Working Models of Family Doctor Assistants in Jiading District of Shanghai：a Current Survey

doi:10.12114/j.issn.1007-9572.2019.00.496

Abstract

Abstract: Background　The supporting documents for the new round of comprehensive community health reform（launched in 2015） in Shanghai proposed that family doctor assistants（FDAs） should be included in the family doctor team.However，the specific definition and duties of FDAs are not elaborated in detail.Objective　To examine the career development status and pathways of FDA workforce in Shanghai's Jiading District，offering a reference for further determination of the working models of FDAs.Methods　This survey was conducted in four community health centers（CHCs） selected from Shanghai's Jiading District（one is in urban area，one in the suburban area，and two in the peri-urban area） from January 2 to 4，2018.Interviews were carried out with three groups（managers，family doctor team leaders，and FDA representatives） from each CHC，respectively，involving a series of questions about the organizational structure of the family doctor team，employment mechanisms，duties，performance allocation and career development pathways of FDAs.Results　All these CHCs had medical assistants for family doctors，but the duties were implemented part time by the members of the family doctor team.Two CHCs had full-time administrative assistants for family doctors without staffing.Each CHC self-determined the duties of FDAs.And the position title，attached department，general tasks，and working relationship of the FDAs differed significantly across the CHCs.For the management of FDAs，two CHCs used two-level assessment and two-level allocation mechanisms.In two CHCs，the family doctor team leader had the right to assess and allocate the performance for FDAs，but in other two，the family doctor team leader had not.In terms of the most suitable person for the position，nurses were proposed by one CHC，while general practitioner assistants receiving trainings of "3+2" program were proposed by other CHCs.Conclusion　In Shanghai's Jiading District，the employment mechanism，duties，and performance allocation for FDAs in each CHC are distinctive，and differ significantly across the CHCs.Moreover，working models of FDAs in all CHCs are not unified.It is suggested that the working mode of FDAs should be constructed according to the ratio of service urban areas to rural areas of the CHC，the needs of the residents served，and the conditions of the local areas.Furthermore，to play the due role of family doctor as the main body responsible for delivering family doctor services，and to achieve the maximum professional value of both family doctors and FDAs，family doctor is suggested to determine the duties of FDAs，allocate tasks to them，and assess and supervise their performance.

Key words: General practitioner assistants, General practitioner team, Service mode, Responsibilities, Performance, Professional development, Status quo

摘要： 背景　上海市新一轮社区卫生综合改革的配套文件中提出将家庭医生助理纳入家庭医生团队，但对于家庭医生助理的具体内涵和岗位职责未做详细阐述。目的　了解上海市嘉定区家庭医生助理的发展现状和职业发展路径，为进一步明确家庭医生助理的工作模式提出建议。方法　于2018年1月2—4日，在上海市嘉定区选取城区1家、郊区1家、城郊结合地区2家社区卫生服务中心进行调研。分别对各社区卫生服务中心的管理者、家庭医生团队长、家庭医生助理代表开展小组座谈会，访谈内容包括所在社区卫生服务中心家庭医生团队的组织架构，以及家庭医生助理的聘用机制、岗位职责、绩效分配、发展路径。结果　4家社区卫生服务中心均设有家庭医生医疗助理，均由团队内部人员兼职；2家社区卫生服务中心设有非编全职家庭医生行政助理。家庭医生助理的岗位职责由各社区卫生服务中心自行拟定，在岗位名称、所属部门、工作内容、与其他团队成员工作关系方面存在差异。2家社区卫生服务中心采取二级考核、二级分配机制，团队长对医生助理有考核分配权；2家社区卫生服务中心的团队长对医生助理没有考核分配权。1家社区卫生服务中心认为护士是最合适的医疗助理，其他3家认为“3+2”助理全科医生是最合适的医疗助理。结论　目前上海市嘉定区家庭医生助理的聘用机制、岗位职责及绩效分配根据各社区特点存在差异，未形成统一的工作模式。建议根据辖区城乡比例、居民需求，因地制宜构建家庭医生助理的工作模式，由家庭医生对家庭医生助理的岗位职责、任务分工进行分配、考核与监管，真正发挥以家庭医生为责任主体的作用，以实现家庭医生与家庭医生助理的工作价值最大化。

关键词: 家庭医生助理, 家庭医生团队, 工作模式, 岗位职责, 绩效, 职业发展, 现状

LU Qiuxia,CHEN Ping,ZHAI Jiayi, et al. Working Models of Family Doctor Assistants in Jiading District of Shanghai：a Current Survey　[J]. Chinese General Practice, 2019, 22(25): 3055-3061. DOI: 10.12114/j.issn.1007-9572.2019.00.496.
陆秋霞,陈萍,翟佳燚等. 上海市嘉定区家庭医生助理工作模式开展现状研究[J]. 中国全科医学, 2019, 22(25): 3055-3061. DOI: 10.12114/j.issn.1007-9572.2019.00.496.

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