社区全科医生选择签约对象影响因素的质性研究
|
摘要
背景居民签约全科医生,是落实社区首诊的一种重要服务形式,同时也是促进居民就医习惯转变的重要举措,作为签约关系的一方,全科医生在选择签约对象时受哪些因素影响,对于完善签约制度有重要意义。目的以上海市浦东新区为例,探讨全科医生选择社区居民签约时受哪些因素影响,为完善社区家庭医生签约服务提供建议。方法于2018年3—4月,基于便利抽样法,选取上海市浦东新区中家庭医生签约双方可自主选择的13家社区卫生服务中心中参与家庭医生签约且有意愿的全科医生代表,通过一对一半结构化访谈采集其选择签约对象的影响因素。基于饱和原则,最终共纳入20名全科医生。结果访谈结果显示,全科医生的签约决策受自身情况、居民情况和执业环境的综合影响。20名全科医生在选择与哪位社区居民签约时均会考虑工作饱和度、执业范围、居民对签约服务的认知和签约数量考核。结论社区可以通过提高全科医生的执业水平,增强社区居民对家庭医生服务制度的了解,完善签约激励考核机制,提高全科医生签约的积极性,从而进一步落实签约服务。
Background To enjoy contracted initial consultation services in primary care,residents need to sign a contract with the general practitioner(GP).The contractual action is an important way to implement initial consultation in primary care,and also is a key measure to promote the transformation of residents' health-seeking behaviors.As a contract party,GPs are influenced by some factors during the selection of contracted residents.And identification of these factors is of great significance in improving the contract system.Objective To investigate the factors associated with selection of contracted residents in GPs in Shanghai's Pudong New Area,providing recommendations for improving the development of contracted family doctor services.Methods Voluntary participants were representative GPs delivering contracted family doctor services recruited from 13 community health centers in Shanghai's Pudong New Area[ in which two-way choice system(residents can choose GPs and GPs can choose residents freely)was implemented]by use of convenience sampling during March to April 2018.Personal interviews concerning factors associated with selection of contracted residents were conducted with them until data saturation was reached.Finally,the interview results of 20 GPs were included.Results GPs' selection of contracted residents were influenced by their own conditions,residents' conditions and practicing environment.In addition,workload saturation,scope of practice,residents' perceptions of the contracted services and appraisal of number of contracted residents were also considered by GPs as the factors associated with selection of contracted residents.Conclusion To further implement the contracted family doctor services,community hospitals can boost GPs' initiative in offering the services by improving the incentive assessment mechanism for assessing GPs' performance in delivering the contracted services,incentivize GPs to enhance their professional levels,and strengthen residents' understanding level of family doctor system.
Background To enjoy contracted initial consultation services in primary care,residents need to sign a contract with the general practitioner(GP).The contractual action is an important way to implement initial consultation in primary care,and also is a key measure to promote the transformation of residents' health-seeking behaviors.As a contract party,GPs are influenced by some factors during the selection of contracted residents.And identification of these factors is of great significance in improving the contract system.Objective To investigate the factors associated with selection of contracted residents in GPs in Shanghai's Pudong New Area,providing recommendations for improving the development of contracted family doctor services.Methods Voluntary participants were representative GPs delivering contracted family doctor services recruited from 13 community health centers in Shanghai's Pudong New Area[ in which two-way choice system(residents can choose GPs and GPs can choose residents freely)was implemented]by use of convenience sampling during March to April 2018.Personal interviews concerning factors associated with selection of contracted residents were conducted with them until data saturation was reached.Finally,the interview results of 20 GPs were included.Results GPs' selection of contracted residents were influenced by their own conditions,residents' conditions and practicing environment.In addition,workload saturation,scope of practice,residents' perceptions of the contracted services and appraisal of number of contracted residents were also considered by GPs as the factors associated with selection of contracted residents.Conclusion To further implement the contracted family doctor services,community hospitals can boost GPs' initiative in offering the services by improving the incentive assessment mechanism for assessing GPs' performance in delivering the contracted services,incentivize GPs to enhance their professional levels,and strengthen residents' understanding level of family doctor system.
引文
[1]国家发改委.关于印发推进家庭医生签约服务指导意见的通知[EB/OL].(2016-06-06)[2018-07-08].http://www.nhfpc.gov.cn/tigs/s3577/201606/e3e7d2670a8b4163b1fe8e409c7887af.shtml.
[2]国家卫生健康委员会.关于规范家庭医生签约服务管理的指导意见[EB/OL].(2018-10-08)[2018-10-16].http://www.nhfpc.gov.cn/jws/s7874/201810/be6826d8d9d14e849e37bd1b57dd4915.shtml.
[3]秦江梅,张丽芳,林春梅,等.我国基层卫生综合改革进展[J].中国全科医学,2017,20(22):2683-2690.DOI:10.3969/j.issn.1007-9572.2017.22.001.QIN J M,ZHANG L F,LIN C M,et al.Progress of comprehensive reform of primary health care in China[J].Chinese General Practice,2017,20(22):2683-2690.DOI:10.3969/j.issn.1007-9572.2017.22.001.
[4]冯雁,董铭,陈淑敏.上海市嘉定区社区全科医生执业现状调查与分析[J].中国公共卫生管理,2016,32(5):562-565.FENG Y,DONG M,CHEN S M.Survey of the status of general practitioners in Jiading District,Shanghai[J].Chinese Journal of Public Health Management,2016,32(5):562-565.
[5]林建荣,陈国中,关炳波,等.影响精神分裂症患者治疗依从性的相关因素研究[J].中国神经精神疾病杂志,2000,26(3):152-155.DOI:10.3969/j.issn.1002-0152.2000.03.009.LIN J R,CHEN G Z,GUAN B B,et al.The compliance of schizophrenic patients and factors that affect it[J].Chinese Journal of Nervous and Mental Disease,2000,26(3):152-155.DOI:10.3969/j.issn.1002-0152.2000.03.009.
[6]施华芳,姜冬九,李乐之,等.病人依从性的研究进展[J].中华护理杂志,2003,38(2):134-136.SHI H F,JIANG D J,LI L Z,et al.Advances in patient compliance[J].Chinese Journal of Nursing,2003,38(2):134-136.
[7]原上海市徐汇区卫生计生委.关于印发《徐汇区家庭医生“1+1+1”签约服务费考核分配方案(2017版)》的通知[EB/OL].(2017-12-08)[2018-07-08].http://www.xuhui.gov.cn/H/xhxxml/mscs_ylzc/Info/Detail_22172.htm.
[2]国家卫生健康委员会.关于规范家庭医生签约服务管理的指导意见[EB/OL].(2018-10-08)[2018-10-16].http://www.nhfpc.gov.cn/jws/s7874/201810/be6826d8d9d14e849e37bd1b57dd4915.shtml.
[3]秦江梅,张丽芳,林春梅,等.我国基层卫生综合改革进展[J].中国全科医学,2017,20(22):2683-2690.DOI:10.3969/j.issn.1007-9572.2017.22.001.QIN J M,ZHANG L F,LIN C M,et al.Progress of comprehensive reform of primary health care in China[J].Chinese General Practice,2017,20(22):2683-2690.DOI:10.3969/j.issn.1007-9572.2017.22.001.
[4]冯雁,董铭,陈淑敏.上海市嘉定区社区全科医生执业现状调查与分析[J].中国公共卫生管理,2016,32(5):562-565.FENG Y,DONG M,CHEN S M.Survey of the status of general practitioners in Jiading District,Shanghai[J].Chinese Journal of Public Health Management,2016,32(5):562-565.
[5]林建荣,陈国中,关炳波,等.影响精神分裂症患者治疗依从性的相关因素研究[J].中国神经精神疾病杂志,2000,26(3):152-155.DOI:10.3969/j.issn.1002-0152.2000.03.009.LIN J R,CHEN G Z,GUAN B B,et al.The compliance of schizophrenic patients and factors that affect it[J].Chinese Journal of Nervous and Mental Disease,2000,26(3):152-155.DOI:10.3969/j.issn.1002-0152.2000.03.009.
[6]施华芳,姜冬九,李乐之,等.病人依从性的研究进展[J].中华护理杂志,2003,38(2):134-136.SHI H F,JIANG D J,LI L Z,et al.Advances in patient compliance[J].Chinese Journal of Nursing,2003,38(2):134-136.
[7]原上海市徐汇区卫生计生委.关于印发《徐汇区家庭医生“1+1+1”签约服务费考核分配方案(2017版)》的通知[EB/OL].(2017-12-08)[2018-07-08].http://www.xuhui.gov.cn/H/xhxxml/mscs_ylzc/Info/Detail_22172.htm.