Investigation On The Current Situation Of Family Doctors In Rural Area Of Gansu Province

Objective: The purpose of this study is to investigate the status quo of contracted services for family doctors in rural areas of Gansu province.By collecting current evidence,the main problems existing in contracted services for rural doctors are deeply discussed,and theoretical reference and feasible suggestions are provided for the better development of contracted services for rural doctors in the future.Methods: 1)The Web of Science and Chinese database CNKI were searched systematically to find relevant literature on the family doctor.We adopt the method of literature visualization to draw the corresponding scientific knowledge map using the VOS viewer software,and to understand the current the family doctor service research hotspot and trend;2)a questionnaire survey was conducted among 601 villagers in rural areas of Gansu province on their awareness,willingness to sign contracts,satisfaction,willingness to renew contracts and relevant Suggestions.Chi-square test was used to analyze the influencing factors of signing willingness and signing satisfaction;3)a structured interview was conducted with 20 rural doctors to learn about the status quo of contracted services,the actual implementation of contracted services,and the views and Suggestions of village doctors on contracted services.Results: 1)We retrieved a total of 8674 records of literature on family doctor in English and 1739 records of literature on family doctor contract service in Chinese,373 records of literature on rural family doctor signed service in Chinese.Through visual analysis,the differences in the volume of publications,the distribution of research institutions,the distribution of countries and regions,the distribution of research fields,and the distribution of key words in the domestic and foreign family doctor literature were compared.Compared with overseas general practitioner services,related studies in China started relatively late and showed a trend of rapid growth after 2013.Family doctors abroad research involved many related areas,including basic medical service policy,the main public health problems(such as quitting smoking,asthma,diabetes,obesity,nutrition,chronic disease,and Alzheimer's,etc.),and health consultation and health assessment,and other branches of research field.While the domestic research mainly focused on the building family doctor service mode and health service mode in poor areas,for the major health problems,the related research is less;2)a total of 601 villagers in 12 cities and 2 autonomous prefectures of Gansu province were surveyed by questionnaire,among which 46.59% were male and 53.41% were female.People aged 18-35 accounted for 66.72%,people aged 36-65 accounted for 31.11%,and people aged 66 and above accounted for 2.16%.When feeling unwell,39.27% of villagers preferred the village clinic,15.47% chose the private clinic and 5.66% chose the town health center.55.57% of villagers said that it takes less than 15 minutes to walk from home to the village clinic,while 28.12% of villagers need to walk for 15-30 minutes.75.87% of villagers said they knew about the family doctors contract services,while 49.75% said they had "heard about it,but didn't know much about it".53.29% of villagers said they would take the initiative to participate in the service,while 25.00% said they would not.As for the actual contract situation,48.60% of the villagers said they had signed the contract,38.82 % had not,and 12.59% were not clear.66.48% of villagers signed basic service packages,7.39% were primary packages,11.93% were intermediate packages,and 14.20% were unclear.84.38% of the villagers were basically satisfied with the contract services they received,14.06% were not satisfied,and 1.56% were not clear.Chi-square test analysis results showed that "age",“gender”,“occupation”,"whether they are resident in the village" and "marital status" might have an impact on the awareness of contract services(P<0.05);"whether to actively demand health knowledge","whether to improve their own health through the advice of the village doctor",and "whether to actively seek help from the village doctor" might have an impact on the willingness to sign the contract service(P<0.05);"whether or not to trust the medical service work of village doctors" might have an impact on the satisfaction of contracted services(P<0.05);3)In-depth interviews were conducted with 20 village doctors,including 14 male villager doctors and 6 female villager doctors,which aimed to learn the basic situation of the current contracted services.At present,the contracted service mainly focused on key population,including chronic disease patients,the elderly,the disabled,children,people with mental disorders and the poor.Contract service was divided into basic service package,primary service package and intermediate service package.The primary package needed 50 yuan per person per year,and the intermediate package for 100 yuan per person per year.The cost was covered by 50% of the basic medical insurance fund for urban and rural residents and 50% of the national basic public health service project fund.Performance appraisal mainly includes three aspects: contract signing,performance and effect evaluation.Through interviews with village doctors and some villagers,it was found that there were still the following problems: the contract service lacked feasible implementation plan;the enthusiasm of villagers was not high;village clinics had limited capacity for medical health services.Conclusions: The implement of family physician contract services in rural areas is an important policy taken by China aimed to accelerate the reform of the medical and health system,and improve the construction of the medical and health system and optimize the medical and health order.Compared with economically developed areas,the health services provided by grassroots medical service institutions in rural areas of Gansu and the paid medical services paid by villagers are limited,and there are still major obstacles in the implementation of rural doctor contract services.Therefore,it is necessary to continue to explore feasible contract contents and continuously improve the contract mode.