Research On The Status Quo And Influencing Factors Of Family Doctor Contract In Main Urban Area Of Chongqing

With the rapid development of economy,regional medical differences are obvious.WHO in the 2008 world health report pointed out that the primary health care as a humanist care,important in the past,now is more important in 2000 the world health organization(WHO)on overall performance evaluation of 191 members,China 144,equity in health financing and distribution,the evaluation of the Chinese listed 188,namely the fourth from bottom,with China's national strength is a far cry from these data,the lag of medical enterprise has seriously hindered the development of China,on the reform of the medical career development is imminent.As an important measure of hierarchical diagnosis and treatment,the family doctor system can effectively reduce the phenomenon of "difficult and expensive medical treatment".But the family doctor system still has many problems in the development process.Therefore,this study conducted questionnaire survey and interview on community residents,family doctors and community leaders in the main urban area of chongqing to study the influencing factors of residents' signing contracts,explore measures to further improve the signing service of family doctors,and provide some Suggestions and measures for further improving the family doctor system.Nine communities health centers in three districts and counties with good,medium and poor implementation effect of family doctor system in the main urban area of chongqing were selected as sample districts and counties and sample community health centers.By using random sampling methods,561 residents and 118 family doctors are investigated.We use descriptive analysis,Chi square test and logistics regression to analyzed the data.At the same time,the person in charge of the community health center was interviewed to understand the current implementation of the family doctor system in the community health center,as well as the difficulties and opportunities encountered.In the survey of basic situation of community residents,397 signed residents and 159 non-signed residents.Among them,tuwan community in shapingba district has the largest number of contract signing,and huaxi health center in banan district has the least number of contract signing.Women make up the majority of contracted residents,54.2 percent.Most of the signed residents are middle-aged and elderly people,and most of the signed residents are teachers.Most of the non-contract residents are male and most of them are workers or individuals.100% of the signed residents have heard of family doctors,and 85.5% of the non-signed residents have heard of family doctors,but they are not familiar with the specific work of family doctors.77.3% of the residents who signed the contract were willing to renew the family doctor contract,and 78.0% of the non-signed residents were willing to sign the family doctor contract.According to the results of chi-square test,the main factors influencing the renewal of family doctor are location,gender,education level and whether the residents have chronic diseases.The main factors influencing the signing of family doctors for nonsigned residents are whether they agree to go to the primary medical institutions for treatment first,their understanding of the specific work of family doctors and the publicity of the family doctor system.According to the questionnaire survey of family doctors,women account for 69.5%,and most of them have bachelor's degree and junior professional title.Family doctor teams have been established in the communities where most family doctors are located,but due to the small number of family doctors,the number of community residents is large and the work pressure is high.According to the interview with the person in charge of the community,the signing rate of family doctors in the sample community is about 20%-30%,which is different from that in Beijing and Shanghai.Therefore,it also shows the development space of family doctor system in chongqing.Through field research,it can be seen that the factors affecting residents' signing up for family doctors are still mainly centered on their awareness of family doctors and the quality of family doctors' service.Community residents have a certain degree of awareness of family doctors,but they are not profound,which affects the community residents' willingness to sign up for family doctors.At the same time,the community also attaches great importance to the quality of family doctors' diagnosis and treatment.Therefore,the government should strengthen the publicity activities of family doctors,carry out more publicity free clinic activities,and improve the awareness of community residents.At the same time,strengthen family doctor training,improve family doctor treatment.The government can also build corresponding incentive mechanism and supporting system,guide family doctors to provide services to family doctors,ensure the enthusiasm and logistics support of family doctors,and further develop the family doctor system.