The Study Of The Effectiveness And Satisfaction For The Contracted Family Physician Services In The Elderly With Chronic Disease

BackgroundChronic diseases in the elderly are a global public health challenge and an important part of China’s health services under the aging population.Family physician signing services cater to the public health service needs of urban and rural residents,and carry out comprehensive and comprehensive health services for urban and rural residents.In 2018,the Government Office of the State Council issued the typical experience measures recognized by the 5th major inspection,including actively promoting family physician signing services in Guangzhou,Guangdong Province,and actively exploring and practicing and improving the service level of family physicians,taking Guangzhou,Shenzhen and other places as examples,to improve people’s health level.However,many patients currently have insufficient understanding of family physician signing services and cannot fully understand the relevant content of family physician signing services,exploring the application effect of family physician contract services among elderly patients with chronic diseases,achieving an effective combination of clinical medicine and preventive medicine,will improve the health level and social well-being of elderly patients with chronic diseases.Objective(1)For patients with diabetes/hypertension who are under the management of chronic diseases in the community,evaluate the application effect of family physician’ contracted services on patients with chronic diseases and the work effect of family physician’contracted services.(2)Analyze the satisfaction and related influencing factors of elderly chronic disease patients receiving contracted services from family physician.MethodsIn the community health service information system of Tianhe District,Guangzhou,917 patients with hypertension and diabetes were screened from the general chronic disease clinic of Linhe Street Community Health Service Center,Tianhe District,Guangzhou from November 2019 to October 2020.638 patients were aged≥60 years,of which 279 patients were younger than 60 years old and did not meet the inclusion criteria,and 216 patients did not receive chronic disease service management in the whole process,10 cases with a history of severe mental illness did not meet the inclusion criteria,and 12 cases were unable to undergo face-to-face follow-up.Finally,385 elderly chronic disease patients who met the criteria were enrolled..Among them,the research group was a chronic disease patient who received contracted family physician services(n=301);Patients who refused to sign the contract were included in the control group(n=84).The research group is a chronic disease patient who agrees to receive family physician signing services.The specific service measures are as follows: The patient and the family physician sign two copies of the family physician signing service agreement through understanding and discussion;After signing the agreement,the nurses in the family physician service team will collect the patient’s personal information to establish residents’ health files,and collect chronic disease information to establish detailed hypertension and diabetes files;Family physician will evaluate the patient’s condition based on their health status,weight,and blood sugar control status,and develop appropriate treatment plans.In order to further improve the patient’s level,we have developed targeted intervention methods,including dietary guidelines,medication usage and dosage,exercise guidance,psychological intervention,weight loss,smoking cessation and alcohol restriction,etc;On the basis of outpatient diagnosis and treatment,family physician conduct detailed face-to-face visits every quarter,as well as four blood pressure and fasting blood glucose measurements,as well as one free physical examination,including glycated hemoglobin measurement,to grasp the patient’s blood pressure,blood sugar control status,and medication status;Carry out health education through door-to-door,online,phone,appointment,and other means to improve patients’ treatment compliance,regularly monitor patients’ blood sugar and blood pressure,and timely adjust medication and intervention measures;Regularly organize learning about diabetes,hypertension,chronic diseases and other related knowledge,and regularly issue chronic disease brochures through lectures(once a month)to improve patients’ understanding,strengthen health education for patients,and give priority to health education materials;Obtain the contact information,phone number,and We Chat friends of the contracted doctors,establish a family physician signing We Chat group,and provide services such as family physician appointments,medical guidance,health counseling,and health education;Provide services such as appointment for medical treatment and priority referral through green channels.The control group consisted of chronic disease patients who refused to sign up but did not receive contracted services from family physician.They were only managed according to routine community health services for chronic diseases and received general and routine on-demand medication treatment.During the process,they were provided with four face-to-face follow-up visits for chronic diseases(including four blood pressure and blood glucose measurements)and one free physical examination(one glycated hemoglobin measurement).Dynamically observe the blood pressure and blood sugar control levels of two groups of patients within one year,and investigate the satisfaction of chronic disease patients with community health services.Independent sample t-tests were used for measurement data,chi square tests were used for counting data,and rank sum tests were used for non-normal variables to compare differences between sample groups.Set the level of statistical significance as ɑ= 0.05.ResultsThis study included 385 chronic disease patients,of which 301 chose to sign a family doctor and 84 chronic disease patients refused to sign a family doctor.The results showed that:(1)There was no significant difference in general information such as gender,educational level,marital status,occupation,and economic source between the signing group and the control group.During the follow-up period of three months,six months,nine months,and one year later,the control of various indicators such as systolic blood pressure,diastolic blood pressure,fasting blood glucose,and glycated hemoglobin in the signing group was superior to that in the control group of elderly chronic disease patients,and the difference was statistically significant(p<0.05).(2)Satisfaction with community health services: 95.3% of the contracted group expressed satisfaction with the health services,4.7% were generally satisfied,and there were no dissatisfied patients.58.3% of the control group expressed satisfaction with health services,38.1% were generally satisfied,and 3.6% were dissatisfied.From the satisfaction rate,it can be seen that the satisfaction level of the contracted group with family physician is significantly higher than that of the control group.Statistical analysis results show that there is a significant difference in the satisfaction level of family physician between the contracted group and the control group(p<0.05).The use of family physician signing services can effectively improve the public’s awareness of chronic diseases,regulate blood pressure,blood sugar and other indicators reasonably,and further enhance patient confidence and satisfaction.After a year of intervention with family physician contract services,this study conducted in-depth exploration on 385 chronic disease patients.Among them,301 patients voluntarily chose to sign a family physician,which achieved good blood pressure and blood sugar control levels.However,84 chronic disease patients refused to sign a family physician.The results showed that signing a family physician service can significantly improve the management effect of chronic diseases and provide more efficient treatment plans for chronic disease patients,To improve the quality of life of patients.By providing lifestyle guidance,education,and medication interventions,we can help patients better control their blood pressure and blood sugar levels,and optimize the health management of chronic disease patients.ConclusionsElderly patients with chronic diseases,such as diabetes and hypertension,have a heavy burden.Compared with conventional community health services,family physician contracted services have advantages in chronic disease management.The popularity of family physician contracted services will help consolidate the clinical efficacy of chronic diseases,improve medical efficiency and build a harmonious doctor-patient relationship.