“1+1+1”医疗机构组合签约服务对签约居民健康管理的效果评价
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摘要
目的通过家庭医生和社区居民建立"1+1+1"医疗机构组合签约服务,提供分级诊疗服务,并对效果进行评估。方法家庭医生与578例社区居民进行"1+1+1"医疗机构组合签约服务,包括完善健康档案、制定个性化诊疗计划、提供长处方和延伸处方等特色服务;通过全科门诊、慢病管理、预约门诊、双向转诊等持续性的健康管理1年。通过HIS系统调阅数据,分析签约居民在签约前(2016年1月—2016年12月)和签约后(2017年1月—2017年12月)家庭医生有效利用率、签约药品支出费用与满意度。结果 "1+1+1"医疗机构组合签约管理1年,578例组合签约居民,签约前年就诊次数为10 429次,签约后为9 663次,对于家庭医生的有效利用率从42.85%提升到66.62%。社区居民的药品支出费用比干预前有不同程度下降,总满意度较签约前明显提升,差异均有统计学意义(P<0.05)。结论家庭医生开展"1+1+1"组合签约工作,提供分级诊疗服务,在提高家庭医生有效利用率控制费用、管理健康、提高满意度等方面具有重要的作用,在社区卫生服务中心家庭医生制工作中应加以推广。
Objective The"1+1+1" medical institutions have been set up by family doctors and community residents to provide a combination of contract services, provide a hierarchical diagnosis and treatment service, and evaluate the effect. Methods The family doctor and 578 community residents"1+1+1"medical institutions signed service, including complete health records,individualized treatment plan to provide prescription and prescription and other characteristics of long extension services; health management through an outpatient, chronic disease management, clinics, two-way referral such sustained 1 years. Through the HIS system data access, analysis of the contracted residents after signing in the family doctor effective use of comparative analysis of drug expenditure and signing rate, satisfaction. Results "1+1+1"medical institutions management contract for 1 years, among 578 group contracted residents, 10 429 visits were made the year before signing the contract and 9 663 visits after signing the contract. The effective utilization rate for family doctors increased from 42.85% to 66.62%. Drug expenses before the intervention of community residents decreased to some extent, the satisfaction was higher than before, the differences were statistically significant(P<0.05).Conclusion Family doctors to carry out the "1+1+1" combination contract work, provide medical services in classification,improve the effective utilization of control costs, improve the satisfaction of health management, plays an important role in family doctor, popularized in community health service center of family doctor system work.
Objective The"1+1+1" medical institutions have been set up by family doctors and community residents to provide a combination of contract services, provide a hierarchical diagnosis and treatment service, and evaluate the effect. Methods The family doctor and 578 community residents"1+1+1"medical institutions signed service, including complete health records,individualized treatment plan to provide prescription and prescription and other characteristics of long extension services; health management through an outpatient, chronic disease management, clinics, two-way referral such sustained 1 years. Through the HIS system data access, analysis of the contracted residents after signing in the family doctor effective use of comparative analysis of drug expenditure and signing rate, satisfaction. Results "1+1+1"medical institutions management contract for 1 years, among 578 group contracted residents, 10 429 visits were made the year before signing the contract and 9 663 visits after signing the contract. The effective utilization rate for family doctors increased from 42.85% to 66.62%. Drug expenses before the intervention of community residents decreased to some extent, the satisfaction was higher than before, the differences were statistically significant(P<0.05).Conclusion Family doctors to carry out the "1+1+1" combination contract work, provide medical services in classification,improve the effective utilization of control costs, improve the satisfaction of health management, plays an important role in family doctor, popularized in community health service center of family doctor system work.
引文
[1]上海卫生和计划生育委员会.关于进一步推进本市社区卫生服务综合改革与发展的指导意见[EB/OL].(2015-09-01)[2019-01-10].http://www.wsjsw.gov.cn/wsj/n429/n432/n1488/n1489/u1ai136396.html.
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[2]安华.英美全科医生对我国医疗保险费用控制的启示[J].北京市工会干部学院学报,2005,4(20):38-42.
[3]马伟,许学国.合同法视角下完善家庭医生签约式服务的思考[J].中国全科医学,2015,18(16):1980-1983.
[4]蔡利强,侯进,陆新建.香港转诊制度对内地实施分级诊疗的启示[J].中国全科医学,2017,20(15):1787-1792,1797.