Implication And Perspective Of General Practitioner Service Team Model In Shanghai

BackgroundSince the meeting of metropolitan community health held by the State Council, community health services have been flourishing all over our country.The forms of community health service have been explored to adapt to their local realities.One of them is the general practitioner service team(GPST).Specifically,the service model, which consists of community health service platform and GPST,has come into being in Shanghai.Moreover,GPST has been an important part and a feature of Shanghai community health service system and plays an important role in the offering the essential clinical services and public health services.However,up to now, there is still few domestic study on its operation model although its implementation for years in Shanghai.The present study attempts to analyse the key elements related to its implementation and satisfaction by medical workers and patients,and to suggest strategies for improving the service team model in the future.Goal and ObjectivesGoad:Based on the analysis of the model of GPST in Shanghai,this work attempts to probe into the best service model and development strategy.Objectives:1.Simple introduce about GPST of Shanghai2.Analysis of the GPST model:(1) Equipments status of GPST;(2) Human resources and their knowledge demand evaluation;(3) Definition of services package;(4) Expectation of service population;(5) Satisfaction degree;(6) Qualitative study.3.Establishment and evaluation of the new GPST model and its effectiveness.4.Strategy development to GPST.MethodsBy prototype,the present study was conducted in Xuhui District of Shanghai by quantitative and qualitativemethods.The quantitative study was carried out using the questionnaire that was developed based on the actual situation and the present study purposes.The questionnaire includes the description of the equipments,human resources,and health education demands,etc.and a cross-sectional survey was implemented among 60 GPSTs in Xuhui District.The service pack was defined using the mode principle.With the combination of quantitative study and by means of interview,the qualitative one tried to obtain civilians' expected value(E-value),satisfaction degree and evaluation to GPSTs as well as the understanding of the head of the Team towards GPST's prospect.ResultsGPST is necessary to the development of community health service in Shanghai, and is decided by the community comprehensive prevention,pre-payment of health insurance and health management.1190 GPSTs have been set up in Shanghai by 2007.1.The investigation on the equipments of GPSTs in Xuhui District1.1 The community health service station is the base of GPST.In Xuhui District, the average building area of the community health stations is 175.6 m~2,and 66.7%of them are within the residential area.None of the stations' rent need be taken charge by Department of Health.The average establishment rate of none- handicap equipment in the community health stations has been at a high level(75%),93.3%of that have toilet,85%of that have handrail and pothook in the toilet.1.2 The department constructing within the community health stations in Xuhui District is appropriate,including the separation of seven kinds of rooms,88%rate of the therapeutic room,transfusion room,health education room,family planning consultation room in the department construction and the realization of one room per doctor within 83.3%stations.Moreover,the equipments in these stations are relevant complete and the distribution rate of those equipments is at a high rate,including the stethoscope,the sphygmomanometer,the blood sugar apparatus,the emergency apparatus,the breathing apparatus,light catalysis air sterilize apparatus and sterilization apparatus.1.3 The investigation of Chinese Traditional Medicine services in those stations shows that the establishment rate of the Chinese massage bed is 68.3%,that of the acupuncture needle is 81.7%,of the measles scrapping board is 71.7%,of the moxa fumigate is 73.3%,of the electroacupuncture is 70.0%,of the cupping is 85.0%and of the electronic moxibustion apparatus is 75.0%. 2.The analysis of the human resources of GPSTs and demand evaluation of their knowledge;2.1 Within the 60 GPSTs,there are 427 professional personnel,including 229 clinicians among whom there are 61 Chinese traditional physicians,124 nursing staffs and 74 public health doctors.Of the 427 employees,69.8%have formal employees and the average working years are 2.09.The average age is 40.51.The educational background is as following:1.9%are graduates,29.3%are undergraduates,32.3%are at junior college degree,36.1%are at secondary school level,0.5%are at junior high school level.The general situation of professional titles is as following:there are 0.2% senior medical consultant,5.2%associate professor,42.2%attending doctor,47.8% resident doctor and 4.7%are personnel with no title.The qualitative investigation shows that the liquid frequency of nurses is at a high level.2.2 80.72%of the interviewees participated in all kinds of trainings in the past years and their attitudes towards those trainings were positive.45%of the interviewees thinked the training effect is preferable,30%of them thinked the training effect is very good and 25%of them thinked it is so-so.The shortcomings revealed by the investigation are as follow:the training time was too short,the training was not highly thought of,the training chances were too little,the pertinence of the training was not of a high pertinence and there was a lack of practice.2.3 The investigation of the willingness of being trained shows that,of the interviewees,37.1%are long for trainings,44.8%are willing to participate to trainings,12.7%think trainings are good,2.8%of them are reluctant to participate in trainings and 2.6%of them do not want any training.As for the training style,of them, 22.3%prefer full-time one,20.2%like spare-time one,55.7%favor in-service one and 1.8%think there could be some other better styles.Moreover,the qualitative investigation has a similar result.The investigation of the demands for skill supplement shows that community working experience,public health knowledge and computer 67.7%,58.4%and 48.7%of the interviewees' demands abilities respectively. Different occupation personnel have different education demands,so trainings should be of pertinence.3.The preliminary study of GPST's basic service package3.1 The GPST's basic service package includes essential clinical services package and public health service package.3.2 According to the mode principle,the family healthcare service includes 12 basic family healthcare service items,including blood pressure measurement,vein injection,muscle injection,blood drawing and saving for testing,medicine allocation, bladder irrigating,ECG,physical therapy,acupuncture,Chinese massage,etc;three items,which are cupping,gastric tube inserting aerosol inhalation,need further study, and two items - enema and nonnasality treatment -are defined to be not suitable to put to operate within a family.3.3 According to the mode principle,the community Chinese Traditional Medicine service includes five basic items,including Chinese Traditional Medicine allocation,cupping,acupuncture,Chinese massage and plaster;two items,which are acupoint injection and measles scrapping,need further study,and two items-autotraction and fumigation & steaming -are defined to be not suitable to put to operate.3.4 According to the scoring method of abilities judging,the defined disease objects of GPST includes 106 sorts of diseases which the team could put to operate completely and still 55 sorts of diseases which the team should be gingerly to put to operate.Presently,there are 28 sorts of diseases couldn't be put to operate.3.5 According to the mode principle,the public health service package includes 109 basic items,and 6 items that are not suitable to put to operate,and 14 items that need further study.4.The study of the expectation to GPST4.1 To study civilian's expectation to GPST with expectation theory.4.2 As for a diabetes patient,when chronically serviced by GPST,his maximum expectation is that the GP could give him psychology induction while the GP is going on a treatment for him.4.3 Community residents' maximum expectation on the health education style held by GPST is that experts could offer free-fee therapy regularly.4.4 Community residents' maximum expectation on the family service is that the possible time limitation for a certain family service could be within one hour.4.5 Community residents' stable expectation on the average prescription expenses is 150-200ï¿¥.4.6 Community residents' maximum expectation on the drug amount of the outpatient prescription is one prescription for one month.4.7 Community residents' maximum expectation on the using of the outpatient Health Insurance Card is that paying down with the card and drug-taking could be realized.5.The investigation of the satisfaction5.1 As for the general satisfaction degree of the serviced towards the team,it is relatively at a high level.0.42%of them thinked highly of the team,67.37%were satisfied with the team,26.74%commonly accepted the team,3.37%were discontent of it and 2.11%were absolutely unaccepted.The general mark was 3.61.5.2 The reason for choosing a GPST to accept the first treatment is as follows according to priority:it is close to the habitation,it's not necessary to go to the hospital when it is just a indisposition,the attitude of service is good,the expense is relatively cheaper,the community doctors know more about their state of illness,they are more acquainted with the community doctors,etc.5.3 The functions of the community health station are as follows:daily medicine distribution(89.10%),therapy(88.50%),injection(41.80%),rehabilitation treatment (19.70%),health consultation(17.90%),physical examination(0.60%).5.4 Of those employees,10.85%were definitely satisfied with the team,43.41% were content of the team,36.50%commonly accepted the team,6.52%were discontent of it and 2.72%were absolutely unaccepted.The general mark was 3.53, and public health doctors gave the lowest mark.The employees of the team had the lowest satisfaction towards their incomes.6.The qualitative study of running models of GPSTThe following results are from interviews on 15 heads of the Team:6.1 The heads of GPST in Xuhui District all agree the out and inner management model,and their ideas have improved greatly.The GPST gains the support from the community health service center and the community organization.The civilians utilize the essential clinical service mostly.6.2 The lack of human resources,relative low quality of employees,relative low informatization level,the lack of residents' understanding and supporting and corresponding laws and regulations and so on have become the main factors which constraint the further development of GPST.7.Estabslishment of the new quaternate GPST model and effect evaluationThe insufficiency of human resources is the biggest difficult for GPST,which can be resolved by chronic disease self-management program and social workers at the extent.The quaternate model is born.Health social workers have been greatly developed overseas,while it is still just beginning in China.According to the present healthcare relationship in China,it is of a necessity and significance for the existence of health social workers.As to resent domestic studies,the service of health social workers focuses on psychology guidance, doctor-patient communication,etc.For the characteristics and properties of General Practitioner Service Team,the appearance and existence of health social workers have their theoretical basis and great significance.The practice results from the Xujiahui and Caohejing community health service centres of Xuhui District in Shanghai reveals that it is great necessary to interpose health service workers into GPST.The interposition enriches the services of the team and expands the range and depth of the services of the team so as to furthest the professional function of healthcare resource.The analysis with ROCCIPI methods proves that the interpose of social workers is feasible,the practice too.Three different models are concluded as follows:triad model,quaternate model, and catenarian model.The quaternate model is the most suitable through their advantage and disadvantage.8.Development strategy to GPSTNine key factors are distinguished from the quantitative and qualitative study data with Scenario Analysis and three development sceneries are established.GPST's strengths,weaknesses,opportunities and threats are analyzed with SWOT analysis.Ten strategies are put forward for its sustainable development.The following is: to collocate human resources reasonably,to establish perfect training system,to improve GPST's inner nmning-system,to improve GPST's out support surroundings.