| ObjectiveCarrying out the family doctor service is an important measure of our new round of medical reform.The demonstration community health service organization represented by Guangzhou,Shenzhen and other places has taken the lead in actively exploring and practicing the construction,management and operation of the family doctor service team.But there had been no research reports in our province family physician and problems.An in-depth understanding of the current situation and existing problems of family doctor signing service is of great significance for the implementation of family doctors signing services,promoting the policy of new medical reform,and achieving hierarchical diagnosis and treatment.Entrusted by the Guangdong provincial health and Family Planning Commission,this study investigated the status of family doctor service in many cities in Guangdong province.In order to systematically optimize and to perfect the family doctor service system in Guangdong Province,we provide the scientific basis for the service effect of the family doctor service team.The purposes of this study include the following.?1?Based on the investigation of family doctor service in different regions of Guangdong province with different economic development level,this paper analyzes the current situation of family doctor service in Guangdong province.?2?We aimed to research and to analysis difficulties in developing family doctor service different economic level areas.We also combined the operation status of the family doctor service and put forward corresponding improvement strategies and countermeasures for the existing problems.MethodsQualitative and quantitative methods were used in the study.Quantitative research mainly includes questionnaire survey of residents and primary medical staff.The method of multistage stratified random sampling is adopted in this study.A total of 12 prefecture level cities in Guangdong were investigated.Research covers the Pearl River Delta region?Foshan,Dongguan,Zhuhai,Huizhou,Shenzhen,Guangzhou?and non Pearl River Delta region of Guangdong includes eastern area?Shantou,Chaozhou and Meizhou?,western area?Zhanjiang,Maoming?and northern area?Qingyuan?.We surveyed 24 community health service centers with a total of 5106 residents and 1171 primary health care workers.The questionnaire was designed on the basis of literature review.After discussion,argument,revision,eventually formed.The investigation includes: 1)community residents survey content: gender,age,education level,occupation and other demographic characteristics,service contract by family doctors,community residents' awareness,and the use of community residents to the health service demand survey.2)the investigation content of medical personnel includes: understanding the contracted service team running the family doctor,present in advance of the family doctor service in the process of signing and the team's primary health care institutions problems.Qualitative research is to further understand and master the relevant theories of family doctor signing service through the literature research and related data collation and analysis.We have read the domestic and foreign family doctor signing service development and the operation present situation.We also interviewed community health service management staff to understand the problems and suggestions of family doctors signing services,and to understand the services of signing services from the perspective of service providers.Including the establishment of health records,service patterns and content,key target crowd management,common chronic disease management.The collected data is input and processed by Excel and Epidata Manager.Qualitative data using analysis and summary method.Quantitative research data were analyzed by statistical software SPSS17.0.Statistical numerical data described by the mean and standard deviation,compared with independent samples student's t test or analysis of variance count data statistics of different groups were described with ratio or proportion.Single factor analysis used Anova variance analysis,and multivariate analysis used logistic.Different groups or percentages were compared using chi square analysis.A statistically significant level was set at =0.05.The survey results are mainly summarized according to region?Pearl River Delta area and non Pearl River Delta area?.Results1.residentsFamily physician awareness: the survey included 5114 residents in 10 cities in Guangdong province.Thirty-six point three percent of residents had heard about the family doctor service,including 31.5% in Pearl River Delta Residents and 47.7% non Pearl River Delta Residents?non PRD region?.There was statistical significance between Pearl River Delta and outside the non PRD region and the difference??2=123.369,P<0.01?.The consultation of family doctor service in different regions of Guangdong mainly comes from community hospital staff,accounting for 71.9%.Family doctor service signing situation: fifty-two point nine percent of the residents contracted to sign contracts.Among them,the Pearl River Delta residents number is 47.1% and the non Pearl River Delta region is 56.4%.The signing rate of different region has statistical difference??2=18.029,P<0.01?.The factors affecting the willingness of signing residents in the Pearl River Delta are the prevalence of chronic diseases.Effect of non Pearl River Delta Residents contract will include the following factors: age,compared with 20 years of age groups,the age group of 41-60 OR=11.546?1.838-72.511?,above 60 years old group OR=16.569?2.518-109.016?;a monthly income of ?2000-4000 are more willing than the low income??2000?population,OR=0.326?0.183-0.580?.People who chose the community health services / health stations as the first consulted hospital,community health services / health stations are more willing to sign the service,OR=3.013?1.70-5.34?;whether there are health records?OR=13.993,6.167-31.747?and reduce the medical expenses of the effects of other factors have influence on the result of?OR=5.146,2.795-9.473?.After signing the service situation in different regions: knowing your family doctors' name??2 =7.735,P<0.05?and contact??2=11.806,P<0.01?were significantly different.In the non PRD region,the degree of understanding is higher.After the signing of the 1 years without family doctor service in the Pearl River Delta and non PRD residents were 74.3% and 45.3%.The results suggest that the utilization of family doctor services and the understanding of family doctors are better in non Pearl River Delta region.The number of receiving services between different regions within a year had significant difference??2 =178.696,P<0.01?.Service utilization is lower in the Pearl River Delta region.Why residents in different areas of Guangdong province are mainly for not signing the service is not clear?298 people?and that they do not need the family doctor service?409 people?,there are a few that I don't trust the family doctor?28 people?.Evaluation of contracted services: 67.1% of Guangdong residents believe that family doctor services play a more important role in disease prevention and treatment.Among them,the Pearl River Delta survey accounted for 59.7% of residents,non PRD residents believe that family doctors are more useful for disease prevention and control,accounting for 72.9%.There are significant differences among the two regions??2 =38.562,P<0.01?.61% of residents believe that family doctor services are more effective in reducing medical costs.The Pearl River Delta residents accounted for 50.8%.The Pearl River Delta residents think the family doctor is useful for disease prevention and treatment for 68.9%.There were significant differences among the two regions??2 =67.972,P<0.01?.70.9% of residents believe that family doctors are more effective in improving the convenience of medical treatment,of which the Pearl River Delta accounted for 65%,non PRD residents accounted for 75.5%.Among the two regions also showed significant difference??2 =26.312,P<0.01?.Demand for contracted services: surveyed residents of the Pearl River Delta said that 29.5% of the demand for family doctors,44% of non PRD residents.Of the 845 signed residents,79.6%?670?were in demand for family physician services.The remaining residents said there was no need for family doctor services.The proportion of residents who sign and demand PRD is 54.7%,and the proportion of non PRD is 88.1%.There were differences between the two areas??2 =109.438,P<0.01?.Many residents said they felt they did not need family doctor service during the investigation,but they were signed".As a result,this situation has a certain proportion.And in the Pearl River Delta region is more obvious.Residents in the Pearl River Delta region in demand for family doctor service is higher than the Pearl River Delta region.The difference was statistically significant??2 =106.778,P<0.01?.Multivariate regression analysis showed that the demand for family doctor service was mainly influenced by the time of walking to community health service institutions.Compared to the demand for family doctor service for more than 30 minutes walk,the demand for the 15-30 minutes walk group was lower,OR=0.320?0.149-0.688?.In addition,the community health service satisfaction is higher?OR=1.983,1.238-3.174?and that to reduce the medical expenses of function?OR=2.857,1.759-4.639?of the family doctor service needs of the residents of relatively high degree.The main influence factors of non Pearl River Delta Residents Demand for family doctor service is age?older than 60 years old compared to the age group of 21-40 demand lower,OR=0.367,0.202-0.668?,the level of monthly income??2000 compared with ?2001-4000,OR=0.469,0.295-0.745 group of lower demand,and patients with chronic diseases?OR=1.908?,1.054-3.455?,community health service center of first hospital?OR=2.112,1.329-3.358?.Community health service satisfaction was high?OR=1.866,1.189-2.929?,and the residents who thought they could improve the convenience of medical treatment?OR=4.409,2.749-7.072?had higher demand for family doctor service.In addition,residents outside the Pearl River Delta and the Pearl River Delta area residents in other areas,such as "family doctor contact"," health consultation period"," sign after the priority of outpatient service,family doctors hope to provide on-site service and other aspects to pay additional costs on both views significant difference.2.medical personnel survey resultsThe survey involved 1171 members of the family doctor service team.Including general practitioners,public health physicians and nurses.In the Pearl River Delta region for undergraduate and medical personnel accounted for more than 44.6%,significantly higher than the outside of the Pearl River Delta region??2=27.843,P<0.01?.Health care workers' monthly income of the Pearl River Delta region is significantly higher than that of outside of the Pearl River Delta region??2=218.986,P<0.01?.There are differences in the degree of understanding of the development of the family doctor service of medical staff in different areas??2=23.913,P<0.01?.The study shows that medical knowledge of family doctor services is higher among medical personnel in the non Pearl River Delta region.The investigation of community medical staff in 79.4% has been involved in carrying out the family doctor service work carried out in different regions,there are also differences??2=27.446,P<0.01?.At the same time,78.6% support the family doctor service system.Participate in the investigation of the medical staff think a team should have 2.74 GPS,the average GP for service 238.29 residents,there is significant difference between the views of staff in different areas?F1=15.766,P<0.01;F2=16.022,P<0.01?.Family doctor service burden and compensation situation,83.3% of the province's medical staff believe that the family doctor service will increase the workload.92.1% of the staff felt the need for compensation for the work.The main expected compensation in different regions "signing service fee??2 =0.312,P=0.856?","total amount of prepaid head"??2 =3.265,P=0.195?and "new services"??2 =0.990,P=0.610?there were no differences between the views.Medical staff suggestion of charge for family doctor service: 46.7% provide limited number of free medical appointment service.42.1% support for limited number of free home visits.56% support free regular cleaning of family medicine chest and guide medication.56.2% support free referral and referral.In the provision of family bed services,support for free?36.7%?and limited number of free?31.8%?based.49.1% support the provision of limited number of free on-site health counseling and guidance services.56.8% support for limited number of free post hospital follow-up visits.62% support for the limited number of free family health management risk assessments.In view of the above eight services,medical staff also gives more than the number of free offer or directly by a single / annual fees in the form of fees.3.qualitative research: the results showed that in the current process of contracted services to promote the development of the hand,the difficulty is the residents' self health responsibility consciousness is weak,the lack of understanding of the importance of family doctors,the government and the community of family doctor system propaganda is not enough.Another difficulty is the shortage of manpower in primary health care institutions.The overall business level of family doctors is not high,especially in the non Pearl River Delta region.At present,most provinces in Guangdong have adopted the policy of paying the total amount of medical insurance.The proportion of primary medical institutions is seriously insufficient,which limits the family doctors to serve more residents,and also reduces the quality of services provided by family doctors after signing.At the same time,the lack of a standardized set of service process planning results in a very difficult payment for the service.The problem is how to increase the performance of the total wages,and to establish the incentive distribution mechanism,play the guiding role of hard work and excellent merit pay.Finally,the medical and public health services in the primary medical and health information systems in different places in Guangdong are not effectively docked,showing a split form.Seriously affect the family doctor service and the development of grading treatment system.Conclusions1.The cognition,signing,utilization,demand and willingness to pay for family doctors in different regions of Guangdong province are different.The factors affecting the willingness to sign contracts among residents in the Pearl River Delta are the prevalence of chronic diseases among the residents.The factors affecting the willingness to sign up for non PRD residents are age,monthly income level,the choice of first visit institution,health records and the effect of reducing medical costs.The results show that the non PRD residents have better understanding of family doctor signing services and the utilization of family doctors.But the survey found that at present there are many residents in Guangdong,"signed",but also allows patients to the family doctor signing services can bring tangible benefits feel uncertain.At the same time,the young residents interviewed feel healthy and in good condition,so the willingness to sign up is not as high as that of the elderly.This result is particularly evident in the Pearl River Delta region.Therefore,the reasons for the non signing of residents in different areas in Guangdong are mainly because they do not understand and think that they do not need family doctor signing services.The use of contract services is based on understanding and cognition.The residents of Guangdong province for the family physician awareness needs to be further improved,especially for the signing of a lower willingness to young people,awareness,to provide convenient services for residents and residents can further improve the contract rate and improve the effect of service should be continued,many residents will improve the signing,publicity focus focus groups.The family doctor system has realized the service pattern based on the residents' demand to a certain extent.Studies have shown that the demand for contracted services by family residents in the PRD is mainly affected by the distance from walking to community health care institutions,the effects of service satisfaction and the reduction of expenditure.The signing of the family doctor service residents of the Pearl River Delta region demand mainly affected by age,monthly income,suffering from chronic diseases,first hospital,the choice of the community health service satisfaction and improve the medical effect of convenience and other factors.The contracted residents feel the benefits of family doctor services and enhance their sense of access and identity to basic medical care and health services.But still need to continuously improve the family physician: to improve medical staff service level,correct the inherent error concept,establish appropriate incentive measures;at the same time to strengthen the propaganda,the use of Medicare residents to guide residents to sign.In addition,the results show that door-to-door service is also the most intuitive experience for residents to sign the family doctor service,providing this service to the family doctor signing services in the development of a good boost.The demand and utilization level of health services in Guangdong will gradually increase in the future,and with the economic development of Guangdong Province,the utilization of primary health resources will continue to grow considerably.In the future,we should pay attention to improving the service capacity of the basic medical and health institutions in the Pearl River Delta region,so that the residents of the PRD can be more trusted to the primary health care institutions,so that they will be more willing to sign up for family doctor services.2.We should improve the level of medical staff.The survey found that the proportion of primary health technical personnel was unreasonable.College degree or less,medical staff accounted for more than half.The medical service industry is a technology industry that needs to be trained for a long time.Therefore,the current situation of low educational background and low level of technology will inevitably become the key bottleneck restricting primary health care services.In the process of signing the service of family doctors,we should strengthen the training and guidance of the members of the family doctor team to improve the overall understanding of the team and continuously improve their service ability.In addition,the government should seriously consider the burden of carrying out family doctor services.We should make a reasonable charge for special or stipulated service packages,and then transfer some of the funds to incentive compensation through the evaluation of the contracted service of medical personnel.Improve the salary distribution system,and further enhance the enthusiasm and initiative of family doctors.To ensure the coordination and enthusiasm of medical staff in the process of family doctor service,and form a virtuous circle to improve personal income through signing service.Income growth can attract more talents to stay at the grassroots level.It is also an important factor in fostering the family doctor's sense of pride and strengthening the stability of the family doctor team.In addition,to smoothly carry out the family doctor service,also need to increase the number of community medical personnel,medical personnel to strengthen the ability and team building,improve service quality and efficiency of medical staff in the community,to carry out cross sectoral action,establish a social support network,cultivate social capital,guide the integration of community resources.3.The result of interview shows that the family doctor service can be developed smoothly if the first visit system is implemented.The medical insurance system plays an important role of economic lever in establishing the community first visit system.We should improve the family doctor signing service,the related medical insurance policy and the payment system.To guide residents to rationally and comprehensively understand the functional orientation of family doctors,so as to improve the utilization rate of basic public health services and basic medical care in the community.As the scope and content of the contracted services of family doctors in Guangdong have not yet been clearly defined,it has led to the temporary signing of service fees as a means of raising funds for the work.Among them,family doctors adopt performance pay payment.However,there is no basis for the formation of relatively independent family doctor contract service investment,protection and tilt mechanism.Therefore,it is recommended to make reasonable fees for special or stipulated service packages,and then transfer some of the funds to incentive compensation through the evaluation of medical service personnel 'contracted service.Only the medical staff income growth in order to attract more talent to stay at grassroots level,work enthusiasm and initiative and further enhance the family doctor,formed to improve the benign circulation of personal income through the signing service.4.Informatization and information sharing are the hardware foundation for the promotion and development of contracted services of family doctors in the province.However,the medical and health informatization levels in different districts and counties in Guangdong are different.Especially,health archives haven't realized dynamic management and regional share.It is difficult for family doctors to provide comprehensive and continuous health care information,which makes it difficult for whole health management.After the medical insurance is synchronized in the province,the patient can be free to visit,and meanwhile,the difficulty of the localization management of the family doctor is correspondingly increased.To improve the health information construction of Guangdong residents' health archives is an important link to implement the contract service of family doctors.Through the interoperability of information integration,can effectively solve the problem of medical treatment of patients at all levels of medical institutions,but also can effectively promote grassroots first visit.Medical services can save costs and build more advanced medical applications through information sharing.Finally,we will improve the level of public health and basic medical treatment,and further assist the family doctors in signing up and signing up for their services. |
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