| The family doctor system is based on the general practitioners as the main carrier, community, family as a unit, a comprehensive health management as the goal, through the contract in the form of services, to provide continuous, safe, effective, appropriate comprehensive medical and health services and health management mode for the family and each of its members.There are more than 50 countries and regions to carry out the family doctor system in the world, which has achieved good effect in grading diagnosis and medical cost control. Shanghai community health service development has achieved good service accessibility, public welfare operation compensation mechanism, standardize personnel training mechanism, comprehensive functions and active service model, have the basic conditions to the "gatekeeper" development, is also facing further straighten out the medical order, further improve the service efficiency. China’s new round of reform of the medical and health system, aiming at the prominent contradiction in China, expensive and difficult to see a doctor, in 2011 May, the family doctor system pilot Xuhui, Changning 10 areas to start, according to "guidance" on the spirit of the city to promote the family doctor system files, explore the establishment of a new mode of family physician system, expand the content of community health services, improve service quality, and gradually assume the health of residents "gatekeeper" role.Facing the expansion of the service population, increasing demands for services, community health service workers in the "family doctor service team" mode of operation, how to improve the quality of service, how to effectively carry out the work is to improve the residents of the community health service’s trust and satisfaction, the key to ensure its sustainable development.ObjectiveSurvey of Shanghai Xuhui District family physician system pilot work carried out since the family doctor system work in Xuhui District family physician system present situation in signing and service, sum up experience and the existence question, proposed the solution countermeasure, provides scientific evidence for the specification of services and the continuous improvement of the community health service ability, make the general practitioner really play a gatekeeper health role, so as to more community residents to better carry out the connotation of the family doctor service system, especially for the study.MethodApplication of micro system framework of analysis, qualitative research and quantitative research methods are combined, for the community residents to investigate the cognition of the family doctor system, and job satisfaction, for the patients’health service satisfaction and community health service center medical staff on the job requirements and evaluation questionnaire. Qualitative research including service process observation, the patients and community health workers in-depth personal interviews, community health workers and managers focus group interview. The data was analyzed by descriptive and analytical method of combining. Including the main analysis methods:descriptive analysis, single factor analysis.Result1. Analysis of service attendersAnalysis of patient satisfaction in the process of service:most patients after illness choose community health service center, the main reason is:the price is cheap, the low proportion of self paid, the nearest convenient medical treatment processes, convenient, good attitude; evaluation of treatment of family doctors service attitude with the high, but less on drugs, poor equipment, medical communication is not sufficient to evaluate low.Evaluation of health service demand and utilization of community health service center patients:patients are mainly in elderly residents, the main disease is a common chronic disease in community. Most elderly people can easily access to the necessary drugs and routine treatment in a timely manner. Chinese medicine and appropriate technology are especially used by older people. The majority of patients the endure the drug limit and the control of medical insurance fees, and hope the government people-oriented, make adjustments to the medical insurance policy. Many community residents have too high expectation value to the family doctor system. Improvement needs focus on medical personnel quantity, treatment, drug treatment; also have higher requirements to the medical staff’s ability and quality.2. Analysis and current situation of human resource service team satisfaction of family doctorsA sampling unit community health human resources quality:community medical staff with bachelor, degree or above 47 people, accounting for 60.3% of the total number of doctors, mostly youth, community health human resources allocation proportion and educational level higher than the basic level of the national.Job satisfactions of medical staff are low on the "income", "promotion", "management" and others. The "work suggestions attention ", "leadership and employee relations" and "job security" have higher satisfaction.The community medical staff problems mainly including:(1) "Workload", including the evaluation target sometimes is not practical, some work and lack of systematic, lead medical staff to be kept constantly on the run. (2) "Community doctor’s low social status", "media publicity, lead to improper" family doctor for some work hard. (3) The level of information needs to be strengthened.3. Analysis of service process and service mode In view of the human condition of full coverage cannot guarantee services, mainly to provide basic medical and public health service focus groups or the population.The family doctor service team working pattern characteristics and management features showed the following characteristics:(1) the team family doctor service team for GPS, is the central figure in the team; (2) the division of work in accordance with the family doctor system cross management team services; (3) chronic disease management, health education and other public health programs the work, by the family doctor service team members to share the burden, according to govenment division of work area.Conclusion:The family doctor system work is good in Shanghai Xuhui District, but there are also some problems need to formulate relevant policies, to ensure the smooth realization of the family doctor system. The following countermeasures are to the family doctor system problems: 1. To strengthen the family doctor service propaganda, let people understand family doctor service system, establish a real family doctor as "gatekeeper health" concept.2. General practitioners training efforts:improve GPS occupation skills and service level, enhance trust residents for GPS.3. To establish a more reasonable family physician performance evaluation mechanism, remodeling the practitioner academic status, reshaping doctor occupation honor. To make a breakthrough in the treatment and compensation of general practitioners, to enhance the social status and income level.4. In the occupation development, set to tilt to the community health service center for titles and positions, enhance the occupation status of community general practitioners.5. Smooth two-way referral channels, to the family doctor and effective resources, changing the habits of residents. |
PDF Full Text Request