北京市家庭医生式服务模式对医务人员的干预效果评价

摘要

Objective To learn the awareness,attitude and behavior changes of medical workers to the family doctor service and the influential factors on their utilization of such service since the service is in place.The purpose is to provide theoretical basis to establish the family doctor service model and the incentive mechanism in line with the development of community health service in Beijing.Methods Eight community health centers were sampled randomly from three representative areas of Haidian,Xicheng and Daxing districts,which were grouped randomly as one intervention group and one control group.All the medical workers surveyed were subj ect to the research.The control group was managed as to the existing management mode,and the intervention group was classified and managed according to the new family doctor service model.A questionnaire survey was made to collect data from the baseline and final stages.Comparisons were made among the districts,institutions,and before-after intervention of the institutions themselves to evaluate the effects of the service model and incentive mechanism.Results The survey found a higher awareness by medical workers to such service,higher recognition and satisfaction, and lower rate of services provided by medical workers.The logistic regression analysis found the influential factors for willingness of medical workers to work as family doctors,include group difference, workload changes after signoff as family doctors,residents′acceptance of the community first visit system,recognition or not for whether a family should have a community service team,residents′acceptance,and the general comments on family doctor service (P< 0.05 ).Conclusions Higher incentives of community doctors to embrace family doctor service,calls for the medical workers to change their perception,better incentive mechanism and greater promotion efforts for family doctors′services.%目的：了解家庭医生式服务模式实施后医务人员对家庭医生式服务的认知、态度和行为变化以及影响医务人员对家庭医生式服务积极性的因素，为建立符合北京市社区卫生服务发展的家庭医生式服务模式及激励机制提供理论依据。方法从海淀区、西城区、大兴区随机抽选8所社区卫生服务中心作为研究现场，随机分为对照组和干预组，机构全部医务人员作为研究对象。对照组按原管理模式进行管理，干预组按照新的家庭医生式服务模式进行分类管理。采取问卷调查法进行基线和结局阶段资料的收集。通过区县间、机构间和机构自身干预前后比较来评价服务模式及激励机制的效果。结果干预后，医务人员对于家庭医生式服务的认知情况有所改善，认可度和满意度有所提高，医务人员提供的服务量有所减少。logistic回归分析结果显示，组别、签约后工作量的变化、首诊制的赞同度、是否有必要配备服务团队、居民认可度和对家庭医生式服务的综合评价都影响着医务人员对于成为家庭医生式服务团队一员的积极性(P<0.05)。结论提高社区医生对家庭医生式服务参与积极性，需转变医务人员认识、完善激励机制和加强对家庭医生式服务的宣传。