Abstract: Background　To enjoy contracted initial consultation services in primary care，residents need to sign a contract with the general practitioner（GP）．The contractual action is an important way to implement initial consultation in primary care，and also is a key measure to promote the transformation of residents' health-seeking behaviors.As a contract party，GPs are influenced by some factors during the selection of contracted residents.And identification of these factors is of great significance in improving the contract system.Objective　To investigate the factors associated with selection of contracted residents in GPs in Shanghai's Pudong New Area，providing recommendations for improving the development of contracted family doctor services.Methods　Voluntary participants were representative GPs delivering contracted family doctor services recruited from 13 community health centers in Shanghai's Pudong New Area〔 in which two-way choice system（residents can choose GPs and GPs can choose residents freely）was implemented〕by use of convenience sampling during March to April 2018.Personal interviews concerning factors associated with selection of contracted residents were conducted with them until data saturation was reached.Finally，the interview results of 20 GPs were included.Results　GPs' selection of contracted residents were influenced by their own conditions，residents' conditions and practicing environment.In addition，workload saturation，scope of practice，residents' perceptions of the contracted services and appraisal of number of contracted residents were also considered by GPs as the factors associated with selection of contracted residents.Conclusion　To further implement the contracted family doctor services，community hospitals can boost GPs' initiative in offering the services by improving the incentive assessment mechanism for assessing GPs' performance in delivering the contracted services，incentivize GPs to enhance their professional levels，and strengthen residents' understanding level of family doctor system.

Key words: General practitioners, Contracted family doctor services, Signing decisions, Root cause analysis, Interviews, Qualitative research

摘要： 背景　居民签约全科医生，是落实社区首诊的一种重要服务形式，同时也是促进居民就医习惯转变的重要举措，作为签约关系的一方，全科医生在选择签约对象时受哪些因素影响，对于完善签约制度有重要意义。目的　以上海市浦东新区为例，探讨全科医生选择社区居民签约时受哪些因素影响，为完善社区家庭医生签约服务提供建议。方法　于2018年3—4月，基于便利抽样法，选取上海市浦东新区中家庭医生签约双方可自主选择的13家社区卫生服务中心中参与家庭医生签约且有意愿的全科医生代表，通过一对一半结构化访谈采集其选择签约对象的影响因素。基于饱和原则，最终共纳入20名全科医生。结果　访谈结果显示，全科医生的签约决策受自身情况、居民情况和执业环境的综合影响。20名全科医生在选择与哪位社区居民签约时均会考虑工作饱和度、执业范围、居民对签约服务的认知和签约数量考核。结论　社区可以通过提高全科医生的执业水平，增强社区居民对家庭医生服务制度的了解，完善签约激励考核机制，提高全科医生签约的积极性，从而进一步落实签约服务。

关键词: 全科医生, 家庭医生签约服务, 签约决策, 影响因素, 访谈, 定性研究