目的：了解天津市契约式家庭责任医生制度的实施现状及影响因素，为今后天津市契约式家庭责任医生制度的发展以及政策的制定提供理论依据。方法选取天津市和平区6个社区卫生服务中心和河东区7个社区卫生服务中心的200名医务人员以及在这13个社区卫生服务中心等待就诊的485名患者为调查对象。于2013年7—8月，采用问卷调查方法，对其就天津市和平区、河东区契约式家庭责任医生制度的实施现状及影响因素进行调查。医务人员问卷有效回收196份，患者问卷有效回收482份。结果认为社区卫生服务机构的就诊时长为5~10 min的医务人员为89人（占45.4％），认为就诊时长为11~20 min的患者为190人（占39.4％）。有150名医务人员（占76.5％）和356名患者（占73.9％）认为话家常的方式是增进医患沟通和情感的一个有效途径。有115名医务人员（占58.7％）和457名患者（占94.8％）认为社区卫生服务机构的就诊费用不高。有341名患者（占80.6％）认为签约家庭责任医生有利于自身的健康，310人（占73.3％）认为家庭责任医生服务态度好。有166名医务人员（占84.7％）认为社区卫生服务机构药品不足是制约患者与家庭责任医生签约的最主要原因。有128名医务人员（占65.3％）认为应将基本医疗作为首要改进的方面，有92名医务人员（占46.9％）认为医患间的沟通亟须加强。结论目前天津市契约式家庭责任医生的角色定位不准确、服务内容不均衡、功能定位不全面，建议创新契约式家庭责任医生制度的服务内容、树立家庭责任医生的新型服务理念。%Objective To investigate the implementation status of contracted family doctor system and its influencing factors and to provide a theoretical basis for the future development and policy making of the contracted family doctor system in Tianjin. Methods We enrolled 200 health workers and 485 patients from six community health centers in Heping District and seven community health centers in Hedong District in Tianjin. From July to August in 2013,implementation status of contracted family doctor system and its influencing factors were investigated using questionnaires. 196 and 482 effective questionnaires were returned from health workers and patients. Results For diagnosis duration of each patient,89(45. 4%)health workers chose 5-10 minutes,190(39. 4%)patients chose 11 -20 minutes. There were 150(76. 5%)health workers and 356(73. 9%) patients who regarded chatting as an effective way to improve doctor - patient communication and relation. There were 115 (58. 7%)health workers and 457(94. 8%)patients who thought charge on community health service was not high. There were 341(80. 6%)patients thought signing a contract of family doctor service was good for health,310(73. 3%)patients thought family doctors had good service attitude,and 166(84. 7%)health workers thought the inadequacy of medicine in CHS settings was the main reason that many patients didn't sign the contract. There were 128 ( 65. 3%)health workers who thought basic medical service should be the first aspect to be improved,and 92(46. 9%)thought communication between doctors and patients should be promoted. Conclusion The current problems in the family doctor system of Tianjin include inaccurate positioning, balance of service content and incomprehensive positioning. We suggest that the content of contracted family doctor service should be innovated and new service concept should be established.
展开▼
