China's primary health care system is advancing family doctor contract services, aiming to provide integrated and continuous services for residents, which are essential characteristics needed by chronic disease patients such as those with diabetes. Existing studies have largely focused on descriptive analyses of the coverage rate of family doctor contract services, with insufficient assessment of their actual effects in chronic disease services.

To understand the impact of family doctor contract services on the cognition, behavior, and health outcomes of diabetic patients.

From February 22 to 25, 2023, a multi-stage stratified random sampling method was used to survey 716 registered diabetic patients in a city in Shandong Province. The questionnaire included demographic information, disease and medical conditions, acceptance of diabetes management services, and patients' disease cognition, health management behaviors, and health outcomes. Descriptive analysis was conducted on the coverage rate of diabetes management services accepted by patients to reflect the integration of family doctor team services. Multifactorial Logistic regression analysis was used to explore the impact of contracting with a family doctor on patients' disease cognition, health management behaviors, and health outcomes.

The contract rate of diabetic patients was 80.9% (579/716). Among them, 47.8% (277/579) felt that the family doctor understood their psychological condition.The rate of receiving follow-up recently was 89.8% (643/716). Among them, 76.0% (489/643) received diabetes health education, and 43.9% (282/643) received the complication-related examination items such as fundus, ECG, and dorsalis pedis artery pulsation. Of the patients with sudden worsening/acute complications, 37.7% (32/85) contacted the family doctor, among which 37.5% (12/32) received emergency treatment, and 25.0% (8/32) received referral services. The correct rate of patients' cognition on diabetes diagnosis was 19.8% (142/716), and the correct rate of cognition on intervention methods other than drug treatment was <70.0%. The results of the multifactorial Logistic regression analysis showed that the probability of contracted patients having a disease cognition score >5.5 was higher [OR (95%CI) =1.80 (1.23-2.62), P<0.05], the probability of undergoing glycosylated hemoglobin testing was higher [OR (95%CI) =2.67 (1.75-4.18), P<0.05], the probability of regular self-monitoring of blood glucose was higher [OR (95%CI) =4.28 (2.57-7.09), P<0.05], the probability of dietary control was higher [OR (95%CI) =0.46 (0.28-0.80), P<0.05], and the acceptance rate of diabetes-related expenses was lower [OR (95%CI) =1.58 (1.04-2.39), P<0.05] .

Family doctor contracted services have shown a significant impact on enhancing the quality of management services for chronic diseases. However, there is still a need for further improvement in implementing patient health education and psychological care components within the service package. Establishing a robust referral mechanism and improving the screening of diabetes complications are essential steps towards enhancing these services. Meanwhile, greater attention should be given to the health services of patients who have not enrolled in the contracted services.

我国基层卫生服务体系正在推进的家庭医生签约服务致力于为居民提供整合、连续性服务，这也是糖尿病等慢性病患者亟须的服务特征，现有研究多聚焦于家庭医生签约服务覆盖率的描述性分析，对其在慢性病服务中的实际效果评估尚显不足。

了解家庭医生签约服务对糖尿病患者认知、行为及健康结果的影响。

于2023年2月22—25日，采用多阶段分层随机抽样法在山东省某市抽取716例登记在册的糖尿病患者进行问卷调查。问卷内容涉及患者的人口学信息、患病和就医情况、接受糖尿病管理服务情况，以及患者的疾病认知、健康管理行为、健康结果。对患者接受的糖尿病管理服务项目覆盖率进行描述性分析，以反映家庭医生团队服务的整合性；采用多因素Logistic回归分析探讨签约家庭医生对患者疾病认知、健康管理行为、健康结果的影响。

579例（80.9%）糖尿病患者已签约家庭医生，其中277例（47.8%）认为家庭医生了解其心理状况。643例（89.8%）患者近期接受过随访，其中489例（76.0%）接受了糖尿病健康教育，282例（43.9%）进行了眼底、心电图及足背动脉搏动等并发症相关检查。37.7%（32/85）出现突发病情加重/急性并发症的患者联系了家庭医生，其中37.5%（12/32）得到了紧急处理，25.0%（8/32）得到了转诊服务。患者对糖尿病诊断的认知正确率为19.8%（142/716），对除药物治疗以外的干预方法的认知正确率<70.0%。多因素Logistic回归分析结果显示，签约患者疾病认知评分>5.5分的概率更高[OR（95%CI）=1.80（1.23~2.62），P<0.05]，进行糖化血红蛋白检测的概率更高[OR（95%CI）=2.67（1.75~4.18），P<0.05]，定期自我监测血糖的概率更高[OR（95%CI）=4.28（2.57~7.09），P<0.05]，进行饮食干预的概率更低[OR（95%CI）=0.46（0.28~0.80），P<0.05]，糖尿病相关费用的接受率更高[OR（95%CI）=1.58（1.04~2.39），P<0.05]。

家庭医生签约服务中的慢性病管理服务质量明显提高，但签约服务包中的患者健康教育及心理关怀内容需进一步完善，应建立健全转诊机制和糖尿病并发症筛查工作，同时对未签约患者的健康服务给予更多关注。