Page 65 - 中国全科医学2022-04

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【Abstract】 Background The elderly residents in the mountainous area of northern Beijing have a high incidence of
chronic diseases，a weak economic foundation，limited access to health knowledge，and a long distance from community health
service institutions. At present，the team of family doctors in the mountainous area of northern Beijing is composed of community
doctors and rural doctors. Both of them play an important role in contracting services for elderly residents in mountainous areas.
Objective To explore the current status of family doctor contracted services in the northern mountain areas of Beijing and put
forward appropriate suggestions on family doctor contracted services with the elderly residents in mountain areas. Methods
A combination of qualitative research and quantitative research was adopted. From September to October 2019，eight townships
were selected in the northern mountain areas of Huairou District in Beijing. A total of 141 community doctors，133 rural doctors
and 345 elderly residents were selected proportionally from each township for questionnaire research. The elderly resident's
questionnaires included basic information of the elderly，the way and the content of services which they want family doctor team
to provide，the channels to obtain health consultation，and the satisfaction evaluation of the contracted services；the rural
doctors and the community doctors' questionnaires included basic information，the use of internet in the contracted services，
and the content of services provided to the elderly residents. During the same period，16 cases of elderly residents，24 cases of
community doctors，and 24 cases of rural doctors were selected by using the purposive sampling method for personal in-depth
interviews，in order to understand the level of awareness of the responsibilities of community doctors and rural doctors in the
linkage contracted services，their views on the contracted services and the application of the internet in this service model，their
suggestions on the development of the contracted services，etc. A content analysis method was used to analyse qualitative data.
Results According to the quantitative research results，the top three services that elderly residents in the northern mountain
areas of Beijing want the family doctor team to provide are ranked as follows：carrying out the health education in countryside
〔199（57.7%）〕，physical examination in countryside〔197（57.1%）〕，the delivery of medical service and medicine in
the countryside〔169（49.0%）〕；the top three ways or channels of services that elderly residents want the family doctor team
to provide are ranked as follows：outpatient clinicservice，in-home medical services，organizing health education lectures in
the community；the top three channels that elderly residents consider most effective to obtain health information are ranked as
follows: publicity by rural doctors or loudspeaker in the village〔253（73.33%）〕，face-to-face publicity by community doctors
during consultation〔134（38.84%）〕，posting and distribution of publicity materials〔126（36.52%）〕. The results of
multiple linear regression analysis showed that service attitude，service effectiveness，service items，and communication ability
were the influencing factors of elderly residents' satisfaction with community doctors and rural doctors' linkage contracted services
（P<0.05）. The health management service，outpatient service，drug distribution and medical guidance service，and long-
term prescription service also had significant differences between community doctors and rural doctors（P<0.05）. There was no
statistically significant difference between community doctors and rural doctors using the Internet to communicate with residents
online （P>0.05）. The qualitative research results showed that the elderly residents had low demand for online services and high
dependence on rural doctors，but the technical level of rural doctors were limited，community doctors had little communication
with elderly residents，and they mainly focused on the coordination of medical resources. Conclusion The development of
contracted services for elderly residents in the northern mountain areas of Beijing cannot be carried out without the joint efforts of
community doctors and rural doctors. Currently，the elderly residents highly depend on rural doctors because of close-up services
and show a great demand on community doctors for high-level technology and medical resources platform. It's recommended to
take the needs of elderly residents as the guide，give full play to the advantages of rural doctors in terms of location and people，
and the advantages of community doctors' technology and platform，and optimize the effectiveness of community doctors and rural
doctors' linkage contracted services.
【Key words】 Contracted family doctor services；Health services for the aged；Mountain areas；Community health
services；Beijing

2021 年第七次人口普查数据显示，全国人口达 服务的指导意见》（国医改办发〔2016〕1 号），提出
到 14.117 8 亿， 其 中 65 岁 及 以 上 人 口 1.9 亿， 占 比 要促进医疗卫生工作重心下移、资源下沉，加快推进家
13.50%，老年人口规模庞大 ［1］ 。老年人占比增多的同时， 庭医生签约服务，提出“明确家庭医生为签约服务第一
老年健康服务需求增大，给国家卫生保健系统带来巨大 责任人”；北京市深化医药卫生体制改革领导小组办公
挑战。当前推行的家庭医生签约服务对提升老年人健康 室于 2017 年印发《北京市推进家庭医生签约服务实施意
管理质量和老年患者卫生服务可及性具有积极的现实意 见的通知》（京医改办〔2017〕2 号），国家卫生健康
义。2016 年国务院医改办出台《关于推进家庭医生签约 委员会、国家中医药管理局于 2018 年印发《关于规范家