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中文摘要: 摘 要：目的：研究北京市某社区家庭医生签约服务现状，分析居民“签而不约”原因，提出改进对策，为完善家庭医 生服务和分级诊疗制度提供参考。方法：2024年12月—2025年1月选择北京市东城区一老旧社区，采用整群抽样法，选取 该社区750名已签约家庭医生服务的居民，收集其社会人口学特征、签约原因与方式、服务利用情况、政策知晓度及满意度 等信息。结果：签约方式上，纳入调查的750名签约居民中，622人为被动签约，占83.73%。只有17.2%(1291750)的签约 居民会主动联系家庭医生，而首诊会主动找家庭医生的占40.93%(3071750)。未选择家庭医生的主要原因为不能转诊至三级 医院、对家庭医生技术水平不信任、无相关就医需求。患慢性病和对医疗水平满意是居民履约的正向预测因素。在服务利用 方面，家庭医生通过主动服务模式弥补了居民参与不足的问题。导致该社区居民“签而不约”现象的主要原因为居民对家庭 医生签约服务政策知晓率低、家庭医生服务利用率存在差异、全科医生在人力配置和服务承载能力方面存在不足。结论：北 京市某社区家庭医生签约服务已实现制度落地，但服务质量、居民参与度、政策落实等方面存在不足。需通过提升全科医生 专业能力、完善转诊机制与医保政策、加大宣传力度等措施，提高居民履约率，减少“签而不约”现象。
Abstract:Abstract: OBJECTIVE To investigate the current status of family doctor contract services in a Beijing community,analyze reasons for residents'“signing without engagement,”propose improvement strategies,and provide references for enhancing family doctor services and the tiered diagnosis and treatment system.METHODS From December 2024 to January 2025,a cluster sampling method was employed in an older residential community in Dongcheng District of Beijing.A total of 750 residents who had signed up for family doctor services were selected.Data collected included sociodemographic characteristics,reasons and methods for signing up,service utilization patterns,policy awareness,and satisfaction levels.RESULTS Regarding enrollment methods,among the 750 enrolled residents surveyed,622 were enrolled passively,accounting for 83.73%.Only 17.2%(129/750)of enrolled residents proactively contacted their family doctors,while 40.93%(307/750)sought their family doctor for their first consultation.Primary reasons for not selecting a family doctor included inability to be referred to tertiary hospitals,distrust in the technical competence of family doctors,and lack of relevant medical needs.Chronic disease status and satisfaction with medical care quality were positive predictors of contract fulfillment.Regarding service utilization,proactive service models by family doctors compensated for residents'low participation rates.Key factors contributing to the “contracted but unused”phenomenon in this community included low awareness of the family doctor contract policy,disparities in service utilization rates,and insufficient GP staffing and service capacity.CONCLUSION While the family doctor contract service has been institutionalized in a Beijing community,deficiencies persist in service quality,resident engagement,and policy implementation. Measures such as enhancing GP professional capabilities,refining referral mechanisms and medical insurance policies,and intensifying publicity efforts are needed to increase resident fulfillment rates,reduce“signing without fulfilling”incidents.
keywords: Keywords: family doctor signing without engagement factors influencing fulfillment tiered diagnosis and treatment community health services
文章编号：3202410003 中图分类号：R197 文献标志码：
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| 作者 | 单位 |
| 钱晨光 |
| Author Name | Affiliation |
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