目的 从基层卫生技术人员角度了解全科医生执业方式和服务模式试点改革成效, 为下一步推进全科医生制度建设提供参考依据. 方法 以 "全科医生执业方式和服务模式改革试点" 项目10个试点城市为研究现场, 抽取试点工作开展处于中等水平的社区卫生服务中心和乡镇卫生院各 1家 (无乡镇卫生院的地区则再抽取1家社区卫生服务中心代替) , 共抽取20家基层医疗卫生机构. 选取调查当日20家基层医疗卫生机构所有在岗的卫生技术人员为问卷调查对象, 于2014年8月18—23日进行问卷调查, 调查内容包括卫生技术人员的基本情况、 对试点改革的知信行情况、 工作强度与压力、 执业现状的满意度情况等. 发放问卷847 份, 有效回收问卷802 份, 问卷的有效回收率为94.69%. 从20家基层医疗卫生机构中分别随机抽取2个全科医生团队, 以全科医生团队的全体人员为访谈对象. 于问卷调查时间同期采用座谈法进行访谈, 访谈内容主要围绕机构全科医生多种执业方式开展情况及实施中存在的困难.结果 在802名卫生技术人员中, 有594人 (74.06%) 知晓医师可以多点执业; 有791人 (98.63%) 只在本单位上班. 249名基层临床医生中, 有214人 (85.94%) 知晓医师可以多点执业; 有246人 (98.80%) 目前只在1个机构执业; 有54人 (21.69%) 认为所在单位支持多点执业; 有45人 (18.07%) 打算开展多点执业. 样本机构均已组建了全科医生团队并已开展了与居民的签约服务, 有729人 (90.90%) 认为首选签约对象是慢性病患者, 其次是65岁以上老年人 (726人, 90.52%). 针对当前执业状况, 工作负荷的满意度最低 (满意度为22.81%, 183/802), 其次是奖金分配制度 (满意度为32.54%, 261/802). 制约全科医生多种方式执业的原因有: 当前人事管理政策和薪酬制度制约; 基层机构全科医生数量不足, 日常任务繁重, 压力大, 无暇开展其他方式执业; 相关配套支撑政策和服务平台建设不健全. 结论 基层卫生技术人员参与试点改革的积极性高; 推动全科医生多种方式执业的配套政策和服务平台建设存在不足; 全科医生薪酬制度需进一步完善; 全科人才缺口较大, 应采取多种方式培养并留住人才.%Objective To investigate the effects of pilot reform of practice and service mode of general practitioners from the perspective of grass -root health workers , with a view to provide reference for the further development of general practice system.Methods We took 10 pilot cities of reform of practice and service mode of general practitioners as the settings of research , and we selected one middle -level community health service center and one middle -level township health center from each pilot city ( If there was no township health center , a community health service center was chosen instead ) .A total of 20 grass-root medical settings were selected , and all in -service health workers of the 20 medical settings were enrolled as the subjects for questionnaire survey .From August 18 to 23 in 2014, questionnaire survey was conducted , and the questionnaire content included the basic information of subjects , the knowledge , attitude and practice about pilot reform , work strength and pressure, satisfaction degree with the practice status , etc.A total of 847 questionnaires were distributed , and 802 effective questionnaires were collected , with an effective rate of 94.69%.We randomly selected 2 teams of general practitioners from each of the 20 medical settings , and all personnel in the teams were taken as the interview objects .The interviews were made in the form of panel discussion in the same period of questionnaire survey .The interviews are mainly about the multiple -way practice and the difficulties in practice .Results Among the 802 health workers , 594 ( 74.06%) knew that physicians can conduct in multi-site practice , and 791 ( 98.63%) thought they can only practice in the medical setting they belonged to .Among 249 grass-root clinical doctors , 214 ( 85.94%) knew that physicians can conduct multi -site practice; 246 ( 98.80%) practiced in only one medical setting then; 54 (21.69%) thought that the medical settings they belonged to support multi -site practice; 45 (18.07%) planned to carry out multi -site practice.Sample medical settings had all established GP team and began contracted service on residents , and 729 (90.90%) health workers thought that the mostly likely contract subjects were chronic disease patients , and 726 ( 90.52%) health workers thought that the mostly likely contract subjects were the elderly aged above 65 years old.For the satisfaction degree with current practice status , the satisfaction degree was lowest for work load ( satisfaction degree was 22.81%, 183/802 ) and was secondly lowest for bonus allocation system ( satisfaction degree was 32.54%, 261/802) .The reasons restricting GP′s multi-site practice included the restriction of current personnel management policy and remuneration system , no spare time to carry out other practices due to the lack of GPs in grass -root medical settings , heavy daily tasks and high pressure , and relevant supporting policies and imperfect service platform construction .Conclusion Grass-root health workers have high positivity in the pilot reform .There are insufficiencies in the supporting policy for multi -way practice and service platform construction .The remuneration system of GPs should be further improved .There is a severe lack of GPs, thus multiple ways should be adopted to carry out training and retain talents .
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