Factors associated with contracted services of Chinese family doctors from the perspective of medical staff and consumers: a cross-sectional study
Factors associated with contracted services of Chinese family doctors from the perspective of medical staff and consumers: a cross-sectional study
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DOI：
10.1186/s12872-019-01304-3
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发表时间：
2019-12-21
影响因子：
2.8
通讯作者：
Lou, Fengge
中科院分区：
文献类型：
--
作者：
Wang, Huanyan;Shi, Lei;Lou, Fengge
背景 家庭医生制度在世界范围内发展迅速，近年来，我国积极探索家庭医生式签约服务。本研究旨在从医务人员和消费者的角度探讨签约家庭医生服务（CFDS）的相关因素，为签约家庭医生服务的发展和推广提供更有力的依据。方法本研究采用定量和定性相结合的方法。通过文献分析、小组讨论、专家咨询和预调查等方式设计自评式调查问卷，在全国4个省份12个社区卫生服务中心的社区卫生服务人员中进行调查。共有389名参与者参与，回收有效问卷320份，有效问卷率为82.3%。共36名消费者参与深度访谈，有效率100.0%。采用探索性因素分析、验证性因素分析、归纳法、专家咨询等方法对CFDS的相关因素进行分析。结果医务人员CFDS相关因素分为4个维度，权重系数分别为国家政府因素（31.9%）、社区卫生服务机构因素（24.7%）、消费者相关因素（22.6%）、签约医生相关因素（20.8%）。消费者视角下的CFDS相关因素分为四个维度，频率顺序为：国家政府因素、签约医生相关因素、社区卫生服务机构因素、消费者相关因素。从医务人员和消费者的角度来看，国家政府因素在CFDS中发挥了重要作用。结论 从医务人员和消费者角度来看，CFDS的相关因素相同，但各因素的权重不同。 CFDS的发展离不开政策的支持。建议政府加强对CFDS的宣传，扩大覆盖面，推出满足不同群体需求的个性化合约方案，促进CFDS快速发展。
Background The family doctor system has developed rapidly all over the world, and in the past few years, China has actively explored family doctor-type contracted services. This study aimed to explore the related factors of Contracted Family Doctors Services (CFDS) from the perspectives of medical staff and consumers, and to provide a stronger basis for the development and promotion of CFDS. Methods A combination of quantitative and qualitative methods were used in this study. A self-reported questionnaire was designed through a literature analysis, group discussions, expert consultations and a pre-investigation, and conducted among community health service providers in 12 community health service centres across four provinces of China. A total of 389 participants participated, and 320 valid questionnaires were obtained, with an effective response rate of 82.3%. A total of 36 consumers participated in in-depth interviews, and the effective rate was 100.0%. An exploratory factor analysis, a confirmatory factor analysis, inductive methods, and expert consultations were used to analyse the related factors of CFDS. Results The related factors of CFDS from the perspectives of medical staff were divided into four dimensions, with the following weighting coefficients: national government factors (31.9%), community health service agency factors (24.7%), consumer-related factors (22.6%), and contracted doctor-related factors (20.8%). The related factors of CFDS from the perspectives of consumers were divided into four dimensions, with the following frequency sequence: national government factors, contract doctor-related factors, community health service agency factors, and consumers-related factors. National government factors played an important role in CFDS from the perspectives of medical staff and consumers. Conclusions The related factors of CFDS were the same from the perspective of medical staff and consumers, but the weight of each factor was different. The development of CFDS is inseparable from the support of policies. It is suggested that the government should strengthen the publicity of CFDS, expand the coverage, introduce personalised contract programs that meet the needs of different groups, and promote the rapid development of CFDS.