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Objective:To analyze factors related to clinic attendance for contracted residents in a community health service center in Shanghai.Methods:It was a cross-sectional study. Through the 'Cloud Management of the Community' APP and the 'Service Fee of Contracted Residents' APP, the basic information, contracted time, hospital visits, number of visits, and medical insurance expenses of the contracted residents in Shanggang Community Health Service Center in 2021 were collected, the visiting rate to the contracted community health center and the contracted medical combination hospitals were analyzed.Results:In 2021, the contracting rate of all residents in the community was 49.96% (51 478/103 033). The contracting rate of the key population was 84.59% (43 545/51 478),among whom 66.28% (34 118/51 478) were over 60 years, 49.93% (25 702/51 478) had been contracted for more than 3 years, and 37.43% (19 270/51 478) had hypertension and/or diabetes. The number of contracted general practitioners was 4.89 times of contracted TCM doctors (1 345.17/274.81). Among all contracted residents 78.75% (40 540/51 478) had at least one visit annually, and 65.00% (33 463/51 478) had at least one visit to community health service center and the average number of visits was 17.63(5.00, 24.00)annually. The rate of visit to contracted the community health service center was (46.97±38.37) %, and 41.78% (16 937/40 540) had≥60% visit to contracted community center; the average visiting rate to the combination hospitals was (70.59±34.57) %, and 55.75% (22 602/40 540) had consultation rate≥80%. These residents were older in age, had longer contract time, higher proportion of hypertension and diabetes, and higher medical expenses, compared to those with less visits to contracted community health center and combination hospitals ( P<0.01). Meanwhile, 11 736 residents (35.07%) only visited to the contracted community health service center. Conclusion:The contracted residents are mainly the elderly and the sick ones in the community, but the use of contracted service is inadequate. Improving the visiting rate to community health center is a challenge for make a full use of the contracted health facilities.
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Objective:To analyze the demands of contracted family doctor service among uncontracted young and middle-aged people in Shanghai Baoshan.Methods:An online questionnaire survey on demands of contracted family doctor service was conducted in June 2021 among 702 uncontracted residents aged 18-60 years from Shanghai Baoshan district selected by stratified random sampling method. The demands of contracted family doctor service, including digital health file, routine laboratory tests and imaging investigation;health promotion;service convenience; home service were surveyed, and the factors related the demands were analyzed with regression analysis.Results:The survey showed that the demands of service convenience (3.8(3.0, 5.0)) and home service (4.0(3.0, 5.0)) were higher, while those of digital health file (3.0(2.0, 5.0)) and health promotion (3.0(2.0, 5.0)) were relatively lower. There were significant differences in the demands of all five contracted services among residents with different gender, age, education level, household register and family income (all P<0.05); while for young residents with different types of medical insurance there was significant difference in demands of all contracted services except digital health file (all P<0.05). Logistic regression analysis indicated that female( OR=1.83, P<0.001), high educational level( OR=4.81, P=0.019), household registered in Shanghai( OR=1.80, P=0.004)had higher demand for service convenience; female gender( OR=1.68, P=0.001), high educational level( OR=4.56, P=0.023)had higher demand for home service demands. Conclusion:The demands for contracted family doctor services are different among the uncontracted young and middle-aged people in Baoshan district, while the service convenience is generally most demanded. The study indicates that the contracted family doctor service should be provided accordingly.
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Objective:To survey the job satisfaction of online contracted nurses who provide " Internet plus nursing services" for reference of hospital managers in improving their management mechanism in this regard.Methods:Based on the two-factor theory, a questionnaire was designed and a purposive sampling method was used to survey the online contracted nurses in Anhui province in April and May 2022. The motivational factors included such five dimensions as workload, work content, colleague relationship, doctor-patient relationship, and their own development, and the healthcare factors included such three dimensions as salary, job recognition and social status. The questionnaire data and job satisfaction scores were analyzed descriptively, and the correlation between the overall job satisfaction of the online contracted nurses, while each dimension was analyzed by Pearson correlation analysis, and the influence of each dimension on job satisfaction was analyzed by stepwise regression analysis.Results:A total of 335 valid questionnaires were recovered. The mean score of job satisfaction of online contracted nurses was (2.26±0.38), with the highest score of (2.56±0.53) for salary satisfaction and the lowest score of (1.78±0.67) for job recognition, and each dimension was positively correlated with job satisfaction ( r=0.34-0.88, P<0.01). Regression analysis showed that workload ( B=0.07), salary ( B=0.11), job content ( B=0.23), social status ( B=0.12), and self-development ( B=0.15) were the main factors affecting their job satisfaction ( P<0.01). Conclusions:The job satisfaction of online contracted nurses was at a medium level, mainly influenced by workload, salary, job content, social status and their own development. It is recommended that hospitals implement multiple targeted measures to improve the job satisfaction of online contracted nurses and promote the healthy development of " Internet plus nursing services" .
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Objective:To analyze the influencing factors related to visiting rate of residents to contracted family doctors in a community health service center in Beijing.Methods:One thousand patients with contracted family doctor services who visited our center from January 2019 to December 2019 were selected for retrospective analysis. According to the corresponding visiting rate of contracted family doctors,patients were divided into low corresponding visiting rate, medium corresponding visiting rate and high corresponding visiting rate, and the influencing factors were analyzed.Results:Among the 1 000 patients, 481 (48.1%) were in the high corresponding visiting rate group, 342 (34.2%) in the middle corresponding visiting rate group, and 177 (17.7%) in the low corresponding visiting rate group. Univariate analysis showed that the corresponding visit rate was significantly associated with the age, marital status and educational level of patients, history of hypertension, the number of family doctor visits, the total visiting time and the consultation time per year (χ 2=12.55, 12.42, 7.69, 21.69, 253.97, 49.54, 9.07, all P<0.05). Multivariate logistic regression analysis showed that compared with the high corresponding visiting rate group, fewer of family doctor visits ( OR=0.68, 95 %CI: 0.58-0.78), lower education level( OR=0.65, 95 %CI: 0.46-0.92), history of hypertension ( OR=0.09, 95 %CI: 0.02-0.49), and 18-65 years old( OR=1.80, 95 %CI: 1.27-2.55) were the influencing factors for the low corresponding family doctor visiting rate(all P<0.05); while fewer of family doctor visits( OR=0.91, 95 %CI: 0.83-0.99),lower education level ( OR=0.74, 95 %CI: 0.55-0.98)and history of hypertension( OR=0.09, 95 %CI: 0.02-0.44)were the related factors of the medium corresponding visiting rate(all P<0.05). Conclusions:The visiting rate of patients to the contracted family doctor needs to be improved. The number of consultations of the contracted family doctor, educational background, history of hypertension, and age are the influencing factors of the corresponding visiting rate.
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Objective:To analyze the psychological contract satisfaction of contracted residents and its impact on their behavioral intentions under the guidance of incomplete contract theory, for reference in improving the effectiveness of contracted family doctor services.Methods:1 100 contracted residents from nine townships/streets in Shandong province were selected as subjects according to stratified random sampling from September 2019 to June 2020, and a questionnaire survey on the level of satisfaction of contracted residents′ psychological contracts(24 items) and assessment of behavior intentions(9 items) was conducted, and the model of the effect of contracted residents′ psychological contracts on behavior intentions was established and analyzed. The correlation was validated by Pearson test and the structural equation method was used for verifying the model.Results:998 valid questionnaires were recovered. The psychological contract satisfaction score of the contracted residents was 3.45±0.56 and the behavioral intention was 2.81±0.29. Both transactional and relational psychological contracts were correlated with all dimensions of behavioral intention( P<0.01). Concerning the impacts of residents′ psychological contracts on behavioral intentions, the effect coefficients of transactional psychological contracts on loyalty intention, voice intention, exit intention and neglect intention were 0.33, 0.24, -0.25 and -0.49 respectively, with an indirect effect on neglect intention; the effect coefficients of relational psychological contracts on loyalty intention, voice intention, exit intention and neglect intention were 0.26, 0.10, -0.14 and -0.50 respectively, with an indirect effect on advice intention and neglect intention. Conclusions:Residents′ psychological contract has yet not been effectively satisfied. Satisfying and improving the residents′ psychological contract can directly enhance their loyalty intention and reduce their exit intention, indirectly influencing the voice and neglect intentions. In order to enhance the effectiveness of family doctor contracted services and improve the healthcare experience of contracted residents, it is suggested that the relevant departments should actively take the following measures, including carrying out a survey on the psychological contract of contracted residents, building a provincial-city-county-township collaborative linkage platform, and so on.
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Objective:To evaluate the current situation of comprehensive medical and health services of primary medical institutions in a city under the policy of family doctor contracted service, and explore the influencing factors and put forward improvement strategies, for the reference to improve the medical and health service level of primary medical institutions.Methods:In January 2021, 18 primary medical institutions in 3 counties(cities, districts) of a city in Shandong province were selected by stratified sampling method, and 60-70 contracted residents were selected from each institution for questionnaire survey. The questionnaire covered two dimensions: service provision(19 items) and metion frequency of health problems(12 items). According to the principle of information saturation, qualitative interviews were conducted with 20 family doctors and 15 contracted residents to identify the current service needs and existing problems. Descriptive analysis was used for all data, and single factor analysis of variance and multiple linear regression analysis were used for influencing factors of comprehensive service scores of primary medical institutions.Results:1 098 contracted residents were included in this study, and the comprehensive service score was 3.15±0.42. The vaccination, maternal health care and health education scored higher with 3.80±0.54, 3.70±0.64, 3.78±0.57 respectively; The dermatology, mental health counseling and family sickbed scored lower, with 2.27±1.20, 2.97±1.01 and 1.92±1.18 respectively. Contracted institution, gender, age and marital status were the influencing factors of comprehensive service scores( P<0.05). Residents′ needs for family sickbeds, psychological counseling and fall prevention had not been met. Conclusions:The primary medical institutions of the city had provided better basic public health services, while unmet needs were demand for home sickbeds, psychological counseling and fall prevention. We should take effective measures to increase the service supply based on the needs of residents, and provide more comprehensive medical and health services for residents at primary medical institutions.
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Objective:To investigate the coexistence status of common chronic diseases among hypertensive patients with contracted family doctor service in the community.Methods:Clinical data of 7 910 hypertensive patients with contracted family doctor service in Yuetan Community Health Service Center and its affiliated service stations were collected. The status of comorbidities and related factors were analyzed.Results:Among 7 910 hypertensive patients, there were 2 959 cases(37.4%) with 2 chronic diseases, 1 747 cases (22.1%) with 3 chronic diseases and 2 289 cases(28.9%) with simple hypertension. There was significant difference in comorbidity status among hypertensive patients in different age groups (χ 2=25.269, P<0.05). The top 3 comorbid chronic diseases were type 2 diabetes (2 979 cases, 37.7%), dyslipidemia (2 227 cases, 28.2%), and coronary heart disease (1 945 cases, 24.6%). Univariate analysis showed that the comorbidity of hypertensive patients was significantly related to age, smoking, marital status,employ status and education level (χ 2=9.697, 19.539, 33.343, 8.986, 7.923; P<0.05). Conclusion:There is a phenomenon of coexistence of multiple diseases in hypertensive patients with contracted family doctor service in Yuetan community.
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Objective:To analyze the cognition and willingness of family physicians on contracted service, and to explore the implementation obstacles and feasible strategies of implementing contracted service of family physicians from the perspective of suppliers.Methods:From July to October 2020, 850 family physicians in community health service centers or township health centers in three cities of Shandong Province were investigated by questionnaire survey and key person interview. Descriptive analysis and binary logistic regression model were used to analyze the willingness of family physicians to provide contracted service. Through questionnaire survey and key person interview, the implementation obstacles and service optimization strategies of family physicians were discussed.Results:791 valid questionnaires were obtained, of which 688(87.0%) approved the implementation of family physician contract service, and 679(85.8%) expressed willingness to provide family physician contract service. Marital status, recognition of service policy, satisfaction of service operation effect, optimistic degree of service development prospect and residents′ first choice of illness were the factors influencing family physician′s service willingness.Conclusions:We should effectively improve the family doctor′s service intention and promote the efficient and orderly implementation of family doctor′s contract service policy through enriching policy supporting measures, innovating the application of " Internet plus" , increasing personnel training, optimizing performance appraisal work and creating favorable public opinion environment.
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Objective:To understand the willingness of contracted residents to renew the family doctor contract service in Shandong Province, and to explore its influencing factors.Methods:From July to August 2020, 1 500 contracted residents in 3cities of Shandong Province were investigated by questionnaire survey.Descriptive statistical analysis, Mann-Whitney U test and binary logistic regression model were used to analyze the contracted residents′ cognition, utilization, satisfaction evaluation and renewal intention of family doctor contract service. Results:1 445 valid questionnaires were obtained, of which 682(47.2%)were willing to renew their contracts.The results of binary logistic regression analysis showed that marital status, educational level, time to see a doctor in contracted institutions, optimism about the development prospect of contracted service policy, whether the proportion of medical insurance reimbursement increased after signing the contract, whether follow-up work was carried out on time, satisfaction with family doctor service attitude and satisfaction with the effect of disease treatment were factors affecting the willingness of contracted residents to renew the contract.Conclusions:The contracted residents in Shandong Province have a high willingness to renew their contracts. On the basis of consolidating and improving the policy cognition and confidence of the contracted residents, we should actively optimize and improve the contracted service quality, ensure the sense of service access of contracted residents, and continuously and effectively realize the comprehensive promotion of the contracted services of family doctors.
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Objective:To describe the content and analyze the constitutive dimensions of the psychological contracts with residents contracted for family physician services.Methods:Based on a collection of policy documents on family doctor contracting services issued by central government ministries and relevant departments in Shandong province as well as 27 signed family doctor agreements in nine counties (cities, districts) of Shandong province, semi-structured interviews were made to 48 residents in both September 2019-January 2020 period and May-June 2020 period, regarding the verbal promises of family doctors and the needs of these contracted residents. Then the documented and non-documented commitments of the family doctors were extracted in the content analysis method, and a credibility test was made using the Myers reliability test formula.Results:A total of 639 written commitments of family doctors were obtained, covering 5 types of responsibilities and 20 commitments, and the credibility coefficient was 0.88. 322 codes of non-documented commitments were obtained, 4 commitments were added on the basis of documented commitments, and the credibility coefficient was 0.90. The psychological contracts were sorted out in such five areas as technical quality responsibility, cost control responsibility, convenient access responsibility, communication responsibility, and empathic responsibility, by matching the residents′ medical service needs obtained from the interviews, while the first three categories and the last two categories were classified as transactional and relational psychological contracts, respectively, with 10 items of technical quality responsibility accounting for the highest percentage (41.67%).Conclusions:The documented and non-documented commitments of family doctors differed in content and structure. The psychological contract signed by residents was mainly transactional, and residents had higher expectations for family doctors to provide high-quality, convenient and economical services.
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Background:Congenital defects, abnormalities of structures or functions present at birth, maybe as a result ofgenetic or environmental factors or both and in most cases; the exact etiology is not clear but can occur in all animals. These abnormalities are responsible for slowing down of genetic progress and economic loss for the breeders, due to the death of animals.Methods:Available record of cases presented to Aliyu JedoVeterinary Clinic,Sokoto from December 2015 to 2019 was used to investigate congenital malformation in ruminants based on species and sex. Surgery was carried out in all the cases with local anaesthesia (infiltration technique) using lignocaine. Surgical procedures carriedout were rectopexy (atresia ani), gingivectomy (gingival fibromatosis), superficial keratectomy and temporary tarssorhaphy (dermoid cyst), casting and physiotherapy (contracted tendons). Results:A total of 47 congenital malformations; atresia ani 22 (46.8%), gingival fibromatosis 18(38.3%), dermoid cyst 6(12.8%), and contracted tendon 1(2.1%) were reviewed in the study.The ovine species had the highest incidence of cases load recorded 23(48.93%) followed by bovine 17(36.17%) and then caprine species7(14.89%). The incidence of all malformations was higher in males (68.1%) than in females (31.9%). All cases were attempted surgically with success in all the procedures.Conclusions:It can be concluded that male ruminants have the highest prevalence of congenital malformation. Congenital malformations are more frequently seen in ovine and least seen in caprine. Atresia ani appeared to be the most commonly reported cases
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Arthrogryposis includes heterogeneous disorders, characterized by congenital contractures of multiple joints. Knee involvement is very common (38–90 % of patients with amyoplasia) ranging from soft-tissue contractures (in flexion or hyperextension) to subluxation and dislocation. Children who present late will require surgery involving quadricepsplasty or lengthening of the contracted quadriceps muscle. Curtis and Fisher describe an open V-Y lengthening of the quadriceps femoris with post-operative immobilization in 30-45 ° of flexion. The main issue of this technique was limited degree of flexion that can be achieved, and the fibrous replacement of the quadriceps muscle. This is a neglected case of hyperextension deformity and congenital dislocation of knee in children with arthrogryposis resistant to conservative management and successfully treated by open quadricepsplasty.
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To analyze the associated factors of signing behavior of the smart medical service model in Hangzhou, 500 residents aged 18 years and older who signed the smart medical service and 500 unsigned residents were randomly selected from 5 urban districts of Hangzhou city from 19 to 26, July 2016. The social-demographic characteristics, chronic disease, health-seeking behavior, kinds of medical insurance were investigated by face-to-face interview. The results showed that there were significant differences in educational level, self-rated health status, chronic disease, seeking behavior and type of medical insurance, while there were no significant differences in gender and age between the signed group and the non-signed group. Logistic regression analysis revealed that residents with higher education level (OR=1.226, 95%CI: 1.118-1.344, P<0.01) and having more chronic diseases (OR=1.854, 95%CI: 1.524-2.257, P<0.01) preferred to sign the service contract. The main reasons for unwillingness of signing contract were " the service was not suitable for me" (17.0%, 61/359), "I didn′t know the specific content of the service" (16.7%,60/359), "the signing procedure was complicated" (15.0%, 54/359). In conclusion, different communication strategies should be adopted considering residents with different educational level and chronic diseases. And delivery of detailed information, simplification of signing process will promote to popularize this smart medical service.
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To analyze the associated factors of signing behavior of the smart medical service model in Hangzhou,500 residents aged 18 years and older who signed the smart medical service and 500 unsigned residents were randomly selected from 5 urban districts of Hangzhou city from 19 to 26,July 2016.The social-demographic characteristics,chronic disease,health-seeking behavior,kinds of medical insurance were investigated by face-to-face interview.The results showed that there were significant differences in educational level,self-rated health status,chronic disease,seeking behavior and type of medical insurance,while there were no significant differences in gender and age between the signed group and the non-signed group.Logistic regression analysis revealed that residents with higher education level (OR=1.226,95%CI:1.118-1.344,P<0.01) and having more chronic diseases (OR=1.854,95%CI:1.524-2.257,P<0.01) preferred to sign the service contract.The main reasons for unwillingness of signing contract were"the service was not suitable for me"(17.0%,61/359),"I didn't know the specific content of the service"(16.7%,60/359),"the signing procedure was complicated"(15.0%,54/359).In conclusion,different communication strategies should be adopted considering residents with different educational level and chronic diseases.And delivery of detailed information,simplification of signing process will promote to popularize this smart medical service.
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Objective This study combined genotyping with family doctors' contracting model to assess the application of precision medicine in rural patients with essential hypertension. Methods In this study, 209 hypertensive patients from 3 villages in Lujiang County, Hefei City, Anhui Province were selected as subjects and randomly divided into experimental group(n=105) and control group(n=104). The medication regimen of observation group was guided by genetic testing for gene sensitivity to antihypertensive drugs, and the control group was implemented routine pharmacy. All the patients were managed by family doctors. Adverse drug reaction rate, treatment compliance, blood pressure, body mass index (BMI), fasting blood glucose (FBG), cholesterol (TC), and triglycerides (TG) of the two groups were analyzed, respectively, during the 6-month intervention. Results After 6-month of intervention, the medication compliance of the experimental group were significantly higher than that of the control group, and the blood pressure and adverse drug reaction rate were significantly lower than that of the control group. After 3 months of intervention, there was no significant decrease in BMI, FBG, TC and TG in the two groups. After 6 months of intervention, the FBG, TC and TG of the experimental group were significantly decreased,while only the FBG value of the control group was significantly decreased. There were no significant changes in body mass index (BMI) values in both groups. Conclusions Individualized medication guided by genotyping can improve the treatment compliance, reduce the adverse drug reaction rate, and improve the treatment efficiency of patients with essential hypertension.
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Objective To explore the influence of policy support on attitude of staff toward contracted service in community health service ( CHS) centers in different areas of China. Methods A multi-stage stratified cluster sampling method was used to select participants, and questionnaire survey was conducted among 192 staff (99 from Chengdu and 93 from Xiamen) from 4 community health service centers in Chengdu and Xiamen. In addition, documents on contracted service in CHS were collected and analyzed. EpiData software was used to establish database. Double input and cross-check were implemented. SAS version 9.4 was used for data analyses. Results Differences were found in goals, financial modes and insurances coverage in contracted service in the two areas. Among the 192 participants, 80.7% considered that contracted service was worth to carry out; 90.8% supported the implementation of contracted service in local settings and 78.1% were willing to take more work load on contracted service. In contrary, only 41.6% wished their child work as a family doctor. The main reasons for the negative attitudes were that the performance-based salary system had not been well established or implemented, and there was much more work load that resulted from contracted service. Conclusions The majority of the study subjects held positive attitude toward contracted service, but there were disparities between the four study sites. Relative policy and financial support, proper human resource distribution were critical determinants of contracted service.
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Objective To evaluate the effect of family doctor contracted service system in Shenzhen and explore the influencing factors for families to contract their family doctors. Methods A total of 480 residents were selected from 12 first-class community medical rehabilitation centers in Luohu, Futian and Nanshan districts of Shenzhen. The contents of the survey included the contracting status between the contracted and non-contracted residents, the utilization of four basic public health services, and the difference of satisfaction with community medical rehabilitation centers.Meanwhile, logistic regression was used to explore the important influencing factors of the contracted family doctors. Results The overall contracting rate of residents was 51.9% (248/478), and the lowest contracting rate was 23.1% (27/117) (P<0.05), found among patients under 40 years old.The utilization rate of contracted residents for growth and development examination, maternal health care as well as guidance of chronic disease prevention and treatment was higher than that of non-contracted residents ( P <0.05 ). fees and medical environment, service attitude,medical fees was higher than that of non-contracted residents(P<0.05).The satisfaction for convenience in medical environment, service attitude,medical fees and access to medical service was higher than that of non-contracted residents(P<0.05).The results of binary logistic regression analysis showed that age, education level, occupation ( retirement ) and chronic diseases were important factors affecting the signing of contracts.Conclusions The family doctors tend to be embraced by residents better than before. Family doctors contracted service system is conducive to improving the utilization rate of basic health services, acceptance rate of health services and satisfaction of residents. At the same time, the young population at large requires greater efforts before they can embrace the family doctor system.
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The family physicians contracted service is an important means to promote hierarchical diagnosis and treatment and realize healthy Chinese strategy. With the continuous introduction of family physicians contracted service policy, it is very important to raise awareness, effectively promote and put into place.This study analyzed the family physicians contracted service policy from the perspective of public policy, and used the multiple streams theory framework to analyze the driving factors of the policy proposed. In addition, it explored the influence of problem stream, policy stream, and political stream on the policy launch process.These efforts can help improvement the policy awareness in the process, and help ensure sustainable progress of the policy.
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Objective To analyze the policy texts related to the contracted service of family physicians, and probe into the key points and existing problems of the policy in the process of promoting the contracted service of family physicians in China, for the purpose of providing references for the optimization and perfection of the system. Methods A total of 54 relevant policy texts issued by the Central Government from 2011 to 2019 were selected, for establishing a two-dimensional analysis framework based on policy tools and stakeholders.By means of quantitative analysis of policy text and literature research method, we analyzed the relevant policy texts. Results Study of the 54 texts found 52.8% (124/235)mentioned commands and regulatory tool use, 27.2% (64/235) mentioned capacity building tool use, 13.2% (31/235) mentioned information and exhortation tool use, 5.1% (12/235)only mentioned incentive tool use, and 1.7% (4/235) only mentioned system change tool use; while most of them(34.3% and 32.7% )mentioned government and physicians, and only a few(17.6% and 15.4% )mentioned patients and medical entities. Conclusions It is suggested to optimize the policy tools mixture, and increase the use of incentive tools to physicians, and explore new forms of system change tools.It is also proposed to pay more attention to resource allocation of primary medical institutions, and to patient awareness and satisfaction.
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Objective To study the implementation effects of China′s contracted service policy for family physicians. Methods Systematic evaluation method was used to extract, describe and analyze the literature information of the research on the implementation effect of family physicians contracted service policy. Results A total of 80 papers of four types were rounded up, including 47 on the effect of health management on patients with chronic diseases, 11 on the effect of health management on the elderly, 15 on the effect on the first diagnosis in the community, and 7 on the effect on the control of medical expenses.The research is mostly distributed in the developed areas in the east. The family physicians contracted service promotes the health management effect of patients with chronic diseases and the elderlies, improves the first visit ratio of residents at their community, and effectively controls the medical expenses.Existing research shows that such a service has achieved initial success.However, the research also identified such common problems as the shortage and low competence of family physicians, low quality, resource integration and inadequate policy publicity. Conclusions The contracted service policy in China has begun to play the role of " health gatekeeper" and " cost gatekeeper" to some extent.It is suggested to strengthen the training of general practitioners, establish and perfect incentive mechanism, and improve the construction of information platform, while the implementation effect of contracted services for family physicians deserve further study in a broader scope, deeper level and design specifications.