To explore the current status of family doctor contracted services in the northern mountain areas of Beijing and put forward appropriate suggestions on family doctor contracted services with the elderly residents in mountain areas.

A combination of qualitative research and quantitative research was adopted. From September to October 2019, eight townships were selected in the northern mountain areas of Huairou District in Beijing. A total of 141 community doctors, 133 rural doctors and 345 elderly residents were selected proportionally from each township for questionnaire research. The elderly resident's questionnaires included basic information of the elderly, the way and the content of services which they want family doctor team to provide, the channels to obtain health consultation, and the satisfaction evaluation of the contracted services; the rural doctors and the community doctors' questionnaires included basic information, the use of internet in the contracted services, and the content of services provided to the elderly residents. During the same period, 16 cases of elderly residents, 24 cases of community doctors, and 24 cases of rural doctors were selected by using the purposive sampling method for personal in-depth interviews, in order to understand the level of awareness of the responsibilities of community doctors and rural doctors in the linkage contracted services, their views on the contracted services and the application of the internet in this service model, their suggestions on the development of the contracted services, etc. A content analysis method was used to analyse qualitative data.

According to the quantitative research results, the top three services that elderly residents in the northern mountain areas of Beijing want the family doctor team to provide are ranked as follows: carrying out the health education in countryside〔199 (57.7%) 〕, physical examination in countryside〔197 (57.1%) 〕, the delivery of medical service and medicine in the countryside〔169 (49.0%) 〕; the top three ways or channels of services that elderly residents want the family doctor team to provide are ranked as follows: outpatient clinicservice, in-home medical services, organizing health education lectures in the community; the top three channels that elderly residents consider most effective to obtain health information are ranked as follows: publicity by rural doctors or loudspeaker in the village〔253 (73.33%) 〕, face-to-face publicity by community doctors during consultation〔134 (38.84%) 〕, posting and distribution of publicity materials〔126 (36.52%) 〕. The results of multiple linear regression analysis showed that service attitude, service effectiveness, service items, and communication ability were the influencing factors of elderly residents' satisfaction with community doctors and rural doctors' linkage contracted services (P<0.05) . The health management service, outpatient service, drug distribution and medical guidance service, and long-term prescription service also had significant differences between community doctors and rural doctors (P<0.05) . There was no statistically significant difference between community doctors and rural doctors using the Internet to communicate with residents online (P>0.05) . The qualitative research results showed that the elderly residents had low demand for online services and high dependence on rural doctors, but the technical level of rural doctors were limited, community doctors had little communication with elderly residents, and they mainly focused on the coordination of medical resources.

The development of contracted services for elderly residents in the northern mountain areas of Beijing cannot be carried out without the joint efforts of community doctors and rural doctors. Currently, the elderly residents highly depend on rural doctors because of close-up services and show a great demand on community doctors for high-level technology and medical resources platform. It's recommended to take the needs of elderly residents as the guide, give full play to the advantages of rural doctors in terms of location and people, and the advantages of community doctors' technology and platform, and optimize the effectiveness of community doctors and rural doctors' linkage contracted services.

了解京北山区老年居民家庭医生签约服务开展现状，并对山区老年居民家庭医生签约服务模式提出适宜建议。

采用定性研究和定量研究相结合的方法。2019年9—10月，选取北京市怀柔区北部山区的8个乡（镇），按比例抽取每个乡（镇）家庭医生团队的社区医生、乡村医生及签约老年居民进行问卷调查，共计抽取社区医生141例、乡村医生133例、老年居民345例。老年居民问卷内容包含基本情况、希望家庭医生团队提供服务的方式及内容、认为获取健康资讯最有效的渠道、对该服务模式的满意度等；乡村医生和社区医生问卷内容包含基本情况、开展签约服务中互联网使用情况、为老年居民提供的服务内容等。同期，采用目的抽样法选取24例社区医生、24例乡村医生、16例老年居民进行个人深度访谈，了解调研对象对联动签约服务模式中乡村医生和社区医生职责的认知、对该签约服务模式的看法、对互联网在该模式中应用的看法、对该签约模式发展的建议等，采用内容分析法对定性资料进行分析。

量性研究结果显示，京北山区老年居民希望家庭医生团队提供的签约服务内容前3位依次为下乡开展大课堂宣传〔199（57.7%）〕、下乡体检〔197（57.1%）〕、送医送药下乡巡诊〔169（49.0%）〕；老年居民希望家庭医生团队开展服务的方式或渠道前3位依次为门诊诊疗服务，上门医疗服务、在社区组织健康宣教讲座；老年居民认为获取健康资讯最有效的前3种渠道依次是乡村医生/村中喇叭宣传〔253（73.33%）〕、社区医生就诊时面对面宣传〔134（38.84%）〕、张贴或发放宣传资料〔126（36.52%）〕。多元线性回归分析结果显示，老年居民对服务态度、服务效果、服务项目、沟通能力的满意度是其对"乡村医生+社区医生"家庭医生服务团队签约服务综合满意度的影响因素（P<0.05）。社区医生和乡村医生健康管理服务、出诊服务、药品配送与用药指导服务、长期处方服务开展情况比较，差异有统计学意义（P<0.05）；社区医生和乡村医生使用网络在线与居民交流的情况比较，差异无统计学意义（P>0.05）。质性研究发现老年居民对网络在线服务需求较低，对乡村医生依赖性高；乡村医生技术水平有限；社区医生与老年居民交流少，主要以协调医疗资源为主。

京北山区老年居民签约服务的开展离不开乡村医生和社区医生的共同努力，现阶段呈现出对乡村医生近距离服务的高度依赖，对社区医生高水平技术和医疗资源平台的需求。建议以老年居民需求为导向，发挥乡村医生地利人和的优势，发挥社区医生技术和平台优势，优化"乡村医生+社区医生"家庭医生服务团队签约服务效果。