Reflection on the Delivery of Contracted Family Doctor Services with Careful and Down-to-earth Efforts

doi:10.12114/j.issn.1007-9572.2018.00.180

Abstract

Abstract: In response to the call of the national government for further promoting contracted family doctor services（CFDSs），Shanghai Pudong New District Weifang Community Health Center focuses on increasing the number of residents access to CFDSs by a series of measures besides delivering the services with careful and down-to-earth efforts，which brings about significantly enhanced rates of implementing outpatient appointments and making stable visits for obtaining health management，and substantially improved levels of satisfaction with both CFDSs and general practitioners in the contracted residents，as well as an obviously increased rate of their health records being timely updated，truly benefitting the residents.However，further improvement remains an arduous task for us for there are challenges and baffles during the delivery of such services.We summarized our experience of delivering CFDSs，and gave a detailed analysis of the encountered problems and baffles.

Key words: Community health services, Family doctor, Contract service

摘要： 为响应国家进一步推进落实家庭医生签约服务工作，上海市浦东新区潍坊社区卫生服务中心在做实做细的前提下提升签约居民数量，通过推行并落实一系列做实做细的措施，使签约对象的预约门诊到位率、签约对象中健康管理人群的定诊率、健康档案更新及时率以及签约对象对签约服务、全科医生满意度显著提高，让社区居民真正获益。目前家庭医生签约服务尚有一些问题与困惑有待解决，做实精细化管理服务任重道远。本文就做实做细家庭医生签约服务的实践进行总结，对出现的一些问题进行分析与思考。

关键词: 社区卫生服务, 家庭医生, 签约服务

ZHU Min,TANG Lan,TONG Xiaowei, et al. Reflection on the Delivery of Contracted Family Doctor Services with Careful and Down-to-earth Efforts[J]. Chinese General Practice, 2018, 21(33): 4047-4052. DOI: 10.12114/j.issn.1007-9572.2018.00.180.
朱敏,唐岚,童晓维等. 关于做实做细家庭医生签约服务的实践与思考[J]. 中国全科医学, 2018, 21(33): 4047-4052. DOI: 10.12114/j.issn.1007-9572.2018.00.180.

References

［1］刘利群.推进家庭医生签约服务加强分级诊疗制度建设［J］．中国全科医学，2018，21（1）：1-4．DOI：10.3969/j.issn.1007-9572.2018.01.001.
LIU L Q.Promoting contracted services of family doctors to strengthen the construction of hierarchical medical system ［J］．Chinese General Practice，2018，21（1）：1-4．DOI：10.3969/j.issn.1007-9572.2018.01.001.
［2］杜兆辉.城市社区家庭医生制服务的实践与思考［J］．中国全科医学，2011，14（31）：3541-3543．DOI：10.3969/j.issn.1007-9572.2011.31.002.
DU Z H.Practice and thinking of community family doctor service in urban community［J］．Chinese General Practice，2011，14（31）：3541-3543．DOI：10.3969/j.issn.1007-9572.2011.31.002.
［3］徐高洁，胡颖颖，杨郗，等．浦东新区东明街道社区家庭医生签约服务利用情况及影响因素研究［J］．中国初级卫生保健，2016，30（9）：11-13．DOI：10.3969/j.issn.1001-568X.2016.
09.0005.
XU G J，HU Y Y，YANG X，et al．Research on the utilization of family doctor contra service and its influencing factors in Dongming community of Pudong New Area［J］．Chinese Primary Health Care，2016，30（9）：11-13．DOI：10.3969/j.issn.1001-568X.2016.09.0005.
［4］邬惊雷.“1+1+1”签约分级诊疗上海之路［J］.中国卫生，2017（7）：38-39．DOI：10.15973/j.cnki.cn11-3708/d.2017.07.011.
［5］胡善联.“健康上海2030”规划纲要之我见［J］.卫生经济研究，2017（6）：3-6．DOI：10.14055/j.cnki.33-1056/f.20170526.022.
HU S L.View on the outline of “Healthy Shanghai 2030” planning［J］．Health Economics Research，2017（6）：3-6．DOI：10.14055/j.cnki.33-1056/f.20170526.022.
［6］沈晓初.上海市构建分级诊疗制度的改革与探索［J］．中国卫生资源，2016，19（1）：1-3．DOI：10.13688/j.cnki.hr.2016.15404.
SHEN X C.The reform and exploration in building the classified diagnosis and treatment system of Shanghai［J］．Chinese Health Resources，2016，19（1）：1-3．DOI：10.13688/j.cnki.chr.2016.15404.
［7］孟仲莹，杜兆辉.开展家庭医师签约服务的体会［J］．上海医药，2012（22）：21-24．DOI：10.3969/j.issn.1006-1533.2012.22.011.
MENG Z Y，DU Z H.The experience of development of family doctors signing the contracts with the community residents［J］．Shanghai Medical and Pharmaceutical Journal，2012（22）：21-24．DOI：10.3969/j.issn.1006-1533.2012.22.011.
［8］“健康上海2030”规划纲要［EB/OL］.［2017-12-10］.http：//wap.sh.gov.cn/nw2/nw2314/nw2319/nw12344/u26aw55477.html.
［9］江一民，孟仲莹.社区健康档案动态管理的研究与实践［J］．中国全科医学，2008，6（11）：1113-1114．DOI：10.3969/j.issn.1007-9572.2008.12.045.
JIANG Y M，MENG Z Y.Research and practice about community health files dynamic management［J］．Chinese General Practice，2008，6（11）：1113-1114．DOI：10.3969/j.issn.1007-9572.2008.12.045.
［10］徐霞凤，杜兆辉.全科医生助理员参与家庭医生签约制服务的效果评价［J］．中国全科医学，2015，18（28）：3140- 3142．DOI：10.3969/j.issn.1007-9572.2015.28.007.
XU X F，DU Z H.Effect evaluation of assistants for general practitioners in family doctor service system［J］．Chinese General Practice，2015，18（28）：3140-3142．DOI：10.3969/j.issn.1007-9572.2015.28.007.
［11］汪洋.潍坊社区卫生服务中心绩效考核与分配制度改革的实践与思考［J］．上海医药，2013（20）：16-18．DOI：10.3969/j.issn.1006-1533.2013.20.008.
WANG Y.Practice and thinking of the reform of performance appraisal and income distribution system of Weifang community health service center［J］．Shanghai Medical and Pharmaceutical Journal，2013（20）：16-18．DOI：10.3969/j.issn.1006-1533.2013.20.008.
［12］上海已有23万居民签约“1+1+1”［J］．中国数字医学，2016，11（7）：40.
230 000 residents in Shanghai have signed “1+1+1”［J］．China Digital Medicine，2016，11（7）：40.
［13］沈世勇，吴忠，张健明，等．上海市家庭医生制度的实施效应研究［J］．中国全科医学，2015，18（10）：1132-1137．DOI：10.3969/j.issn.1007-9572.2015.10.008.
SHEN S Y，WU Z，ZHANG J M，et al．Effect of the implementation of family doctor system in Shanghai［J］．Chinese General Practice，2015，18（10）：1132-1137．DOI：10.3969/j.issn.1007-9572.2015.10.008.
［14］王良晨，葛敏，江萍，等．社区居民对家庭医生签约服务的认知与意愿研究［J］．中国全科医学，2018，21（4）：401-406．DOI：10.3969/j.issn.1007-9572.2018.04.006.
WANG L C，GE M，JIANG P，et al．Community residents' awareness and willingness towards contractual service from family doctors［J］．Chinese General Practice，2018，21（4）：401-406．DOI：10.3969/j.issn.1007-9572.2018.04.006.
［15］孟仲莹，杜兆辉.全科医生“1+1+1”签约服务现状调查及浅析［J］．中国初级卫生保健，2017，31（10）：8-10．DOI：10.3969/j.issn.1001-568X.2017.10.0003.
MENG Z Y，DU Z H.Investigation and analysis of general practitioners' "1+1+1"contract service residents［J］．Chinese Primary Health Care，2017，31（10）：8-10．DOI：10.3969/j.issn.1001-568X.2017.10.0003.
［16］汪洋，杜兆辉，张怡，等．基于全科医生签约服务的全科助理员模式探讨［J］．中国全科医学，2015，18（19）：2265-2268．DOI：10.3969/j.issn.1007-9572.2015.19.006.
WANG Y，DU Z H，ZHANG Y，et al．General practice assistant mode based on general practitioner contract-signing service［J］．Chinese General Practice，2015，18（19）：2265-2268．DOI：10.3969/j.issn.1007- 9572.2015.19.006.
［17］朱敏，童晓维，张怡，等．社区眼病分级诊疗与双向转诊模式探索［J］．中华全科医师杂志，2018，17（1）：10-13．DOI：10.3760/cma.j.issn.1671-7368.2018.01.004.
ZHU M，TONG X W，ZHANG Y，et al．Hierarchical system and two-way referral model for eye diseases management in community health service center［J］．Chinese Journal of General Practitioners，2018，17（1）：10-13．DOI：10.3760/cma.j.issn.1671-7368.2018.01.004.
［18］国务院办公厅.国务院办公厅关于改革完善全科医生培养与使用激励机制的意见［EB/OL］．［2017-12-10］.http：//www.gov cn/zhengce/content/2018-01/24/content-5260073.htm.

[1]	JI Bing, JIANG Dudu, CHEN Chen, ZHENG Yanling, SHI Jianwei, FANG Lizheng, DU Xueping. Constructing a Comprehensive Community Clinical Pathway for Herpes Zoster under Graded Treatment Framework [J]. Chinese General Practice, 2025, 28(25): 3110-3118.
[2]	SHI Jiarui, WANG Zili, ZHANG Xueqing, SONG Yulei, XU Guihua, BAI Yamei. The Current Status of Initial Cognitive Screening Services in Community-based Cognitive Services Centers in Nanjing [J]. Chinese General Practice, 2025, 28(22): 2784-2790.
[3]	CHEN Youlan, LAN Yanqi, WU Ahua, ZHANG Haixia, HUANG Jiankang, GUO Zhinan. The Health Management Effect of Contracted Family Doctor Services under the Joint Management of Three Teachers in Xiamen City on Elderly Hypertensive Patients [J]. Chinese General Practice, 2025, 28(22): 2769-2775.
[4]	LIU Hongya, YU Dehua. Construction and Practice of Clinical Diagnosis and Treatment Technology Combining General Practice and Specialist in Shanghai Community [J]. Chinese General Practice, 2025, 28(19): 2390-2397.
[5]	LI Jie, DU Yue, SHAO Shen, PAN Dong, ZHANG Yaxin. The Operational Efficiency of Traditional Chinese Medicine Diagnosis and Treatment Services in Primary Medical Institutions in Tianjin Based on DEA and SFA [J]. Chinese General Practice, 2025, 28(16): 1980-1986.
[6]	YE Qing, CHEN Mingmin, REN Jingjing. The Necessity and Path Exploration of Developing Psychosis Subspecialty among General Practitioners in Primary Care Settings [J]. Chinese General Practice, 2025, 28(16): 1950-1954.
[7]	JIN Feng, LI Wangling, XIE Fei. Case Sharing of Closed-loop Management Based on the Prevention and Treatment Platform for Chronic Obstructive Pulmonary Disease [J]. Chinese General Practice, 2025, 28(16): 2059-2064.
[8]	CAO Chenchen, ZHENG Lyuyun, WANG Lin, LIU Jing. Preference Study on Family Doctor Contract Service among Patients with Hypertension and Type 2 Diabetes Mellitus [J]. Chinese General Practice, 2025, 28(16): 2011-2016.
[9]	HE Meiliang, LIU Xiuliang, ZHAO Meigui, GUO Yanfang, XU Ying. The Utilization and Influencing Factors of Community Electronic Health Records [J]. Chinese General Practice, 2025, 28(13): 1628-1634.
[10]	ZHAO Linlin, LUO Qi, HU Qinghua, CHEN Xiaolei, DU Juan, SHAO Shuang. Current Situation and Obstacles of Integrated Services for Chronic Diseases Provided by Family Doctor Team: a Qualitative Research [J]. Chinese General Practice, 2025, 28(13): 1661-1667.
[11]	LIN Chunmei, LI Sisi, ZHANG Yanchun, ZHANG Lifang, QIN Jiangmei. Evaluation and Measurement of Primary Health Services Based on Patients' Experience in China [J]. Chinese General Practice, 2025, 28(13): 1553-1559.
[12]	LI Wanyu, FU Qiangqiang, JIN Hua, YU Dehua. Analysis of Health Literacy Levels and Influencing Factors of Chronic Disease Patients under Active Health Perspective [J]. Chinese General Practice, 2025, 28(11): 1315-1319.
[13]	YU Dehua. Development Strategy of Community Specialized Diseases Diagnosis and Treatment Technology Combining General Practice and Specialist [J]. Chinese General Practice, 2025, 28(10): 1256-1258.
[14]	ZHANG Hanzhi, YU Dehua. Empirical Exploration on the Collaboration of General Practice and Speciality in Chronic Disease Management: Taking the "Six Ones" Construction of Community Osteoarthritis Management as an Example [J]. Chinese General Practice, 2025, 28(10): 1259-1264.
[15]	SHI Jianjun, JIN Hua, LU Yuan, YU Dehua. Construction Model and Optimization Strategy of Outpatient Clinics of Combination of General Practice and Specialty in the Community [J]. Chinese General Practice, 2025, 28(10): 1249-1255.