Mechanisms Affecting the Effectiveness of Contracted Family Doctor Services: a Grounded Theory Analysis

Background It is urgent to improve the effectiveness of contracted family doctor services due to high prevalence of problems such as uninformed contracting, and contracting but making no appointments. Objective To analyze the mechanism influencing the effectiveness of contracted family doctor services. Methods From September 2021 to January 2022, in-depth interviews were conducted with 24 family doctors, 8 institutional managers, and 25 contracted residents purposively sampled from Weifang, Heze, and Jinan of Shandong Province, using an interview guide regarding implementation status of relevant policies and their work status, performance distribution and supervision and management, and sense of gain obtained from the contracting and desired services, respectively. The grounded theory using three levels of coding was used to systematically analyze the mechanism affecting the effectiveness of contracted family doctor services. Results Through the coding, 90 concepts (such as "residents' weak health awareness"), 24 categories (such as "awareness of the contracting"), and 8 core categories (such as "capacity in primary care") were obtained. A theoretical model of mechanisms influencing the effectiveness of contracted family doctor services was constructed, mainly including the implementation deviation of policies related to contracted family doctor services, capacity of primary care, and characteristics of residents. Conclusion The effectiveness of contracted family doctor services is affected by the deviation in implementing relevant policies, the capacity of primary health services and characteristics of residents. Therefore, to improve the effectiveness of these services, it is necessary to optimize the implementation path of relevant policies, improve family doctors' capacities, and improve residents' health literacy level.