Status quo of contracted family doctor services in China: a literature study
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摘要:
目的 分析中国家庭医生签约服务现状及研究进展,总结家庭医生签约服务政策实施过程中存在的普遍问题,为探索符合我国国情的家庭医生签约服务模式提供参考。 方法 系统检索中国生物医学文献数据库、中国知网、万方数据知识服务平台和维普数据库,检索时间为2018年4月,纳入家庭医生签约服务现状相关研究文献,利用EndNote X7与Excel 2010对纳入文献进行筛选管理和数据分析。 结果 共纳入文献24篇,均为横断面研究,其中,以城市居民为调查对象的研究有20篇,以农村居民为调查对象的研究仅有4篇。统计分析发现,近年来家庭医生签约服务知晓率最高的地区为广东省(36.3 %~96 %),其次为北京市(16 %~90.66 %);签约率最高的地区为北京市(42.5 %~100 %),其次为上海市(30.25 %~74.9 %);满意度最高的地区为北京市(86.33 %),其次为广东省(56.2 %~80 %)。家庭医生签约服务实施过程中普遍存在家庭医生人员紧缺,居民缺乏了解,家庭医生待遇低,服务、管理、激励和保障等运行机制尚不完善,信息化建设滞后等问题。 结论 家庭医生签约服务知晓率、签约率和满意度在发达省市高于落后省市,城市高于农村,未来需要更多研究关注家庭医生签约服务的有效实施,及时给出政策反馈。 Abstract:Objective To examine the status of and research progress in contracted family doctor services in China and to summarize general problems existing in the implementation the services for providing references for the development of applicative mode of contracted family doctor services in China. Methods Studies on contracted family doctor services in China published till April 2018 were systematically searched through China National Knowledge Infrastructure (CNKI), Chinese Biomedicine Database (CBM), Wanfang and Chinese Science-Technology Periodical Database (VIP) database. EndNote X7 and Excel 2010 were used to manage and analyze the retrieved studies. Results All the 24 finally included articles were cross-sectional studies, of which 20 and 4 were conducted among urban and rural residents. Higher rates (36% – 96%) of awareness about contracted family doctor services were reported by studies conducted among residents in Guangdong province, followed by among those (16% – 90%) in Beijing. Higher proportions (42% – 100%) of participating in contracted family doctor services were reported by the studies conducted among the residents in Beijing, followed by those (30% – 74%) in Shanghai. A higher rate (86.33%) of satisfaction to contracted family doctor services was reported by the studies conducted among the residents in Beijing, followed that (56% – 80%) in Guangdong province. Major hindering factors for the implementation of contracted family doctor services indicated by the studies were shortage of family doctors, lack of awareness on the services among the public, low salary of family doctors, imperfect management, incentive, insurance, and information support for the services. Conclusion The rate of awareness about, participating in, and satisfaction to contracted family doctor services are higher among residents in economically developed provinces/municipalities and in urban area than among those in less developed regions and in rural areas in China. More researches on the issue need to be performed for effective implementation of contracted family doctor services. -
Key words:
- family doctor /
- contracted service /
- bibliometrics /
- research status
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表 1 纳入文献报道居民签约率、知晓率和满意度
地区 时间(年) 知晓率(%) 签约率(%) 满意度(%) 城市 农村 城市 农村 城市 农村 北京市 2013 — 2016 16.00~90.66 42.50~100 38.00~100 86. 33 上海市 2014 — 2017 30.20~74.90 46.00 广东省 2016 — 2017 36.30~96.00 49.30 20.94~52.90 20.94~50 56.20~80.00 天津市 2015 88.30 陕西省 2016 — 2017 51.70 91.10 31.40 96.00 四川省 2014 — 2016 16.40~100 32.26 海南省 2017 49.30 25.30 哈尔滨市 2017 46.33 昌吉市 2015 71.40 武汉市 2017 67.90 表 2 家庭医生签约服务实施过程中存在问题(n = 15)
政策实施过程中存在问题 报告文献数 构成比(%) 家庭医生人员紧缺 9 60.0 宣传不到位,居民不了解 8 53.3 财政保障不到位,家庭医生待遇低 7 46.7 运行机制尚不完善 6 40.0 信息化建设滞后 5 33.3 家庭医生服务配套政策与措施不完善 4 26.7 缺少完善的绩效考核和激励机制 3 20.0 居民参与积极性不高 2 13.3 社会重视度与参与度不够 1 6.7 家庭医生服务内容与患者需求有差距,导致患者认可度低 1 6.7 法律法规不健全,存在法律风险 1 6.7 服务模式评价体系还有待于进一步完善 1 6.7 表 3 家庭医生签约服务现状的政策建议(n = 20)
政策建议 报告文献数 构成比(%) 加大宣传,提高居民知晓度和参与度 14 70 加强家庭医生服务团队建设 12 60 提升卫生服务能力, 丰富卫生服务内容 12 60 完善医务工作人员绩效考核制度和激励机制 10 50 政府倡导,落实配套政策,完善补偿机制 10 50 完善信息化建设 6 30 健全医疗保险制度 6 30 增加对家庭医生式服务的专项投入 4 20 动员全社会参与 4 20 加快推进“社区首诊” 1 5 -
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