Zhongguo quanke yixue (Apr 2023)
Impact of Appointment Service on the Quality of Family Doctor Contract Service Outcomes
Abstract
Background 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. Objective 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. Methods 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. Results 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) . Conclusion 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.
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