Implementation Effect Evaluation Of Family Doctor Contract Service System For The Elderly In Anhui Province Based On RE-AIM Model

Family doctor contract system is an important choice to deepen the reform of medical and health system,strengthen primary medical and health services,and realize the strategic goal of "healthy China".It is also a key means to implement the hierarchical diagnosis and treatment system,and an important driving force to alleviate the contradictions in medical and health needs in China and realize the goal of new medical reform in China.Since 2016,the state has successively issued a number of policies,such as the Guiding Opinions on Promoting Family Doctor Contract Services and the Guiding Opinions on Standardizing the Management of Family Doctor Contract Services,to promote family doctor contract services and plan contract service packages with targeted services according to residents’ health conditions.In the 13 th Five-Year Plan for deepening the reform of the medical and health system,it is proposed to improve the contract service system of family doctors,improve the capacity of primary medical services,deepen the reform of the payment method of basic medical insurance,and encourage urban and rural residents to sign contracts with primary doctors or family doctor teams.In March 2022,the National Health Commission and six other departments jointly issued the Guidelines on Promoting the High-quality Development of contracted Services for Family Doctors,proposing to gradually build a family doctor system with family doctors as the "gatekeepers" of health,and basically achieve full family coverage by 2035.Starting from 2022,the coverage rate of contracted services for the whole population and key groups will increase by 1 to 3 percentage points every year,and by 2035,the coverage rate will reach more than 75 percent,basically covering all families,and the coverage rate for key groups will reach more than 85 percent,and the satisfaction rate will reach about 85 percent.However,in recent years,with the increasing aging,urbanization and the high incidence of chronic diseases,the unbalanced regional distribution of medical resources,the disease-centered medical and health service model is difficult to meet the growing medical and health needs of residents.This requires a qualitative leap in the quality and level of services provided by medical institutions at all levels.The implementation of family doctor contract service can promote the shift of the focus of medical and health work and the sinking of resources,make reasonable use of health resources,reduce medical costs and improve the health status of the whole people,enhance residents’ sense of obtaining medical reform,and lay a foundation for the realization of the first diagnosis at the grass-roots level and hierarchical diagnosis and treatment.With the gradual deepening of the hierarchical diagnosis and treatment system,the expansion of the coverage rate and the increase of the signing rate of family doctors,various problems derived from the signing of family doctors are gradually emerging,such as the shortage of family doctors,especially general practitioners,the lack of personalized signing services to meet the health needs of residents,and the low quality of signing services.The establishment of hierarchical diagnosis and treatment system and the implementation of family doctor contract service are the development direction of medical and health services in China at present.Anhui Province started to carry out pilot contract work in community health service institutions at the end of 2011,which has experienced a long process from "strange exclusion--household name--trial experience--service recognition" and achieved initial results.However,there is still a certain gap between the expected target and requirements.Five evaluation dimensions of RE-AIM framework(coverage degree of Reach target population,Effectiiveness intervention effect,participation of Adoption agencies,Implementation of intervention implementation,and Maintenance program)Coverage of service projects contracted with family doctors In this paper,RE-AIM framework is applied to comprehensively evaluate the implementation status and effect of family doctor contract service for the elderly in Anhui Province.In order to improve the elderly’s awareness of family doctor contract service and improve the practical effect of contract service utilization,countermeasures and thoughts are proposed,and reference basis is provided for improving family doctor contract service.