| Aims To understand the efficacy of implementation and existing problems of the family-physician services for seniors;To explore the influence factors of seniors on the contract of family physicians;To make suggestions for the services from family physicians;To Provide the guidance for the next step in the family-physician services for seniors at H District in Guangzhou.Objects and methods In this study,family physicians and senior citizens from six public community health service centers at H district in Guangzhou City were recruited as the research subjects and the questionnaires were designed and included.The questionnaire was divided into:(1)The family physician questionnaire consists of the basic conditions of the family physicians,the Cognition,attitudes and required services from physicians,and workload,manner and content of services,assessment and income,evaluation of the system,difficulties and problems existing in current family physician services.(2)The senior questionnaire: Including the basic information,awareness of the situation,demand,signing and utilization,satisfaction,and attitude towards family physician-type services.The database was established using Excel2007.The SPSS23.0 software was utilized to do the descriptive analysis,Chi-square tests,and the principal component analysis,which is statistically significant to the P < 0.05.Results Part I: Results based on family physician survey and investigation 193 family physicians were recruited for the study,72% of them were women,76.7% were undergraduates,48.7% were engaged in medical work for 10 years,56% were junior professional titles,and 61% were part-time family physicians(A part-time family physicians a dual task of taking on basic medical and family services).94.8% of them claimed that the workload increased after the family physician system was implemented.30.1% means that the existing workload cannot be borne.58.5% indicates that it is difficult to complete the existing workload,and only 11.4% indicates that the existing workload can be completed.In terms of service mode,all physicians provide outpatient consultation,health talks,and telephone consultation,39.4% provide home visits,13% online consultations.The most frequently offered services are outpatient visits(100%),health talks(22.8%)and telephone counseling(10.9%).In terms of service content,all physicians provide health education,common disease treatment,health consultation,chronic disease management,medication guidance,physical examination and referral,30.1% provide rehabilitation care,and 39.4% provide family care.The most frequently provided services were chronic disease management(89.6%),medication guidance(82.9%),and health counseling(51.3%).Only 13.5% of physicians are highly motivated.95.9% of them complained that personal income did not increase after the implementation of the family care system,and 92.7 percent believed that the compensation was not matched with the amount of service provided,and the remuneration was low.The main points of the work assessment of family doctors are the completion rate of contract and task indicators,and other assessment works include outpatient visits(55.4%)and referral rates(21.8%).69.4% of them consider the family doctor system is running in a general way,26.4% think the effect is not good.55.4% believe that most of the contracted seniors never use the services provided by family doctors.52.8% think most of the seniors choose high-level hospitals when they got sick first.Physicians believe that the current difficulties are mainly the number of jobs(69.4%)and the number of contracts(59.6%).The current problems in the system are: policy propaganda is insufficient(76.7%),residents' awareness(75.6%),the discount is not enough,the residents lack of attraction(65.3%),insufficient incentives,less attractive to the medical workers(57.0%),the family doctor shortage(57.0%),imperfect information systems(51.8%).Part II: The results of the survey based on the signed seniors 275 seniors who signed a family doctor were surveyed,accounted for 61.4% of all the old people,60.7% were women,81.1% were 65-75 years old,89.5% were registered in Guangzhou,with a primary culture and below 41.8%,85.5% suffered from chronic diseases,all had health insurance.Most of them are basic medical insurance of urban and rural residents(46.2%).13.8% of the signed seniors expressed a good understanding of the family doctor policy,47.6% expressed some understanding of family doctor policy,and 38.5% said that family doctor policy had been heard.The main way for the seniors to know the family doctor's policy is to go to the neighborhood committee for free physical examination(49.8%).75.3 percent of seniors said they would first visit a community hospital after getting sick.170(61.8%)signed seniors did not go to the family doctor.The reason is: so far,no need(39.3%).The services from large hospitals is much better(19.4%),the medical equipment and drugs in community hospitals are limited(8.2%),lack of confidence in technical level of family doctors(6.5%)etc.105(38.2%)seniors who signed and visited the family doctor indicated that the services provided by the family doctor team were mainly chronic disease management,health education and health examination.15.2% thought it is very convenient to see a doctor or consult a doctor,38.1% thought it relatively convenient.80% said that there was a decrease in medical expenses at the family doctor's office.87.6 percent of seniors who signed up and visited the family doctor said the doctor-patient relationship had improved,while 38.1 percent said they were very optimistic about family doctor services and 46.7 percent were relatively optimistic.22.9% said that the community health service center should not be able to access the medicine they wanted.36.2% indicated that the family doctor had recommended upward referral when the patient was in need,and 24.8% referred to the high-level hospital under the recommendation of the family doctor. The senior's satisfaction degree to the family doctor team is as follows: service attitude>medical costs> communication time> effect of service> visiting service= medical level> appointment and referral>treatment scope> the waiting time> medical facilities and drug supply.Very satisfaction and relatively satisfaction together account for 72% of all options.In general,the seniors are relatively satisfied with the services of family doctors,but there is room for improvement.The dissatisfaction of the seniors is mainly manifested in the scope of treatment,medical facilities and drug supply,waiting time,appointment and referral.Part III: The results of the survey based on the unsigned seniors 173 seniors who has not signed a family doctor were surveyed,accounted for 38.6% of all the old people,59.0% were women,74.0% were 65-75 years old,89.0% were registered in Guangzhou,with a primary culture and below 67.6%,90.8% did not suffer from chronic diseases,all had health insurance,basic medical insurance of urban and rural residents is65.3%.Unsigned seniors have a low awareness of family doctors.22.5% said that the family doctor policy was not known,49.7% said that the family doctor policy was heard,and 27.7% expressed some understanding of the family doctor policy.The main way for seniors to know the family doctor's policy is to go to the neighborhood committee for free physical examination(31.2%).The most important thing for seniors is the technical level of family doctors(50.9%).They believe that the services provided by family doctors are physical examination(100%)> Health Education(92.5%)> appointment(79.8%)> chronic disease management(71.1%)> family sickbed service(37%).48.6 percent of seniors said they would first visit a community hospital after getting sick.Reasons for not signing a family doctor: do not understand family doctor signing policy(44.5%)> don't know how to sign up(28.9%)> afraid after signing they could not choose the doctor freely(12.1%)> the medical equipment and drugs in community hospitals are limited(6.4%)> distrust family doctors' medical level(2.9%)> there is no need(1.2%).Part IV: Research on the influencing factors of seniors signing family doctors Chi-square results showed: gender,age,household registration of seniors have no statistically significant differences in the family doctor's contract rate(P > 0.05).Education,chronic disease,the type of medical insurance purchase,awareness,the choice of medical treatment tendency and community first diagnosis have statistical significance in the family doctor's contract rate(P<0.05).The overall level of education for the signed seniors is higher than that of the unsigned ones.The rate of chronic disease in the contract group was higher than that of the unsigned group.The proportion of medical insurance,new rural cooperation,public health care and commercial insurance for the purchase of urban workers in the signed seniors is greater than that of the unsigned old people.The signed seniors are better aware of the policy of the family doctor than the unsigned old people.Seniors who have not signed the contract pay more attention to the length of work,education,technical level and specialty of the family doctor than the ones signed.The community first-diagnosis rate of the signed seniors is greater than that of the unsigned ones.Conclusions 1.The results of senior family doctor service at H District in Guangzhou are good: the satisfaction of the seniors is better,the doctor-patient relationship has been improved,the medical expenses of the seniors have been reduced,and the convenience for seniors to get health care services has been improved.2.The existing problems of family doctor service for seniors at the H District in Guangzhou are: the burden on the work of the family doctor is heavy and the proportion of part-time family doctors is high.The examination and incentive system of family doctors is not perfect,and the enthusiasm of work is not high.The service skills of family doctors need to be improved and the conditions of service need to be improved as well.The information service platform cannot be interconnected and the health files have not been shared.The publicity of family doctor service is not enough,and the identity of seniors needs to be improved.Suggestion 1.Scientifically draw up the talent introduction plan for physicians and rationally arrange the workload for physicians.2.Unicom integrated information system to realize the establishment and sharing of health files.3.Strengthen training and introduce specialist to join the family doctor team to improve family doctors' service capabilities.4.Improve community service conditions and enhance community service capabilities.5.Strengthen the establishment of comprehensive management information systems for basic medical institutions and refine performance evaluation indexes.6.Focus on the influencing factors of signing contracts,step up publicity efforts to increase the awareness and signing rate for seniors. |
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