中国全科医学Issue(28)：3405-3409,5.DOI:10.3969/j.issn.1007-9572.2015.28.006
家庭医生责任制下不同公共卫生服务模式的效果研究
Effectiveness Evaluation of Three Public Health Service Models Within Family Doctor Responsibility System
摘要
Abstract
Objective To investigate the effect of three public health service models within family doctor responsibility system.Methods Using typical sampling method , we selected one community health service center of each of the three public health service models in Minhang District of Shanghai.We conducted investigation on the three public health service models including conventional service model based on community health service station and the management of general practitioner team (model 1), progressive service model based on cooperative management service by family doctors and public health outsourcing centers ( model 2) and advanced service model based on small teams of general practitioners and doctor assistants ( model 3) .Evaluation was made on human cost , work efficiency and service effect of the three models.Results For the three models, the numbers of public health service personnel allocated for every 100 000 residents were 61.22, 61.37 and 61.91 respectively.Model 1 had the largest proportion of public health personnel input which was 14.53%, model 3 has the largest proportion of general practitioners and doctor assistants which was 40.10%, and model 2 had a proportion of 10.96%for public health personnel and 30.82%for family doctors and doctor assistants.The three models were significantly different (P<0.05) in the rates of household electronic health record , vaccination , hypertension management , diabetes management , coverage of health education , coverage of physical examination for residents older than 60 years old, systematic management of pregnant and lying-in women, systematic management of children aged 0 -6 years old, standard management of mentally ill patients and standard management of students′diseases.By pairwise comparison among the three models , model 1 and model 2 were not significantly different in the rate of standard management of mentally ill patients ( P =0.034 ) and the rate of standard management of students′diseases (P=0.460), and there was no significant difference among model 2 and model 3 in the rate of standard management of students′diseases ( P=0.232 ) , apart from which significant differences were found in all the other items among the three groups ( P<0.016 7 ) .The three models were significantly different ( P<0.05 ) in the prevalence of infectious diseases of class A and class B , the effective control rate of hypertension and the effective control rate of diabetic blood sugar; by pairwise comparison among the three models , significant difference (P<0.016 7) was found in all items except that no significant difference (P=0.718) was found between model 1 and model 3 in the prevalence of infectious diseases of class A and class B.Conclusion Given the same health human cost and serving the same population , model 2 provides more efficient public health services and better effects.Model 3 has more advantages in chronic disease controlling and prevention.Cooperative management-based service by general practitioners and public health outsourcing centers ( model 2) is better in terms of public health service balance , thus it may be a better choice for reforming community public health services.Small team-based service composed of general practitioners and doctor assistants ( model 3 ) may be the future direction of the public health services in community health service centers.关键词
家庭医生服务/公共卫生服务/服务模式/效果评价Key words
Family doctor service/Public health service/Service model/Effectiveness evaluation分类
医药卫生引用本文复制引用
吴燕,王君燕,黄晓霞,许慧琳,苏华林,赵燕萍..家庭医生责任制下不同公共卫生服务模式的效果研究[J].中国全科医学,2015,(28):3405-3409,5.基金项目
上海市卫生和计划生育委员会2014年面上项目---家庭医生责任制公共卫生服务项目包设计及服务协同机制研究 （）
