Current situation and problems with general practitioners from the core hospitals of the compact county medical community participating in contracted family doctor services: a qualitative study
10.3760/cma.j.cn114798-20240823-00707
- VernacularTitle:紧密型县域医疗卫生共同体综合医院全科医生参与家庭医生签约服务现状与问题的质性研究
- Author:
Qi WANG
1
;
Yanli LIU
1
;
Li MA
1
Author Information
1. 首都医科大学附属北京天坛医院全科医疗科，北京 100070
- Publication Type:Journal Article
- Keywords:
General practitioner;
Qualitative research;
Contracted family doctor services;
County-level medical alliance
- From:
Chinese Journal of General Practitioners
2025;24(4):441-448
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To understand the current situation and problems of general practitioners′ participation in family doctor services in the general hospitals of the tight county medical community (county medical community).Methods:This study was a qualitative study. From February to May 2024, the participants were selected by convenient sampling method from the experimental units of county medical community during the 9th General Practitioner Training Summit Forum organized by the Chinese Medical Doctor Association. The participants included general practitioners from the family doctor service teams of primary healthcare institutions within these county medical community, as well as general practitioners from the county medical community. We conducted semi-structured interviews with the respondents, and finally a total of 22 respondents were selected according to the principle of information saturation. The interview outline was developed based on the problems and needs of general practitioners in the county medical community general hospitals, and the data were analyzed using thematic framework analysis.Results:Twenty-two respondents came from 12 provinces/municipalities and 20 county medical community, including 6 from primary hospitals and 16 from general hospitals. A total of 6 themes and 23 sub-themes were extracted. The six topics are the construction of county medical communities, the establishment of general practice departments, the participation of general practice departments in the signing of family doctors at the grassroots level, the role of general practice departments in county medical communities, the factors influencing general practitioners in county-level general hospitals to perform family doctor signing services at the grassroots level, and the mechanisms that need to be established to promote the development of this work. The majority of the county medical community had been identified and surveyed. All the county general hospitals in this study had independently set up general practice departments, but they faced issues such as staffing shortages, unclear positioning, and insufficient role play, and the majority of them (13/16) did not participate in the family doctor services. General practitioners in general hospitals (5/16) are willing to participate in the primary contracted family doctor services, although the numbers are often insufficient. Restraining reasons include a lack of staff, inadequate capability, not supported by the hospital, poor effect, not demanded from residents, under management from primary healthcare institutions to large-scale medical institutions, and an incomplete assessment. The motivation of general practitioners in county-level general hospitals to participate in the primary contracted family doctor services can be enhanced by establishing relevant working mechanism, guarantee mechanism and incentive mechanisms.Conclusions:At present, the participation of general practitioners in county-level medical community general hospitals in family doctor contract services is seriously inadequate, with problems such as staff shortages, insufficient ability, and lack of hospital support.
