Abstract: Background　The implementation of health poverty alleviation project in China has entered a critical stage.One of its present difficult task is，how to implement contracted family doctor services（CFDSs） to make comprehensive coverage of CFDSs for poor people in rural areas.Objective　To identify the key problems in delivering CFDSs in rural areas of China，an important initiative for the implementation of the health poverty alleviation project，providing recommendations for further development of CFDSs in such areas.Methods　From August 1 to September 22，2018，the databases of CNKI，Wanfang Data，and VIP were searched for articles published during January 2012 to September 2018 by use of keywords of "rural + family doctor" and "rural +signing a health services contract with a family doctor+ problems/current situation/research".After careful retrieval in accordance with the inclusion and exclusion criteria of this study，18 articles were finally included.Relevant data were extracted following articles reviewing，and key problems during the implementation of CFDSs in rural areas were summarized，of which those needing to be solved most urgently were determined by use of TOPSIS.Results　Sixty-one problems were summarized initially.With reference to the results of further discussion and expert consultation，17 problems were included in the problem database finally.The top three most important problems that need to be solved first are as follows：No.6 problem（insufficient family doctors）（Ci=0.997），No.10 problem（backward informatization construction and lack of information management system）（Ci=0.898），and No.4 problem（unsatisfied capability level of family doctors in rural areas（Ci=0.800）．Conclusion　The most prominent problems existing in the implementation of CFDSs in rural areas are about the delivery system structure of such services.Priorities for future work should be given to primary care workforce construction and intra-regional informatization construction.

Key words: General practice, Rural health, Family doctor contracts, TOPSIS method, Health poverty alleviation

摘要： 背景　随着我国健康扶贫工作进入攻坚阶段，如何落实农村地区的家庭医生签约服务，实现贫困人口签约的全覆盖成了目前健康扶贫工作的重大难题。目的　明确我国农村地区家庭医生签约服务存在的关键问题，为健康扶贫背景下农村地区家庭医生签约服务的关键问题提供相关建议。方法　2018年8—9月，在中国知网、万方数据知识服务平台、维普网中检索2012年1月—2018年9月公开发表的相关文献，末次检索日期为2018-09-22。以“农村+家庭医生”“农村+家庭医生签约+问题/现状/研究/调查”为关键词进行检索，并依据研究的纳入与排除标准进行反复筛选，最终得到文献18篇。阅读文献并摘录文献中对问题的不同表述，归纳总结并整理问题，并运用TOPSIS法对文章中提及的问题进行优先排序，找出目前最亟待解决的问题。结果　阅读18篇文献后共摘录61个问题，进一步整理、讨论、咨询专家意见，最终纳入问题库的问题共17个。依据TOPSIS法优先排序得到排名靠前的3个问题依次是“问题6：家庭医生数量不足”（Ci=0.997）、“问题10：信息化建设滞后，信息管理系统缺乏”（Ci=0.898）和“问题4：农村地区家庭医生能力水平不高”（Ci=0.800）；即为目前农村地区实行家庭医生签约服务最需要优先解决的关键问题。结论　目前农村地区家庭医生签约服务的问题主要集中在基层医疗卫生人才队伍建设和区域内信息化建设，其将是之后工作的重点。

关键词: 全科医学, 农村地区, 家庭医生签约, TOPSIS法, 健康扶贫