新疆某市各级医院医生对分级诊疗制度的认知调查
|
摘要
目的了解新疆某市各级医院医生对分级诊疗制度的认知情况。方法采用问卷调查法,于2018年5月在新疆某市5个城区选取14所社区卫生服务中心、3所二级医院、3所三级医院,共计20所医疗机构进行调查。共计发放问卷415份,回收408份,其中有效问卷403份,有效率为98.77%。结果三级医院医生对分级诊疗内涵、工作内容和目的的知晓率分别为95.31%、84.24%和78.90%,高于社区卫生服务中心和二级医院医生。社区卫生服务中心医生对基层首诊内涵的认知程度最高,为80.24%,二级医院医生对双向转诊内涵的认知程度最高,为71.30%。社区卫生服务中心、二级医院和三级医院医生能够对各级医院功能作出正确回答的比例分别为46.91%、53.47%和46.61%。各级医院医生通过"单位组织学习"渠道获取分级诊疗制度信息的比例最高,分别为29.42%、28.10%和24.17%。各级医院医生认为制约开展分级诊疗的主要条件是基层卫生人力服务能力不足,开展项目有限以及各级医院间利益分配机制不完善。结论该市各级医院医生对分级诊疗制度的目的、内容及各级医院功能知晓率偏低,获取分级诊疗的信息来源不系统。行政部门和医院应定期对医务人员开展系统规范化培训,使其了解分级诊疗制度,保障分级诊疗制度的执行和发展。
Objective To understand the cognition on the hierarchical medical services of doctors in all levels of hospitals in a city in Xinjiang. Methods A questionnaire survey was conducted, and a total of 20 medical institutions including 14 community health service centers, 3 secondary hospitals and 3 tertiary hospitals were selected from 5 urban areas of a city in Xinxiang. A total of 415 questionnaires were issued. The recovery rate was 98.31% and the effective rate was 98.77%. Results The awareness rate of the doctors in the three-level hospitals was 95.31%, 84.24%, and 78.90%, respectively, which was higher than that of the first-level hospital doctors. The first-level hospital doctors had the highest awareness of the primary diagnosis of the primary level, which was 80.24%. The second-level hospital doctors had the highest awareness of the two-way referral connotation, which was 71.30%. The proportion of doctors in community health service centers, secondary hospitals and tertiary hospitals who could give correct answers to the functions of hospitals at all levels was 46.91%, 53.47% and 46.61%, respectively. Doctors at all levels obtained the highest proportion of information about graded diagnosis and treatment system through "unit organizational learning" channels, which were 29.42%, 28.10% and 24.17% respectively. Doctors of hospitals at all levels believe that the main constraints to the implementation of hierarchical diagnosis and treatment were the insufficient human service capacity at the grass-roots level, limited projects and imperfect profit distribution mechanism among hospitals at all levels. Conclusion Doctors in hospitals at all levels in the city have low awareness of the purpose, content and functions of the hierarchical diagnosis and treatment system, and the information source of hierarchical diagnosis and treatment is not systematic. Administrative departments and hospitals should regularly carry out systematic and standardized training for medical personnel to understand the hierarchical medical system and ensure the implementation and development of the hierarchical medical system.
Objective To understand the cognition on the hierarchical medical services of doctors in all levels of hospitals in a city in Xinjiang. Methods A questionnaire survey was conducted, and a total of 20 medical institutions including 14 community health service centers, 3 secondary hospitals and 3 tertiary hospitals were selected from 5 urban areas of a city in Xinxiang. A total of 415 questionnaires were issued. The recovery rate was 98.31% and the effective rate was 98.77%. Results The awareness rate of the doctors in the three-level hospitals was 95.31%, 84.24%, and 78.90%, respectively, which was higher than that of the first-level hospital doctors. The first-level hospital doctors had the highest awareness of the primary diagnosis of the primary level, which was 80.24%. The second-level hospital doctors had the highest awareness of the two-way referral connotation, which was 71.30%. The proportion of doctors in community health service centers, secondary hospitals and tertiary hospitals who could give correct answers to the functions of hospitals at all levels was 46.91%, 53.47% and 46.61%, respectively. Doctors at all levels obtained the highest proportion of information about graded diagnosis and treatment system through "unit organizational learning" channels, which were 29.42%, 28.10% and 24.17% respectively. Doctors of hospitals at all levels believe that the main constraints to the implementation of hierarchical diagnosis and treatment were the insufficient human service capacity at the grass-roots level, limited projects and imperfect profit distribution mechanism among hospitals at all levels. Conclusion Doctors in hospitals at all levels in the city have low awareness of the purpose, content and functions of the hierarchical diagnosis and treatment system, and the information source of hierarchical diagnosis and treatment is not systematic. Administrative departments and hospitals should regularly carry out systematic and standardized training for medical personnel to understand the hierarchical medical system and ensure the implementation and development of the hierarchical medical system.
引文
[1] 张雪, 杨柠溪. 英美分级诊疗实践及对我国的启示[J]. 医学与哲学, 2015, 36(13):37-41.
[2] 吕键. 论深化医改进程中分级诊疗体系的完善[J]. 中国医院管理, 2014, 34(6):1-3.
[3] 刘钢, 吴浩, 李宁燕,等. “分级诊疗制度”主题研讨[J]. 中国全科医学, 2016, 19(16):1917-1923.
[4] 孙衍果,张亚男.如何接地气、增底气、聚人气——对山东省潍坊市中医院医联体的调查[J].中国农村卫生,2018(5):9-11.
[5] 杨阳,方国瑜,崔华欠,等.广州市医护人员分级诊疗模式认知及其影响因素分析[J].中国卫生事业管理,2015,32(1):22-26.
[6] 刘译婷. 我国分级诊疗发展的制约因素与对策分析[J]. 长沙民政职业技术学院学报, 2016, 23(2):26-29.
[7] 张彦生,王虎峰.基于分级诊疗的公立医院功能定位探究[J].中国卫生经济,2017,36(9):14-17.
[8] 范玉改. 我国与经合组织国家医院床位数比较及其对我国分级诊疗制度建设的启示[J]. 中国全科医学, 2017, 20(22):2694-2697.
[9] 朱小凤,张莉,张永恒,等.医务人员对实施分级诊疗的态度、行为及影响因素分析[J].中国社会医学杂志,2018,35(2):133-136.
[10] 胡安霞,闫娟娟.山西省医务人员对分级诊疗认知、态度及影响因素分析[J].卫生软科学,2017,31(11):6-9.
[11] 何思长,赵大仁,张瑞华,等.我国分级诊疗的实施现状与思考[J].现代医院管理,2015,13(2):20-22.
[12] 刘恒旸, 鞠永和, 王静成. 分级诊疗视域下城乡卫生人才竞争力协同提升的现状与思考[J]. 中国全科医学, 2016, 19(28):3409-3412.
[13] 姜金星,苗春霞,卓朗,等.徐州市居民分级诊疗制度知晓情况及影响因素分析[J].现代预防医学,2017,44(14):2568-2571,2596.
[14] 王清波, 胡佳, 代涛. 建立分级诊疗制度的动力与阻力分析——基于利益相关者理论[J]. 中国卫生政策研究, 2016, 9(4):9-15.
[15] 姚泽麟. 政府职能与分级诊疗——“制度嵌入性”视角的历史总结[J]. 公共管理学报, 2016,13(3):61-70.
[16] 潘景业, 徐长恩, 全世超. 双向转诊下转难原因的“冰山角”分析[J]. 中国卫生事业管理, 2009, 26(5):300-301.
[2] 吕键. 论深化医改进程中分级诊疗体系的完善[J]. 中国医院管理, 2014, 34(6):1-3.
[3] 刘钢, 吴浩, 李宁燕,等. “分级诊疗制度”主题研讨[J]. 中国全科医学, 2016, 19(16):1917-1923.
[4] 孙衍果,张亚男.如何接地气、增底气、聚人气——对山东省潍坊市中医院医联体的调查[J].中国农村卫生,2018(5):9-11.
[5] 杨阳,方国瑜,崔华欠,等.广州市医护人员分级诊疗模式认知及其影响因素分析[J].中国卫生事业管理,2015,32(1):22-26.
[6] 刘译婷. 我国分级诊疗发展的制约因素与对策分析[J]. 长沙民政职业技术学院学报, 2016, 23(2):26-29.
[7] 张彦生,王虎峰.基于分级诊疗的公立医院功能定位探究[J].中国卫生经济,2017,36(9):14-17.
[8] 范玉改. 我国与经合组织国家医院床位数比较及其对我国分级诊疗制度建设的启示[J]. 中国全科医学, 2017, 20(22):2694-2697.
[9] 朱小凤,张莉,张永恒,等.医务人员对实施分级诊疗的态度、行为及影响因素分析[J].中国社会医学杂志,2018,35(2):133-136.
[10] 胡安霞,闫娟娟.山西省医务人员对分级诊疗认知、态度及影响因素分析[J].卫生软科学,2017,31(11):6-9.
[11] 何思长,赵大仁,张瑞华,等.我国分级诊疗的实施现状与思考[J].现代医院管理,2015,13(2):20-22.
[12] 刘恒旸, 鞠永和, 王静成. 分级诊疗视域下城乡卫生人才竞争力协同提升的现状与思考[J]. 中国全科医学, 2016, 19(28):3409-3412.
[13] 姜金星,苗春霞,卓朗,等.徐州市居民分级诊疗制度知晓情况及影响因素分析[J].现代预防医学,2017,44(14):2568-2571,2596.
[14] 王清波, 胡佳, 代涛. 建立分级诊疗制度的动力与阻力分析——基于利益相关者理论[J]. 中国卫生政策研究, 2016, 9(4):9-15.
[15] 姚泽麟. 政府职能与分级诊疗——“制度嵌入性”视角的历史总结[J]. 公共管理学报, 2016,13(3):61-70.
[16] 潘景业, 徐长恩, 全世超. 双向转诊下转难原因的“冰山角”分析[J]. 中国卫生事业管理, 2009, 26(5):300-301.