全科医生视角下的北京市家庭医生签约服务质量现况：一项半结构访谈研究
he Current Status of the Quality of Family Doctor Contracting Services Based on General Practitioners' Perspectives：a Semi-structured Interview Study
背景 ?家庭医生签约服务（家医服务）是我国深化医改的重要措施，旨在提升人民健康水平、卫生服务体系效率，家医服务在数量上已取得较快发展，但目前尚缺少家医服务质量相关的研究证据。目的 ?基于全科医生视角了解北京市家医服务质量现状和存在问题，为家医服务的质量改进提供参考依据。方法 ?2023年8月—2024年6月通过目的抽样选取来自北京市9个区18家社区卫生服务机构（机构）的18名全科医生，基于结构-过程-结果框架的访谈提纲对全科医生进行半结构访谈。通过主题分析法对资料进行分析并提炼访谈主题。结果 ?研究提炼出3个主题和11个子主题。主题一：家医服务的结构质量（政策引导及落实、机构的条件设施、家医服务的考核和激励机制、家医团队建设）。主题二：家医服务的过程质量（签约服务内容、转诊和就诊服务流程、出诊服务标准）。主题三：家医服务的效果（居民的健康水平提升、居民的就诊意愿增强、家医服务的居民认可度有待加强、全科医生的职业压力增加）。结论 ?自开展家医服务以来，服务质量逐步提升，但仍存在部分制约因素。应加强政策支持，优化服务内容及流程，将质量评价体系与激励机制相融合，提升全科医生的综合服务能力并建立高效的家医团队。
Background ?Home medicine contract servicehome medicine serviceis an important measure for deepening medical reform in Chinaaimed at improving people's health level and the efficiency of the health service system.home medicine service has achieved rapid development in terms of quantitybut there is currently a lack of research evidence related to the quality of home medicine service. Objective ?To understand the current status and existing problems of home medicine service quality in Beijing from the perspective of general practitionersand provide reference for improving the quality of home medicine services. Methods ?18 general practitioners from 18 community health service institutions in 9 districts of Beijing were selected through purposive sampling from August 2023 to June 2024and semi-structured interviews were conducted with general practitioners based on the structure process outcome framework interview outline. Analyze the data through thematic analysis and extract interview themes. Results ?the study extracted 3 themes and 11 sub-themes. Topic 1The structural quality of home medicine servicespolicy guidance and implementationinstitutional conditions and facilitiesassessment and incentive mechanisms for home medicine serviceshome healthcare team building. Topic 2Process quality of home medicine servicescontract service contentreferral and treatment service processoutpatient service standards. Theme 3The effectiveness of home medicine servicesimprovement in residents' health levelsincreased willingness to seek medical treatmentneed to strengthen residents' recognition of home medicine servicesincreased occupational pressure on general practitioners.Conclusion ?Since the implementation of home medical servicesthe quality of services has gradually improvedbut there are still some limiting factors. We should strengthen policy supportoptimize service content and processesintegrate quality evaluation systems with incentive mechanismsenhance the comprehensive service capabilities of general practitioners and establish efficient home medical teams.
崔亚佳、金光辉
医药卫生理论医学研究方法医学现状、医学发展
全科医生家庭医生签约服务现状服务质量家庭医生团队北京
崔亚佳,金光辉.全科医生视角下的北京市家庭医生签约服务质量现况：一项半结构访谈研究[EB/OL].(2024-12-18)[2025-08-02].https://chinaxiv.org/abs/202412.00271.点此复制
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