家庭医生团队成员和残疾人对残疾人签约服务效果评价的质性研究

doi:10.12114/j.issn.1007-9572.2021.00.165

摘要/Abstract

摘要： 背景　残疾人是家庭医生签约服务优先覆盖的人群，如何为残疾人群提供符合其需求的家庭医生签约服务，提高残疾人的获得感及满意度，家庭医生团队的人员如何有针对性地为残疾人服务，以达到双方共赢的服务效果有待进一步研究。目的　了解残疾人家庭医生服务团队为签约残疾人服务过程中发现的问题并提出改进办法和建议，为社区家庭医生服务团队管理和服务签约残疾人提供依据。方法　2018年10月—2019年9月，采用半结构式访谈法，在首都医科大学附属复兴医院月坛社区卫生服务中心，设立6个焦点小组，其中3个由25名残疾人家庭医生服务团队成员组成，另外3个由21名签约的5类不同残疾人组成。以4种障碍（身体、态度、专业和系统障碍）为理论框架，结合《残疾人家庭医生签约服务指导手册》（《手册》）中残疾人接受服务的内容分别进行了深度访谈。进行实地笔记、录音和转录，编码提炼主题。结果　家庭医生团队成员都对《手册》的内容和实用性给予了肯定，同时签约家庭医生服务团队成员和残疾患者针对目前的家庭医生签约服务提出不同的需求和建议。经过比对分析，家庭医生团队方面共析出3个主题：诊疗时间长，包括残疾的身体，沟通和认知；对医生、护理进行残疾相关知识的培训，包括特定的学习需求；残疾人的服务部分超出初级保健范畴，需要再次培训学习。残疾患者方面共析出残疾人在与医疗保健系统的交互过程中存在身体、态度、专业和系统四种障碍4个主题。结论　制定完善合理的签约服务内容手册有较好的实用性，为残疾人基层医疗实践提供了工作方法，揭示了签约服务内容手册在指导特殊人群的基层卫生保健过程中的常见问题和解决办法。

关键词: 残疾人, 家庭医生签约服务, 半结构式访谈, 焦点小组, 质性研究

Abstract: Background　People with disability are a priority group covered by contracted family doctor services.It is necessary to study what family doctor team members should do（including targeted services） to satisfy the needs of people with disability，improve their sense of gain and satisfaction，achieving a win-win situation for both of them. Objective　To identify problems in the delivery of contracted family doctor services for people with disability via a survey and put forward improvement recommendations，to provide useful information for the management of family doctor team and the delivery of such services for this group. Methods　This survey was conducted in Yuetan Community Health Center，Fuxing Hospital，Capital Medical University，Beijing's Xicheng District，from October 2018 to September 2019. Six focus groups were set up，of which three were composed of 25 members of the family doctor service team for the disabled，and the other three were composed of 21 persons with five different types of disabled who signed the contract. Taking four kinds of barriers（physical，attitude，professional and systemic barriers） as the theoretical framework，the in-depth interviews were carried out with Guidebook for Family Physicians Providing Contracted Services for People with Disabilities（hereinafter referred to as the Guidebook）. Field notes，recording and transcription were used to encode and refine the theme. Results　All the interviewees approved the content and practicability of the Guidebook，reported self-perceived requirements for current contracted services for those with disabilities and proposed improvement recommendations. Three themes were identified after analyzing the interviews with family doctor team members：longer time needed for consultation，including physical examination，communication and identification of the disease；providing trainings related to care for people with disabilities for physicians and nurses，including special care for this group；retraining medical workers with the services for people with disabilities that are not included in the scope of primary care. Four themes were identified after analyzing the interviews with adults with disabilities and guardians of children with disabilities：physical，service attitude，professional and system barriers in the interaction process with the healthcare system. Conclusion　The Guidebook with comprehensive and reasonable contents has good practicability，providing primary healthcare workers with a useful method for the delivery of services for people with disabilities，and instructive solutions to common problems occurring in the delivery of services for special groups.

Key words: Disabled, Contracted family doctor services, Semi-structured interview, Focus group, Qualitative research

刘宇春,蔡澍,杜雪平,等. 家庭医生团队成员和残疾人对残疾人签约服务效果评价的质性研究[J]. 中国全科医学, 2021, 24(10): 1236-1241. DOI: 10.12114/j.issn.1007-9572.2021.00.165.
LIU Yuchun,CAI Shu,DU Xueping, et al. Family Doctor Team Members and Disability Patients' Perspectives on the Effectiveness of Contracted Services：a Qualitative Study　[J]. Chinese General Practice, 2021, 24(10): 1236-1241. DOI: 10.12114/j.issn.1007-9572.2021.00.165.

参考文献

［1］World Health Organization．World report on disability［EB/OL］．
（2011-12-13）［2020-09-12］．https://www.who.int/publications/i/item/9789241564182.
［2］WHO global disability action plan 2014—2021［EB/OL］．
［2020-09-12］．https://www.who.int/disabilities/actionplan/en/.
［3］CIEZA A，SABARIEGO C，BICKENBACH J，et al．Rethinking disability［J］．BMC Medicine，2018，16（1）：14．
［4］TROEGER C，COLOMBARA D V，RAO P C，et al．Global disability-adjusted life-year estimates of long-term health burden and under nutrition attributable to diarrhoeal diseases in children younger than 5 years［J］．Lancet Global Health，2018，6（3）：e255-269．DOI：10.1016/S2214-109 X(18)30045-7.
［5］RAMSEY T，SVIDER P F，FOLBE A J．Health burden and socioeconomic disparities from hearing loss：a global perspective［J］．Otology &Neurotology，2018，39（1）：12-16．DOI：10.1097/MAO.0000000000001630.
［6］LISA I I，ROGER B D，JANE S，et al．Satisfaction with quality and access to health care among people with disabling conditions［J］．International Journal for Quality in Health Care，2002，14（5）：369-381．DOI：10.1093/intqhc/14.5.369.
［7］MC C R，TAGGART L，KANE M．Optimizing uptake of health checks for people with intellectual disabilities［J］．J Intellect Disabil，2015，19（3）：205-214.
［8］MORRISON E H，GEORGE V，MOSQUEDA L．Primary care for adults with physical disabilities：perceptions from consumer and provide focus［J］．Fam Med，2008，40（9）：645-651.
［9］OSMUN W E，CHAN N，SOLOMON R．Approach to caring for developmentally disabled adults in the community：medical，ethical，and legal considerations［J］．Canadian Family Physician，2015，6（1）：27-31.
［10］PERSAUD D．Barriers to preventive health practices in women with spinal cord impairments［J］．Spinal Cord Injury Nurs，2000，17（4）：168-175.
［11］DREW J A R，SHORT S E．Disability and pap smear receipt among U.S. Women，2000 and 2005［J］．Perspectives on Sexual & Reproductive Health，2010，42（4）：258-266．
［12］MCCOLL M A，JARZYNOWSKA A，SHORTT S E D．Unmet health care needs of people with disabilities：population level evidence［J］．Disability & Society，2010，25（2）：205-218.
［13］PHARR J R，BUNGUM T．Health disparities experienced by people with disabilities in the united states：a behavioral risk factor surveillance system study［J］．Global Journal of Health Ence，2012，4（6）：99-108.
［14］BACHMAN S S，VEDRANI M，DRAINONI M L，et al．Provider perceptions of their capacity to offer accessible health care for people with disabilities［J］．Journal of Disability Policy Studies，2006，17（3）：130-136．DOI：10.1177/10442073060170030101.
［15］JUNIUS-WALKER U，WREDE J，SCHLEEF T，et al．What is important，what needs treating?How GPs perceive older patients' multiple health problems：a mixed method research study［J］．BMC Research Notes，2012，5（1）：1-10．
［16］MCCOLL M A，FORSTER D，SHORTT S E D，et al．Physician experiences providing primary care to people with disabilities［J］．Healthcare Policy，2008，4（1）：e129-147．DOI：10.12927/hcpol.2008.19989.
［17］Statistical bulletin of China disabled career development 2015［M］．Beijing：China Statistics Press，2015.
［18］国家卫生健康委员会基层卫生司，中国残疾人联合会康复部．残疾人家庭医生签约服务指导手册［J］．全科医学临床与教育，2018，16（6）：605-608．DOI：10.13558/j.cnki.issn1672-3686.2018.06.002.
［19］HSIEH H F，SHANNON S E．Three approaches to qualitative content analysis［J］．Qual Health Res，2005，15（9）：1277-1288．DOI：10.1177/1049732305276687.
［20］BRAUN V, CLARKE V．Successful qualitative research a practical guide for beginners［M］. Thousand Oaks：USA，2013
［21］Beijing statistical year book 2016［M］．Beijing：China Statistics Press，2016.
［22］MCCONKEY R，TAGGART L，KANE M．Optimizing uptake of health checks for people with intellectual disabilities［J］．Journal of Intellectual Disabilities，2015，19（3）：205.
［23］GREENWOOD N W，WILKINSON J．Sexual and reproductive health care for women with intellectual disabilities：a primary care perspective［J］．Int J Fam Med，2013，2013：642472.
［24］PERRY J，FELCE D，KERR M，et al．Contact with primary care：the experience of people with intellectual disabilities［J］．Journal of Applied Research in Intellectual Disabilities，2014，27（3）：200-211．DOI：10.1111/jar.12072.
［25］STILLMAN M D，FROST K L，SMALLEY C，et al．Health care utilization and barriers experienced by individuals with spinal cord injury［J］．Arch Phys Med Rehabil，2014，95（6）：1114-1126．DOI：10.1016/j.apmr.2014.02.005.

[1]	郝爱华, 曾韦霖, 李观海, 夏英华, 陈亮. 基于全科医生视角的家庭医生团队签约现状调查研究[J]. 中国全科医学, 2023, 26(34): 4261-4268.
[2]	郭亚红, 郭浩乾, 宁艳花, 姜婷, 李美曼, 吕兄兄, 孔维娟, 刘海燕. 基于家庭医生签约服务构建老年人"互联网+"家庭护理管理模式[J]. 中国全科医学, 2023, 26(23): 2876-2881.
[3]	赵琳琳, 邵爽, 罗琪, 陈小垒, 杜娟. 国内家庭医生团队医防融合实践策略研究[J]. 中国全科医学, 2023, 26(22): 2715-2719.
[4]	徐佳玙, 颜骅, 方军波, 王海琴, 郭佩, 沈福来, 王形松. 基于标化工作量的社区卫生服务机构家庭医生团队工作开展现状研究[J]. 中国全科医学, 2023, 26(13): 1641-1647.
[5]	孟文奇, 柳松艺, 姜晓利, 彭海波, 李子鑫, 于倩倩, 尹文强, 孙葵, 陈钟鸣, 郭洪伟. 基于扎根理论的家庭医生签约服务效果影响机制研究[J]. 中国全科医学, 2023, 26(10): 1192-1197.
[6]	周其如, 李举双, 郝春, 汪永刚, 沈睿, 朱敏贤, 程新. 预约诊疗服务对家庭医生签约服务结果质量的影响[J]. 中国全科医学, 2023, 26(10): 1198-1204.
[7]	马志强, 吴香兰. 基于信任源模型的全科医疗服务医患信任问题及对策建议[J]. 中国全科医学, 2023, 26(10): 1172-1178.
[8]	丁玲玉, 蒋小曼, 缪雪怡, 陈丽, 朱涵菲, 陆金玲, 胡洁蔓, 徐欣怡, 许勤. 健康生态学视角下老年胃癌患者术前衰弱感知影响因素的质性研究[J]. 中国全科医学, 2023, 26(08): 972-979.
[9]	徐萍萍, 赵静, 李春晓, 李林峰, 刘森元. 我国中央层面家庭医生签约服务政策量化评价：基于PMC指数模型[J]. 中国全科医学, 2023, 26(04): 440-446.
[10]	李心言, 韩优莉. 家庭医生签约服务中引入竞争机制的影响及其启示[J]. 中国全科医学, 2023, 26(04): 447-452,459.
[11]	马志强, 张宝丽, 郭乐. 签约服务情境下全科医生岗位胜任力自评量表的开发与信效度检验[J]. 中国全科医学, 2023, 26(04): 477-485.
[12]	马志强, 郭乐, 李钊, 葛柏麟. 签约服务情境下基于扎根理论的全科医生胜任力模型构建研究[J]. 中国全科医学, 2023, 26(04): 460-466,485.
[13]	刘智敏, 冯磊. 家庭医生签约服务协议的内容分析及优化路径探索[J]. 中国全科医学, 2023, 26(04): 453-459.
[14]	柳松艺, 孟文奇, 彭海波, 姜晓利, 李子鑫, 于倩倩, 尹文强, 陈钟鸣, 孙葵, 郭洪伟. 签约居民对家庭医生签约服务连续性的评价及其影响因素研究[J]. 中国全科医学, 2022, 25(34): 4312-4317.
[15]	姚岗, 张诚, 徐健, 潘文雷, 陈晨, 朱敏, 王朝昕, 黄蛟灵. 中青年楼宇人群对家庭医生签约服务的需求及影响因素研究[J]. 中国全科医学, 2022, 25(22): 2773-2781.