Evaluation Of The Pilot Project Of Family Doctor Contract Service For The Disabled In Luzhou City Based On The Theory Of SPO

Objective: This research is conducted to understand the effect and problems of the pilot project of family doctor contract service for the disabled in Luzhou City and explore the satisfaction and the willingness to renew the contract and its influencing factors of the family doctor and the disabled for the pilot project.We will provide suggestions for the promotion of family doctor contract service for the disabled.Methods: Based on the theory of structure-process-outcome(SPO),using literature research,questionnaire method,and interview to evaluate the current situation of the pilot project of family doctor contract service for the disabled in Luzhou.The subjects of the study were seven primary medical and health institutions and their managers,project managers,family doctors,and disabled persons who participated in the pilot project from 2018 to 2020.The survey mainly included policy and organizational security,the service capacity of the primary medical and health institutions,the serviceability of family doctors,the evaluation and the satisfaction and renewal willingness of family doctors to the pilot project,the cognition and needs and utilization and the satisfaction and renewal willingness of disabled persons to the pilot project.SPSS 26.0 was selected as the statistical software.Qualitative variables were expressed as counts(%).The univariate analysis was analyzed using the chi-squared test and Fisher.The multivariate analysis was analyzed by logistic regression.Inspection level setting.α=0.05.Results:(1)The pilot project of family doctor contract service for the disabled in Luzhou has been put into trial operation for three years.The contracting rate of family doctors for the disabled fluctuated between 3.32% to40.16%.(2)Among 52 family doctors surveyed,9.61% of them thought their professional level could meet 81% to 100% of the pilot project needs,and57.69% of them believed that the remuneration for participating in the disabled family doctors’ contracted services was low.69.23% of family doctors believed that the main difficulty in the pilot project of family doctors for the disabled was the low professional level of medical staff,and 59.62% of them believed that the main difficulty was the insufficient number of medical staff.(3)Of the216 disabled people surveyed,64.35% of them were aware of the family doctor contract service,60.65% of them had received rehabilitation training services,and 34.72% of them had received rehabilitation needs assessment and referral services.(4)76.92% of the family doctors were satisfied with the pilot work of the family doctors’ contract service for the disabled.The satisfaction of family doctors who provided rehabilitation knowledge and rehabilitation skills propaganda service was high(P<0.05),while family doctors who had low incomes and served as the team leader had lower satisfaction(P<0.05).(5)The overall renewal willingness rate of family doctors was 84.62%.The renewal willingness promoting factors of family doctors included having primary and intermediate professional titles,having participated in relevant training,having signed a contract for 3 years,and being satisfied with the overall pilot project,service content,rehabilitation training effect,workload,training opportunities,and content,salary,and social recognition(P<0.05).Family doctors who had low incomes had a lower willingness to renew their contracts(P<0.05).(6)82.41% of the disabled were satisfied with the pilot work of the family doctor contract service.The results of the multifactor analysis showed that receiving rehabilitation medication guidance services(OR 6.135,95%CI 2.125-17.711),receiving rehabilitation training services(OR 6.065,95%CI 2.453-14.993),and receiving regular blood pressure and blood glucose monitoring services(OR3.385 95%CI 1.197-9.569)were the promoting factors of satisfaction in disabled.(7)The overall renewal willingness rate of the disabled was 83.33%.The results of multivariate logistic regression analysis showed that long-term medication(OR 3.518,95%CI 1.065-11.616),contracting with township health centers(OR 4.387,95%CI 1.561-12.331),satisfied with the overall pilot project(OR 8.084,95%CI 1.890-34.568)and satisfied with service content(OR 5.712,95%CI 1.322-24.677)were the promoting factors of renewal willingness in disabled.Conclusion: The results of the pilot project of family doctor contract service for the disabled are good: the rates of satisfaction and renewal willingness with the contract service of family doctors are high,and the rates of satisfaction and renewal willingness with the contract service of the disabled are high.The main problems of family doctor contract service for the disabled are as follows: the disabled with low awareness of the contracted service of family doctors,and with a low utilization of the contracted service of family doctors.The number and the service skills of family doctors are insufficient,and their workload of them is large.The infrastructure of primary medical and health institutions is not perfect.The examination and incentive system of family doctors needs to be further improved.The signing service project of family doctors for severe disabilities needs to be further improved.