At present, the contracting rate of family doctors in China is high, but there are problems such as low service quality and low service utilization rate.

To comprehensively investigate the current situation of contracting, performance and renewal of family doctor services in Meizhou and Heyuan cities of Guangdong Province, and explore the impact of appointment consultation service on the quality of contract services.

From July to August 2021, 11 districts and counties in Meizhou and Heyuan cities were selected using a multi-stage sampling method, the list of rural health centers that can be investigated was provided by the health bureau of each district (county). The questionnaire was administered through the "questionnaire star" platform to the head of the rural health centers or the directors of public health. The questionnaire was prepared by the Guangdong Internet + Family Doctor Contract Guidance Center, which was called "Guangdong Family Doctor Contract Service Current Situation Questionnaire", including the basic information of the invesgated rural health centers, the current situation and progress of family doctor contract service. Based on the structure-process-outcome (SPO) model, the dependent variables were set as outcome quality indicators (effective contract rate of general population/focused population, number of institutions with difficulty in compliance and low renewal rate) to compare the current situation of family doctor contract service in rural health centers with different appointment consultation service provision capacity. The Logistic regression was used to analyze the impact of appointment consultation service on the outcome quality of contract service.

The median family doctor contract rate of 100 rural health centers for focused population and general population was 69.0% (60.0%, 85.0%) and 31.8% (29.1%, 54.5%), respectively; the number of institutions reaching family doctor contract service coverage target for focused population/general population of 2025 was 42 (42.0%) and 30 (30.0%), respectively. A total of 78 (78.0%) of these 100 rural health centers faced difficulties in compliance implementation, including 38 (90.5%) rural health centers did not provide appointment consultation service; 50 (50.0%) rural health centers had problems with low renewal rates, including 18 (42.9%) of which did not provide appointment consultation service and faced difficulties in compliance implementation. Logistic regression analysis showed that among the health centers reaching the target, there was no effect the providing of appointment consultation service on the contracting rate of family doctors in the focused and general population (P>0.05) ; among the 100 investigeted health centers, the providing of appointment consultation service had a significant effect on the compliance difficulties of the contracted institutions〔OR (95%CI) =0.28 (0.08, 0.98), P<0.05〕; and the providing of appointment consultation service had no effect on the low renewal rate of contracted residents (P>0.05) .

The performance of family doctor contract service in Guangdong Province is closely related to the providing of appointment consultation service by the health cenyers, and it is recommended to enrich the form and content of appointment service in the process of subsequent service, enhance residents' trust and motivation to use the service actively through the Internet + platform "improve efficiency and quality", while injecting motivation for service provision and utilization from both doctors and patients in order to provide continuous and effective integrated medical and health services as well as health management.

现阶段，我国家庭医生签约服务的居民签约率较高，但签约服务质量和服务利用率问题仍有待改善。

全面了解广东省梅州、河源两市的家庭医生服务签约、履约、续约现状，并探索预约诊疗服务对签约服务结果质量的影响。

于2021年7—8月，采用多阶段抽样的方法抽取梅州市和河源市的11个区（县），由各区（县）卫生健康局提供可调查乡镇卫生院名单，通过"问卷星"平台对乡镇卫生院的分管院长或公卫负责人进行问卷调查。问卷采用广东省互联网+家庭医生签约指导中心统一编制的调查问卷《广东家庭医生签约服务现状调查表》，调查内容包括所调查乡镇卫生院的基本情况，家庭医生签约服务现状及进展。基于结构-过程-结果（SPO）模型，设置因变量为结果质量指标（一般人群/重点人群的有效签约率、履约困难机构数和续签率低机构数），比较不同预约诊疗服务提供能力的乡镇卫生院的家庭医生签约服务现状，采用Logistic回归分析预约诊疗服务对签约服务结果质量的影响。

100家乡镇卫生院重点人群和一般人群家庭医生签约率中位数分别为69.0%（60.0%，85.0%）、31.8%（29.1%，54.5%）；重点人群/一般人群的家庭医生签约服务覆盖率已达2025年工作目标的机构数分别为42家（42.0%）、30家（30.0%）。这100家乡镇卫生院面临履约落实困难的机构共78家（78.0%），其中未提供预约诊疗服务的乡镇卫生院存在履约落实困难的机构共38家（90.5%）；存在续约率低问题的机构共50家（50.0%），其中未提供预约诊疗服务的乡镇卫生院面临履约落实困难的机构18家（42.9%）。Logistic回归分析显示，在达标机构中，是否提供预约诊疗服务对重点人群及一般人群的家庭医生签约率无影响（P>0.05）；在所调查的100家机构中，是否提供预约诊疗服务对签约机构履约困难存在影响〔OR（95%CI）=0.28（0.08，0.98），P<0.05〕，对签约居民续约率低无影响（P>0.05）。

广东省家庭医生签约服务的履约情况与机构是否提供预约诊疗服务密切相关，在之后的服务过程中建议丰富预约形式和内容，通过互联网+平台"提质增效"，增强居民的信任和主动利用服务的动力，同时从医患双方注入服务提供和利用的动力，以便提供持续、有效的综合医疗卫生服务和健康管理。