摘       要：目的 了解杭州主城区居民对社区卫生服务和签约服务的知晓及利用情况，客观评价签约工作的实效，为后续服务的改进提供借鉴。方法 按照分层随机抽样的方法调查杭州市江干区、下城区、拱墅区共721名居民，其中签约居民386人。问卷内容主要包括调查对象基本情况、社区卫生服务情况、签约服务情况，主要分析了签约对居民基本公共卫生服务知晓、利用等情况的影响以及不同地区签约居民对签约服务的认知、利用以及需求情况。结果 高龄、男性、小学及以下文化程度、丧偶者的知晓程度偏低。慢性病患病及是否签约是知晓率提升的影响因素。签约人群在线预约诊疗服务平台使用率低于非签约人群，差异有统计学意义。在需求方面，签约居民在“优先就诊、转诊”、“预约服务”这两项服务上需求要高于非签约组，而非签约居民对“咨询服务”、“远程健康监测”、“个人健康信息查询”、“健康评估”较为关注。各签约对象中，以门诊签约为主（占85.5%），大部分在2014年、2015年即开始签约。在签约政策知晓方面，除了“服务时间”外，下城区每项政策知晓率均高于江干区、拱墅区，差异均有统计学意义。签约前后到签约医生就诊的频率无差异。就诊方式“以想看就看、没有预约过“为主，各居住地到相熟医生就诊无差异。签约对象对签约服务主要的不满是认为“缺少上门服务”（145人）和“个性化健康管理服务缺少”（133人）其次对“医保报销力度”和“转诊手续”不尽满意，分别有125人和96人选择。选择前三的建议是“增加能上门服务的家庭医生数量”、“家庭医生签约团队定期举办健康讲座”、“增加中医药健康管理服务”，分别是有191、161、148人选择。结论 杭州的家庭医生签约服务在优先满足就诊就医，提高社区卫生服务资源（人、财、物）的利用率上的思维逻辑是正确的。长远看，要想签约居民更多受益还需要再强化基本公共卫生的服务能力，提供家庭病床、远程健康监测、健康评估等服务项目上下硬功夫。

Objective To understand the residents' knowledge and use of community health services and subscription services in the main city of Hangzhou, and to objectively evaluate the effectiveness of the contracted work, and provide reference for the improvement of follow-up services. Methods A total of 721 residents of Jianggan District, Xiacheng District, and Gongshu District were surveyed according to a stratified random sampling method, of which 386 were residents. The contents of the questionnaire mainly include the basic situation of the survey, community health service, and contract service. This study mainly analyzes the impact of contracting on the awareness and utilization of residents' basic public health services and the knowledge, use, and demand of contracted residents in different regions. Results The degree of knowledge of senior citizens, men, primary school and below, and widowers was low. The prevalence of chronic diseases and whether they sign a contract are the factors that influence the awareness rate. The number of signed family doctors using mobile phones was higher than that of non-contracted people, but the use rate of online booking service platforms was lower than that of non-contracted people. The difference was statistically significant. In terms of demand, "contracted residents have higher demand than non-contracted groups in terms of priority visits, referrals, and appointment services, and non-contracted residents have "consulting services," "remote health monitoring," " "Inpidual health information search" and "health assessment" are of more concern. Among the signatories, outpatient signing is mainly used (85.5%), and most of them sign contracts in 2014 and 2015. In addition to "services," In the period of time, the awareness rate of each policy in Xiacheng District was higher than Jianggan District and Gongshu District, and the differences were statistically significant. In terms of services enjoyed after signing contracts, residents in Gongshu District enjoyed more health consultation services than before. (71.7%), higher than Jianggan District (69.7%) and Xiacheng District (58.7%), and the difference was statistically significant. There was no difference in frequency of visits to contracted doctors before and after signing the contract. “However, there is no appointment. There was no difference between the “mainly” and the various places of residence to familiar doctors. The major dissatisfaction with the contracted services by the signing parties was that “the lack of on-site service” (145 people) and “personalized health management services Less" (133 people) was not satisfied with the "reimbursement of Medicare reimbursement" and the "transmission procedure". There were 125 people and 96 people selected respectively. The first three recommendations were "to increase the number of family doctors who can visit the hospital" and " The family doctor signing team regularly holds health talks and "adds health care management services for Chinese medicine", with 191, 161, and 148 people selected.Conclusion The signing service of family doctors in Hangzhou is the right way to satisfy the needs of doctors for medical treatment and improve the utilization of community health service resources (human, financial, and material). In the long run, if we want to sign contracted residents to benefit more, we need to further strengthen the basic public health service capabilities and provide services such as family beds, remote health monitoring, and health assessment.