社区居民与全科医生对家庭医生签约服务的选择偏好

程连; 张勇; 李媛媛; 黄燕飞; 李卿慧

doi:10.16766/j.cnki.issn.1674-4152.003803

社区居民与全科医生对家庭医生签约服务的选择偏好

doi: 10.16766/j.cnki.issn.1674-4152.003803

1.
宁夏医科大学第三临床医学院，宁夏回族自治区人民医院(宁夏医科大学附属自治区人民医院)全科医学科, 宁夏银川 750001
2.
宁夏医科大学第二临床医学院，宁夏银川 750000
3.
宁夏回族自治区人民医院全科医学科, 宁夏银川 750001
4.
大鹏新区医疗健康集团, 广东深圳 528051

基金项目:

宁夏回族自治区重点研发计划重大专项 2021BEG01001

详细信息

通讯作者:
黄燕飞，E-mail: lovelylily820327@163.com

中图分类号: R499 R197.61
计量
- 文章访问数: 16
- HTML全文浏览量: 14
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-02-04
- 网络出版日期: 2025-01-20

The choice preferences of community residents and general practitioners for the selection of family doctor contracted services

1.
The Third Clinical Medical College of Ningxia Medical University, Department of General Practice, People ' s Hospital of Ningxia Hui Autonomous Region (People ' s Hospital of Ningxia Medical University), Yinchuan, Ningxia 750001, China

摘要

摘要: 家庭医生签约服务是落实医改政策的体现，是现阶段基层服务的主要模式，是实现健康中国的重要抓手。旨以全科医生为核心，家庭医生团队为支柱，通过签约的方式，促使全科医生与签约居民或家庭建立一种长期、稳定的服务关系，为签约者提供全方位、高质量、便捷化的健康服务，打造家门口的健康服务体系，实现全生命周期的健康管理。尽管家庭医生签约服务总体签约率、知晓率、履约率逐年上升，但由于存在很大的经济、社会、文化、政治等地域差异性，我国部分地区仍处于低知晓率、低签约率、低履约率，另外，由于社区居民与全科医生在家庭医生签约服务中选择偏好的不匹配，导致供需双方对签约服务满意度不高，这可能是目前“为签而签”“签而不约”“伪签约”“服务项目无法落实”等现象的主要原因之一，严重影响服务质量。为更好落实家庭医生签约服务、提高签约服务质量，本文综合分析了社区居民与全科医生对家庭医生签约服务选择偏好的相关研究，探讨了影响供需双方家庭医生签约服务的潜在因素，并提出了相应提升其质量与数量的策略。主要从供需双方的不同视角提供家庭医生签约服务的偏好依据，为进一步推进有效签约及规范履约、提升签约双方满意度、强化签约服务内涵提供参考，以促进家庭医生签约服务高质量发展。
- 家庭医生签约服务 /
- 社区居民 /
- 全科医生 /
- 选择偏好
Abstract: The family doctor contracted service is a manifestation of the implementation of health care reform policies, the main mode of grass-roots service at this stage, and an important hand in realizing a healthy China. The aim of family doctor contracted service is to establish a long-term and stable service relationship between general practitioners and contracted residents or families, with a focus on general practitioners and a family doctor team as the pillar. Through signing contracts, we aim to provide comprehensive, high-quality, and convenient health services to contracted individuals, create a health service system at the doorstep, and achieve full lifecycle health management. Although the overall signing rate, knowledge rate, and fulfillment rate of family doctor contracted service have been increasing year by year, there are great geographical differences (such as economy, society, culture, and politics), and some regions of China are still in the low knowledge rate, low signing rate and low fulfillment rate, in addition, due to the mismatch of the selection preferences of the community residents and general practitioners in family doctor contracted service, the low satisfaction of the supply and demand is probably the cause of the current "signing for the sake of signing" "signing without contracting" "pseudo-signing" "service items not being implemented", and so on. There are such phenomena as "signing for the sake of signing" "signing but not contracting" "pseudo-signing" and "failure to implement service programs", which seriously affect the quality of services. In order to better implement the contracted services of family doctors and improve the quality of contracted services, this paper summarizes the studies on the preference of community residents and general practitioners for contracted services of family doctors, exploring the potential factors affecting the supply and demand of family doctor signing services, proposing corresponding strategies to improve their quality and quantity. and provides the basis for the preference of family doctor contracted service from the different perspectives of supply and demand, providing reference for further promoting effective contracting and standardized performance, improving satisfaction of both parties, and strengthening the connotation of contracted service, so as to promote the high-quality development of family doctor contracted service.
- Family doctor contracted service /
- Community residents /
- General practitioners /
- Choice preference

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表 1 全科医生对家庭医生签约服务供给偏好的研究

Table 1. Studies on the general practitioners ' preferences for the supply of family doctor contracted services

发表年份	第一作者	国家/地区	研究对象	样本量	抽样方法	研究方法	偏好排序(高-低)
2012	CARLSEN B^[7]	挪威	全科医生	571	随机抽样	DCE	治疗效果-医疗总成本-考虑患者偏好
2016	BERCHI C^[8]	法国	全科医生	106	方便抽样	DCE	患者医疗费用成本-治疗效果-风险评估-患者接受程度
2020	张晗^[9]	武汉市研口区	全科医生	411	随机抽样	DCE	中西医结合-预期疗效-患者信任度-纳入医保-提高收入
2019	MOHEBBIFAR R^[10]	伊朗	全科医生	150	随机抽样	DCE	与医务委员会签约-分配医学专业课程入学名额-人头支付+15%奖金
2016	RIISE J^[11]	苏格兰/英国/挪威	全科医生	1 127	随机抽样	DCE	患者选择偏好-医疗成本-收入情况
注：DCE为离散选择实验(discrete choice experiment)。

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表 2 社区居民对家庭医生签约服务偏好的研究

Table 2. Studies on the community residents ' preferences for family doctor contracted services

发表年份(年)	第一作者	国家/地区	研究对象	样本量(n)	抽样方法	偏好排序(高-低)
2020	贺焜^[12-13]	北京、上海、杭州、厦门	各区(市)社区居民	400	方便抽样	慢性病长处方-面对面健康咨询-疾病治疗-上门服务、预约专家号-用药指导-健康管理及免费健康体检
2012	刘登^[14]	上海市闸北区	社区居民	300	多阶段抽样	常见病、慢性病的诊疗-健康咨询-慢性病管理及预约服务
2019	ZHU J R^[16]	浙江省杭州	社区居民	704	方便抽样	药品供应可及性-减少等待时间-提供专家优先就诊权-增加医疗保险报销额
2015	RYAN M^[17]	英格兰	社区居民	1 706	方便抽样	签约服务连续性及电话咨询服务-上门服务-全科医生执业时间
2008	CHERAGHI-SOHI S^[21]	英国	家庭诊所	1 193	方便抽样	服务可及性-预约灵活性-连续性-技术质量-沟通能力
2013	MENGONI A^[22]	意大利	社区居民	6 970	方便抽样	获得更多信息-参与决策-就诊等待时间
2022	WANG C L^[23]	安徽省	社区居民	545	方便抽样	家医的能力和态度-年度合同成本费(低)-服务包选项

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