Analysis On The Status Quo And Influencing Factors Of Family Doctor’s Contract Service Among Residents In Zhuhai

1 ObjectiveTo understand the status quo of family doctor’s contract service among residents in Zhuhai City,and analyze the cognition,needs,participation and utilization of residents and primary medical staff on family doctor’s contract service,find out the problems and their influencing factors,and propose relevant countermeasures and suggestions.To provide a scientific reference for the comprehensive promotion of family doctor’s contract service and the construction of a comprehensive Hierarchical medical system.2 method(1)Data: Literature review,statistical statements and questionnaires.(2)Survey method: Multi-stage sampling method was used for the resident’s investigation.A total of 570 residents were selected for household survey in Xiangzhou District,Doumen District and Jinwan District of Zhuhai City,and 570 questionnaires were effectively recovered,the effective recovery rate of the questionnaire was 100%.Using stratified cluster random sampling method,593 primary medical staff from 25 community health service institutions/township health centers were randomly selected from Xiangzhou District,Doumen District and Jinwan District of Zhuhai City for questionnaire survey,and 555 questionnaires were effectively collected,the effective recovery rate of the questionnaire was 93.59%.(3)Statistical methods: including descriptive statistics,u test for comparison of sample rate and population rate,one-way chi-square test and multi-factor logistics regression analysis.3 Results(1)Status quo of family doctor’s contract service: Among 570 sample survey residents,289 residents have signed a contract with the family doctor’s service team,and the family doctor’s service signing rate is 50.70%.Among 273 sample survey key residents(including children aged 0～6 years,pregnant women,elderly people over 65 years old,chronic patients,disabled people,poor households,people who have lost their families,etc),171 key residents have signed with the family doctor’s service team,the family doctor’s service signing rate of key residents was 62.64%.Relevant report data showed that the ratio of medical treatment of family doctor’s contract service agencies decreased from 32.14% in 2015 to 27.74% in 2018;and 41.98% of primary medical staff believed that there was a situation in Zhuhai that “the primary medical institutions are arrogant,and the superior hospitals are overcrowded” is very serious.(2)Cognitive analysis of family doctor’s contract service: 34.91% of residents do not know about family doctor’s contract service,and only 35.68% of primary medical staff said they knew the family doctor’s contract service.Residents and primary medical staff have different on the choice of the way that the family doctor’s contract service is offered.Residents are more likely to choose home-based medical services as the main provider of family doctor’s contract service(P<0.05).(3)Analysis of the use of family doctor’s contract service and its influencing factors: Multivariate logistics regression results showed that the independent influencing factors of resident contracted family doctor’s services were different marital status,whether they received community health services last year,whether they knew about family doctor’s contract service,and whether they had established resident’s personal health record.The main reason for not signing with the family doctor’s service team is that the residents do not know about the family doctor’s contract service.More than 60% of the contracted residents accepted the contract service no more than two times last year.(4)Analysis of the willingness and influencing factors of primary medical staff participating in the family doctor’s team: 55.68% of the primary medical staff indicated that they are willing to participate in the family doctor’s team.Multivariate logistics regression results show that the degree of understanding of family doctor’s contract service,whether it can alleviate the dilemma of medical treatment,the type of primary medical institution,and the type of primary medical job are independent factors influencing the willingness of primary medical staff to participate in family doctor’s team.(5)The primary medical staff believes that the problems that need to be solved in order to comprehensively promote family doctor’s contract service are mainly: the basic medical institutions have limited service capabilities,the related systems are not perfect,the residents’ medical treatment concepts are outdated,and the signing services are ineffective.(6)Influencing factors of resident contracted family doctor’s services based on the perspective of primary medical staff: the three most important factors are doctor-patient relationship,social recognition of family doctors/general practitioners,and basic drug types of primary medical institutions.4 ConclusionSince the pilot was launched in 2014,the development of family doctor’s contract service in Zhuhai has been better,but the residents’ utilization of family doctor’s contracted services is not good.The ability of family doctor’s contract service to divert patients to the primary medical institutions is slightly insufficient,and there is a long way to go to fully promote family doctor’s contract service.Zhuhai residents have insufficient awareness of family doctor’s contract service.They should strengthen the propaganda of family doctor’s contract service,change the traditional concept of medical treatment for residents,build a good doctor-patient relationship,and guide residents to sign contracts.Match the basic drug types of primary medical institutions,enhance the medical technology service capabilities of primary medical institutions,enhance the quality of contracted services,and improve the sense of acquisition of contracted residents.By strengthening the training and education of primary medical staff,improving their medical ability,improving their understanding of contracting services,enhancing the social recognition of family doctors/general practitioners,establishing a scientific and rational performance appraisal and distribution mechanism,and improving the enthusiasm of primary medical staff,providing better family doctor’s services to the contracted residents.