| ObjectiveObjective to explore the influence of community family doctor contract signing service under the guidance of general practice department of people’s Hospital of Zhengzhou University on the service satisfaction and chronic disease control rate of contracted patients with chronic diseases,as well as the help role in improving family doctor’s chronic disease management ability,evaluate the guidance effect,find out the problems and deficiencies,and provide reference for exploring the implementation scheme of family doctor contract signing service under the guidance of general practice department of general practice department of general hospital Empirical basis.Methods1.Literature research.Objective to understand the current situation of family doctor contract service in China and the development of general practice in general hospitals in China,and to sort out the advantages of general practice in guiding family doctor contract service in chronic disease management.It also summarizes the practical experience of the general practice department of the people’s Hospital of Zhengzhou University in guiding community family doctors to sign up for service in the past four years.2.Questionnaire survey.Two stage sampling method was adopted.First,two community health service centers in Zhengzhou City were conveniently selected.500 patients with hypertension and diabetes were randomly selected from each of the two communities who had signed family doctors.The community receiving guidance from the general practice department of people’s Hospital of Zhengzhou University was taken as the general practice Guidance Group,and the other community was taken as the non guidance group.From December 2020 to February 2021,the basic information questionnaire and European satisfaction scale(EUROPEP)were used to conduct a cross-sectional survey of the two groups of patients to understand their basic demographic data and satisfaction with family doctor contracted services,and to collect the blood pressure and fasting blood glucose control data of the two groups of patients.The differences of service satisfaction,hypertension and diabetes control rate between the two groups were compared,and the guidance effect of general practice department of general hospital on chronic disease management of community family doctors was evaluated.Spss.21 was used for statistical description and difference analysis.Chi square test was used for the comparison of count data between groups,rank sum test was used for the comparison of grade data between groups;t test and analysis of variance were used for the comparison of measurement data in line with normal test,and P < 0.05 was regarded as the difference with statistical significance.3.Qualitative interview.The semi structural interview was conducted with the team leaders of 12 community doctors signing teams(all of them are general practitioners of each team)under the guidance of general medical department of Zhengzhou University People’s Hospital,and their views and opinions on the guidance of general hospital general medical department to improve the management ability of family doctors with chronic diseases were understood.Results1.Literature research shows that since 2016,China has carried out the signing service of family doctors in an all-round way,which has made positive progress.However,the rapid expansion of the signing coverage also exposes the development problem of low quality of signing service.Chronic disease patients are the key group of family doctor contract service.Chronic disease management is an important part of family doctor contract service,and its management effect directly affects the quality of contract service.The disease spectrum of patients in general medicine department of general hospital is similar to that of grassroots,and they have more experience in general management of chronic diseases.The general practice department of people’s Hospital of Zhengzhou University,through nearly four years of exploration and practice,closely linked with the grassroots,fully integrated its own medical teaching and other advantages with the community family doctor contract service,to guide the community contract management of chronic disease patients as a breakthrough,in outpatient,ward,consultation,referral,training and other aspects to provide guidance and support for the community family doctor contract service,and promote the development of family medicine The quality and efficiency of student contract service have been improved,forming a characteristic guidance mode.2.A total of 1000 questionnaires were sent out,and 924 valid questionnaires were recovered,of which 471 cases were in general practice guidance group,with an effective recovery rate of 94.2%;453 cases were in non Guidance Group,with an effective recovery rate of 90.6%.In terms of population structure,there were no significant differences in gender,age,education level,medical insurance,occupation,income,self-rated health status and chronic diseases between the two groups(P >0.05);In terms of satisfaction evaluation,the scores and total scores of the five dimensions of doctor-patient relationship and communication,health care services,information acquisition and support,continuity and cooperation of medical services,and service organization in the general practice guidance group were higher than those in the non Guidance Group(P < 0.001);The satisfaction rate of patients in general practice guidance group was the highest(68.58%),and that of patients in non guidance group was the highest(55.19%).The satisfaction rate of patients in both groups was the lowest(20.17% in general practice guidance group and 9.27% in non Guidance Group);In the control of chronic diseases,the blood pressure control rate of the guidance group was 68.80%,which was higher than that of the non Guidance Group(53.85%,P < 0.001);the blood glucose control rate of the simple diabetes group was 56.25%,which was higher than that of the non Guidance Group(38.81%,P < 0.05);the combined control rate of hypertension and diabetes was 40.80%,which was higher than that of the non Guidance Group(26.55%,P < 0.05).3.The results of qualitative interview showed that all interviewees believed that it was necessary for the general practice department of general hospital to guide and help the community family doctors in the management of chronic diseases,and it was also helpful for the improvement of their service ability.The role of this guidance model is mainly reflected in improving family doctors’ general knowledge and medical level,enhancing patients’ trust and sense of acquisition,and enhancing the influence of community health institutions;the needs of family doctors to improve the management ability of contracted chronic diseases are diversified,mainly including the diagnosis and treatment thinking of common symptoms,the identification and treatment of acute and severe cases,the consultation and referral of difficult cases,and the grassroots At present,the existing problems mainly include the fragmentation of guidance and assistance,the lack of systematic coordination,the insufficient consideration of the actual situation and practical needs of the grassroots,and the lack of internal communication with the family doctor team.ConclusionsThe signing service of community family doctors under the guidance of general practice department of general hospital has effectively improved the satisfaction of patients with hypertension and diabetes on signing service and the control rate of blood pressure and blood glucose,which has played a positive role in improving family doctors’ chronic disease management ability.At the same time,we should pay attention to the organization,content,form,object and other aspects to further improve the guidance mode of general practice department of general hospital for the management of chronic diseases of family doctor contract service,improve the quality of contract service,and promote the sustainable and healthy development of family doctor contract service... |
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