新冠疫情下签约患者对家庭医生签约服务及团队组成需求的质性研究

王佳欣; 史大桢; 马文翰; 赵亚利

doi:10.16766/j.cnki.issn.1674-4152.003209

新冠疫情下签约患者对家庭医生签约服务及团队组成需求的质性研究

doi: 10.16766/j.cnki.issn.1674-4152.003209

1.
首都医科大学全科医学与继续教育学院, 北京 100069
2.
北京市丰台区蒲黄榆社区卫生服务中心, 北京 100075

基金项目:

北京市社会科学基金一般项目 18SRB012

详细信息

通讯作者:
赵亚利，E-mail：zylnmtb@ccmu.edu.cn

中图分类号: R499
计量
- 文章访问数: 90
- HTML全文浏览量: 28
- PDF下载量: 10
- 被引次数: 0
出版历程
- 收稿日期: 2022-05-12
- 网络出版日期: 2023-11-23

A qualitative study of contracted patients' needs of family doctor services and team composition under COVID-19

1.
School of General Practice and Continuing Education, Capital Medical University, Beijing 100069, China

摘要

摘要: 目的了解新冠疫情下北京城区签约患者对家庭医生签约服务的看法及需求，并同时了解签约患者认为可以满足其需求的团队成员组合，为今后家庭医生签约服务质量的改进提供参考。方法采用目的抽样方法，在北京市5个城区各选取1家社区卫生服务中心，拟每家中心分别选取10名门诊就诊的签约患者进行面对面个人深入访谈；于2021年6—7月，共对47名签约居民访谈后达到信息饱和。使用内容分析法对访谈资料进行分析归纳。结果 (1) 访谈对象接受了基本服务包中的6项基本医疗服务、4项基本公共卫生服务及3项其他服务；接受了个性化服务包中的8项服务；以上服务的提供者以全科医生为主，护士或家医助理辅助；(2)访谈对象对家医服务的认可体现在便捷、连续及贴心3个主题；(3)患者对家医服务的需求可归纳为6个主题：增加药品种类及供应、提供老年人上门服务、优化团队结构、药品配送到家、组织健康宣教及手机定期推送健康信息。结论不断改进家庭医生签约服务内容及服务方式，优化服务团队结构，以满足新冠疫情下签约患者的需求，进一步提升突发公共卫生事件中家医服务质量。
- 新冠疫情 /
- 家庭医生签约服务 /
- 团队服务 /
- 签约患者 /
- 需求 /
- 质性研究
Abstract: Objective To understand the views and needs of contracted patients on contracted family doctor services in urban Beijing under COVID-19, and to understand the team members that can meet their needs, so as to provide reference for the improvement of family doctor contract service quality in the future. Methods Purpose sampling method was used to select one community health service center in each of five urban districts in Beijing, and ten contracted outpatients were selected from each center for face-to-face in-depth personal interviews. A total of 47 contracted residents were interviewed to reach information saturation from June 2021 to July 2021. The interview materials were analyzed by content analysis method. Results (1) The contents of basic services (including 6 basic medical services, 4 basic public health services and 3 other services) and 8 personalized services were delivered for signed patients. The above services were mainly provided by general practitioners and assisted by nurses or assistants. (2) The interviewees' recognition of contracted family doctor services was reflected in the three themes of convenience, continuity and caring. (3) The needs of signed patients for family doctor team services could be summarized into six themes: increasing the variety and supply of drugs, providing home-visit services for the elderly, optimizing the team structure, delivering drugs to the home, organizing health education, and regularly sending health information through mobile phones. Conclusion We should improve the content and methods of contracted family doctor services, optimize the structure of the service team to meet the needs of signed patients under the COVID-19 and continue to improve the quality of contracted family doctor services in public health emergencies.
- Corona Virus Disease 2019 /
- Contracted family doctor services /
- Team services /
- Contracted patients /
- Needs /
- Qualitative study

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表 1 访谈对象对家医服务的需求

Table 1. Demands of the interviewees for family care services

需要团队提供的服务	被建议提供此服务的家医团队成员	提此建议的人数	原话引用
增加药品种类及供应	全科医生开处方；药房工作人员负责药品管理	16	“根据患者需求，尽力保证常用药、急需药的供应”(H5)；“开方由全科医生来负责，由药房的人员来配药”(H10)。
提供老年人群上门服务	全科医生上门看病、急救、开药，护士上门送药及护理	8	“比如可以上门做一些居家指导，有慢性病的做一些饮食运动方面的指导；家里有老人的，帮忙做一些防跌倒的指导”(H37)；“提供这项服务需要家医团队中的全科医生和护士，全科医生负责病人疾病的判断、急救、开药；护士负责打针、输液等”(H38)。
优化团队结构：团队中增加三级医院专家、药师、辅助人员等	全科医生预约上级医院挂号、开处方，专家解决实际问题，护士预约就诊，药师保证药品供应	7	“在线咨询能不能连线大医院的专家帮忙一起去解决这个问题；因为社区医生看的全科，但是很多别的更专业更细化的问题，需要别的团队的人员一起共同解决这个问题”(H10)；“团队可以引入药师，让他们负责药品的供给；另外可以让团队中的护士或者医师来负责预约就诊，保证患者可以分时段预约就诊；全科医生负责帮忙预约上级医院的号，甚至邀请上级医院的医师加入团队，利用专家的专业知识帮助我们解决更多的问题”(H16)。
药品配送到家	全科医生开处方；护士或家医助理审核；合作配送公司送药上门	6	“开方由全科医生来负责，由药房的人员来配药，剩下的由医院自己的人员或者和其他公司合作给送药都可以”(H2)；“我们现在可以通过手机跟自己的家庭医生对话，对话后医生会告诉我们需要吃哪些药；如果可以线上开处方，医院跟快递公司合作代寄，就像外卖一样”(H9)。
组织健康宣教	签约医生和护士	6	“现在都是全科医生讲课，其实还希望护士给我们讲一些家庭护理，居家防跌倒的措施等，我觉得也非常有必要”(H32)。
手机定期推送信息：如健康知识、全科医生出诊信息、开药提醒	医生、护士、家医助理均可	5	“在线签约了家庭医生，系统能不能提示我们开药的时间，省得我们忘记了，或者不到日子就来了”(H12)；“签约医生可以帮我们发一些正确的对我们有用的知识”(H18)；“我觉得可以把医生出诊信息定期发送给我们”(H25)；“提供发送健康知识可以是家医团队中的医生、护士、家医助理，根据他们不同的专业发送他们熟悉的健康知识”(H39)。

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