北京市东城区家庭医生签约服务效果及影响因素研究

doi:10.12114/j.issn.1007-9572.2021.00.227

摘要/Abstract

摘要： 背景　近年来，北京市东城区家庭医生签约服务从供需两端发力，创新家庭医生激励机制，取得了一些成效。研究家庭医生签约服务效果和影响因素对完善相关政策、提高签约居民和家庭医生签约服务团队获得感具有重要意义。目的　分析北京市东城区2018—2019年家庭医生签约服务现状、成效及存在问题，提出进一步完善北京市乃至全国家庭医生签约服务相关政策的建议。方法　于2020年1—6月，利用北京市常规数据监测平台和医改监测平台、东城区社区卫生服务信息平台相关数据分析东城区家庭医生签约率、重点人群签约率和签约居民履约情况；利用家庭医生团队和签约居民问卷调查，获得社区家庭医生团队和居民对签约服务满意度情况。结果　2019年东城区一般人群和重点人群签约率分别为36.26%和94.50%，高于2018年（33.19%、88.08%），高于同期北京市（35.02%、93.06%）。2019年签约居民预约就诊率达到17.41%，与上年相比提高8.13个百分点，高于同期北京市5.44个百分点。与2018年相比，2019年东城区高血压和糖尿病患者规范管理率分别提升2.12、3.61个百分点，控制率分别提升11.65、13.78个百分点。签约居民满意度为83.09%（3 596/4 328），签约服务提供者满意度达到91.59%（850/928），家庭医生团队愿意继续提供签约服务的达89.22%（828/928）。定性研究结果显示部分居民对家庭医生签约服务的理解存在偏差、家庭医生工作负荷重、医保政策支持不足等。结论　东城区家庭医生签约服务一般人群签约率和重点人群签约率均符合北京市工作要求；居民对签约服务的认知度、利用率和满意度较好，下一步需要通过加强精准宣传、遵循客观实际不冒进、创新考评激励机制和完善医保调节政策等措施，促进家庭医生签约服务发挥更大作用。

关键词: 家庭医生签约服务, 现状研究, 影响因素分析, 北京

Abstract: Background　Beijing's Dongcheng District has achieved some improvements in the effectiveness of family doctor services via balancing supply and demand and innovating incentive mechanisms for family doctors. It is of great importance to study the effectiveness of family doctor services and associated factors to improve relevant policies and the sense of gain of both contracted residents and family doctor teams. Objective　To analyze the status of family doctor services implemented in Beijing's Dongcheng District from 2018 to 2019，and the effectiveness and problems，providing policy recommendations for improving such services in Beijing and the whole country. Methods　From March to June 2020，we collected the data used for analyzing the contracting rates of general population and priority populations，rates of making and keeping an appointment in contracted residents and so on in Beijing's Dongcheng District during 2018 to 2019 from Beijing Common Data Monitoring Platform，Beijing Healthcare Reform Monitoring Platform and Dongcheng District Community Health Information System，and obtained the information regarding satisfaction levels with family doctor services of both family doctor team members and contracted residents using questionnaire surveys. Results　Dongcheng District owned a higher contracting rate of general population in 2019 compared to 2018（36.26% vs 33.19%）. It also had a higher contracting rate of priority populations in 2019 compared to 2018（94.50% vs 88.08%）. Moreover，the contracting rates of general population（36.26% vs 35.02%） and priority populations（94.50% vs 93.06%） in the district in 2019 were all higher compared with those of Beijing. The rate of keeping an appointment in contracted residents in the district was 17.41% in 2019，with a year-on-year increase of 8.13 percentage points. And it was 5.44 percentage points higher than that of Beijing in 2019. Compared with 2018，the standardized management rate of hypertension and diabetes in the district raised by 2.12 and 3.61 percentage points，respectively，and the control rates of hypertension and diabetes raised by 11.65 and 13.78 percentage points，respectively，in 2019. 83.09%（3 596/4 328） of the contracted residents were satisfied with the services they received. 91.59%（850/928） family doctors were satisfied with the delivery of contracted services，and 89.22%（828/928） of them were willing to continue to provide such services. Qualitative data reflected that residents' misunderstanding of contracted services，heavy workload of service delivery and inadequate health insurance policy support. Conclusion　Both the contracting rates of general population and priority populations in Dongcheng District met the requirements of Beijing. The residents' understanding level，utilization rate and satisfaction level regarding the contracted services were relatively good. To further improve the effectiveness of such services，more efforts should be made to strengthen the relevant publicity appropriately，deliver the services according to the real condition by step not by leap，innovate evaluation and incentive systems，and improve health insurance policies.

Key words: Contracted family doctor , services；Current status analysis；Root cause analysis；Beijing

王芳,邓红月,曹桂丽,等. 北京市东城区家庭医生签约服务效果及影响因素研究[J]. 中国全科医学, 2021, 24(22): 2805-2809. DOI: 10.12114/j.issn.1007-9572.2021.00.227.
WANG Fang,DENG Hongyue,CAO Guili, et al. Effectiveness of Family Doctor Services and Associated Factors in Dongcheng District，Beijing　[J]. Chinese General Practice, 2021, 24(22): 2805-2809. DOI: 10.12114/j.issn.1007-9572.2021.00.227.

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