Abstract: Objective　To investigate the family doctor contractual service delivery status in Nanjing's Pukou District，and to put forward solutions to the major challenges，providing a reference for further extension of this kind of services in the district.Methods　A convenience sample of 31 stakeholders was selected in July 2017，including directors，family doctors and other members in the family doctor team from four community health centers of Qiaolin，Xingdian，Taishan and Tangquan Streets.Face-to-face semi-structured interviews were conducted with a self-designed interview outline for collecting the data mainly about the delivery of contractual services by family doctors in Nanjing's Pukou District，featured and major contractual services，problems faced by the contracted residents during seeking hierarchical medical treatment as well as major challenges in delivering such services.Results　Contractual services from family doctors achieved good acceptance in the local residents，especially in the elderly with chronic diseases，which could be enjoyed after signing the contract with family doctors in the outpatient department of the community health center or at the community.The featured family doctor services included online consultation with family doctors via the family doctor APP；cell-phone numbers of family doctors are publicized for better doctor-patient communication；issuing a contractual service card，by using it，contracted residents can enjoy some discount on certain services.During seeking hierarchical medical treatment，the problems faced by the contracted residents are as follows：they could go to the secondary or tertiary hospitals based on their own demands without referrals from family doctors；family doctor APP did not fully play its role in making appointments and referrals.Major challenges for family doctors during delivering contractual services consisted of the following aspects：the procedure for signing contracts was too complicated；how to set the time limit for mobile phone-based online consultation；contracted residents lacked understanding of the responsibilities of family doctors；health professionals were found with poor motivation for work due to imperfect incentive mechanism；the types of the medicines for contractual services were insufficient；the workload became too heavy after the contractual services were delivered；services that the contracted residents can be accessible via the family doctor APP needed to be further developed.Conclusion　In general，family doctor contractual service delivery is relatively good in this district although there are some challenges.In order to promote the delivery of such kind of services，we put forward the following suggestions.The local government provides adequate funds for the extension of this kind of services；the performance evaluation mechanism for health professionals is to be perfected；medical insurance programs are to be well implemented for ensuring the successful delivery of contractual services as well as the development of hierarchical medical system；trainings about professional knowledge and communication skills for family doctors should be strengthened；more talents should be recruited as family doctors；the types of medicines for community health centers should be enriched；common medicines in medical insurance reimbursement list should be increased；The family doctor APP should be further developed.

Key words: Community health services, Family doctors contract services, Semi structured interview

摘要： 目的　了解南京市浦口区家庭医生签约服务开展情况、面临的主要问题及改善对策，为南京市浦口区进一步推广家庭医生签约服务提供参考依据。方法　2017年7月，采用便利抽样法选取南京市浦口区桥林街道、星甸街道、泰山街道、汤泉街道社区卫生服务中心的负责人、家庭医生及其团队成员共31名进行面对面半结构式访谈。采用自制访谈提纲，访谈内容包括：简单介绍南京市浦口区家庭医生签约服务开展情况；家庭医生签约后的特色服务项目与主要服务内容；签约居民分级诊疗存在的问题；目前家庭医生签约服务工作面临哪些主要问题和困难等。结果　目前南京市浦口区开展家庭医生签约服务主要包含门诊签约和社区签约两种形式，居民对家庭医生签约服务的接受程度较高，家庭医生签约服务对慢性病老年人吸引力最大。开展的特色家庭医生签约服务包含家庭医生APP线上交流；家庭医生公布手机号以方便沟通；发放家庭医生签约服务卡，享受特定医疗服务项目折扣。签约居民分级诊疗存在的问题：签约居民根据就医需求可自行前往二、三级医院，不需要家庭医生为其进行转诊；家庭医生APP转诊预约功能未起到实质性的作用。目前家庭医生签约服务工作面临的主要问题和困难：签约流程过于繁琐；如何界定家庭医生手机咨询服务时间；签约居民对家庭医生职责界定不清；激励机制不健全，医务人员积极性不高；签约后药品种类配备不全；原全科医生引入家庭医生模式后工作量增加、精力不济；家庭医生APP需要进一步完善服务项目的开发。结论　南京市浦口区家庭医生签约服务开展情况较好，但还存在诸多问题，建议政府财政投入到位，完善绩效考核机制；医保助力家庭医生，落实分级诊疗制度；加强家庭医生医疗知识培训与沟通技巧，招募家庭医生人才；增加社区卫生服务中心药品的品种以及医保报销的常用药物；完善家庭医生APP；切实推进家庭医生签约服务的开展。

关键词: 社区卫生服务, 家庭医生签约服务, 半结构式访谈