基于供方视角的家庭医生团队签约服务工作感知及其相关因素研究

doi:10.12114/j.issn.1007-9572.2021.00.123

摘要/Abstract

摘要： 背景　随着家庭医生签约服务逐步推广，作为居民“全方位、全过程健康服务”的提供主体，家庭医生团队成员也将实现从“守门人”到“健康管理者”再到“健康代理人”的角色转变，其工作感知对签约服务质量起着关键作用。目的　了解家庭医生团队成员签约后的工作感知情况，为进一步提高签约服务质量，完善签约服务政策提供依据。方法　2019年4—10月，结合典型抽样和分层抽样法对贵州省、青海省、安徽省、广东省、福建省和江苏省共1 042例家庭医生团队成员进行问卷调查。问卷主要内容为家庭医生团队成员对签约服务的感知情况，包括服务内容、服务方式、服务态度、个人收入、工作负担等。采用描述性统计方法对家庭医生团队成员的工作感知情况进行分析，采用χ2检验对不同地区、岗位和职称的家庭医生团队成员的工作感知差异进行分析，采用Spearman秩相关分析个人收入与工作负担的相关性。结果　1 042例调查对象中，85.93%（873/1 016）的成员感知签约后服务内容有所增加；86.86%（879/1 012）的成员感知签约后服务方式有所区别，其中，71.44%（628/879）的成员表示签约后增加了上门服务，32.99%（290/879）的成员表示签约后单次诊疗服务时间更长，93.97%（826/879）的成员表示签约后增加了随访服务；40.77%（413/1 013）的成员感知签约后自身服务态度更好；58.61%（599/1 022）的成员感知签约后个人收入增加；81.94%（835/1 019）的成员感知签约后工作负担加重；91.09%（930/1 021）的成员表示愿意为辖区老年人提供签约服务，94.62%（967/1 022）的成员感知所在团队工作能够协调有序开展，94.72%（968/1 022）的成员感知团队模式能够为居民提供更好的服务。Spearman秩相关分析结果显示：个人收入与工作负担呈正相关（rs=0.121，P<0.01）。不同地区团队成员对服务内容、服务方式、个人收入和工作负担变化的感知情况比较，差异有统计学意义（P<0.05）；不同岗位团队成员对服务内容、服务方式、服务态度、个人收入变化的感知情况比较，差异有统计学意义（P<0.05）；不同职称成员对个人收入和工作负担变化的感知情况比较，差异有统计学意义（P<0.05）。结论　家庭医生团队成员感知相比传统诊疗服务，签约服务的服务内容更加综合化，服务方式更加个性化；家庭医生团队成员对签约服务的组织状态及服务价值的感知较好，为辖区老年人提供签约服务的意愿程度普遍较高；家庭医生团队成员感知签约后个人收入与工作负担相匹配，不同地区、岗位、职称的成员对个人收入变化的感知差异较大。

关键词: 家庭医生签约服务, 家庭医生团队, 工作感知, 相关因素

Abstract: Background　With the promotion of contracted services，the role of family doctor team members has been transforming from "gatekeeper" to "health manager" and finally to "health agent"，as they are the main provider of "all-round and whole health services". Their job perception plays a key role in ensuring the quality and smooth development of contracted services. Objective　To understand family doctor team members' the perceptions of contracted services，so as to provide a basis for further improving the quality and supportive policies of such services. Methods　By use of purposive and stratified sampling，a total of 1 042 family doctor team members were selected from Guizhou，Qinghai，Anhui，Guangdong，Fujian and Jiangsu provinces to attend a questionnaire survey regarding subjective evaluation of contracted services（service profile，delivery patterns，serving attitude，personal income and workload） from April to October 2019. Descriptive statistical method was used to analyze the job perception of the family doctor team members. Chi square test was used to analyze the differences of job perception among family doctor team members with different regions，positions，professional titles. Spearman's test was used to analyze the correlation between personal income and workload. Results　According to the respondents，compared to traditional non-contracted health services，the profile of contracted services increased〔85.93%（873/1 016）〕，the delivery patterns of contracted services were different〔86.86%（879/1 012）〕，and home-based delivery was an increased delivery pattern〔71.44%（628/879）〕，per consultation time for contracted services increased 〔32.99%（290/879）〕，follow-up service was thought to be an increased kind of services〔93.97%（826/879）〕，attitude in delivering contracted services was better〔40.77%（413/1 013）〕，personal income was reported to be increased after delivering contracted services〔58.61%（599/1 022）〕，the workload increased after delivering contracted services 〔81.94%（835/1 019）〕. 91.09%（930/1 021） of the respondents indicated that they were willing to provide contracted services for the elderly in the serving areas of their hospital，and 94.62%（967/1 022） believed that their team members cooperated well and orderly in delivering services，and 94.72%（968/1 022） thought that team-based delivery pattern could serve patients better. Spearman rank correlation test showed a correlation between workload and personal income（rs=0.121，P<0.01）. The perceptions of profile and delivery pattern of contracted services，and changes in personal income and workload after delivering contracted services differed significantly among the respondents by region（P<0.05）. The perceptions of profile and delivery pattern of contracted services，and changes in personal serving attitude and income after delivering contracted services differed significantly among the respondents by position（P<0.05）. The perceptions of changes in personal income and workload after delivering contracted services differed significantly among the respondents by professional title（P<0.05）. Conclusion　On the whole，in the opinion of these family team members，contracted services are more comprehensive and have more personalized delivery patterns compared with traditional non-contracted medical services，the management of family team in delivery services is good，and the value of such services is high. Moreover，almost all of these members are willing to provide contracted services for the elderly in the serving areas of their hospital. However，personal income is thought to be increased with workload，and this kind of thought varies by region，position and professional title.

Key words: Contracted family doctor services, Family doctor team, Job perception, Related factors

王艺园,孙艳春,王伟,等. 基于供方视角的家庭医生团队签约服务工作感知及其相关因素研究[J]. 中国全科医学, 2021, 24(10): 1218-1223. DOI: 10.12114/j.issn.1007-9572.2021.00.123.
WANG Yiyuan,SUN Yanchun,WANG Wei, et al. Family Doctor Team Members' Perceptions of Contracted Services and Related Factors Based on Supplier Perspective 　[J]. Chinese General Practice, 2021, 24(10): 1218-1223. DOI: 10.12114/j.issn.1007-9572.2021.00.123.

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