基层医务人员的家庭医生签约服务政策响应度及工作满意度研究
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摘要
背景基层医务人员是开展家庭医生签约服务的主要执行者,其政策响应度和工作满意度是稳步推进家庭医生签约服务的关键。目的探讨基层医务人员的家庭医生签约服务政策响应度及工作满意度,为促进签约服务的持续发展提供对策建议。方法于2018年2—5月,采用多阶段抽样法在湖北省宜昌市抽取基层医务人员500例进行问卷调查,主要内容包括基本情况、对开展家庭医生签约服务的评价、对家庭医生签约服务的政策响应度及工作满意度。采用多因素Logistic逐步回归分析基层医务人员工作满意度的影响因素。结果共回收有效问卷462份,问卷有效回收率为92.4%。30.5%(141/462)的医务人员非常/比较积极参与家庭医生签约服务,25.9%(120/462)的医务人员认为现有激励机制完全/比较能调动医务人员积极性。医务人员对工资薪酬、工作环境、同事关系、发展前景、个人成就感的满意度得分分别为(2.7±0.7)、(3.4±0.7)、(4.1±0.8)、(3.3±0.9)、(3.5±0.8)分("很不满意"～"非常满意"分别计为1～5分),总体工作满意度得分为(17.4±3.5)分。多因素Logistic逐步回归分析结果显示,平均月收入、开展家庭医生签约服务后工作时间的变化、家庭医生岗位的工作风险、家庭医生岗位的重要性、现有激励机制能否调动医务人员积极性是基层医务人员工作满意度的影响因素(P<0.05)。结论基层医务人员的家庭医生签约服务政策响应度与工作满意度均有待提高。建议创新基层医务人员的激励措施,完善签约服务工作价值的绩效考核;加强培养优秀的家庭医生队伍,建立长期家庭医生人才培养机制,提高家庭医生职业稳定性。
Background Primary healthcare workers are the main providers of contracted family doctor services(CFDSs).Their responses to the supportive policies for the implementation of CFDSs and job satisfaction are the key to steadily promote the development of such services.Objective To investigate primary healthcare workers' responses to the supportive policies for the implementation of CFDSs and job satisfaction,to provide recommendations for the sustainable development of such services.Methods A questionnaire survey was conducted in a multistage stratified sample of 500 primary healthcare workers from Yichang City,Hubei Province during February to May 2018.The main contents of the survey included general personal characteristics,evaluation of CFDSs,responses to the supportive policies for the implementation of CFDSs,and job satisfaction.Stepwise multivariate Logistic regression analysis was used to analyze the influencing factors of job satisfaction.Results Overall,462 participants handed in responsive questionnaires,obtaining a response rate of 92.4%.Among them,30.5%(141/462) played a role in delivering CFDSs very/comparatively actively,25.9%(120/462) reported that current incentive mechanism can motivate their working enthusiasm.The mean overall job satisfaction score,salary satisfaction score,working conditions satisfaction score,coworker relationships satisfaction score,personal development satisfaction score,and personal achievement satisfaction score obtained by the respondents were( 17.4±3.5),(2.7±0.7),(3.4±0.7),(4.1±0.8),(3.3±0.9),(3.5±0.8),from "very unsatisfied" to "very satisfied" were scored 1-5,respectively.Stepwise multivariate Logistic regression analysis revealed that mean monthly income,changes in working hours after delivering CFDSs,risks of being a family doctor,importance of family doctors,and the functions of current incentive mechanism in arousing the working enthusiasm were influencing factors for job satisfaction(P<0.05).Conclusion The levels of responses to the supportive policies for the implementation of CFDSs and job satisfaction in primary healthcare workers need to be improved.The suggested corresponding facilitation strategies are as follows:innovating the incentives for family doctors,improving the evaluation system of family doctors' performance in delivering CFDSs,strengthening the training of high-quality family medicine workforce,establishing a sustainable training system for family medicine workforce,and enhancing the stability of family doctor as a vocation.
Background Primary healthcare workers are the main providers of contracted family doctor services(CFDSs).Their responses to the supportive policies for the implementation of CFDSs and job satisfaction are the key to steadily promote the development of such services.Objective To investigate primary healthcare workers' responses to the supportive policies for the implementation of CFDSs and job satisfaction,to provide recommendations for the sustainable development of such services.Methods A questionnaire survey was conducted in a multistage stratified sample of 500 primary healthcare workers from Yichang City,Hubei Province during February to May 2018.The main contents of the survey included general personal characteristics,evaluation of CFDSs,responses to the supportive policies for the implementation of CFDSs,and job satisfaction.Stepwise multivariate Logistic regression analysis was used to analyze the influencing factors of job satisfaction.Results Overall,462 participants handed in responsive questionnaires,obtaining a response rate of 92.4%.Among them,30.5%(141/462) played a role in delivering CFDSs very/comparatively actively,25.9%(120/462) reported that current incentive mechanism can motivate their working enthusiasm.The mean overall job satisfaction score,salary satisfaction score,working conditions satisfaction score,coworker relationships satisfaction score,personal development satisfaction score,and personal achievement satisfaction score obtained by the respondents were( 17.4±3.5),(2.7±0.7),(3.4±0.7),(4.1±0.8),(3.3±0.9),(3.5±0.8),from "very unsatisfied" to "very satisfied" were scored 1-5,respectively.Stepwise multivariate Logistic regression analysis revealed that mean monthly income,changes in working hours after delivering CFDSs,risks of being a family doctor,importance of family doctors,and the functions of current incentive mechanism in arousing the working enthusiasm were influencing factors for job satisfaction(P<0.05).Conclusion The levels of responses to the supportive policies for the implementation of CFDSs and job satisfaction in primary healthcare workers need to be improved.The suggested corresponding facilitation strategies are as follows:innovating the incentives for family doctors,improving the evaluation system of family doctors' performance in delivering CFDSs,strengthening the training of high-quality family medicine workforce,establishing a sustainable training system for family medicine workforce,and enhancing the stability of family doctor as a vocation.
引文
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[11]杨阳,师璐,何少峰,等.不同岗位社区医务人员对家庭医生式服务认知调查[J].广东医学,2017,55(21):3337-3340.DOI:10.13820/j.cnki.gdyx.2017.21.022.YANG Y,SHI L,HE S F,et al.Investigation on family doctors'service cognition of medical staff in different positions[J].Guangdong Medical Journal,2017,55(21):3337-3340.DOI:10.13820/j.cnki.gdyx.2017.21.022.
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[13]张雷,傅涵,李月娥.沈阳市某区家庭医生人力资源现状与对策研究[J].中国公共卫生,2018,34(2):282-284.DOI:10.11847/zgggws1117448.ZHANG L,FU H,LI Y E.Human resources for family doctor service at district level in Shenyang City:current status and countermeasures[J].Chinese Journal of Public Health,2018,34(2):282-284.DOI:10.11847/zgggws1117448.
[14]周娇娇,彭迎春,吕璐丹,等.居民视角下家庭医生签约服务医患信任对策探析[J].中华医院管理杂志,2018,34(7):540-543.DOI:10.3760/cma.j.issn.1000-6672.2018.07.004.ZHOU J J,PENG Y C,LYU L D,et al.Analysis of the doctorpatient trust strategies in family physicians contracted service from residents'perspectives[J].Chinese Journal of Hospital Administration,2018,34(7):540-543.DOI:10.3760/cma.j.issn.1000-6672.2018.07.004.
[2]国家卫生健康委员会办公厅.关于做好2018年家庭医生签约服务工作的通知[Z].2018.
[3]林春梅,秦江梅,张丽芳,等.基层卫生综合改革重点联系区县基层医务人员职业满意度研究[J].中国全科医学,2018,21(1):32-35.DOI:10.3969/j.issn.1007-9572.2018.01.008.LIN C M,QIN J M,ZHANG L F,et al.Occupational satisfaction in primary care providers in highly focused districts/counties during the comprehensive reform of primary care system in China[J].Chinese General Practice,2018,21(1):32-35.DOI:10.3969/j.issn.1007-9572.2018.01.008.
[4]王敏,赵京,赵建功,等.北京市社区医务人员家庭医生式服务认知现状研究[J].中华全科医学,2016,14(8):1243-1246.DOI:10.16766/j.cnki.issn.1674-4152.2016.08.001.WANG M,ZHAO J,ZHAO J G,et al.Assessment of current cognitive status in community medical staffs about family doctor service in Beijing[J].Chinese Journal of General Practice,2016,14(8):1243-1246.DOI:10.16766/j.cnki.issn.1674-4152.2016.08.001.
[5]杨阳,柳琳璠,师璐,等.广州市社区医务人员家庭医生式服务认知调查[J].医学与社会,2017,30(3):13-15,25.DOI:10.13723/j.yxysh.2017.03.004.YANG Y,LIU L F,SHI L,et al.Investigation on community medical professional's cognition of family doctor service in Guangzhou City[J].Medicine&Society,2017,30(3):13-15,25.DOI:10.13723/j.yxysh.2017.03.004.
[6]荆丽梅,刘坤,周徐红,等.上海市浦东新区卫生人才激励机制改革实施效果研究[J].中国全科医学,2017,20(19):2329-2333.DOI:10.3969/j.issn.1007-9572.2017.19.007.JING L M,LIU K,ZHOU X H,et al.Effectiveness evaluation of the reform in incentive system for healthcare professionals implemented[J].Chinese General Practice,2017,20(19):2329-2333.DOI:10.3969/j.issn.1007-9572.2017.19.007.
[7]鲁志鸿,孟庆跃,王颖.新医改前后中国基层卫生人力资源配置公平性分析[J].中国公共卫生,2017,33(7):1086-1088.DOI:10.11847/zgggws2017-33-07-14.LU Z H,MENG Q Y,WANG Y.Equity in basic health human resource allocation in China before and after health reform[J].Chinese Journal of Public Health,2017,33(7):1086-1088.DOI:10.11847/zgggws2017-33-07-14.
[8]张冬莹,郑婵娇,黄翔,等.广东省城乡地区开展家庭医生式服务的SWOT分析[J].中华全科医学,2015,13(5):689-691.DOI:10.16766/j.cnki.issn.1674-4152.2015.05.002.ZHANG D Y,ZHENG C J,HUANG X,et al.SWOT analysis carrying out the family doctor service in urban and rural areas of Guangdong[J].Chinese Journal of General Practice,2015,13(5):689-691.DOI:10.16766/j.cnki.issn.1674-4152.2015.05.002.
[9]李海明,徐颢毓.医保政策能否促进分级诊疗的实现:基于医疗需求行为的实证分析经济社会体制比较[J].经济社会体制比较,2018,34(1):28-35.DOI:10.16766/j.cnki.issn.1003-3947.2018.01.0028-0.LI H M,XU H Y.Whether health insurance policy can promote the realization of the hierarchical medical system:an empirical analysis based on medical demand behavior[J].Comparative Economic&Social Systems,2018,34(1):28-35.DOI:10.16766/j.cnki.issn.1003-3947.2018.01.0028-0.
[10]桂小海,王洪波,刘慧,等.基于家庭医生服务制度的弹性薪酬模型构建研究[J].中国全科医学,2018,21(25):3038-3043.DOI:10.12114/j.issn.1007-9572.2018.25.003.GUI X H,WANG H B,LIU H,et al.Construction of incentive salary model based on family doctor services system[J].Chinese General Practice,2018,21(25):3038-3043.DOI:10.12114/j.issn.1007-9572.2018.25.003.
[11]杨阳,师璐,何少峰,等.不同岗位社区医务人员对家庭医生式服务认知调查[J].广东医学,2017,55(21):3337-3340.DOI:10.13820/j.cnki.gdyx.2017.21.022.YANG Y,SHI L,HE S F,et al.Investigation on family doctors'service cognition of medical staff in different positions[J].Guangdong Medical Journal,2017,55(21):3337-3340.DOI:10.13820/j.cnki.gdyx.2017.21.022.
[12]刘利群.推进家庭医生签约服务加强分级诊疗制度建设[J].中国全科医学,2018,21(1):1-4.DOI:10.3969/j.issn.1007-9572.2018.01.001.LIU L Q.Promoting contracted services of family doctors to strengthen the construction of hierarchical medical system[J].Chinese General Practice,2018,21(1):1-4.DOI:10.3969/j.issn.1007-9572.2018.01.001.
[13]张雷,傅涵,李月娥.沈阳市某区家庭医生人力资源现状与对策研究[J].中国公共卫生,2018,34(2):282-284.DOI:10.11847/zgggws1117448.ZHANG L,FU H,LI Y E.Human resources for family doctor service at district level in Shenyang City:current status and countermeasures[J].Chinese Journal of Public Health,2018,34(2):282-284.DOI:10.11847/zgggws1117448.
[14]周娇娇,彭迎春,吕璐丹,等.居民视角下家庭医生签约服务医患信任对策探析[J].中华医院管理杂志,2018,34(7):540-543.DOI:10.3760/cma.j.issn.1000-6672.2018.07.004.ZHOU J J,PENG Y C,LYU L D,et al.Analysis of the doctorpatient trust strategies in family physicians contracted service from residents'perspectives[J].Chinese Journal of Hospital Administration,2018,34(7):540-543.DOI:10.3760/cma.j.issn.1000-6672.2018.07.004.