Analysis on the Difference of Expectation and Actual Value of Contracted Services among Residents and Its Countermeasures in Datuan Community Health Service Center

doi:10.12114/j.issn.1007-9572.2018.00.390

Abstract

Abstract: Background　As a platform for the government to provide basic medical and public health services to the people，the efficient and orderly service of community health service centers will improve the operational efficiency of family doctors' contracted services and meet the basic health needs of residents.Objective　To analyze the difference between the expected value and the actual value of contracted services among residents in Datuan Community Health Service Center，and understand the operation status of the Center，so as to put forward countermeasures against existing problems.Methods　Contracting residents of Datuan Community Health Service Center were selected from April to June 2017 using a simple random sampling method.Self-designed Survey on the Evaluation of Expectations and Actual Values of Community Health Services by Contracting Residents were used during face-to-face interviews with contracting residents.The questionnaire consisted of 25 entries in 3 dimensions.Dimension 1 was the evaluation of 4 projects：visiting environment，service attitude，doctor's diagnosis and treatment skills，and construction of auxiliary functional platform of the health service center（including expected and actual values）；dimension 2 was the evaluation of environment，service attitude，diagnostic and therapeutic skills in different departments （actual value）；dimension 3 was the evaluation of operational service items，clinical laboratory items，radiation/echocardiography/electrocardiogram examinations，and drug supply（actual values）．Results　A total of 400 questionnaires were distributed，396 were recovered，and 390 valid questionnaires were collected，with an effective recovery rate of 97.50%.Among 390 contracted residents，206（52.82%）indicated that they concerned“doctors' diagnosis and treatment skills” the most，75 （19.23%）indicated that they focused on the“construction of auxiliary functional platform”.Visiting environment's expectation score was（8.34±1.27） points，actual value score was（8.23±1.34） points，service attitude expectation score was （8.49±1.17） points，the actual value score was （8.22±1.29） points，doctor's diagnosis and treatment skills expectation score was （8.59±1.06） points，and actual value score was （8.14±1.24） points，auxiliary function platform expectation score was （8.25±1.27） points，and actual value score was （7.97±1.33） points.Contracted residents evaluated the departments and top three highest actual value departments were general practice clinic〔（8.42±1.25） points〕，outpatient lobby〔（8.37±1.23） points〕，and outpatient department of Traditional Chinese Medicine〔（8.28±1.32） points〕.The actual value of doctors' operational service items in the community health service center was （7.95±1.40） points；clinical laboratory items was （7.92±1.33） points；radiation/echocardiography/electrocardiogram examinations items was（8.01±1.23） points；drug supply was （7.66±1.38） points.209（53.59%）contracting residents thought that there was an urgent need to improve the“drug supply”.Ninety-eight （27.22%）thought it was urgent to improve“perational service items”.Conclusion　Contracting residents are most concerned about the diagnosis and treatment skills of doctors in community health service centers.The gap between the expected value and the actual value is large.The evaluation of doctors' operation items is low，and the supply of drugs can not meet the demand.Under the guidance of the government，we suggest to establish Family Doctor Studio，introduce internal competition mechanism，change performance appraisal standards，and speed up the construction of talent team.Through the“system+science and technology” management model，the function of community health service centers can be improved.

Key words: Family doctors contract service, Community health services, Family doctor

摘要： 背景　社区卫生服务中心作为政府向老百姓提供基本医疗和公共卫生服务的平台，其高效、有序的服务将提升家庭医生签约服务工作的运行效率，满足居民基本健康需求。目的　分析大团社区卫生服务中心签约居民对签约服务期望值和实际值差异，了解大团社区卫生服务中心的运行现状，并针对存在问题提出对策。方法　2017年4—6月，采用简单随机抽样法抽取大团社区卫生服务中心的签约居民。采用自行设计的《签约居民对社区卫生服务期望值和实际值的评价调查表》对签约居民进行面对面问卷调查。调查问卷共3个维度25个条目。维度1：对社区卫生服务中心就诊环境、服务态度、医生诊疗技术、辅助功能平台建设4个项目进行评价（包括期望值和实际值）；维度2：签约居民对社区卫生服务中心的科室环境、人员服务态度及诊疗技术进行评价（实际值）；维度3：对社区卫生服务中心医生操作类服务项目、临床检验类项目、放射/超声/心电类检查项目、药物供应项目4个项目进行评价（实际值）。结果　共发放调查问卷400份，回收396份，回收有效问卷390份，有效回收率为97.50%。390例签约居民中，206例（占52.82%）签约居民表示“最关注医生诊疗技术”，75例（占19.23%）表示“最关注辅助功能平台建设”。就诊环境期望值得分（8.34±1.27）分，实际值得分（8.23±1.34）分，服务态度〔期望值得分（8.49±1.17）分，实际值得分（8.22±1.29）分，医生诊疗技术期望值得分（8.59±1.06）分，实际值得分（8.14±1.24）分，辅助功能平台建设期望值得分（8.25±1.27）分，实际值得分（7.97±1.33）分。签约居民评价科室环境的实际值得分的前3位依次是全科门诊（8.42±1.25）分、门诊大厅（8.37±1.23）分、中医门诊（8.28±1.32）分。签约居民评价社区卫生服务中心医生操作类服务项目实际值得分为（7.95±1.40）分；临床检验类项目实际值得分为（7.92±1.33）分，放射/超声/心电类检查项目实际值得分为（8.01±1.23）分，药物供应项目实际值得分为（7.66±1.38）分。其中209例（占53.59%）签约居民认为急需改进“药物供应项目”，98例（占27.22%）签约居民认为急需改进“医生操作类服务项目”。结论　签约居民最关注社区卫生服务中心的医生诊疗技术，其期望值与实际值差距也较大；对医生操作类服务项目评价较低，且药物供应无法满足其需求。建议在政府指导下，建立“家庭医生工作室”、引入内部竞争机制、转变绩效考核标准，加快推进人才队伍建设，通过“制度+科技”管理模式，加强社区卫生服务中心平台功能建设。

关键词: 家庭医生签约服务, 社区卫生服务, 家庭医生

CAI Liqiang,HOU Jin,LU Xinjian. Analysis on the Difference of Expectation and Actual Value of Contracted Services among Residents and Its Countermeasures in Datuan Community Health Service Center[J]. Chinese General Practice, 2019, 22(6): 691-695. DOI: 10.12114/j.issn.1007-9572.2018.00.390.
蔡利强,侯进,陆新建. 大团社区卫生服务中心签约居民对签约服务期望值和实际值差异的分析及其对策研究[J]. 中国全科医学, 2019, 22(6): 691-695. DOI: 10.12114/j.issn.1007-9572.2018.00.390.

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