Page 112 - 2022-34-中国全科医学

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of high-quality development of family doctor system in China. Objective To investigate the family doctor confidence index（FDCI）in
2020 and its trend from 2014 to 2020 among general practitioners（GPs）in Pudong New Area of Shanghai，and to predict their future
3-year FDCI，providing insights into the promotion of the construction of family doctor system. Methods Participants were incumbent
GPs who provided family care services in 9 community health centers in Pudong New Area of Shanghai，the settings in which the 2014
FDCI survey in Shanghai's Pudong New Area was conducted. They were invited to attend an online survey through the platform of www.wjx.
cn in December 2020 using a questionnaire developed by ourselves based on the implementation of family doctor system in Pudong New
Area，the contents of E2-E3 pages of the original China Medical Tribune•General Practice Weekly published on June 22，2017，and
the survey contents of FDCI developed by GU Yuan Family Doctor Studio. FDCI was compared by demographic indices. The future 3-year
FDCI was estimated overall，and compared across GPs by demographic indices. The trend of FDCI between 2014 and 2020 was analyzed.
Results A total of 350 cases attended the survey, and 347 of them（99.1%）who returned were responsive questionnaires were included
for analysis. The average FDCI of the participants was（51.96±28.42）in 2020，and that predicted for 2023 was（54.03±26.56），
showing no significant difference（P>0.05）. In 2020，GPs working at rural areas had higher FDCI than those working at urban and peri-
urban areas（P<0.05）；Those who became a GP after training prior to the post shift had higher FDCI than those who became a GP after
standardized residency training or passing the professional title examination（P<0.05）；GPs with junior college education or below had
higher FDCI than those with a bachelor/master degree or above（P<0.05）；GPs who held a concurrent administrative post or handled
administrative matters in their hospital had higher FDCI than those did not（P<0.05）. Higher FDCI predicted for 2023 was found in those
with working at rural areas instead of those working at urban and peri-urban areas，and in those with junior college education or below
instead of those with a bachelor /master degree or above（P<0.05）. Those who were male，aged 23-29，worked at urban area，had an
experience of ≤ 1 or>5 years of working as a family doctor，had a bachelor degree or intermediate professional title were predicted to have
higher FDCI in 2023 than in 2020（P<0.05）. The overall FDCI in 2020 was higher than that in 2014〔（51.96±28.42）vs （24.65±22.75）〕
and 2017〔（51.96±28.42）vs（48.20±23.10）〕，with statistical significance（P<0.05）. Conclusion The overall FDCI of
GPs in Shanghai's Pudong New Area in 2020 and that predicted for 2023 was moderate，and the overall FDCI in 2020 was significantly
higher than that in 2014 and 2017. The present and future 3-year FDCI varied among GPs by demographic characteristics. GPs were fully
confident in the future development of the industry and their own occupation，and needed continuous policy and social supports.
【Key words】 Family doctors；General practitioners；Confidence index；Licensed confidence；Community health
services；Shanghai

1997 年，中共中央、国务院发布《关于卫生改革 查，发现家庭医生信心指数呈上升趋势，2017 年已接
与发展的决定》，明确指出要“加快发展全科医学、培 近中立水平，但调查结果仍反映出家庭医生行业存在诸
养全科医生”，并陆续出台了一系列的政策和文件 ［1］ 。 多问题 ［4-6］ 。2020 年既是我国全科医生制度建设的关
相关政策的颁布与实施为我国全科医学的发展营造了适 键时间节点，也是上海市家庭医生制度建设 1.0 版收官
宜的政策环境，使全科医生的培养进入了规范化阶段， 之年。在此背景下，了解家庭医生信心指数及其未来的
也标志着我国全科医学的发展进入一个新时期 ［1］ 。到 执业信心水平，对于完善家庭医生制度设计与体系建设
2020 年，我国将初步建立起充满生机和活力的全科医 （家庭医生制度 2.0 版建设）、让全科医生“下得去、
生制度 ［2］ 。 留得住、用得好”、持续推进家庭医生签约服务高质量
上海市自 2011 年 4 月起，就将建立家庭医生制度 发展具有重要意义。研究者于 2020 年 12 月，继续对上
作为医药卫生体制改革的五大基础性工程之一，浦东新 述 9 家社区卫生服务中心的家庭医生展开调查，以期了
区则是率先启动家庭医生制度试点的 10 个区之一。多 解家庭医生执业的主要影响因素、执业信心指数的变化
年来，上海市稳步推进社区卫生服务机构建设；通过打 趋势及其对执业状况的预期，进而为家庭医生制度建设
造社区卫生综合管理平台和分级诊疗支持平台，出台人 的深入推进提供一定的借鉴。
才培养及团队建设制度、收入分配与绩效考核 / 激励制 1 对象与方法
度，加强信息互联互通等举措，不断夯实基层医疗服务 1.1 调查对象 于 2020 年 12 月，以 2014 年参与上海
“网底”，推进家庭医生制度的完善 ［3］ 。家庭医生信 市浦东新区家庭医生信心指数调查的 9 家社区卫生服务
心指数反映了家庭医生执业信心的强弱和从业的主观 中心 ［5］ 为样本来源地，整群抽取 9 家社区卫生服务中
感受，其亦是用于评估家庭医生行业发展现状和趋势 心的全科医生作为研究对象。纳入标准：（1）已注册、
的重要指标。研究者于 2014、2017 年发起了对上海市 在职且正在从事家庭医生相关工作的全科医生；（2）
浦东新区 9 家社区卫生服务中心家庭医生的信心指数调 知情同意，自愿参加本次调查，并且已签署知情同意书。