以预约门诊为特色的家庭医生责任制的实践和探讨

胡隽 王海琴

（上海市徐汇区华泾镇社区卫生服务中心 上海 200231）

摘 要目的：探索以预约门诊为特色的家庭医生责任制团队服务模式。方法：随机抽取2011年7月至2012年7月期间华泾镇社区卫生服务中心预约门诊患者（观察组）100例和非预约门诊患者（对照组）100例。以电话形式在患者就诊后第3天、第7天和第15天进行回访，对患者用药情况按完全依从(完全执行医生医嘱)、部分依从（超过或不足剂量用药、增加或减少用药次数等）和完全不依从(不按照医生开具处方所指示的医嘱服药)进行分类。结果：观察组3、7、15 d预约门诊后对医嘱的执行力，3 d时完全依从100例，7 d时完全依从和部分依从分别为92例和8例，15 d时分别为89例和11例；对照组3 d时完全依从和部分依从分别为95例和5例，7 d时完全依从和部分依从分别为88例和7例，15 d时完全依从和部分依从分别为76例和11例，组间差异有统计学意义（P<0.05）。结论：以预约门诊为特色的家庭医生责任制能更有效的提高居民诊疗依从性，也能更有效的服务于社区。

关键词预约门诊 家庭医生责任制 依从性

Practice and exploration of the responsibility system of the family doctors with the outpatient appointment as the characteristics

HU Jun, WANG Haiqin

(Huajing Community Health Service Center of Xuhui District, Shanghai 200231, China)

ABSTRACTObjective: To explore the team service mode of the responsibility system of the family doctors with the outpatient appointment as the characteristics. Methods: One hundred cases of the outpatient appointment patients (the observation group) and one hundred cases of non-outpatient appointment ones (the control group) in Huajing Community Health Service Center from July 2011 to July 2012 were selected randomly. The patients were paid the return visits by the telephone after the visit on the third, seventh and fifteenth days. The medication compliance of the patients was classified according to the complete compliance (completely executing the doctor orders), partial compliance (more or less dosage, increasing or decreasing the times of medication) and complete non-adherence (not in accordance with the prescribed medicine indicated by the doctor’s prescription). Results: After the outpatient appointment of 3, 7 and 15 days, the execution of the doctor’s advice was that the complete compliance rate was 100 cases on the third day, the full compliance rate and partial compliance rates 92 and 8 cases on the seventh day and 89 and 11 cases in the fifteenth day in the observation group, respectively. In the control group, the complete compliance rate was 95 and 5 cases on the third day, the full compliance rate and partial compliance rates 88 and 7 cases on the seventh day, and 76 and 11 cases on the fifteenth day, whose group difference had the statistical significance (P<0.05). Conclusion: The responsibility system of the family doctors with the outpatient appointment as the characteristics can enhance the treatment compliance of the residents, and also can serve the community more effectively.

KEY WORDSoutpatient appointment; responsibility system of family doctors; compliance

上海市新医改方案的出台显示，全面推行家庭医生责任制是各项工作的重点。开展家庭医生制服务是医改政策，也是承担居民健康“守门人”职责的现实要求[1]。家庭医生制服务即通过签约方式，促使具备成为家庭医生条件的全科医生与签约家庭建立起一种长期的服务关系，居民可自由选择所信赖的家庭医生进行签约，享受到个性化的家庭医疗服务，家庭医生对签约家庭的健康进行全过程维护。接受家庭医生制服务的居民签约后的优惠体现在：①慢性病1次就诊可配1个月药量；……