摘要
目的了解北京郊区家庭医生签约服务中的医患信任现状,基于家庭医生角度厘清影响医患信任的因素并提出相应的对策。方法采取分层随机抽样的方法,从北京市的10个远郊区中分层抽取4个有代表性的区H、M、D、G作为研究现场,按家庭医生人数及岗位构成比例抽取参与家庭医生签约服务的全科医生、护士、防保人员共计202人进行问卷调查,深入了解家庭医生签约服务开展情况,医患之间系统信任与人际信任程度,签约前后医患关系变化情况,分析影响医患信任的相关因素等。结果从家庭医生的视角来看,目前社区居民对家庭医生签约服务团队比较信任和完全信任的有139人(68.8%);社区居民对家庭医生签约服务的认可度较高和很高的有42人(20.8%)。家庭医生的履约行为、尊重和沟通程度会影响居民对家庭医生的系统信任,家庭医生的岗位及其在诊疗过程中所遵循的伦理准则及行为均对医患之间的人际信任产生影响。结论医务人员参与家庭医生团队签约服务意愿较强,但相应的配套政策尚不完善;京郊居民的信任模式仍以人际信任为主,系统信任的作用未充分发挥;在社会转型的关键时期,家庭医生签约服务团队需关注签约居民的伦理诉求,建立医患互信的良善环境。
Objective: To explicit the current situation of doctor-patient trust in the contract service of family doctors in Beijing suburbs, to clarify the factors affecting the doctor-patient trust from the perspective of family doctors and put forward the corresponding countermeasures. Methods: Four representative districts H, M, D, G were selected from 10 remote suburbs of Beijing by stratified random sampling. According to the number of family doctors and the proportion of positions, a total of 202 general practitioners, nurses, and defense personnel who participated in the family doctor contract service were selected for questionnaire survey. To gain an in-depth understanding of the development of family doctor s contracted services, the degree of system trust and interpersonal doctor-patient trust, the changes in doctor-patient relationship before and after signing, and the analysis of factors affecting doctor-patient trust, etc. Results: At present, from the perspective of family doctors, 139 (68.8%) of the community residents had relatively trust and complete trust in the family doctor s contract service team. 42( 20.8 %) of the community residents had high recognition and higher recognition for the signed service of family doctor s contract service. The performance, respect and communication level of family doctors would affect residents systemic trust in family doctors. The position of the family doctors and the ethical guidelines and behaviors followed during the diagnosis and treatment process all had an impact on the interpersonal doctor-patient trust. Conclusion: The willingness of medical staff to participate in the family doctor s contract service team is strong, but the corresponding supporting policies are still not perfect. The trust model of residents in the suburbs of Beijing is still mainly interpersonal trust, and the role of system trust is not fully exerted. Based on the critical period of social transformation, the family doctor s contract service team should pay attention to the ethical demands of the contracted residents and establish a good environment of mutual doctor-patients trust.
作者
周娇娇
彭迎春
吕璐丹
ZHOU Jiaojiao;PENG Yingchun;LYU Ludan(School of Health Management and Education,Capital Medical University,Beijing 100069,China)
出处
《中国医学伦理学》
2019年第7期887-892,共6页
Chinese Medical Ethics
基金
首都卫生管理与政策研究基地开放性课题“制度信任视角下京郊家庭医生服务的医患信任困境及对策研究(2017JD08)”
北京市社会科学基金项目“卫生管理体制机制对乡村两级医德关系的作用研究”(15JGB074)
关键词
家庭医生签约服务
医患信任
社区卫生服务
Family Doctor s Contracted Service
Doctor-patient Trust
Community Health Services
作者简介
通信作者:彭迎春,E-mail:pycjql@163.com.
