Quality of Family Doctor Contracted Services in Beijing from the Perspective of General Practitioners: A Semi-Structured Interview Study

Abstract

Background: Home medicine contract service Family doctor contracted service (home medicine service) is an important measure for deepening medical reform in China, aimed at improving people's health level and the efficiency of the health service system. home medicine service Family doctor contracted service has achieved rapid development in terms of quantity, but there is currently a lack of research evidence related to the quality of home medicine service.

Objectives To understand the current status and existing problems of home medicine service family doctor contracted service quality in Beijing from the perspective of general practitioners (GPs), and provide reference for improving the quality of home medicine service family doctor contracted service.

Methods: A total of 18 general practitioner GPs from 18 community health service institutions centers in 9 districts of Beijing were selected through purposive sampling from August 2023 to June 2024, and semi-structured interviews were conducted with general practitioner GPs based on the structure process outcome framework interview outline. Analyze tThe data were analyzed through thematic analysis and to extract interview themes.

Results: The study extracted 3 themes and 11 sub-themes. Topic 1: The structural quality of home medicine service family doctor contracted service (policy guidance and implementation, institutional conditions and facilities, assessment and incentive mechanisms for home medicine services, home healthcare team building). Topic 2: Process quality of home medicine service family doctor contracted service (contract service content, referral and treatment service process, outpatient service standards). Theme 3: The effectiveness of home medicine service family doctor contracted service (improvement in residents' health levels, increased willingness to seek medical treatment, need to strengthen residents' recognition of home medicine service family doctor contracted service, increased occupational pressure on general practitioner GPs).

Conclusions Since the implementation of home medical service family doctor contracted service, the quality of services has gradually improved, but there are still some limiting factors. We should strengthen policy support, optimize service content and processes, integrate quality evaluation systems with incentive mechanisms, enhance the comprehensive service capabilities of general practitioner GPs and establish efficient home medical familu doctor teams.

Keywords

General practitioners / Family doctor contracting / Status of services / Quality of service / Family doctor teams / Beijing

Competing interests

The authors declare that they have no competing interests.

Declarations

Not applicable.

Authors' contributions

Conceptualization, C.Y. and J.G.; Methodology, C.Y. and J.G.; Data curation, C.Y. and J.G.; Formal analysis, C.Y.; Funding acquisition, not applicable; Project administration, not applicable; Resources, not applicable; Supervision, J.G.; Validation, J.G.; Writing—original draft, C.Y.; Writing—review and editing, J.G. All authors have read and agreed to the published version of the manuscript.

Ethics approval and consent to participate

This research was supported by grants from Capital Medical University (Z2023SY070).

Consent for publication

Not applicable.

Availability of data and materials

Not applicable.

Funding

Not applicable.

Acknowledgements

Not applicable.

Authors' other information

Yajia Cui: https://orcid.org/0009-0006-4290-1984; Guanghui Jin: https://orcid.org/0000-0002-8269-2842.

References

[1] Li X, Lu JP, Hu S, et al. The primary health-care system in China. Lancet. 2017; 390(10112):2584-2594. doi: 10.1016/S0140-6736(17)33109-4.

[2] Pan GY, Yang Y. Research status of family doctor team service models in China. Chin Gen Pract. 2017; 20(28):3457-3462. doi: 10.3969/j.issn.1007-9572.2017.28.002.

[3] Li LN, Zhong CW, Mei J, et al. Effect of family practice contract services on the quality of primary care in Guangzhou, China: a cross-sectional study using PCAT-AE. BMJ Open. 2018; 8(11). doi: 10.1136/bmjopen-2017-021317.

[4] Liu H, Liu DP. A propensity score matching study on the impact of family doctor contract services on residents’ health literacy. Chin J Health Educ. 2023; 39(11):1051-1055. doi: 10.16168/j.cnki.issn.1002-9982.2023.11.016.

[5] Lv B, Cui CS, Feng XM, et al. What factors affect Beijing residents’ contracts with family doctors? A comparative study of Beijing’s urban and suburban areas. Front Public Health. 2023; 11:1159592. doi: 10.3389/fpubh.2023.1159592.

[6] Shen SY, Wu Z, Zhang JM, et al. Study on the implementation effect of the family doctor system in Shanghai. Chin Gen Pract. 2015; 18(10):1132-1137. doi: 10.3969/j.issn.1007-9572.2015.10.008.

[7] National Health and Family Planning Commission. Notice on issuing the guidelines for promoting family doctor services ; 2016 Jun 6 [Internet][cited 2024 Apr 15]. Available from: https://www.gov.cn/xinwen/2016-06/06/content_5079984.htm.

[8] Li X, Krumholz HM, Yip W, et al. Quality of primary health care in China: challenges and recommendations. Lancet. 2020; 395(10239):1802-1812. doi: 10.1016/S0140-6736(20)30122-7.

[9] Wong WCW, Jiang SF, Ong JJ, et al. Bridging the gaps between patients and primary care in China: a nationwide representative survey. Ann Fam Med. 2017; 15(3):237-245. doi: 10.1370/afm.2034.

[10] Li MY, Zhang XT, Tang HQ, et al. Quality of primary health care for chronic diseases in low-resource settings: evidence from a comprehensive study in rural China. PLoS One. 2024; 19(7). doi: 10.1371/journal.pone.0304294.

[11] Guiding Opinions on Promoting the High-Quality Development of Family Doctor Services [Internet]. 2022 Mar 3 [cited 2024 Apr 15]. Available from: https://www.gov.cn/zhengce/zhengceku/2022-03/15/content_5679177.html.

[12] World Health Organization. Quality in primary health care [Internet]. 2018 [cited 2024 Jul 2]. Available from: https://www.who.int/docs/default-source/primary-health-care-conference/quality.pdf.

[13] Royal College of General Practitioners. Quality in general practice [Internet]. 2017 [cited 2024 Jul 2]. Available from: https://www.rcgp.org.uk/representing-you/policy-areas/quality-in-general-practice.

[14] Family doctor contract rate among Beijing’s permanent population has reached 42% [Internet]. 2024 Jan 12 [cited 2024 Apr 15]. Available from: https://wjw.beijing.gov.cn/xwzx_20031/mtjj/202401/t20240111_3532751.html.

[15] Shi DZ, Ma WH, Zhao YL. Analysis of the current status of family doctor contract services in Beijing from the perspective of team members. Chin Community Doctors. 2024; 40(16):167-169. doi: 10.3969/j.issn.1007-614x.2024.16.056.

[16] Xiao P, Yang J, Liang ZH, et al. The impact of family doctor contract duration in Chaoyang District, Beijing, on service utilization and management. J Chronic Dis. 2020; 21(8):1187-1189 1192. doi: 10.16440/j.cnki.1674-8166.2020.08.021.

[17] Zhao J, Liu FY, Li Z, et al. A study on satisfaction with family doctor contract services in Beijing: Based on the patients’ perspective. Health Econ Res. 2022; 39(1):54-58. doi: 10.14055/j.cnki.33-1056/f.2022.01.016.

[18] Wang QR. Research progress and prospects of family doctor contract services in China based on CiteSpace. J Manag Sci. 2024(1):158-166. doi: 10.16517/j.cnki.cn12-1034/f.20230512.002.

[19] Hu X. Current status and suggestions for family doctor contract services based on bibliometrics. Chin Prim Health Care. 2022; 36(9):39-43. doi: 10.3969/j.issn.1001-568X.2022.09.0011.

[20] Han XR, Qin CX, Wu Y, et al. Study on accessibility and comprehensiveness of rural family doctor services based on perceived quality evaluation. Chin Gen Pract. 2021; 24(19):2428-2434. doi: 10.12114/j.issn.1007-9572.2021.00.181.

[21] Huang XN. Study on accessibility issues of promoting family doctor contract services in Dongguan City. Guilin: Guangxi Normal University; 2022.

[22] Donabedian A. Evaluating the quality of medical care. 1966. Milbank Q. 2005; 83(4):691-729. doi: 10.1111/j.1468-0009.2005.00397.x.

[23] Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE guide No. 131. Med Teach. 2020; 42(8):846-854. doi: 10.1080/0142159X.2020.1755030.

[24] Merriam S. Qualitative research: a guide to design and implementation. Fourth edition; 2016.

[25] Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19(6):349-357. doi: 10.1093/intqhc/mzm042.

[26] Zhang XY, Wang YX, Yang SY, et al. Exploration of the model for health insurance payment of family doctor contract services under the perspective of contract theory. J Jinzhou Med Univ Soc Sci Ed. 2021; 19(1):25-28. doi: 10.13847/j.cnki.lnmu(sse).2021.01.007.

[27] Jia M, Guan XF, Meng YC, et al. Investigation of the current status of family doctor service fee financing and payment in China. Chin Health Econ. 2023; 42(9):66-69.

[28] Hao AH, Zeng WL, Li GH, et al. Investigation on the current status of family doctor team contracts from the perspective of general practitioners. Chin Gen Pract. 2023; 26(34):4261-4268. doi: 10.12114/j.issn.1007-9572.2023.0035.

[29] Bodenheimer T, Ghorob A, Willard-Grace R, et al. The 10 building blocks of highperforming primary care. Ann Fam Med. 2014; 12(2):166-171. doi: 10.1370/afm.1616.

[30] Xu H, Ma XJ, Wang YD, et al. International experience on the framework and indicator system of per capita payment performance evaluation. Chin Hosp Manag. 2023; 39(10):756-762. doi: 10.3760/cma.j.cn111325-20230428-00341.

[31] Rao X, Luo L, Wang XY. A spatial feature analysis of primary health care utilization in a large city in China and its implications for family doctor contract service policy. BMC Health Serv Res. 2024; 24(1):194. doi: 10.1186/s12913-023-10389-8.

[32] Guan B, Guan Z, Feng SX, et al. Evaluation of the application effect of family doctor contract services in the health management of elderly patients with chronic diseases. Hosp Manag Forum. 2023; 40(2):94-96 55. doi: 10.3969/j.issn.1671-9069.2023.02.023.

[33] Zhang B, Xiang J, Zou YL. Visual analysis of research hotspots and frontiers in domestic community health management based on CiteSpace. Chin Gen Pract. 2023; 26(S1):1-6.

[34] Zhou QR, Li JS, Hao C, et al. The impact of appointment-based medical services on the quality of family doctor contract service outcomes. Chin Gen Pract. 2023; 26(10):1198-1204. doi: 10.12114/j.issn.1007-9572.2022.0438.

[35] Yu Y, Ye AZ, Chen C, et al. The impact of the family doctor system on patients’ utilization of general practitioners in primary care facilities —Evidence from Hangzhou, China. Int J Health Plann Manage. 2022; 37(6):3089-3102. doi: 10.1002/hpm.3540.

[36] Wang C, Yan SJ, Jiang H, et al. Residents’ willingness to maintain contracts with family doctors: a cross-sectional study in China. J Gen Intern Med. 2021; 36(3):622-631. doi: 10.1007/s11606-020-06306-y.

[37] Zhao N, Gu M, Li J, et al. Factors influencing contracting of residents with family doctors in China: a national cross-sectional survey. BMC Health Serv Res. 2024; 24(1):213. doi: 10.1186/s12913-024-10606-y.

[38] Chen JH, Wang YJ, Du W, et al. Analysis on the relationship between effort-reward imbalance and job satisfaction among family doctors in China: a cross-sectional study. BMC Health Serv Res. 2022; 22(1):992. doi: 10.1186/s12913-022-08377-5.

[39] He GS, Ren JJ, Chen XY, et al. GP’s GP, general practitioner’s health and willingness to contract family doctors in China: a national cross-sectional study. BMC Prim Care. 2024; 25(1):253. doi: 10.1186/s12875-024-02492-4.