中国全科医学2016，Vol.19Issue(1)：19-23,5.DOI:10.3969/j.issn.1007-9572.2016.01.004
基于全国十个试点城市基层卫生技术人员角度的全科医生执业方式和服务模式试点改革成效研究
Effects of the Pilot Reform of Practice and Service Mode of General Practitioners From the Perspective of Grass-root Health Workers in 10 Pilot Cities in China
摘要
Abstract
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 .关键词
全科医生/执业方式/服务模式/试点改革/基层卫生技术人员Key words
General practitioners/Practice mode/Service mode/Pilot reform/Grass-root health workers分类
医药卫生引用本文复制引用
李家伟,景琳,黄金虎,金承刚,张向东,毛春芳,陈博文..基于全国十个试点城市基层卫生技术人员角度的全科医生执业方式和服务模式试点改革成效研究[J].中国全科医学,2016,19(1):19-23,5.基金项目
世界银行"中国经济改革实施项目"(TCC5)子项目——全科医生执业方式和服务模式改革试点(A29-12) （TCC5）
