The Study On Implementing The System About Family Physician At Zhabei District In Shanghai

ObjectivesThis research aimed to analysis the feasibility of implementing family physician service model inZhabei District，Shanghai；explore the will and the factors of signing with family physicians for the users ofcommunity health care service；understand the cognition of family physicians and managers of thecommunity health care on implementing family physician service model．The aim was to providetheoretical basis and policy suggestions for promoting practice of family physician service model．Methods1．Study on the Feasibility of implementing family physician service model in Zhabei District，ShanghaiBased on the development level of community health care service，explored the feasibility ofimplementing family physician service model from the infrastructure， the operation mechanismconstruction，the services function and the health care reform policy through consulting relevant documentand collecting routine report material of community health service in Zhabei District．2．The will and factors of signing with family physicians for the users of community health careserviceA self-designed structured questionnaire was used in this survey among the total of900users ofcommunity health care service from9community health service centers in Zhabei District were chosen byconvenience sampling．The software of EpiData3.1was used to built the database and the software SPSS11.5was used to analyse the data，the main statistical methods were describing statistics and2tests, inwhich the level of the test was0.05and P values were two-tail probability．3．The cognition of family physicians on implementing family physician service modelIn-depth interview was executed among23family physicians from the community health care servicecenter of Zhabei District chosen by purposive sampling．Software of MAXqda10was used to analyse the qualitative material through open encoding，axial coding and selective coding to understand the cognitionof family physicians on implementing family physician service model．4．The cognition of community health care managers on implementing family physician service modelIn-depth interview was executed among the community health care managers from Zhabei Districtchosen by purposive sampling．Software of MAXqda10was used to analyse the qualitative materialthrough open encoding，axial coding and selective coding to understand the cognition of community healthcare managers on implementing family physician service model．Results1．Study on the Feasibility of implementing family physician service model in Zhabei District，ShanghaiIn the infrastructure construction aspects：the infrastructure of community health care serviceinstitutions had laid a good foundation for implementing family physician service model in ZhabeiDistrict，Shanghai，based on its sound service network and standardized construction of community healthservice institutions，and established the collaborative sharing regional health information initially．However,the shortage of family physicians had become a key bottleneck in implementation family physician servicemodel. In the operating mechanism construction aspects：recruit and incentive of talents in human resourcemanagement system was improving gradually，but family physician’s income increase was limited byperformance-based pay implementing；the system of income and expenses was not conducive to healthfunds payment reform．In the service function aspects：the proportion of diagnosis and treatment incommunity health care service institutions was relatively high, the service contents and service patternswere gradually improving．In the health care reform policy aspects：relevant policies were issued to createa policy environment for implementing family physician service model，but these policies were lack ofoperability．2．The will and factors of signing with family physicians for the users of community health careservice25.0%users of community health care service were willing to contract with family physicians without concerns；the contracting will had no statistically significant differences between different genders, ages,education levels，types of occupation，but had statistically significant differences among insured types．Theusers of community health care service who had higher degree awareness on carrying out family physicianservice had higher will to contract with family physicians（P<0.001）．The users of community health careservice were willing to choose a fixed general practitioner when see a doctor had higher will to contractwith family physicians（P<0.001）．The users of community health care service who had higher level ofacceptability for first diagnosis in community health care service center had higher will to contract withfamily practitioners（P<0.001）；the transferring experiences for medical treatment had bidirectionalinfluence to contract will．3．The cognition of family physicians on implementing family physician service modelIn the service delivery aspects：family physician should have a higher level of skill，and shouldprovide continuous health management services for contracted residents in the form of team work.；In thepolicy aspects：the two-way referral channels should be unimpeded，the community first diagnosis shouldbe established，the medical insurance payment should be reformed，and the family physician trainingmechanism should be perfected；In the measures aspects：the propaganda of family physician service modelshould be broad and correct，service commitment should based on the capacity of family physicians team．4．The cognition of community health care managers on implementing family physician service modelIn the service connotation aspects：family physician should have high overall quality；the scope ofservice object should be extended gradually to the whole population；the service content should be clearlydefined；encourage service forms should diversified and differentiated．In the talent team constructionaspects：strengthen the recruit and cultivation of talents；pay attention to the coordinated development offamily physician team；consummate training mechanism and performance evaluation of family physicianservice model．In the guarantee system and measures aspects：the propaganda of family physician servicemodel should be strengthened；the level of informatization should be improved；the two-way referralchannels should be unimpeded，the community first diagnosis should be established，and the medicalinsurance payment should be reformed． Conclusions1．The basic conditions of implementing family physician service model had been formed in ZhabeiDistrict，Shanghai．The shortage of general medical talent and payment method of health care insurancewere limiting factors of implementing family physician service model．2．The willing to contract with family physicians was lower，insured types，degree awareness oncarrying out family physician service，the level of acceptability for first diagnosis in community health careservice center and the transferring experiences were the main factors．3．Implementing of family physician service model in community health care service institutions needto strengthen coordinated development of family physician team；define service contents and forms；improve gradually the level of health informatization；and improve gradually the reform of medicalinsurance payment．...