签约服务、家庭医生优先转诊专科医生等方式，为签约居民提供“一站式”全专结合服务；鼓励三级医院采取“包干分片”方式，通过对口支援、科室共建、人才下沉、多点执业等多种途径，促进优质医疗资源下沉，与辖区基层医疗卫生机构共同增强签约服务力量，共同做好家庭医生签约服务；建议二级以上医疗机构在绩效工资分配上给予参与签约服务的医师以适当的倾斜。
2018年10月	关于规范家庭医生签约服务管理的指导意见(国卫基层发〔2018〕35号)	鼓励医联体内二级及以上医疗机构卫生技术人员依法到基层医疗卫生机构参与家庭医生签约服务；将开展签约服务情况纳入对医联体的考核评价体系。
2016年6月	关于印发推进家庭医生签约服务指导意见的通知(国医改办发〔2016〕1号)	鼓励二级以上医院和非政府办医疗卫生机构参与，提高签约服务水平和覆盖面；积极引导符合条件的公立医院医师和中级以上职称的退休临床医师，作为家庭医生在基层提供签约服务；二级以上医院应提供技术支持和业务指导；加强医院与基层医疗卫生机构对接，可在与家庭医生团队签约同时，自愿选择一所二级医院、一所三级医院，建立“1+1+1”的组合签约服务模式；同时在绩效工资分配上向参与签约服务的医师倾斜。可对通过相应评价考核的家庭医生团队予以资金支持。

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