| Objectives: According to analyze the implementation status of the signing service of general practices(GPs)and it’s influencing factors of signing willingness in Lanzhou New District of Gansu Province,thus understanding the implementation of the signing service work under the background of the new round of deepening medical and health system reform.Finding out problems which existed in the construction of the general practices(GPs)contract service system and team building in three towns’ Health Center of Lanzhou New District.Putting forward some suggestions to promote the sustainable development of GPs in Lanzhou New Area,and providing some reference for deepening the general practices(GPs)contract service.Methods: Literature analysis method was used to collect research progress and existing status of signing work for GPs at homeland,abroad and Gansu Province,and it’s also used to collect relevant documents and policies of signing services in Lanzhou New District.With the assistance of Lanzhou New District Health and Food and Drug Administration(Health Bureau),we used Annex1 to make qualitative interview for associate leaders of Lanzhou New District Health Bureau and directors of three towns’(Zhongchuan,Qinchuan and Xicha)Health Center Conduct.We also made quantitative questionnaire surveys for contracted residents(Annex2)and unsigned residents(Annex3)at 54 administrative villages in three towns.Annex 2and 3 are involved questions as follows: Basic conditions of contracted residents and their awareness,utilization and demand for health services,their willingness to continue signing.Basic conditions of unsigned residents,their awareness and demand for health services,their willingness to sign contracts.Questionnaire survey(Annext4)was made for members of GPs team of three towns’ Health Center,which involves basic information of their knowledge,attitude and satisfaction for general practices(GPs)working.The number of papers we leased are as follows: Annex 1(6),Annex2(650),Annex 3(650)and Annex 4(77).After review and validity test,the validity of the questionnaire was Annex 1(6),Annex2(622),Annex 3(630)and Annex4(77).Questionnaire results were analyzed by percentage,chi-square test andmultivariate logistic regression analysis.Results: 1.Overall situations of the signing work in Lanzhou New District: It’s pilot work of general practices(GPs)started at three towns in April 2017,which fully launched in August 2017.Up to now,there are 47 GPs work teams at three towns’ health centers in Lanzhou New District,the signing people accounted for 70,132 and signing rate is above 49%.During these signing people,the poor and key population signed 22,847,it’s signing rate reached 16.0%.However,there is still a certain gap between the signing rate of GPs and the key population signing rate from 2017.At the year of 2018,there were 89,417 people who have signed GPs in Lanzhou New District,which include 27,496 key people(the signing rate was 72.99%).The signing service of GPs in Lanzhou New District was operated smoothly and orderly.2.Analysis of factors affecting the willingness of signed residents to renew their services: there were 622 respondents,510(82.00%)of the signed residents had the willingness to renew GPs.The results of multiple regression analysis showed as follows: “Treatment institutions of general disease”,“The function of signing services in reducing medical and health expenses”,“Is it willing to be rehabilitated in primary medical institutions after illness”,“Whether people hope to establish a health record”,“Whether it is necessary for GPs to provide outpatient services for signed residents”,and “whether GPs are required to provide on-site services” has an impact on the willingness of signatory residents to renew their visas(P<0.05).3.Analysis of factors affecting the willingness to sign contract for unsigned contract GPs: there were 630 respondents,and 405(64.29%)unsigned residents are willing to sign contracts.For those who are unwilling to sign,the number of respondents who “Do not trust community health workers” is accounted for 103(45.78%);the next answer was “The poor medical conditions of community health service institutions”,which accounted for 98(43.56%).The results of multiple regression showed that “The age”,“It’s effects on disease prevention and treatment”and “whether GPs need health management for them” affected the willingness of unsigned residents to sign contracts(P<0.05).4.Analysis of factors which affect GPs’ satisfaction with contract work: there were 77 respondents,only 46 workers who are satisfied with their work,which accounted for 59.74%.The results of multiple regressions showed as follows: “Their age”,“If the current contracting work process reasonable”,“Do you understand the policy related to general practices contracting services”,“Can your current workinglevel meet the needs of GPs services”,and “Do you agree to sign the contract” “ Do you agree that sign work is helpful to residents’ health” has an impact on GPs’ job satisfaction(P<0.05).Conclusions: The work of signing GPs in Lanzhou New Area began in April2017,while the key populations’ signing rate has increased from 16.00%(2017)to72.99%(2018),and it’s service level has gradually increased.However,there are still some problems in the unsound health care service system,such as a lack of health human resources,a lag in the construction of GPs’ information,and weak publicity.GPs are less satisfied with their work,their sense of identity needs to be strengthened,and they believe that their wages need to be further improved.Some GPs believe that their own medical level can’t meet their work and thus have a negative attitude towards their work.Suggestions: Increasing grassroots health resources investment to improve primary health care environment.Enhancing different medical insurance policies to promote rational diversion of sources.Integrating medical resources and clarify institutional positioning at different levels.Increasing publicity efforts to highlight residents’ awareness and give priority to special populations.Governing health records dynamically and providing specialized health management services.Implementing the responsibility mechanism and clarifying the responsibility of the contracting party.Enriching the work team to improve the working ability.Improving salary for GPs and strengthen their recognition of their work. |
