Research On The Utilization Status Of Family Doctor Services For Some Chronic Disease Patients In A District Of Nanjing

With the improvement of people’s living standards and the increasing aging of population,noninfectious chronic diseases have become the main factors that threaten people’s health and life.As the representative of community health care service,family doctor service has been popularized nationwide in a situation where our country is vigorously promoting hierarchical diagnosis and treatment system and it plays an important role in chronic disease management.However,family doctor service comes from foreign countries and it is in the early stage of development in our country,so there is some problems that limits its expansion.In particular,whether people can utilize the family doctor services efficiently affects the effectiveness of family doctor services to a great extent.Therefore,to enhance the utilization rate to family doctor service is of great significance.Objective: To investigate how family doctors in A community healthcare center of Xuanwu District in Nanjing serve and manage chronic disease patients(taking hypertension and diabetes for example),and how patients utilize healthcare services provided by family doctors,in order to find out problems,analyze the factors that affect family doctor service utilization,and analyze the influence of family doctor services on the effectiveness of chronic disease management through the evaluation on the chronic disease management,providing suggestions for the improvement of family doctor services.Methods: Theoretical and empirical research were combined in this research.To make comprehensive knowledge on the development and research status about family doctor services at home and abroad by means of literature research and provide theoretical basis for further research.To investigate how chronic disease patients utilize family doctor services and the effectiveness of chronic disease management by means of questionnaire survey.And the satisfaction index was quantified by Likert 5 scale.To investigate how family doctors in sample institution serve and manage the chronic disease patients by interview method.Average,rate and proportion were used in descriptive statistics;rank sum test was used in the comparison of quantitative data;chi-square test was used in the comparison of categorical data.Results:(1)Chronic disease management of sample institution: there are six family doctor teams in sample institution,and each team consists of family doctor,nurse and public health worker;there are eight services provided for chronic disease patients whether he or she has family doctor or not,including establishing personal health record,follow-up management,health consultation,medication guide,health education,free blood pressure/blood glucose measurement,free physical examination and month-long prescription;green channel of referral and family medical service are exclusive for patients with family doctors.(2)The signing status of chronic disease patients: there are 725 respondents in total,including 437 hypertensive patients and 116 diabetics who have family doctor in observation group,129 hypertensive patients and 43 diabetics who don’t have family doctors in control group.(3)The utilization status of family doctor services: patients’ awareness to family doctor services should be enhanced,and some of them have mistaken understanding about the services;observation group knows more about family doctor services than control group(P(27)0.05);the utilization rates of free blood pressure/blood glucose measurement and free physical examination are both 100%;the utilization rates of health consultation and health education should be enhanced;the utilization rates of green channel of referral and family medical service are the lowest;the utilization rates of follow-up management,health consultation and health education in observation group are higher than that in control group(P(27)0.05);the total family doctor first contact care rate is no more than 50%,but it is higher in observation group than in control group(P(27)0.05);(4)The evaluation on chronic disease management: the rate of health care knowledge awareness,the frequency of blood pressure/blood glucose measurement,the compliance to self-control behavior,the effectiveness of blood pressure/blood glucose control and the rate of patient satisfaction in observation group are higher than that in control group(P(27)0.05).Conclusion: The efficient utilization to family doctor services can strengthen patients’ compliance to health management,enhance the health management level and improve the effectiveness of chronic disease management.But there is also some obstruction that prevents people from efficiently utilizing the services,such as inadequate publicity,insufficient number and competence of family doctors,the lack of efficient incentive and assessing systems,traditional medical-seeking behavior and the lack of supporting policy and measures.Therefore,it is necessary to make better publicity,cultivate more qualified general practitioners,improve family doctor teams,establish efficient incentive,assessing and supervision system,create care-oriented doctor-patient relationship based on friendship and improve supporting policy and measures.