Research On The Status Of Contracting Services For Family Doctors In Beijing

Objective:The purpose of this study is to summarize and analyze the status of signing services for family doctors in Beijing.Through the coverage,we have an in-depth understanding of community family doctors signing service methods,content and summarize the unique experience and problems since the signing of Beijing family doctors,It provides case basis for the promotion of signing services for family doctors in China,and proposes reference suggestions for building a unified family doctor system.Methods:1.Questionnaire method:A questionnaire survey was conducted on patients in typical community patients.There were five types of survey contents:basic information,cognitive information,demand information,availability information and satisfaction survey.The family doctor’s survey includes:basic information,cognitive information,workload and satisfaction survey.2.Interview method:’Responsible person in charge of community management center and community health service organization.Results:1.The course of signing service development for Beijing family doctors:All regions across the country have introduced policies to promote the development of contracted services.After many years of exploration in Beijing,a special model has been formed.2.Cognition of community residents and doctors signing up services for family doctors:(1)From the perspective of residents,84.7%of the residents agree with the first consultation in the community,and the signing situation is not related to the attitude of the first diagnosis;the awareness rate of residents for signing services reaches 81.9%,most of which is known through community propaganda.There are still 55.6%residents who have not signed up.Because they did not understand the signing service and did not sign,the level of residents’education influences the situation.(2)From the doctor’s point of view,42.5%of the team members think that the signing service is difficult to implement,of which 58.2%think the reason is the lack of an effective incentive mechanism;95%of team members think that the family doctor needs to improve,especially the basic medical services and family health management.3.The signing rate of family doctors in Beijing has generally increased year by year.Signature analysis shows that there is a statistically significant difference in the number of residents signing up in different types of participation and physical conditions.At present,Beijing has a variety of signing methods coexisting,including signing events,signing contracts,and signing contracts.4.Provision and utilization of contracted services:(1)Detailed contracted service content,and the establishment of a family doctor contracted service package;Significant differences between contracted service contents and community health institutions in the past are mainly reflected in standardized appointment referral,informatized targeted triage,home visits and health consultation,change from passive to active.(2)The rate of establishment of health records,health tests,and long prescription prescriptions were all above 50%,different types of participants(χ2=11.8 P<0,01),and chronic patients.Disease status(χ2=3.7,P<0.1)affected the access to health records.Different chronic disease conditions(χ2=3.7,P<0.1)affected the availability of health testing,and affected communities,gender,age,type of insured,and prevalence of chronic diseases.With the acquisition of prescriptions for medicines,different community residents have different access to Chinese medicine services.(3)Family doctors believe that the services that should be carried out are inconsistent with the ones with the highest residents’ needs.Income,participation,self-inductance,and health status affect residents’ needs for prescriptions.5.Satisfaction and effect analysis:(1)Satisfaction:As a whole,the residents have a higher degree of satisfaction with the family doctor’s contracting services.Different gendersand types of insurance influence the residents’ satisfaction with the service.(2)Different ages,working conditions,insured and chronic diseases affect service effectiveness More than 60%of family doctors believe that residents’ consciousness,referral,number of doctors,and doctor-patient relationship have all changed significantly since the implementation of contracted services.6.The team of Beijing family doctors is basically a model of "doctors,nurses,and preventive care workers." Individual communities add or delete roles according to actual conditions and form a variety of combination patterns;Title affects the number of family doctors trained and working hours.Differences,in which the input of files and other information takes a lot of time;the work enthusiasm and initiative of family doctors are affected by the incentive mechanism,and the initiative of team members of different ages and roles is different.Conclusions:1.The awareness rate of community residents for signing services of family doctors is relatively high,but the cognitive level is not high,and many misunderstandings are generated,which affects the use of contracted services.2.Beijing has issued a detailed family doctor signing service package.Signed residents use projects focused on basic medical and public health services.The utilization rate of health management is relatively low,and the inherent medical concept has not been changed.3.The signing service of family doctors has increased the workload of community doctors,but the effective incentive mechanism for family doctor teams is not perfect,and the enthusiasm and initiative of team members are affected.In the future,it is also necessary to change propaganda points,optimize publicity channels,and correct misunderstandings among residents;community health agencies must do a good job of introducing policies and services;strengthen guidance on residents’ health management;and promote multi-channel communication between doctors and patients through information construction.Improve the incentive mechanism and charge system,establish a uniform evaluation criteria,and enhance the work motivation of family doctor team members.