门诊患者对分级诊疗制度的认知评价调查
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摘要
背景分级诊疗作为优化卫生资源配置的重要形式,其意义已得到充分认可并在全国范围内开展探索工作。江苏省自2015年全面推进分级诊疗制度建设工作。目的通过调查江苏省门诊患者对分级诊疗制度的知晓情况、就医意愿,探讨患者对分级诊疗制度的认知评价及其影响因素,为合理引导患者就医流向、促进分级诊疗制度的实施提供循证决策依据。方法通过分层抽样方法选择江苏省6个城市,采用典型抽样法在每个城市选择4家医疗卫生机构,2017年11—12月采用偶遇抽样法对上述4家医疗卫生机构的门诊患者进行面对面访谈式调查,采用自行设计的调查问卷对门诊患者分级诊疗制度的知晓情况、基层首诊意愿及对双向转诊制度的评价进行调查。结果有42.5%(738/1 738)门诊患者知晓分级诊疗制度,39.9%(694/1 738)门诊患者知晓基层首诊制度。不同文化程度、工作状态、职业类型、医疗保险类型、平均月收入、居住地、地区门诊患者对分级诊疗制度知晓情况比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,文化程度、医疗保险类型、地区是影响门诊患者对分级诊疗制度知晓情况的因素(P<0.05)。48.6%(845/1 738)门诊患者首诊愿意选择基层医疗卫生机构,51.4%(893/1 738)门诊患者首诊愿意选综合医院。知晓基层首诊制度的门诊患者与不知晓基层首诊制度的门诊患者对首诊机构的选择比较,差异有统计学意义(P<0.05)。结论江苏省门诊患者对分级诊疗制度知晓率较低、基层首诊意愿低,双向转诊中转上不转下问题突出。卫生行政部门需要加强政策宣传与引导、加强基层医疗卫生机构服务能力建设、规范双向转诊制度流程、完善分级诊疗支撑保障制度的建设,逐步完善分级诊疗服务体系建设。
Background As an important form of allocation optimization of health resources,hierarchical diagnosis and treatment system has been fully recognized and explored nationwide.Jiangsu Province has comprehensively promoted the construction of hierarchical diagnosis and treatment system since 2015.Objective By investigating the awareness and willingness of outpatients in Jiangsu Province about the hierarchical diagnosis and treatment system,this paper explored the knowledge and evaluation of hierarchical diagnosis and treatment system and its influencing factors,so as to provide evidence-based decisionmaking basis for reasonably guiding the flow of patients to medical treatment and promoting the implementation of hierarchical diagnosis and treatment system.Methods Six cities in Jiangsu Province were selected by stratified sampling and four medical institutions were selected in each city by typical sampling.And outpatients in the medical institutions were interviewed face-toface through occasional sampling from November to December 2017.The self-designed questionnaires were used to investigate the awareness of hierarchical diagnosis and treatment system,patients' willingness to have primary treatment at the community level,and the evaluation of two-way referral system.Results 42.5%(738/1 738)of outpatients had a certain knowledge of hierarchical diagnosis and treatment system and 39.9%(694/1 738)of outpatients had a certain knowledge of initial diagnosis at the community level.There were significant differences among outpatients in terms of different education level,work status,occupation type,type of medical insurance,average monthly income,residence and region(P<0.05).The results of multivariate Logistics regression analysis showed that education level,type of medical insurance and area were the main factors influencing the knowledge of hierarchical diagnosis and treatment system(P<0.05).48.6%(845/1 738)of outpatients showed a willingness to have the primary treatment in community health service centers and 51.4%(893/1 738)of outpatients showed a willingness to have the primary treatment in the hospital.There were significant differences in the choice of primary medical treatment institution among outpatients with or without the knowledge of the initial diagnosis at the community level(P<0.05).Conclusion Outpatients in Jiangsu Province have a low awareness of hierarchical diagnosis system and low willingness to have primary treatment at the community level.Problems on two-way referral are prominent.Therefore,the health administration should step up publicity and guidance on policies,strengthen the capacity building of primary health care institutions,and regulate twoway referral system process.They should also provide more support and improve hierarchical diagnosis and treatment system.
Background As an important form of allocation optimization of health resources,hierarchical diagnosis and treatment system has been fully recognized and explored nationwide.Jiangsu Province has comprehensively promoted the construction of hierarchical diagnosis and treatment system since 2015.Objective By investigating the awareness and willingness of outpatients in Jiangsu Province about the hierarchical diagnosis and treatment system,this paper explored the knowledge and evaluation of hierarchical diagnosis and treatment system and its influencing factors,so as to provide evidence-based decisionmaking basis for reasonably guiding the flow of patients to medical treatment and promoting the implementation of hierarchical diagnosis and treatment system.Methods Six cities in Jiangsu Province were selected by stratified sampling and four medical institutions were selected in each city by typical sampling.And outpatients in the medical institutions were interviewed face-toface through occasional sampling from November to December 2017.The self-designed questionnaires were used to investigate the awareness of hierarchical diagnosis and treatment system,patients' willingness to have primary treatment at the community level,and the evaluation of two-way referral system.Results 42.5%(738/1 738)of outpatients had a certain knowledge of hierarchical diagnosis and treatment system and 39.9%(694/1 738)of outpatients had a certain knowledge of initial diagnosis at the community level.There were significant differences among outpatients in terms of different education level,work status,occupation type,type of medical insurance,average monthly income,residence and region(P<0.05).The results of multivariate Logistics regression analysis showed that education level,type of medical insurance and area were the main factors influencing the knowledge of hierarchical diagnosis and treatment system(P<0.05).48.6%(845/1 738)of outpatients showed a willingness to have the primary treatment in community health service centers and 51.4%(893/1 738)of outpatients showed a willingness to have the primary treatment in the hospital.There were significant differences in the choice of primary medical treatment institution among outpatients with or without the knowledge of the initial diagnosis at the community level(P<0.05).Conclusion Outpatients in Jiangsu Province have a low awareness of hierarchical diagnosis system and low willingness to have primary treatment at the community level.Problems on two-way referral are prominent.Therefore,the health administration should step up publicity and guidance on policies,strengthen the capacity building of primary health care institutions,and regulate twoway referral system process.They should also provide more support and improve hierarchical diagnosis and treatment system.
引文
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[7]肖淑娴,钟迪浩,陈志强,等.广州地区患者就诊选择的影响因素分析[J].中国医疗管理科学,2016,6(5):41-45.DOI:10.3969/j.issn.2095-7432.2016.04.009.XIAOSX,ZHONGDH,CHENZQ,etal.Analysisof inlfuence factors to patients'selection of medical treatment by taking example of Guangzhou area[J].China Medical Administration Sciences,2016,6(5):41-45.DOI:10.3969/j.issn.2095-7432.2016.04.009.
[8]陈饶,杜旭东,杨展,等.成都市门诊就诊患者就医选择及影响因素分析[J].现代预防医学,2016,43(22):4217-4220.CHEN R,DU X D,YANG Z,et al.Analysis of choice of healthcare services and the influencing factors among outpatients in Chengdu City[J].Modern Preventive Medicine,2016,43(22):4217-4220.
[9]孟娜娜,丁宏,章雨晨.某三甲医院门诊就诊患者分级诊疗认知分析[J].中国农村卫生事业管理,2017,37(8):917-919.DOI:10.3969/j.issn.1005-5916.2017.08.015.MENG N N,DING H,ZHANG Y C.Cognition of hierarchical diagnosis for outpatients in a third-grade class-A hospital[J].Chinese Rural Health Service Administration,2017,37(8):917-919.DOI:10.3969/j.issn.1005-5916.2017.08.015.
[10]李习平,史华英.新医改背景下患者就医影响因素调查研究[J].现代医院管理,2016,14(1):26-28.DOI:10.3969/j.issn.1672-4232.2016.01.009.LI X P,SHI H Y.Investigation and study of influencing factors on patients'decision for medical treatment in new medical reform[J].Modern Hospital Management,2016,14(1):26-28.DOI:10.3969/j.issn.1672-4232.2016.01.009.
[11]邓明,张柠.医联体服务模式下慢性病患者社区首诊意愿分析[J].中国全科医学,2017,20(36):4534-4538.DOI:10.3969/j.issn.1007-9572.2017.00.092.DENG M,ZHANG N.Willingness to have the initial diagnosis in community health service centers of patients with chronic diseases in medical integration model[J].Chinese General Practice,2017,20(36):4534-4538.DOI:10.3969/j.issn.1007-9572.2017.00.092.
[12]杨敬宇,杨永宏.双向转诊是构建农村分级诊疗体系的基础[J].中国医疗保险,2014,12(12):18-20.DOI:10.3969/j.issn.1674-3830.2014.12.005.YANG J Y,YANG Y H.two-way referral system is the base for that of diagnosis and treatment classification[J].China Health Insurance,2014,12(12):18-20.DOI:10.3969/j.issn.1674-3830.2014.12.005.
[13]石亚丽,李宁燕,赵建功.北京市西城区居民社区首诊意愿及影响因素研究[J].中国全科医学,2016,19(16):1939-1942.DOI:10.3969/j.issn.1007-9572.2016.16.019.SHI Y L,LI N Y,ZHAO J G.Residents'willingness to seek first contact in community health organizations and influencing factors in Xicheng District of Beijing[J].Chinese General Practice,2016,19(16):1939-1942.DOI:10.3969/j.issn.1007-9572.2016.16.019.
[2]杜平.中小城市分级诊疗制度实证研究——以太仓为例[D].上海:上海交通大学,2014.
[3]国务院办公厅关于推进分级诊疗制度建设的指导意见[EB/OL].(2015-09-11)[2018-06-10].http://www.gov.cn/zhengce/content/2015-09/11/content_10158.htm.
[4]程苏华,杨照,孙玮.北京某医联体医患双方对分级诊疗模式认知的调查研究[J].医院管理论坛,2017,34(3):19-22.CHENG S H,YANG Z,SUN W.Investigation on cognition of hierarchical medical system for both doctors and patients in a medical partnership of Beijing[J].Hospital Management Forum,2017,34(3):19-22.
[5]于洗河,万龙涛,顾文涛,等.吉林省县级公立医院患者分级诊疗认知状况调查[J].医学与社会,2017,30(12):11-14.DOI:11.13723/j.yxysh.2017.12.004.YU X H,WAN L T,GU W T,et al.Investigation on cognition of hierarchical diagnosis system among patients of county level public hospitals in Jilin Province[J].Medicine and Society,2017,30(12):11-14.DOI:11.13723/j.yxysh.2017.12.004.
[6]宋晨,陈泽,查晓丽,等.患者对分级诊疗的认知及分级诊疗推行情况调查与分析[J].中国卫生信息管理杂志,2017,14(5):731-736.DOI:10.3969/j.issn.1672-5166.2017.05.020.SONG C,CHEN Z,ZHA X L,et al.A survey and analysis of patients'cognition of the hierarchical diagnosis and the hierarchical diagnosisimplementation[J].ChineseJournalofHealth Informatics and Management,2017,14(5):731-736.DOI:10.3969/j.issn.1672-5166.2017.05.020.
[7]肖淑娴,钟迪浩,陈志强,等.广州地区患者就诊选择的影响因素分析[J].中国医疗管理科学,2016,6(5):41-45.DOI:10.3969/j.issn.2095-7432.2016.04.009.XIAOSX,ZHONGDH,CHENZQ,etal.Analysisof inlfuence factors to patients'selection of medical treatment by taking example of Guangzhou area[J].China Medical Administration Sciences,2016,6(5):41-45.DOI:10.3969/j.issn.2095-7432.2016.04.009.
[8]陈饶,杜旭东,杨展,等.成都市门诊就诊患者就医选择及影响因素分析[J].现代预防医学,2016,43(22):4217-4220.CHEN R,DU X D,YANG Z,et al.Analysis of choice of healthcare services and the influencing factors among outpatients in Chengdu City[J].Modern Preventive Medicine,2016,43(22):4217-4220.
[9]孟娜娜,丁宏,章雨晨.某三甲医院门诊就诊患者分级诊疗认知分析[J].中国农村卫生事业管理,2017,37(8):917-919.DOI:10.3969/j.issn.1005-5916.2017.08.015.MENG N N,DING H,ZHANG Y C.Cognition of hierarchical diagnosis for outpatients in a third-grade class-A hospital[J].Chinese Rural Health Service Administration,2017,37(8):917-919.DOI:10.3969/j.issn.1005-5916.2017.08.015.
[10]李习平,史华英.新医改背景下患者就医影响因素调查研究[J].现代医院管理,2016,14(1):26-28.DOI:10.3969/j.issn.1672-4232.2016.01.009.LI X P,SHI H Y.Investigation and study of influencing factors on patients'decision for medical treatment in new medical reform[J].Modern Hospital Management,2016,14(1):26-28.DOI:10.3969/j.issn.1672-4232.2016.01.009.
[11]邓明,张柠.医联体服务模式下慢性病患者社区首诊意愿分析[J].中国全科医学,2017,20(36):4534-4538.DOI:10.3969/j.issn.1007-9572.2017.00.092.DENG M,ZHANG N.Willingness to have the initial diagnosis in community health service centers of patients with chronic diseases in medical integration model[J].Chinese General Practice,2017,20(36):4534-4538.DOI:10.3969/j.issn.1007-9572.2017.00.092.
[12]杨敬宇,杨永宏.双向转诊是构建农村分级诊疗体系的基础[J].中国医疗保险,2014,12(12):18-20.DOI:10.3969/j.issn.1674-3830.2014.12.005.YANG J Y,YANG Y H.two-way referral system is the base for that of diagnosis and treatment classification[J].China Health Insurance,2014,12(12):18-20.DOI:10.3969/j.issn.1674-3830.2014.12.005.
[13]石亚丽,李宁燕,赵建功.北京市西城区居民社区首诊意愿及影响因素研究[J].中国全科医学,2016,19(16):1939-1942.DOI:10.3969/j.issn.1007-9572.2016.16.019.SHI Y L,LI N Y,ZHAO J G.Residents'willingness to seek first contact in community health organizations and influencing factors in Xicheng District of Beijing[J].Chinese General Practice,2016,19(16):1939-1942.DOI:10.3969/j.issn.1007-9572.2016.16.019.