A Study On The Status And Influencing Factors Of Contract Service For Family Doctors In Jinan City

OBJECTIVETo investigate the status of contracted residents in Jinan City by signing residents,non-contracted residents and family doctors in Jinan City,to understand the status of contracted services of family doctors in Jinan,to grasp the signing willingness and influencing factors of contracted residents,and to discover the impact on non-contracted residents.Unsigned factors and reasons for not willing to sign contracts,and discuss the residents’satisfaction and influencing factors of family doctors’ contracted services,and put forward targeted strategies and suggestions to provide a scientific basis for further improving the family doctor contracted service system.MethodsFrom October 2017 to October 2018,surveys were conducted using questionnaires and interviews.Eleven regions in three districts of eight districts of Jinan City were selected and sampled by stratified random sampling according to the proportion of population.First determine the number of samples to be sampled in 11 counties and districts,and then randomly select 4-7 community health service centers or township health service centers in each district and county,and select the age of 18-80 years for each selected primary medical institution.The patients who came to see the doctor were investigated.The self-designed Family Doctor Services Questionnaire was used to investigate the included samples.The investigators conducted interviews through face-to-face and question-and-answer methods and explained individual issues.The survey includes:(1)basic conditions,namely,demographic characteristics,health status,medical treatment habits,etc.;(2)knowledge of different types of family doctor services,signing of contracts,contracted residents’evaluation of contracting services and satisfaction;(3)Find the degree of cognition of family doctors and the acceptance of the first consultation in the community;grasp the relationship between different survey objects and contractual intentions such as economic status and type of medical insurance;through analysis,find out the influence of Jinan urban and rural residents to choose to sign a family doctor(4)By understanding the residents’perceptions and expectations of family doctors,and grasping the service content and service forms of family doctor services with the most urgent needs of residents.Data entry uses Excel spreadsheets for data entry,database creation,and data analysis using descriptive statistics and chi-square test statistics.In each of the 11 counties and districts,two institutional leaders and family doctors were randomly selected to conduct interviews to understand the current contracting situation,performance,difficulties and the original problems affecting family doctors’contracting services.Results(1)In the 2404 valid questionnaires signed by family doctors,the signing rate was 30.8%.Using the description and statistics to analyze the composition ratio of the survey sample to the family doctor contract service,the reasons for signing the contract,the reasons for not signing the contract,and the cumulative percentage,the results show that:1)the top three in the knowledge path is:medical staff introduction,The percentage of publicity and TV broadcasting channels is 77.17%;2)the top three reasons for signing are:doctor introduction,convenient medical treatment,cheap medical treatment,cumulative percentage 65.4%;3)unwilling to sign the top three:not understanding No,no need for drugs,the cumulative percentage is 74.2%.(2)Analysis of the factors affecting the signing of family doctors:l)There is no statistical significance(P<0.05)for family doctors’ contract service without age,different marital status,no medical insurance,different education,occupation and family per capital income;2)for different ages,different degrees of education,different family marital status,different occupations,different medical insurance conditions and different income levels will have a greater impact on whether or not to sign a family doctor service,the difference is statistically significant(P<0.05);3.Whether residents understand that the degree of accessibility of contracted doctors and residents to the nearest primary care institutions and the relationship with doctors have a significant impact on whether sample residents choose to sign a family doctor,the difference is statistically significant(P<0.05);4.The medical expenses,communication time,waiting time and overall satisfaction of the sample residents during the medical treatment have a significant impact on the satisfaction of the family doctors1 contracting services.The difference is statistically significant(P<0.05),that is,the signatory’s Medical expenses,communication time,waiting time,overall satisfaction Better than non-contracted residents.(3)Through in-depth interviews with the managers of the primary medical institutions and family doctors,the results show that:l)the family doctor team has no obvious performance and enthusiasm;2)the grassroots medical institutions are seriously lost,and the overall business level of the personnel is low.3)Information platform is not perfect,resident files can not be used well;4)lack of support from government departments,especially the medical insurance department has no obvious bias towards residents signing a family doctor team.Conclusions and recommendations(1)Strengthen publicity and increase residents’willingness to sign contracts;(2)Improve basic service capabilities and improve performance distribution system;(3)Improve policies and payment systems related to family doctor contract services;(4)Establish medical information integration.