吉林市基层医务人员对双向转诊的认知及影响因素
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摘要
目的:了解吉林市基层医疗机构医务人员对双向转诊的认知情况并分析影响因素。方法:对吉林市216名基层医务人员以及56名基层卫生机构院长进行问卷调查,应用秩和检验和有序多分类Logistic回归进行双向转诊认知情况的影响因素分析。结果:基层医务人员对双向转诊的知晓率为92.1%,基层医务人员及院长对双向转诊实施效果不满意的分别占81.8%、64.3%。工作年限、是否接受过相关培训、单位是否有明确的双向指南、是否向上级医疗机构上转过患者是影响双向转诊认知的主要因素。基层医务人员以及院长一致认为影响双向转诊的主要因素为社区卫生服务能力、统一的转诊标准、各级医院之间的利益冲突。结论:基层医务人员对双向转诊的知晓率较高,但基层医务人员及院长对双向转诊实施效果不满意比例较高。通过加强医务人员培训以及医疗机构制定明确的转诊手册有利于加深基层医务人员对双向转诊的了解,通过提升基层医疗机构卫生服务能力、统一转诊制度及标准等措施有利于对双向转诊政策进行效果评价。
Objective: To understand the situation of medical staff in basic medical institutions in Jilin City and analyze their impact on two-way referral. Methods: A questionnaire survey was conducted on 216 grassroots medical personnel and 56 presidents of primary health care institutions in Jilin City. Rank sum test and orderly multi-category Logistic regression were used to analyze the factors affecting two-way referral cognition. Results: The rate of awareness of the two-way referral by the grass-roots medical staff was 92.1%,but the grassroots medical personnel and the dean were less satisfied with the results of the two-way referral implementation accounting for 81.8%,64.3% respectively. The number of years of work,whether or not they have received relevant training,whether the unit has a clear two-way guide,and whether or not the patient has been transferred to a higher-level medical institution are the main factors affecting the cognition of two-way referral. The grass-roots medical personnel and the dean agreed that the main factors affecting two-way referral are: community health service capabilities; uniform referral standards; and conflicts of interest among hospitals at all levels. Conclusion: The awareness rate of two-way referral is higher among grass-roots medical staff,and the unsatisfactory rate of implementation effect of two-way referral is higher among grass-roots medical staff and hospital president. By deepening the training of medical personnel and establishing clear referral manuals for medical institutions,it will deepen their understanding of the two-way referral,and facilitate the implementation of the two-way referral policy by improving health service capabilities,unified referral systems and standard recommendations of primary health care institutions effect.
Objective: To understand the situation of medical staff in basic medical institutions in Jilin City and analyze their impact on two-way referral. Methods: A questionnaire survey was conducted on 216 grassroots medical personnel and 56 presidents of primary health care institutions in Jilin City. Rank sum test and orderly multi-category Logistic regression were used to analyze the factors affecting two-way referral cognition. Results: The rate of awareness of the two-way referral by the grass-roots medical staff was 92.1%,but the grassroots medical personnel and the dean were less satisfied with the results of the two-way referral implementation accounting for 81.8%,64.3% respectively. The number of years of work,whether or not they have received relevant training,whether the unit has a clear two-way guide,and whether or not the patient has been transferred to a higher-level medical institution are the main factors affecting the cognition of two-way referral. The grass-roots medical personnel and the dean agreed that the main factors affecting two-way referral are: community health service capabilities; uniform referral standards; and conflicts of interest among hospitals at all levels. Conclusion: The awareness rate of two-way referral is higher among grass-roots medical staff,and the unsatisfactory rate of implementation effect of two-way referral is higher among grass-roots medical staff and hospital president. By deepening the training of medical personnel and establishing clear referral manuals for medical institutions,it will deepen their understanding of the two-way referral,and facilitate the implementation of the two-way referral policy by improving health service capabilities,unified referral systems and standard recommendations of primary health care institutions effect.
引文
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[2]刘运杰,王艳红,张智勇,等.三级医院与社区医院住院患者双向转诊路径初探[J].中国全科医学,2010,13(7):701-703.
[3]田野.武汉市分级诊疗模式认知情况调研报告[D].华中科技大学,2016.
[4]苏瑾,杨恽,易春涛.社区卫生服务中心双向转诊的实践与思考[J].中国医院管理,2016,36(5):74-75.
[5]高阔,甘筱青.我国患者双向转诊行为决策及影响因素研究[J].中国全科医学,2015,18(28):3393-3395.
[6]杨巧,秦琼,陈登菊.从三级医院下转实践看分级诊疗存在问题及改进建议[J].中国卫生质量管理,2016,23(6):81-84.
[7]姜成邦,陈水,顾翔.区县医院和社区卫生服务机构双向转诊现状调查和对策[J].江苏医药,2016,42(3):356-357.
[8]高阔,甘筱青.我国患者双向转诊行为决策及影响因素研究[J].中国全科医学,2015,18(28):3393-3395.
[9]申曙光,张勃.分级诊疗、基层首诊与基层医疗卫生机构建设[J].学海,2016(2):48-57.
[10]付强.促进分级诊疗模式建立的策略选择[J].中国卫生经济,2015,34(2):28-31.
[11]何露洋,姚岚,洪阳,等.全科医生试点城市改革方案比较[J].医学与社会,2015,28(4):50-54.
[12]邓迎翔.农村基层卫生服务体系建设研究[D].中南大学,2012.
[13]崔华欠,方国瑜,杨阳,等.广州市社区居民对分级诊疗模式的知晓和认知情况调查[J].中国全科医学,2014,17(34):4123-4126.
[14]朱小颖,夏海晖,匡莉,等.社区全科基层医务人员转诊服务体系的现状、问题与发展对策研究[J].中国全科医学,2015,8(16):1888-1892.
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