科创承载型功能社区家庭医生服务情况及其供需差异研究

吴娟丽; 陈远虹; 程慧琴; 杨翠; 董萍; 施榕

doi:10.16766/j.cnki.issn.1674-4152.002949

科创承载型功能社区家庭医生服务情况及其供需差异研究

doi: 10.16766/j.cnki.issn.1674-4152.002949

吴娟丽¹,
陈远虹^2, ,,
程慧琴¹,
杨翠²,
董萍²,
施榕³

1.
上海市杨浦区大桥社区卫生服务中心预防保健科，上海 200090
2.
上海市杨浦区大桥社区卫生服务中心全科，上海 200090
3.
上海中医药大学公共健康学院，上海 201203

基金项目:

上海市杨浦区卫生健康系统重点研究项目 YP19ZC05

详细信息

通讯作者:
陈远虹, E-mail: 443992556@qq.com

中图分类号: R197.61 R499
计量
- 文章访问数: 193
- HTML全文浏览量: 41
- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-15
- 网络出版日期: 2023-05-31

Service situation of family doctors and the difference between supply and demand in sci-tech innovation bearing functional community

1.
Department of Comprehensive Prevention and Healthcare, Shanghai Yangpu DaQiao Community Health Service Center, Shanghai 200090, China

摘要

摘要: 目的调研科创承载型功能社区家庭医生服务情况，分析供需差异及原因，为进一步落实功能社区家庭医生服务提供参考。方法于2021年5—7月采用多阶段随机抽样法，选取杨浦区大桥街道长阳创谷、互联宝地、城市概念、复地四季4个科创园区职业人群及为其提供健康服务的所有家庭医生作为研究对象。调研基本信息、家庭医生服务签约现况及健康管理服务、疾病诊疗与转诊服务、药品配备的供需情况，分析供需差异及原因。结果共调研功能社区职业人员1 045名、家庭医生48名。供需双方对家庭医生服务的期望基本一致，主要集中在健康错时服务、健康宣教与指导、康复理疗、智能健康监测与评估方面。但实际服务供给比例远远低于服务需求，供需比值前三高为健康宣教与指导(71.0%)、慢病长处方(69.2%)和中医保健(65.2%)；配备二三级医院药品、转诊至大医院专家门诊、免费健康体检、健康错时服务、智能健康监测与评估及预约就诊6个项目的供需比值还不足10.0%。对家庭医生缺乏信任和认可是造成供需差异的首要原因，医疗制度及基层药品目录不完善、供需双方积极性不高、社区医院的诊疗设施设备条件有限也是差异形成的重要原因。结论建议家庭医生团队进一步提升服务能力、整合优质资源、引入创新理念，为科创承载型功能社区人群提供针对性、精细化的健康管理服务。
- 家庭医生服务 /
- 功能社区 /
- 供给与需求
Abstract: Objective To investigate the service situation of family doctors in sci-tech innovation bearing function community, and analyze the difference between supply and demand and the reasons, so as to provide reference for further implementation of family doctor service in functional community. Methods Multi-stage random sampling was performed to select the occupational population and all family doctors who provide health services in Changyang Chuanggu, Interconnected Baodi, Urban concept and Four seasons in Yangpu District Bridge Street. Basic information, family doctor service contract status, as well as the supply and demand situation of health management services, disease diagnosis and treatment and referral services, drug equipped, were collected and the reasons for supply and demand differences were analyzed. Results A total of 1 045 community professionals and 48 family doctors were investigated. The expectations of both supply and demand for family doctor services were basically the same, mainly focusing on health timing service, health education and guidance, rehabilitation therapy, intelligent health monitoring and evaluation. However, the proportion of actual service supply was far lower than that of service demand. The top three ratios of supply and demand were health education and guidance (71.0%), long prescription for chronic diseases (69.2%) and traditional Chinese medicine health care (65.2%). The ratio of supply and demand for six items, including second-and-third-level hospital drugs, referral to specialist clinics in large hospitals, free health examination, health mistime services, intelligent health monitoring and evaluation and appointment diagnosis, was less than 10.0%. The lack of trust and recognition of family doctors was the primary reason for the difference between supply and demand. The imperfect medical system and primary drug catalogue, the low enthusiasm of both supply and demand, and the limited equipment conditions of diagnosis and treatment facilities in community hospitals were also important reasons for the difference. Conclusion It is suggested that the family doctor team should further improve the service ability, integrate high-quality resources, and introduce innovative ideas, so as to provide targeted and refined health management services for the population of sci-tech innovation bearing functional communities.
- Family doctor services /
- Functional community /
- Supply and demand

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表 1 调查对象基本情况[人(%)]

Table 1. The basic information of the investigative objects [people(%)]

项目	功能社区职业人群	家庭医生
性别
男性	548(52.4)	16(33.3)
女性	497(47.6)	32(66.7)
年龄(岁)
<25	28(2.7)	1(2.1)
25~34	437(41.8)	5(10.4)
35~44	505(48.3)	33(68.8)
≥45	75(7.2)	9(18.7)
教育水平
初中及以下	75(7.2)	0
大专、高中	168(16.1)	1(2.1)
大学及以上	802(76.7)	47(97.9)
医疗保险
上海	899(86.0)	48(100.0)
非上海	146(14.0)	0
婚姻状况
已婚	751(71.9)	46(95.8)
未婚	294(28.1)	2(4.2)

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表 2 供需双方对“功能社区职业人群对家庭医生服务的期望”的认知情况

Table 2. Cognition of the supply and demand sides on the "expectations of functional community professionals for family doctor services"

需求	功能社区职业人群(n=1 045)		家庭医生(n=48)		χ²值	P值
需求	人(%)	排序	人(%)	排序	χ²值	P值
儿童保健与预防接种	344(32.9)	13	17(35.4)	11	0.129	0.719
妇女保健及生育指导	440(42.1)	10	24(50.0)	9	1.171	0.279
养老服务	379(36.3)	12	16(33.3)	13	0.171	0.679
免费健康体检	494(47.3)	8	36(75.0)	4	14.126	0.001
智能健康监测与评估	862(82.5)	3	36(75.0)	5	1.756	0.185
健康宣教与指导	855(81.8)	4	44(91.7)	2	3.049	0.081
健康错时服务	905(86.6)	1	46(95.8)	1	3.459	0.063
家庭病床服务	54(5.2)	16	4(8.3)	16	0.394	0.530
心理问题疏导	397(38.0)	11	21(43.8)	10	0.645	0.422
预约就诊	798(76.4)	5	35(72.9)	6	0.301	0.583
转诊至大医院专家门诊	741(70.9)	6	16(33.3)	14	30.434	0.001
康复理疗	866(82.9)	2	37(77.1)	3	1.070	0.301
中医保健	630(60.3)	7	26(54.2)	8	0.716	0.397
慢病长处方	129(12.3)	15	13(27.1)	7	8.819	0.003
配备二三级医院药品	451(43.2)	9	31(64.6)	15	8.546	0.003
延伸处方药品免费配送	272(26.0)	14	15(31.3)	12	0.646	0.422

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表 3 家庭医生服务期望与实际供给情况比较[人(%)]

Table 3. Comparison between service expectation and actual supply of family doctors[people(%)]

项目	服务期望	实际供给
儿童保健与预防接种	344(32.9)	16(13.7)
妇女保健及生育指导	440(42.1)	20(17.1)
养老服务	379(36.3)	13(11.1)
免费健康体检	494(47.3)	3(2.6)
智能健康监测与评估	862(82.5)	7(6.0)
健康宣教与指导	855(81.8)	68(58.1)
健康错时服务	905(86.6)	7(6.0)
家庭病床服务	54(5.2)	3(2.6)
心理问题疏导	397(38.0)	10(8.5)
预约就诊	798(76.4)	7(6.0)
转诊至大医院专家门诊	741(70.9)	3(2.6)
康复理疗	866(82.9)	23(19.7)
中医保健	630(60.3)	46(39.3)
慢病长处方	129(12.3)	10(8.5)
配备二三级医院药品	451(43.2)	0
延伸处方药品免费配送	272(26.0)	7(6.0)

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表 4 家庭医生服务供需差异原因分析

Table 4. Analysis on the causes of difference between supply and demand of family doctor service

原因	签约人群(n=117)		家庭医生(n=48)
原因	人(%)	排序	人(%)	排序
供需双方积极性不高	78(66.7)	2	30(62.5)	6
宣传力度不足	55(47.0)	5	31(64.6)	4
家庭医生人员短缺	49(41.9)	6	25(52.1)	8
社区医院的诊疗设施设备条件有限	72(61.5)	3	33(68.8)	3
信息化建设不完善，预约、转诊渠道不畅通	39(33.3)	8	28(58.3)	7
对家庭医生缺乏信任和认可	81(69.2)	1	39(81.3)	1
国家和政府支持力度不够	46(39.3)	7	31(64.6)	5
医疗制度及基层药品目录不完善	59(50.4)	4	36(75.0)	2

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