家庭医生责任制下不同公共卫生服务模式的效果研究  

Effectiveness Evaluation of Three Public Health Service Models Within Family Doctor Responsibility System

作　　者：吴燕[1] 王君燕[1] 黄晓霞[1] 许慧琳[1] 苏华林[1] 赵燕萍 

机构地区：[1]上海市闵行区疾病预防控制中心,201105 [2]上海市第五人民医院

出　　处：《中国全科医学》2015年第28期3405-3409,共5页Chinese General Practice

基　　金：上海市卫生和计划生育委员会2014年面上项目--家庭医生责任制公共卫生服务项目包设计及服务协同机制研究

摘　　要：目的探讨上海市闵行区家庭医生责任制下不同公共卫生服务模式的效果。方法采用典型抽样法,在闵行区实施3种不同公共卫生服务模式的社区卫生服务中心中各抽取1家社区卫生服务中心,以其公共卫生服务模式为研究对象。3种公共卫生服务模式分别为：借助社区卫生服务站依托全科医生团队管理的传统型服务模式（模式1）、依托家庭医生/公共卫生外包中心协同管理的渐进型服务模式（模式2）、依托全科医生/医生助理小团队管理的激进型服务模式（模式3）。评价2014年3种不同公共卫生服务模式的卫生人力成本、公共卫生工作效率及服务效果。结果 3种模式每10万管理人口中分配的公共卫生服务人员数相近,分别为61.22、61.37、61.91人。模式1中,公共卫生人员投入比例最大,占14.53%;模式3中,全科医生及医生助理投入比例最大,占40.10%;模式2中,公共卫生人员、家庭医生及医生助理投入比例分别为10.96%、30.82%。3种模式的居民家庭电子健康档案建档率、免疫规划疫苗接种率、高血压管理率、糖尿病管理率、健康教育覆盖率、60岁以上老年人体检覆盖率、孕产妇系统管理率、0~6岁儿童系统管理率、精神疾病患者规范管理率及学生疾病规范管理率比较,差异均有统计学意义（P〈0.05）;3种模式的两两比较中,除模式1与模式2的精神疾病患者规范管理率（P=0.034）、学生疾病规范管理率（P=0.460）和模式2与模式3的学生疾病规范管理率（P=0.232）间差异无统计学意义外,其余差异均有统计学意义（P〈0.016 7）。3种模式的甲乙类传染病发病率、高血压血压有效控制率、糖尿病血糖有效控制率比较,差异均有统计学意义（P〈0.05）;3种模式的两两比较中,除模式1与模式3的甲乙类传染病发病率（P=0.718）间差异无统计学意义外,其余差异均有统计学意义（P〈0.016 7）。结论Objective To investigate the effect of three public health service models within family doctor responsibility system. Methods Using typical sampling method,we selected one community health service center of each of the three public health service models in Minhang District of Shanghai. We conducted investigation on the three public health service models including conventional service model based on community health service station and the management of general practitioner team（ model 1）,progressive service model based on cooperative management service by family doctors and public health outsourcing centers（ model 2） and advanced service model based on small teams of general practitioners and doctor assistants（ model 3）.Evaluation was made on human cost,work efficiency and service effect of the three models. Results For the three models,the numbers of public health service personnel allocated for every 100 000 residents were 61. 22, 61. 37 and 61. 91 respectively. Model 1 had the largest proportion of public health personnel input which was 14. 53%,model 3 has the largest proportion of general practitioners and doctor assistants which was 40. 10%,and model 2 had a proportion of 10. 96% for public health personnel and 30. 82% for family doctors and doctor assistants. The three models were significantly different（ P〈0. 05） in the rates of household electronic health record, vaccination, hypertension management, diabetes management, coverage of health education,coverage of physical examination for residents older than 60 years old,systematic management of pregnant and lying- in women,systematic management of children aged 0- 6 years old,standard management of mentally ill patients and standard management of students＇ diseases. By pairwise comparison among the three models, model 1 and model 2 were not significantly different in the rate of standard management of mentally ill patients（ P = 0. 034） and the rate of standard management of students＇ diseases（ P = 0. 460）,and there was no sig

关 键 词：家庭医生服务 公共卫生服务 服务模式 效果评价 

分 类 号：R197[医药卫生—卫生事业管理]