| BackgroundBasic medical and health is the terminal link of constructing three-tertiary medical service system, the main carrier of "keeping basic, strengthening grass-roots, constructing mechanism". Improving the construction of basic medical service system is the emphasis of deepening medical reform health and family planning. Establish an effective and reasonable hierarchical diagnosis relationship and improve the current medical treatment dilemma is one of the emphases of deepening medical and health system reform. However, to set up the lasting hierarchical diagnosis relationship, improving the level of basic medical service is particularly important.The establishment of the family doctor system is an important measure to improve the level of basic medical and health service, ensure and improve urban and rural residents’health, and promote the transformation of medical and health service model. And the establishment is an important trend of basic medical and health system reform. Family doctor as the main carrier of family doctor system, community as the scope, family as the unit, the goal is comprehensive health management. The system provides continuous, safe, effective and appropriate comprehensive medical and health service for each family and its members through the contract service, to promote the evolving pattern of medical treatment of "in community with slight illness, to hospital with serious illness, back to community for rehabilitation", and to promote the gravity down and resource sink of medical health work, achieving the goal of "everyone will have access to basic medical and health service".ObjectivesInvestigating signed residents, unsigned residents and the family doctors of pilot communities in Guangzhou, to understand the status of family doctor service of pilot areas in Guangzhou, and find the factors that influence the satisfaction of signed residents, the intend and influencing factors of unsigned residents, and then put forward the corresponding strategies and suggestions, laying the foundation for the full implementation of the family doctor service in Guangzhou.MethodsBased on the references and relevant questionnaires, we designed the investigation questionnaires under the guidance of related policies. Questionnaires include:(1) Signed residents questionnaire:signed residents’ basic situation; health status; treatment habits; the cognition and attitude about family doctor service; contract time; the satisfaction and renew willingness to family doctor service. (2) Unsigned resident questionnaire:unsigned residents’basic situation; health status; treatment habits; the cognition and attitude about family doctor service; the demand and willingness of contract to family doctor service. (3) Family doctor questionnaire: family doctors’ basic situation; the cognition and attitude about family doctor service; difficulty evaluation about the implementation of family doctor service items; the problems and suggestions about family doctor service.The Epidata3.1 was adopted to establish the database and enter data of questionnaires. The descriptive analysis, x2 test, Spearman correlation analysis, single factor analysis and multifactor regression analysis were achieved by SPSS20.0, and the difference has statistical significance when P<0.05.ResultsIn order to know the whole situation of the family doctor service of Guangzhou comprehensively, the research objects include signed residents, unsigned residents and family doctors in this study, therefore the research results are divided into three parts.The first part——signed residents.(1) Basic situation, health status and treatment habit.178 signed residents were surveyed in this study.84.6% of them are people that over 50 years old, and 64.8% over 60. Most signed residents are local community residents, married, and have medical insurance. The overall health of signed residents is not good. More than seventy percent of them is general or poor (75.8%), and 76.8% is suffering from chronic diseases. Vast majority of signed residents (87.6%) prefer primary care institutions when meet common diseases or frequently-occurring diseases, and 96.5% in favor of to the community clinic when meet non-emergency. As well as they support the viewpoint "in the community with slight illness, to the hospital with serious illness, back to the community for rehabilitation" very much (97.0%), which is introduced by the national.(2) Cognition, attitude, willingness to renew the contract and overall satisfaction.Among the signed residents,4.0% still don’t know what family doctors are, and 16.6% don’t know who their family doctors are. Only 38.9% know the preferential measures that can be enjoyed after signed. Introduction by doctors when the residents accept medical service at community institutions is the preferred way to accept relevant information, also the most effective propaganda way.In this survey, the average time of signed residents is 14.380 ± 9.224 months (1 ～36 months). The satisfaction after signed from high to low is:service attitude, medical fee, medical level, exchange time, service effect, waiting time, service range. Some residents has never experienced the family doctor service after signed.27.5% of signed residents said there is no problem about family doctor service. The dissatisfaction from high to low is:less service, long waiting time, other aspects (most of them is drug problem), general service effect, less communication time, bad service attitude, and medial medical level.94.6% of the signed residents are willing to renew the contract. In the single factor analysis, there are several factors as follows that influence it:common and frequently-occurring disease preferred medical institutions, whether agree to go to community medical institutions to see a doctor when sick (non-emergency), whether agree with the viewpoint "to the community with slight illness, to the hospital with serious illness, back to the community for rehabilitation", whether has heard of family doctor, whether know who his family doctor is, satisfaction of family doctor service, and whether it is necessary.84.3% of the signed residents were satisfied or basically satisfied with family doctor service after signed. According to multiple factors regression analysis:the influence factors of family doctor service satisfaction of signed residents are that whether are the community residents, whether suffering from chronic diseases, whether take medicine for a long time, whether agree with the viewpoint" to the community with slight illness, to the hospital with serious illness, back to the community for rehabilitation", service attitude, service effect, waiting time, service range, medical level.The second part——unsigned residents.(1) Basic situation, health status and treatment habit.557 unsigned residents were surveyed in this study. Compare with signed residents, the basic situation of unsigned residents is relatively balanced,and health status is better.90.4% of them feel general or better, and 41.4% suffer from chronic diseases. There is no significant difference between signed residents and unsigned residents at the time walking from home to the community (x2=2.825, P=0.244). There are differences between the signed residents and unsigned residents in respect of treatment habit——"preferred medical institutions for common and frequently-occurring disease" (χ2=18.845, P=0.000). 87.6% of signed residents preferred community medical institutions, but unsigned residents is 71.6%; 18.2% of signed residents preferred tertiary hospitals, but the proportion of signed residents is only 7.9%.(2) Cognition, attitude, demands about family doctor and willingness to sign.The majority (77.0%) of unsigned residents heard of family doctor, compared with signed residents (96.0%). The difference was statistically significant (χ2=32.335, P=0.000), and the cognitive rate about family doctor of signed residents was higher. About the propaganda way of family doctor, TV, radio, newspapers and other traditional way is the preferred and the most effective way that residents receive related information. The second is introduction by doctors when the residents accept medical service at community institutions. The reality and the residents’viewpoint about the most effective propaganda way are consistent. In terms of unsigned residents’demands for family doctor service, the demand rate of health examination is highest accounting for 49.4%, then is appointment (41.0%), the screening and management of chronic diseases (29.8%), the treatment of common and frequently-occurring diseases (29.7%), the demand rate of team service as the lowest, only 4.2%. Nearly half (46.0%) of unsigned residents said that they know the family doctor service has been carried out in their communities, and the vast majority of residents (96.5%) agreed with the service, but over half (57.8%) residents said that "they can move now", "still healthy", didn’t need a family doctor, and didn’t want to sign up.The leading cause of residents who didn’t want to sign up is that they don’t understand the policy of family doctor service, the second is that they are reluctant to change the old habits, and the next is the poor hardware of community medical institutions. Only a few residents didn’t want to sign up due to distrust for community doctors. In the single factor analysis, there are 10 factors that influence the willingness of residents to sign up, as follows:gender, age, level of education, health status, whether has heard of family doctor, whether know their own community has carried out the family doctor service, the attitude about family doctor service, whether need a family doctor for you and your family for health management, whether agree to go to community medical institutions to see a doctor when sick (non-emergency), whether agree with the viewpoint "in the community with slight illness, to the hospital with serious illness, back to the community for rehabilitation". According to the binary logistic regression analysis after eliminating the interference factors, there are 4 factors affect the willingness to contract:gender, level of education, whether agree to go to community medical institutions to see a doctor when sick (non-emergency), whether need a family doctor for themself and their family for health management.The third part——family doctor.(1) Basic situation.97 family doctors were surveyed in this study. Women accounted for 64.9%, 58.8% majored in general practice medicine, and 81.4% got bachelor degree or graduate degree.58.7% of general practitioners have worked 5 years or above. The highest percentage of monthly income (before tax) is 5001-7000 yuan (40.2%).(2) Cognition, attitude and difficulty assessment to family doctor serviceThe vast majority of family doctors (96.9%) agree with the government’s family doctor service policy, and know the Family Doctor Service Package of Guangdong Province. For the primary responsibility system of general practitioner, team work system and team performance assessment, the agreement proportions were 96.9%, 97.9% and 88.7%. Nearly half of the family doctors said that number of signed residents for one family doctor is appropriate when the number less than 500, followed as "500-1000". The actual signed number is:324.850±416.990 (0～1500). The differences were great between different family doctors. To most family doctors (87.2%), the proportion of family doctor service workload of the total was less than 50.0%, half of them below 25.0%.For the items of Family Doctor Service Package of Guangdong Province, most of the family doctors said that the implementation difficulty can be accepted. The top three difficult items were home health care (44.8%), door-to-door service (39.6%), and family medicine cabinet management (21.6%). The family doctors in this survey said that there are many difficulties in the process of family doctor service, ratio from high to low as follows:medical staff is short, participation enthusiasm of community doctor was not high, and special funding is not enough. The top four methods that improve the enthusiasm of family doctors were improve the treatment, national policy support, improve the social status and improve the level of profession.Conclusions1. Because of significant outcome of family doctor service in the aspect of propaganda, residents and family doctors’ awareness and approval ratings high, but still have cognitive biases on the connotation of family doctor.2. The residents’ demand degree for family doctor service matchs family doctors’s own capacity providing corresponding service, while community lack of work full-time family doctor with corresponding ability at present.3. The habits, acknowledge, attitudes, and demand to family doctors produce an effect on willingness to sign, in which the influence of demand is the largest.4. The demographic situation, chronic disease prevalence, medical and family doctor service experience of signed residents affect the overall satisfaction on the family doctor service, and then affect willingness to renew.5. The smooth development of the family doctor service rely on breakthroughing numerous bottlenecks.6. Go deep into signed residents, focus on the implementation of the signment, finally let people truly feel the signed benefits.7. Increase the propaganda, promote the signment, and let people really understand and accept the family doctor service.8. Expand the scope of the family doctor service content, rich family doctor signing and service methods.9. Improve the family doctor’s treatment, strengthen the training of family doctor, improve the quality of family doctor service, to cultivate qualified family doctors.10. Increase the special funds investment and policy supportment, improve the social status of family doctors, in order to promote the long-term development of the family doctor service. |
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