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

Abstract

Background: 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.

The impact of hypertension follow-up management on the choices of signing up family doctor contract services: does socioeconomic status matter?

“…Our study found that regular hypertension follow-up management was positively associated with contracting family doctor services among older adults. Older adults with regular hypertension follow-up management preferred to sign family doctor contract services, which was similar to the findings of previous studies on primary health services [ 36 , 37 ]. This result can be explained in terms of both supply and demand characteristics of health services.…”

Factors associated with access to healthcare services for older adults with limited activities of daily living

“…And it gains low acceptance by patients especially older adults who are unfamiliar with information technology ( 48 ). With the increasing population and older adults, the total amount of family doctors was insufficient ( 49 ). In terms of the development of an integrated healthcare system, it was limited by the inadequate technical level of secondary or primary services centers ( 11 ), the fragmented governance, and incoordination of healthcare resources in China ( 50 , 51 ).…”

Health Management Service Models for the Elderly with Visual Impairment: A Scoping Review

“… 87 The contract between the family doctor and the service provider and the service content needs to be improved. 88 National government factors are the main trigger for family contract services. Public health services provided by family doctors should be included in the scope of health insurance and linked to health insurance to assist family doctor health management.…”