Objective To explore the practical effect of family doctor service on promoting hierarchical diagnosis and treatment in Fangzhuang community.Methods By equidistant random sampling method,587 patients with type 2 diabetes mellitus who signed contract with family doctors in Fangzhuang Community Health Service Center from 2011 to 2015 were selected as the study subjects.Their data taking type 2 diabetes mellitus and its complications as first diagnosis were extracted from the Beijing Management Center of Medical Insurance Affairs.A statistical analysis of these data including times of outpatient visiting and hospitalization,outpatient costs of medical care and medical insurance fund,hospitalization costs of medical care and medical insurance fund in primary health care institutions,secondary hospitals and tertiary hospitals was conducted in this study.Results From 2011 to 2015,there was significant difference in the per capita number of outpatient visit between primary health care institutions and tertiary hospitals among patients who had signed contract (P<0.05);there were no significant differences in the per capita number of outpatient visit and per capita number of hospitalization in secondary hospitals,and the per capita number of hospitalization in tertiary hospitals among the research subjects (P>0.05).From 2011 to 2015,there was significant difference in outpatient costs of medical care per capita between primary health care institutions and tertiary hospitals among the subjects (P<0.05);there were no significant differences in the per capita costs of medical care and hospitalization in secondary hospitals,and the per capita costs of hospitalization in tertiary hospitals among the research subjects (P>0.05).From 2011 to 2015,there was significant difference in the per capita costs of outpatient medical insurance fund between primary health care institutions and tertiary hospitals among the subjects (P<0.05);there were no significant differences in the per capita costs of outpatient and hospitalization medical insurance fund in secondary hospitals,and the per capita costs of hospitalization medical insurance fund in tertiary hospitals among the subjects (P>0.05).Conclusion The family doctor service in Fangzhuang community has effectively reduced the number of outpatient visit and saved medical expenses to a certain extent of patients with type 2 diabetes mellitus,and has a positive significance in achieving initial diagnosis in community and promoting hierarchical diagnosis and treatment system.%目的 探讨方庄社区开展家庭医生式服务推进分级诊疗的实践效果.方法 采用等距随机抽样方法,从2011-2015年在方庄社区卫生服务中心同家庭医生全程签约的2型糖尿病患者中抽取587例为研究对象.通过北京市医疗保险事务管理中心调取其以2型糖尿病及其并发症为第一诊断的数据,包括在基层医疗卫生机构、二级医院及三级医院的门诊就诊次数和住院次数、门诊医疗费用和医保基金费用、住院医疗费用和医保基金费用,进行统计分析.结果 2011-2015年,签约患者的基层医疗卫生机构人均门诊就诊次数、三级医院人均门诊就诊次数比较,差异有统计学意义(P<0.05);签约患者的二级医院人均门诊就诊次数、二级医院人均住院次数、三级医院人均住院次数比较,差异均无统计学意义(P>0.05).2011-2015年,签约患者的基层医疗卫生机构人均门诊医疗费用、三级医院人均门诊医疗费用比较,差异均有统计学意义(P<0.05);签约患者的二级医院人均门诊医疗费用、二级医院人均住院医疗费用、三级医院人均住院医疗费用比较,差异均无统计学意义(P>0.05).2011-2015年,签约患者的基层医疗卫生机构人均门诊医保基金费用、三级医院人均门诊医保基金费用比较,差异有统计学意义(P<0.05);签约患者的二级医院人均门诊医保基金费用、二级医院人均住院医保基金费用、三级医院人均住院医保基金费用比较,差异均无统计学意义(P>0.05).结论 方庄社区家庭医生式服务有效减少了2型糖尿病患者的门诊就诊次数,在一定程度上节约了医疗费用,对实现社区首诊和推进分级诊疗体系建设具有积极意义.
展开▼
