Abstract: Background　The contracted family doctor service is a major measure to deepen the reform of the medical and health system and improve people's sense of gain when seeking medical attention.However，there are still many problems in the development of contracted family doctor services in China.Through the introduction of bibliometrics theory to study related problems，identifying problems that need to be resolved first will make it easier for the government to determine the main direction of governance and further promote the development of contracted family doctor services.Objective　On the basis of literature analysis，to clarify the list of problems affecting contracted family doctor services in China，reveal the main problems，and identify the severity of the problems.Methods　Literature related to remaining problems of the contracted family doctor services was retrieved from CNKI database，Wanfang Data Knowledge Service Platform，and CQVIP database in April 2019.The publication time of literature was limited to 2009—2018.Basic information about the included literature and relevant statements of problems affecting contracted family doctor services were collected.The list of problems were summarized and analyzed based on the macro model of health system.Selecting the geographical areas of the problems，the levels of authors' affiliations and fields the problems involving in as indicators to measure the severity of the problems.The cluster analysis method was used to classify the problems into three categories，severe problems，general problems，and not serious problems.Results　A total of 222 qualified documents were analyzed and 22 categories of problems affecting contracted family doctor service were identified.There were three severe problems，and all of them were structural problems，the lack of professional talents in the family doctor team，relatively low professional level，education level，and poor service skills of family doctors，unclear understanding and distrust of residents with contracted family doctor services and family doctor's service ability.Conclusion　This study has drawn a ranking of problems affecting contracted family doctor services and identified the severe problems.The main direction of the government's next step is to increase the number of family doctors，improve their professional quality and pay more attention to individual attitudes of residents towards contracted family doctor services.

Key words: Contracted family doctor services, Problem, Criticality analysis, Bibliometrics

摘要： 背景　家庭医生签约服务是深化医疗卫生体制改革、提高群众就医获得感的重大举措，但其在开展过程中仍存在一定问题。通过引入文献计量学理论进行相关问题的研究，找出需优先解决的问题，便于政府确定主要治理方向，进一步促进家庭医生签约服务的开展。目的　在文献分析的基础上，明晰影响我国家庭医生签约服务的问题清单，揭示存在的主要问题，明确问题的严重性。方法　于2019年4月，系统检索中国知网、万方数据知识服务平台、维普网中与家庭医生签约服务尚存问题相关的文献，发表时间限定为2009—2018年。收集纳入文献的基本信息和影响家庭医生签约服务问题的相关表述，基于卫生系统宏观模型对问题清单进行归纳分析，选取问题覆盖地域、作者单位层次、问题涉及领域范围指标来计算问题的严重性，采用聚类分析法将问题划分为严重、一般、不严重3类。结果　共纳入合格文献222篇，归纳出影响家庭医生签约服务的问题22类。其中严重问题有3个，均属于结构层问题，分别为：家庭医生团队专业人才数量缺乏；家庭医生专业水平相对不足，学历偏低，服务能力较弱；居民对家庭医生签约服务不了解，对家庭医生服务能力不信任。结论　本研究得出了影响家庭医生签约服务问题的严重性排序，确定了严重问题，政府下一步主要治理方向为：增加家庭医生数量，提升家庭医生素质，关注居民个人态度。

关键词: 家庭医生签约服务, 问题, 严重性分析, 文献计量学