Abstract: Background　People with disability are a priority group covered by contracted family doctor services.It is necessary to study what family doctor team members should do（including targeted services） to satisfy the needs of people with disability，improve their sense of gain and satisfaction，achieving a win-win situation for both of them. Objective　To identify problems in the delivery of contracted family doctor services for people with disability via a survey and put forward improvement recommendations，to provide useful information for the management of family doctor team and the delivery of such services for this group. Methods　This survey was conducted in Yuetan Community Health Center，Fuxing Hospital，Capital Medical University，Beijing's Xicheng District，from October 2018 to September 2019. Six focus groups were set up，of which three were composed of 25 members of the family doctor service team for the disabled，and the other three were composed of 21 persons with five different types of disabled who signed the contract. Taking four kinds of barriers（physical，attitude，professional and systemic barriers） as the theoretical framework，the in-depth interviews were carried out with Guidebook for Family Physicians Providing Contracted Services for People with Disabilities（hereinafter referred to as the Guidebook）. Field notes，recording and transcription were used to encode and refine the theme. Results　All the interviewees approved the content and practicability of the Guidebook，reported self-perceived requirements for current contracted services for those with disabilities and proposed improvement recommendations. Three themes were identified after analyzing the interviews with family doctor team members：longer time needed for consultation，including physical examination，communication and identification of the disease；providing trainings related to care for people with disabilities for physicians and nurses，including special care for this group；retraining medical workers with the services for people with disabilities that are not included in the scope of primary care. Four themes were identified after analyzing the interviews with adults with disabilities and guardians of children with disabilities：physical，service attitude，professional and system barriers in the interaction process with the healthcare system. Conclusion　The Guidebook with comprehensive and reasonable contents has good practicability，providing primary healthcare workers with a useful method for the delivery of services for people with disabilities，and instructive solutions to common problems occurring in the delivery of services for special groups.

Key words: Disabled, Contracted family doctor services, Semi-structured interview, Focus group, Qualitative research

摘要： 背景　残疾人是家庭医生签约服务优先覆盖的人群，如何为残疾人群提供符合其需求的家庭医生签约服务，提高残疾人的获得感及满意度，家庭医生团队的人员如何有针对性地为残疾人服务，以达到双方共赢的服务效果有待进一步研究。目的　了解残疾人家庭医生服务团队为签约残疾人服务过程中发现的问题并提出改进办法和建议，为社区家庭医生服务团队管理和服务签约残疾人提供依据。方法　2018年10月—2019年9月，采用半结构式访谈法，在首都医科大学附属复兴医院月坛社区卫生服务中心，设立6个焦点小组，其中3个由25名残疾人家庭医生服务团队成员组成，另外3个由21名签约的5类不同残疾人组成。以4种障碍（身体、态度、专业和系统障碍）为理论框架，结合《残疾人家庭医生签约服务指导手册》（《手册》）中残疾人接受服务的内容分别进行了深度访谈。进行实地笔记、录音和转录，编码提炼主题。结果　家庭医生团队成员都对《手册》的内容和实用性给予了肯定，同时签约家庭医生服务团队成员和残疾患者针对目前的家庭医生签约服务提出不同的需求和建议。经过比对分析，家庭医生团队方面共析出3个主题：诊疗时间长，包括残疾的身体，沟通和认知；对医生、护理进行残疾相关知识的培训，包括特定的学习需求；残疾人的服务部分超出初级保健范畴，需要再次培训学习。残疾患者方面共析出残疾人在与医疗保健系统的交互过程中存在身体、态度、专业和系统四种障碍4个主题。结论　制定完善合理的签约服务内容手册有较好的实用性，为残疾人基层医疗实践提供了工作方法，揭示了签约服务内容手册在指导特殊人群的基层卫生保健过程中的常见问题和解决办法。

关键词: 残疾人, 家庭医生签约服务, 半结构式访谈, 焦点小组, 质性研究