成都市武侯区家庭医生签约服务开展现状研究
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摘要
成都市武侯区自2014年开始试点以人为中心的主动健康管理服务(PCAC)模式下的家庭医生签约服务,现已取得初步成效。截至2018-06-30武侯区居民的家庭医生签约率为31.0%,重点人群签约率为55.0%,有效签约率为5.1%。根据家庭医生签约服务平台数据:2017年7月—2018年6月签约高血压、糖尿病患者的关键指标达标率、并发症筛查率高于2016年7月—2017年6月(P<0.05);2018年1—6月签约居民的主动预约率、预约到诊率、固定就诊率高于2017年7—12月(P<0.05);2017年7月—2018年6月签约居民的上转人次、下转人次以及专科医生到社区卫生服务中心服务人次高于2016年7月—2017年6月(P<0.05),但远程协同服务人次间无差异(P>0.05)。同时,社区医务人员的工资收入和居民的就诊满意度有一定程度的提高。但目前,武侯区家庭医生签约服务仍存在人员配置不足、信息化建设有待提高、医保等配套政策有待完善等问题,进一步的工作也将重点围绕上述问题开展。
The Wuhou District of Chengdu has been piloting the contracted family doctor service under the PeopleCentered Active Care(PCAC) model since 2014,and preliminary results have been achieved.As of June 30,2018,31.0% of the residents in Wuhou District have signed contracts with family doctors,55.0% of the key population has signed contracts with family doctors,and 5.1% of the population used ID cards to sign the contracts that were regarded as the effective ones.Data from Electronic Patient Management platform were analyzed,and the up-to-standard rate of key indicators of patients with hypertension and diabetes in July 2017 to June 2018 was better than that in July 2016 to June 2017 as well as the screening rate of complications.For the contracted residents,the appointment rate on their own initiatives,the rate of visits to a doctor after an appointment,and the fixed visit to one's own family doctor rate in July to December in 2017 were higher than those in January to June in 2018.The number of contracted residents refeeal to hospitals from community or to community from hospitals,and specialists serving at the community from July 2017 to June 2018 was higher than that from July 2016 to June 2017(P<0.05),while there was no difference in the number of contracted residents receiving remote cooperative service(P>0.05).Meanwhile the salary income of community medical workers increased as well as the satisfaction of residents.However,there are still some problems of the contracted family doctor service at present in Wuhou District,such as insufficient personnel allocation,imperfect information construction,and lack of supporting policies such as medical insurance.The further major work will be carried out around the above issues.
The Wuhou District of Chengdu has been piloting the contracted family doctor service under the PeopleCentered Active Care(PCAC) model since 2014,and preliminary results have been achieved.As of June 30,2018,31.0% of the residents in Wuhou District have signed contracts with family doctors,55.0% of the key population has signed contracts with family doctors,and 5.1% of the population used ID cards to sign the contracts that were regarded as the effective ones.Data from Electronic Patient Management platform were analyzed,and the up-to-standard rate of key indicators of patients with hypertension and diabetes in July 2017 to June 2018 was better than that in July 2016 to June 2017 as well as the screening rate of complications.For the contracted residents,the appointment rate on their own initiatives,the rate of visits to a doctor after an appointment,and the fixed visit to one's own family doctor rate in July to December in 2017 were higher than those in January to June in 2018.The number of contracted residents refeeal to hospitals from community or to community from hospitals,and specialists serving at the community from July 2017 to June 2018 was higher than that from July 2016 to June 2017(P<0.05),while there was no difference in the number of contracted residents receiving remote cooperative service(P>0.05).Meanwhile the salary income of community medical workers increased as well as the satisfaction of residents.However,there are still some problems of the contracted family doctor service at present in Wuhou District,such as insufficient personnel allocation,imperfect information construction,and lack of supporting policies such as medical insurance.The further major work will be carried out around the above issues.
引文
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[3]魏威,苏宇,郭丹丹,等.武汉市全科医生签约服务模式现状分析[J].中国社会医学杂志,2017,34(3):271-273.DOI:10.3969/j.issn.1673-5625.2017.03.019.WEI W,SU Y,GUO D D,et al.The status of contract service mode of general practitioner in Wuhan City[J].Chinese Journal of Social Medicine,2017,34(3):271-273.DOI:10.3969/j.issn.1673-5625.2017.03.019.
[4]苏枫,徐庆,钱茜.镇江市家庭医生签约服务实践探索及发展思路[J].中国医疗管理科学,2017,7(1):19-22.SU F,XU Q,QIAN Q.The practice exploration and development idea of the contracted services of family doctors in Zhenjiang[J].Chinese Medical Management Science,2017,7(1):19-22.
[5]张明明,蔡传.北京和上海家庭医生制服务模式的现状及中医思考[J].中国农村卫生,2018,11(20):92-93,96.ZHANG M M,CAI C.Current situation of family doctor service mode in Beijing and Shanghai and reflection on traditional Chinese medicine[J].Rural Health in China,2018,11(20):92-93,96.
[6]成都市武侯区人民政府.武侯年鉴(2017)[EB/OL].[2018-01-05].http://www.cdwh.gov.cn/wuhou/whnj2017m/whnj.shtml.
[7]世界银行集团,世界卫生组织财政部,原国家卫生和计划生育委员会,等.建设基于价值的优质服务提供体系[R].2016.
[8]AAFP.American academy of family physicians[EB/OL].[2018-12-01].https://www.aafp.org/home.html.
[9]AAFP.Patient-centered medicalhome checklist[EB/OL].[2018-11-01].https://www.aafp.org/pcmh and transformed.com.
[10]李岩.医疗质量监测与评估[M].北京:北京大学医学出版社,2016.
[11]曹桂荣.医院管理学[M].北京:人民卫生出版社,2004.
[12]张丽芳,刘利群.基层卫生综合改革典型案例[M].北京:中国人口出版社,2018.
[13]《中国高血压防治指南》修订委员会.中国高血压防治指南2018年修订版[M].北京:人民卫生出版社,2018.
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[16]王家骥,陈先辉,孙国平.家庭医生制度实践[M].北京:人民卫生出版社,2017.
[17]秦江梅,刘利群.2014-2016基层卫生综合改革重点联系点居民健康询问调查报告[M].北京:中国人口出版社,2018.
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[19]蒋羽萍,张莲芳,张齐苑,等.条块结合的全科服务团队管理模式研究与实践[J].中华全科医师杂志,2012,11(8):594-595.DOI:10.3760/cma.j.issn.1671-7368.2012.08.014.JIANG Y P,ZHANG L F,ZHANG Q Y,et al.Research and practice on the management mode of general service team[J].Chinese Journal of General Practitioners,2012,11(8):594-595.DOI:10.3760/cma.j.issn.1671-7368.2012.08.014.2018122020190416