| Objective: The purpose of this study is to analyze the actuality of family doctor contract service in rural areas of Fujian Province from the perspective of residents and medical staff of family doctor team,and evaluate the effect of family doctor contract service.On this basis,policy suggestions are put forward to explore how to effectively change "contracting" into "servicing" when the number of signers is completed,providing reference for rural signed residents to use more valuable services.Methods: This study summarizes the research status of family doctor service in rural and economically underdeveloped areas at home and abroad,summarizes the effectiveness and experience of family doctor service,and existing problems;summarizes the status,team model and innovative practices of family doctor contract service in Fujian Province.According to the content of the study,self-made Questionnaire on the Contracted Services of Family Doctors in Rural Areas and Questionnaire on the Management of the Contracted Services Team of Family Doctors in Rural Areas were made.The stratified random sampling method was used to analyze the situation of 8 districts(Fuzhou,Quanzhou,Putian,Sanming,Ningde,Longyan,Nanping and Zhangzhou)in Fujian Province except for the Ping Tan Comprehensive Experimental Area of Xiamen City.A survey was conducted among rural residents and medical staff of township hospitals participating in the family doctor contract service team;semi-structured interviews were conducted with the principals of township hospitals or family doctors in 8 districts and municipalities by in-depth interviews;using general statistical description analysis,chi-square test,binary logistic regression,ordered logistic and other methods to analyze residents to the family The awareness of the doctor contract service,the status of the contract,the willingness and the influencing factors,and the effect of the contracted service.Results: The family doctor contract service has a large gap in the scores of the five dimensions of the RE-AIM framework.The two dimensions with higher scores are “Adoption”and “Implementation”,followed by “Effectiveness”and “Maintenance”,and “Reach” with lower scores.(1)Adoption: The participation of institutions is high,and the participation of medical team staff in the organization is ideal,but at the same time there is a phenomenon that the incentive mechanism is not perfect and the enthusiasm is not strong.(2)Reach: Residents have a low awareness rate and signed rate of family doctor contract service,and need to further strengthen publicity so that residents are willing to sign contract.(3)Implementation: The family doctor team provides medical services mainly for basic public health services and basic medical services.Personalized health management services are provided less,need to be in line with the needs of residents,and improve residents' sense of contracting.(4)Effectiveness: Residents generally have a benefit after signing,and the satisfaction is high;the medical staff of the family doctor team has higher support for the contract service,but the effect of the current contract service is unsatisfactory.(5)Maintenance: Residents have a strong willingness to sign and renew their contracts.They need to further mobilize the enthusiasm of family doctors to provide residents with higher quality contracted services.Conclusions: From the five dimensions of RE-AIM framework,the implementation status of family doctor contract service in rural areas of Fujian Province has achieved some results,but there are inconsistencies in different dimensions.In order to promote the development of contracted services for family doctors in rural areas,suggestions on improving the contracted service for family doctors in rural areas are put forward from three aspects: before signing,the process of implementation and the follow-up of contracting services. |
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