Facilitate Signing with the Family Doctor: A Study of the Practice in Shanghai, China

Abstract

Huimin Dai,1 Lan Tang,1 Zhaoxin Wang,2 Xiaoming Sun,3 Fang Zhang,1 Min Zhu,1 Qian Huang,1 Bing Hu,1 Linqiang Wang,1 Xianqin Fu,1 Li Luo,3 Jianwei Shi2,4 1Shanghai Pudong Weifang Community Health Center, Shanghai, 200120, People’s Republic of China; 2School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People’s Republic of China; 3School of Public Health, Fu Dan University School of Medicine, Shanghai, 200433, People’s Republic of China; 4Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, People’s Republic of ChinaCorrespondence: Lan Tang; Jianwei Shi Email [email protected]; [email protected]: In the time since primary care was implemented in China in 2009, programs of promoting residents signing with family doctor services have been key. However, there has been a lack of effective evaluation of its implementation.Methods: We used mixed methods for evaluating existing measures of facilitating signing with family doctors in Shanghai. Based on the Donabedian model, qualitative informant interviews were conducted to obtain experts’ evaluations in aspects of team construction (structure) and innovative solutions for promoting and supervising signings (process). Quantitative data were used to analyse the utilization situation (outcome) from “Shanghai Family Doctor Signing Data Platform”.Results: Measures of signing with family doctors in Shanghai have functioned well, but there is still a lack of sufficient family doctors and specialists, including paediatricians and gynaecologists. Although proportions of the key population (average=62.59%) and the elderly population (> 65 years) (average=78.10%) who had signed with family doctors were relatively high, the proportion of the permanent resident population (average=29.36%) who had signed with family doctors was low from 2017 to 2020 in Shanghai. The proportions of residents seeking medical advice in signed community health centres in outskirts (71.08%) were higher than those in suburbs (63.51%) and urban areas (53.49%), whereas the proportion of those seeking medical advice from recommended multiple medical institutions were similarly low in urban areas, outskirts and suburbs.Conclusion: The practice of facilitate signing with family doctors in Shanghai has increased. However, we showed that numbers of family doctors were relatively low, and there remains a need for more experienced gynaecology and paediatrics professionals, compared with Western countries. Additionally, efforts should be made to increase proportions of residents who utilize the program, especially in urban areas, and seek medical services in contracted group hospitals and community health centres.Keywords: primary care, family doctor service, evaluation, practice

Keywords

• primary care
• family doctor service
• evaluation
• practice