基于全科医生视角的家庭医生团队签约现状调查研究

Background ??Currentlythere are many studies on family doctor contracting services from the perspective of residentsbut few scholars have conducted studies on the current situation of family doctor team contracting based on the perspective of general practitioners. Objective?? To understand the current situation of family doctor contracting services in primary health care institutions in Guangdong Provinceand explore the factors affecting the contracted number from the perspective of the supplierGPs. Methods ??From July 5—312021GPs in primary health care institutions in Guangdong Province were selected as the study subjects by using a multi-stage stratified cluster sampling method to conduct the survey with a self-designed questionnaire. The contracted number was compared by different GPs and their family doctor team characteristics. A two-level Logistic regression developed by R 4.2.2 software was used to identify influencing factors of contracted number above 2000. Results?? A valid sample of 3 252 cases in family doctor team with contracted number more than 100 was screenedand the median contracted number was 1 4002 499in 2020. The differences were statistically significant when comparing the contracted number by genderageeducation levelpositionemployment formworking yearsworking unitworking areatraining acceptanceand annual incomenumber of team memberspopulation size under jurisdictionwillingness of specialists from medical community to join the teaminpatient bed resources and guidance from superior departmentsP<0.05.?Zero model fitting showed that contracted number was clustered at the regional levelP<0.05. Two-level Logistic regression model showed thatwith master's degree as the referencethe contracted number of the team including GPs with collegeOR95%CI=2.791.843.74and secondary/high schoolOR95%CI=2.831.803.86degrees were more likely to be above 2 000taking no position as referencethe contracted number of the team including unit leadersOR95%CI=0.660.330.99were more likely to be above 2 000taking temporary staff as referencethe contracted number of the team including formal staffOR95%CI=2.021.532.51were more likely to be above 2 000taking the team with size of 3 or less people as referencethe contracted number of the teams with size of 4 to 6 peopleOR95%CI=1.311.051.577-10 peopleOR95%CI=2.061.752.3711-19 peopleOR95%CI=3.673.314.03and≥ 20 peopleOR95%CI=3.462.744.18were more likely to be above 2 000taking population size under jurisdiction at 2 000 or less as referencethe contracted number of the team with population size under jurisdiction at 2001 to 9999OR95%CI=2.372.122.6210 000 to 29 999OR95%CI=2.922.653.19and more than 30 000OR95%CI=2.862.553.17were more likely to be above 2 000taking condition of having inpatient bed resources as referencethe contracted number of the teams without such resourcesOR95%CI=1.381.141.62were more likely to be above 2 000. Conclusion ?The population under jurisdiction and the large number of team members create favorable conditions for contractingfamily doctor teams with GPs with positionsinpatient bed resources and high education level have a good understanding of family doctor contracting service policies and control the number of contracted patients bettercomparing with temporary staffGPs team with formal staff may undertake more contracting tasks.