ABSTRACT
【Objective:】 To understand the current status and problems of the doctor-patient relationship under the family doctor contract service system through the investigation on residents contracted by community family doctors, and to provide reference for constructing harmonious doctor-patient relationship and promoting the healthy operation of the family doctor contract service system. 【Methods:】 A questionnaire survey was conducted on 1 655 residents of a certain university community in Xi’an from January to February 2023 who completed family doctor contract services in 2022. Through the general situation of signed residents, the willingness of signed family doctors, and the satisfaction and opinions with signed family doctors’ services, this paper investigated the current status of the doctor-patient relationship and proposed corresponding improvement strategies. 【Results:】 A total of 856 residents(52.68%) were willing to sign the contract, 322 residents(19.82%) were unwilling to sign the contract, 397 residents(24.43%) expressed indifference, and 50 residents(3.07%) abstained from signing the contract. There was no statistical difference in service satisfaction between residents of different genders(P=0.292). The satisfaction of working staff aged 40-60(72.33%) was higher than that of retirees aged over 60(61.05%, P<0.001). The satisfaction of those with bachelor’s degree or above(58.23%) was higher than that of those with bachelor’s degree below(51.77%, P=0.008). The satisfaction of individuals living alone(70.21%) was significantly higher than that of non-solitary individuals(54.35%, P<0.001). The overall satisfaction score of contracted residents with contracted services was(4.48±0.14) points, including 4.31 points for satisfaction with service methods, 4.47 points for satisfaction with service attitudes, 4.52 points for satisfaction with service content, and 4.60 points for satisfaction with service effectiveness. 【Conclusion:】 Most community residents have a positive attitude towards family doctor contract services. Improving service satisfaction and strengthening doctor-patient communication are feasible ways to improve grassroots doctor-patient relationships and promote the operation of the family doctor contract service system.
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Objective:To explore the effect of family doctor-specialist dual-contract service model on the management of type 2 diabetic patients in the community.Methods:Two hundred patients with type 2 diabetes mellitus (T2DM)who were treated in Changfeng Community Health Service Center between February 2019 and January 2021 were selected as the study objects by cluster sampling method. Patients were randomly divided into study group and control group with 100 cases in each group. The control group was managed with the conventional family doctor contract service, and the study group was managed with the family doctor-specialist double contract service. After one year of management, the fasting blood glucose, 2 h-postprandial blood glucose, glycosylated hemoglobin, diet control, blood glucose monitoring, medication compliance, exercise and other health behaviors, quality of life and satisfaction of patients were compared between two groups.Results:After intervention, fasting blood glucose, 2 h-postprandial blood glucose and glycosylated hemoglobin in the study group were significantly lower than those in the control group ( t=10.29, 8.49, 7.99, all P<0.05); the health related behaviors such as diet control, exercise behavior, blood glucose monitoring, and medication compliance in the study group were significantly better than those in the control group ( t=9.78, 6.72, 39.81, 7.88, all P<0.05); the quality of life in patients of study group was higher than that of the control group ( P<0.05); the satisfaction rate in study group was higher than that of control group (90.0% vs. 69.0%, χ 2=6.39, P=0.031). Conclusion:Compared with conventional family contract service model, the double contract service improves patient self-management, helps to reduce the blood glucose level and gains high patients′ satisfaction, which is worth promoting and applying in the management of type 2 diabetic patients in the community.
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Objectives:To analyze the effectsof family doctor contracting service on the integration of medical care and prevention and its mechanism. Methods:Based on the representative sampling, 541 family doctors from seven districts were surveyed, and focus group and personal interviews were conducted withfamily doctors and other relevant informants. Descriptive statistical analysis was mainly used to analyze quantitative data and NVIVO 9. 0 was used for encoded qualitative data. Results ; Different contracted service models have different effects on medical protection on medical care and prevention. The contractingservice with the family doctor is helpful to facilitate the integration of medical care and preventive treatment ; the signing service that helps the team members to get effective incentives and personal paid contracts can help promote the combination of medical defense and preventive treatment ; whereby the service content includes basic medical treatment. Moreover, signing a family doctor contract with public health services can also help promote medical integration. Suggestions :Family doctor contracting services should implement team and individual contracted services. Designing a comprehensive service package that integrates basic public health service projects and basic medical and personalized health management services should be prioritized to reflect the concept of covered medical care and preventive treatment. A new approach to explore the path of integration of basic public health and medical insurance fundsshould be found to strengthen the combination of medical and preventive measures, and promote the transformation of general practitioners from service gatekeepers to health gatekeepers.
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Shanghai is the earliest city in China for starting family doctor system at national level. It has actively explored the contract service mechanism between residents and family doctors. It has developed from "soft contract signing of guiding residents to understand, contact and gradually accept family doctor services" to the " main and close contracting using the comprehensive service from medical institutions". This paper systematically analyzed the implementation status in " one community health center, one district hospital and one municipal hospital (1 + 1 + 1)" contractservice system of family doctor in Shanghai from the aspects of adjustment background, design ideas, progress and obstacles of the policy. Based on the analysis of barriers to the policyimplementation, some suggestions were put forward including the improvement of the contract service system in order to increase the number and build the capacity of general practitioners, and the optimization of the existing payment distribution systems.
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Objective To explore the effect of family doctor contracting service combined with drug therapy on the quality of life of patients with hypertension. Methods Selected in May 2016 to May 2017 in a city in a district of three community health service center clinics diagnosed with hypertension in patients with 840 cases, were given amlodipine besylate tablets treatment, and the implementation of conventional health management And community intervention. According to whether or not to accept the family doctor contract service is divided into observation group (a total of 435 cases) and the control group (a total of 405 cases). Health status questionnaire (SF-36) was used to assess the quality of life before and after the intervention, and the blood pressure control and quality of life improvement were compared between the two groups before and after treatment.Results There was no significant difference in the blood pressure level between the two groups before treatment. The systolic and diastolic blood pressure in the observation group were better than those in the control group (P<0.05). There were no significant differences in physiological function, physiological function, physical pain, general health, mental health, energy, social function, affective function and total score of SF-36 before treatment. The scores of the observation group were significantly higher than those of the control group before and after treatment. The difference was statistically significant (P<0.05). Conclusion Family doctor contract service combined with drug therapy can effectively control the patient's blood pressure levels, improve the quality of life.
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Community health service centers provide basic medical and public health service for the residents in community with the contract service mode.In the last five years our center started the construction of primary care team.The family physicians,nurses and public health workers formed the basis of health care team,and pharmacists and nutritionists actively joined the team work.The pharmacists provided health education of rational medication,participated in the ward-rounds of home beds and comprehensive management of chronic disease patients,and also conducted counseling clinic of drug use.The clinical nutritionists provided special nutrition guidance for patients,delivered nutrition education and conducted nutrition clinic.The involvement of pharmacists and nutritionist in contract service has greatly ungraded the primary care team,improved the quality of comprehensive care and provided better service for the people in the community.
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Exploring the Chinese family doctor system is an important policy issue in the process of deepening the medical and health care system reform in China. Changning District is the first comprehensive reform pilot area of community health service in the country,and the first demonstration area to explore the family doctor system reform. Since 2008,Changning began to gradually explore the family doctor system, and it has accumulated a lot of experi-ences which can be copied and extended in signing services to improve the family doctor,the full establish a compre-hensive system of hierarchical diagnosis and treatment system,the formation of the reasonable medical order that first primary diagnosis,two-way referral,upper and lower linkage,acute and chronic treatment. The four articles of this topic are from a survey from 10th anniversary of the comprehensive reform of the family doctor system in Changning District,Respectively from the service model,government coordination,performance appraisal and continuing educa-tion,to demonstrate the effectiveness of the policy and practice of the comprehensive reform about family doctor sys-tem in Changning District. With the implementation of the family doctor service on-site promotion meeting, the Changning model of Chinese family doctor system will provide valuable experience to explore and deepen the reform of the family doctor system.
ABSTRACT
Any reform needs to be converted into a series of institutional arrangements or micro behavior incen-tive mechanism,not only to ensure basic behavioral strategies of incentive compatibility between actors are motivated, but also to ensure that the behavior mode of grass-roots actors and policy direction are consistent. From the practice of community health reform of Changning District of Shanghai,it has generally gone through four stages:standardization construction and organization establishment,service model and mechanism reform, incentive mechanism design and connotation construction,platform build and performance improvement. Changning medical reform in the continuous deepening of policy trials and solve all kinds of new problems in the new medical reform policy implementation gener-ated by the process of policy and system innovation in the test(such as doctors weakened incentive problems after two lines of revenue and expenditure) and its compatibility with the environment problem. In order to realize the system of health care policy and provide stable behavioral expectations for the stakeholders to improve the welfare of stake-holders thereby continuously reducing the potential resistance to the implementation of the policy of grass-roots actors, and gradually guide the behavior of various actors to guide the direction consistent with the policy objectives
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Objective:To investigate the effects of sign-contract services on hypertension patient disease control and the satisfaction of medical staff. Methods:a face-to-face questionnaire survey was conducted among hypertension patients selected from 20 primary health centers in 10 provinces in China. Results:This paper collected 1 ,881 valid questionnaires, and the average age of the population was 65. 72 ± 10. 88. Respondents that received sign-contract services accounted for 53. 88%, and there was no difference between patients who signed the service contract and who did not in terms of demographics. In self-reporting of blood pressure controls, respondents who signed the service contract, aged 40~50 years old, enjoyed the free medical care, preferred to seek medical services from primary a-gencies ( i. e. community health centers and township hospitals) for minor illnesses, controlled their blood pressure better ( P<0. 05 ) . Respondents enjoyed the civil resident medical insurance, preferred to seek medical care from community health centers for minor illnesses and signed the service contract were more likely to be satisfied with their medical practitioner (P<0. 05). After adjusting for age, gender, education level, medical insurance style, patient willingness to seek medical care for minor illnesses, signing service contracts was found to be an independent factor both associated with blood pressure self-control and attitudes towards medical service providers, with the odds ratio of 3. 007 (95%CI:2. 572 -3. 517) and 1. 814 (95%CI: 1. 563 -2. 105) respectively. Conclusion: Contracts are correlated with blood pressure control and satisfaction toward medical practitioners, which means that patients who signed the service contract control their blood pressure better and are more satisfied with their medical deliverers.
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Objetivo Utilizar técnicas de clustering para caracterizar a los proveedores de servicios de mantenimiento de una institución de salud. Métodos El estudio analiza el inventario del equipamiento perteneciente a 7 áreas pilotos (264 equipos médicos). Se aplican técnicas de clustering usando 26 variables. Entre las más significativas: el tiempo de respuesta (RT), la duración de las intervenciones (DR), la disponibilidad y el tiempo de cambio de estado (TAT). Resultados La obsolescencia del equipo biomédico en promedio es de 0,78. Se identifican 4 grupos de proveedores de servicios. Grupos (1 y 3): Mejor desempeño, menores valores de TAT, RT y DR; cuyos proveedores son: O, L, C, B, I, S, H, F, G; representan el 56 por ciento del total; con valores de TAT entre: 1,4 días
Objective Using clustering techniques for characterising companies providing health institutions with maintenance services. Methods The study analysed seven pilot areas' equipment inventory (264 medical devices). Clustering techniques were applied using 26 variables. Response time (RT), operation duration (OD), availability and turnaround time (TAT) were amongst the most significant ones. Results Average biomedical equipment obsolescence value was 0.78. Four service provider clusters were identified: clusters 1 and 3 had better performance, lower TAT, RT and DR values (56 percent of the providers coded O, L, C, B, I, S, H, F and G, had 1 to 4 day TAT values: Subject(s)
Cluster Analysis
, Equipment and Supplies/statistics & numerical data
, Maintenance and Engineering, Hospital/economics
, Outsourced Services/statistics & numerical data
, Biomedical Engineering/economics
, Biomedical Engineering/statistics & numerical data
, Contract Services/statistics & numerical data
, Costs and Cost Analysis
, Health Services Accessibility
, Maintenance and Engineering, Hospital/statistics & numerical data