The "14th Five Year" Plan for National Economic and Social Development and the Long Range Obj ectives for 2035 points out the need to steadily improve the quality of contracted family doctor services. The contracted family doctor services system has been comprehensively promoted in Guangxi for six years, but there are few reports on the changes of such service.

To understand the changes of contracted family doctor services in Guangxi and analyze the reasons, so as to provide reference for the high-quality development of contracted services.

In July 2018 and October 2022, the study adopted purposive sampling method to select representative cities according to the geography, economic development level and the progress of contracted family doctor services in 14 prefecture-level cities in Guangxi as samples. The medical staff in the family doctor team and residents were selected by convenience sampling method to hand out questionnaires. In 2018, a total of 1 560 questionnaires were distributed to residents, and 1 285 valid questionnaires were returned, with an effective rate of 82.37%. A total of 627 questionnaires were distributed to family doctor team members, and 595 valid questionnaires were returned, with an effective rate of 94.90%. In 2022, a total of 1 800 questionnaires were distributed to residents, and 1 740 valid questionnaires were returned, with an effective rate of 96.67%. A total of 780 questionnaires were distributed to family doctor team members, and 775 valid questionnaires were returned, with an effective rate of 99.36%. Through literature review and expert consultation, the questionnaire of residents' cognition and satisfaction with contracted family doctor services and the questionnaire of family doctors' work situation and satisfaction were designed in combination with the actual situation in Guangxi. Multivariate Logistic regression analysis was used to analyze the influencing factors of satisfaction.

Perspective of suppliers: there was no significant difference in the proportion of medical staff who thought that their work content had increased, working methods had changed, and working hours had increased in 2022 compared with 2018 (P>0.05). Among them, the proportion of medical staff who increased their working hours by more than 2 hours per working day and by more than 4 hours on weekends increased from 30.5% to 40.0% and 25.2% to 32.0%, respectively. The increase in working hours is mainly for essential public health services. The proportion of medical staff with an average monthly income of less than 4 000 yuan in 2022 was lower than that in 2018, and the proportion of medical staff with an average monthly income of 4 000-6 000 yuan and more than 6 000 yuan was higher than that in 2018, and the difference was statistically significant (P<0.05). The job satisfaction of medical staff in the family doctor team in 2022 and 2018 was "average". Perspective of the demand side: The proportion of community health service centers/township health centers as the first choice of medical institutions for residents in 2022 was higher than that in 2018 (P<0.05), from 69.3% to 78.3%. There was no significant difference in the proportion of residents who knew contracted family doctor services in 2022 compared with 2018 (P>0.05). In 2022, the proportions of residents who understood the relevant policies of contracted family doctor services, basic service packages and their free service items, and personalized service packages and their corresponding charging rates were higher than those in 2018 (P<0.05), from 35.3%, 35.6% and 26.9% to 54.0%, 53.6% and 49.2%, respectively. At present, the channels for learning about contracted family doctor services are mainly offline activities, with few online forms. The proportion of residents willing to sign contracted family doctor services and personalized service packages in 2022 was higher than that in 2018 (P<0.05), from 80.5% to 91.0% and 67.4% to 73.0%, respectively. Among them, about 70% of residents are willing to sign up for personalized service packages under 100 yuan in 2022 and 2018. In 2022, more residents enjoyed health consultation, home visits, and personalized health management services. And 94.7% of the contracted residents had a positive change in health management awareness. The overall satisfaction, trust, satisfaction with technical ability, and satisfaction with diagnosis and treatment process and results of residents in 2022 were all higher than those in 2018 (P<0.05), reaching the "satisfied" state. The results of multivariate Logistic regression analysis showed that the influencing factors of residents' satisfaction with contracted family doctor services included whether they preferred primary medical institutions for treatment, whether they understood the personalized service package and its corresponding charging standard, and whether they trusted family doctors (P<0.05) .

The family doctor team members have a heavy workload. It is necessary to accelerate the construction of information technology and gradually expand the team. Performance appraisal and incentives should be improved to enhance the enthusiasm of medical staff. Residents' willingness to seek medical treatment in primary care has increased, and their trust and cognition of contracted services have been improved. In the future, we should increase the publicity and improve the service capacity of contracted family doctor services. Residents' willingness to sign personalized services has increased. It is necessary to improve the supporting mechanism according to local conditions.

"十四五"规划和二〇三五年远景目标纲要指出要稳步提高家庭医生签约服务质量，广西壮族自治区（以下简称广西）全面推进家庭医生签约服务制度已有6年，但目前对于签约服务变化情况的研究鲜见报道。

了解广西家庭医生签约服务变化情况并分析原因，为签约服务工作高质量发展提供参考依据。

本研究分别于2018年7月、2022年10月，采用立意抽样法，按照广西14个地级市的地理、经济发展水平以及家庭医生签约服务工作进展情况，选择具有代表性的城市作为样本，均采用方便抽样法选取家庭医生团队医务人员和居民发放问卷。2018年共发放居民问卷1 560份，回收有效问卷1 285份，问卷有效率82.37%，共发放家庭医生团队成员问卷627份，回收有效问卷595份，问卷有效率94.90%。2022年共发放居民问卷1 800份，回收有效问卷1 740份，问卷有效率96.67%，共发放家庭医生团队成员问卷780份，回收有效问卷775份，问卷有效率99.36%。通过阅读文献资料和专家咨询，结合广西实际情况设计居民对家庭医生签约服务的认知与满意度调查问卷以及家庭医生工作情况与满意度调查问卷。满意度影响因素分析采用多因素Logistic回归分析。

供方视角：2022年认为工作内容增加、工作方式发生改变、工作时间增加的家庭医生团队医务人员占比与2018年相比，差异无统计学意义（P>0.05）。其中，工作日每日增加工作时间>2 h、周末增加工作时间>4 h的医务人员比例分别由30.5%增至40.0%、25.2%增至32.0%；增加的工作时间主要用于基本公共卫生服务。2022年月平均收入<4 000元的医务人员占比低于2018年，4 000~6 000元和>6 000元的医务人员占比高于2018年（P<0.05）。2022年与2018年家庭医生团队医务人员工作满意度情况均为"一般"。需方视角：2022年居民首选看病的医疗机构为社区卫生服务中心/乡镇卫生院的比例高于2018年（P<0.05），由69.3%提高至78.3%。2022年知晓家庭医生签约服务的居民占比与2018年相比，差异无统计学意义（P>0.05）。2022年了解家庭医生签约服务相关政策、了解基础服务包及其免费提供服务项目内容、了解个性化服务包及其相应收费标准的居民占比均高于2018年（P<0.05），分别由35.3%、35.6%和26.9%提高至54.0%、53.6%和49.2%。目前了解家庭医生签约服务的渠道主要以线下活动为主，线上形式极少。2022年愿意签约家庭医生服务、个性化服务包的居民占比高于2018年（P<0.05），分别由80.5%提高至91.0%、67.4%提高至73.0%。其中，2022年与2018年均有70%左右居民愿意签约100元以下的个性化服务包。2022年有较多居民享受到了健康问题咨询、家庭巡诊、个性化健康管理服务，有94.7%的签约居民健康管理意识发生积极改变。2022年居民对家庭医生签约服务的总体满意度、信任度、技术能力满意度、诊疗过程及结果满意度均高于2018年（P<0.05），达到"满意"状态。多因素Logistic回归分析结果显示，是否首选基层医疗卫生机构就诊、是否了解个性化服务包及其相应收费标准、是否信任家庭医生是居民对家庭医生签约服务满意度的影响因素（P<0.05）。

家庭医生团队成员工作负担较重，需加快信息化建设，逐步扩充团队人员；应完善绩效考核与激励，提高医务人员积极性；居民基层就医意愿增强，对签约服务的信任度和认知不断提高，未来应加大家庭医生签约服务宣传和提高服务能力；居民个性化服务签约意愿增强，需因地制宜健全配套机制。