医联体模式下漯河市双向转诊制度实施现状与分析

魏俊涛; 葛梦颍; 刘钟灵; 赵阳光; 刘小娜; 陈泊霖

doi:10.16766/j.cnki.issn.1674-4152.002418

医联体模式下漯河市双向转诊制度实施现状与分析

doi: 10.16766/j.cnki.issn.1674-4152.002418

1.
漯河市中心医院科教科，河南漯河 462300
2.
漯河市中心医院党委办公室
3.
漯河市中心医院办公室

基金项目:

河南省医学科技攻关计划联合共建项目 2018021030

详细信息

通讯作者:
葛梦颍, E-mail: 403912696@qq.com

中图分类号: R197.323.2
计量
- 文章访问数: 135
- HTML全文浏览量: 33
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2021-11-02
- 网络出版日期: 2022-08-20

Current situation and analysis of the two-way referral system in Luohe based on the mode of health alliance

1.
Science and Education Division, Luohe Central Hospital, Luohe, Henan 462300, China

摘要

摘要: 目的了解医联体模式下漯河市医患双方对双向转诊的认知情况、调查医患双方对双向转诊实施途径的看法和态度、了解医患双方对双向转诊实施决定权的看法，探讨双向转诊难以实施的主要原因，并提出改进措施，为顺利实施双向转诊制度提供理论和政策依据。方法本研究2019年7—12月进行调查，采用简单随机抽样的方法，随机抽取该地区8所医疗机构，其中社区卫生服务中心4所，二级、三级医院各2所，随机从中抽取医务人员300名和当日住院或在门诊就医的患者300名进行面对面问卷调查。利用统计学软件SPSS 21.0对数据进行统计分析。结果回收有效问卷585份，患者对双向转诊的知晓程度仅为27.92%，医患双方对双向转诊的认知程度差异有统计学意义(P＜0.05)；56.55%的患者选择到二级及以上医院就诊，36.90%的患者选择到社区卫生服务中心就诊，医院患者与社区患者就诊意向的差异有统计学意义(均P＜0.001)；医院工作人员和患者之间、社区卫生工作人员和患者之间对双向转诊实施途径的看法差异均有统计学意义(均P＜0.001)；55.88%的医院医生和74.21%的社区医生认为双向转诊的决定权在医生，50.69%的患者认为决定权在患者。医患双方均认为，影响双向转诊的重要原因是医疗机构经济利益驱使、没有统一的双向转诊制度和标准、患者不了解转诊制度。结论医患双方对双向转诊认知不足、转诊意识不强，医疗机构经济利益驱动、缺乏统一的转诊制度和标准成为阻碍双向转诊的重要原因。应完善制度和补偿机制，促进双向转诊的顺利开展。
- 医疗联合体 /
- 双向转诊 /
- 现状
Abstract: Objective To understand the two-way referral system between doctors and patients in Luohe under the mode of health alliance, investigate the views and attitudes about the two-way referral implementation methods, understand the views of doctors and patients on the decision-making power of two-way referral, explore the main reason why the two-way referral is difficult to implement and put forward improvement measures to provide a theoretical and policy basis for the smooth implementation of the two-way referral system. Methods We conducted this survey from July to December 2019. Completely random sampling was used. Eight medical institutions in the area were randomly selected, including four community health service centres, two second level hospitals and two third level hospitals. A face-to-face questionnaire survey was conducted amongst 300 medical personnel and 300 patients who were hospitalised or visited the outpatient department on the same day. SPSS 21.0 statistical software was used for statistical analysis of the data. Results Five hundred and eighty-five valid questionnaires were collected. The awareness of patients on two-way referral was only 27.92%. There was a statistical difference between the doctors and patients' cognition of two-way referral (P < 0.05). Approximately 56.55% of patients chose to seek medical treatment in secondary or above hospitals, and 36.90% of patients chose to seek medical treatment in community health service centres. There was a statistical significance between hospital and community patients in terms of their intention to seek medical treatment (all P < 0.001). The differences of views on the implementation of two-way referral were statistically significant between hospital staff and patients, as was the case between community health staff and patients (P < 0.001). Approximately 55.88% of hospital doctors and 74.21% of community doctors believed that the decision of two-way referral should be made by doctors; 50.69% of patients believed that the decision should be made by patients. Both doctors and patients believed that the important reasons for two-way referral were medically driven by institutional economic interests, there was no unified two-way referral system and standards, and patients did not understand the referral system. Conclusion Insufficient cognition, weak awareness of referral, driven by the economic interests of medical institutions and the lack of unified referral system and standards have become important reasons for hindering two-way referral. The system and compensation mechanism should be improved to promote the smooth development of two-way referral.
- Health alliance /
- Two-way referral system /
- Current situation

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表 1 295名医务人员基本情况[例(%)]

Table 1. Basic information of 295 medical personnel [cases (%)]

项目	医院医生	社区医生	合计	χ²值	P值
性别				1.068	0.301
男性	62(45.59)	63(39.62)	125(42.37)
女性	74(54.41)	96(60.38)	170(57.63)
文化程度				74.348	< 0.001
高中/中专及以下	4(2.94)	16(10.06)	20(6.78)
大专	50(36.76)	123(77.36)	173(58.64)
本科及以上	82(60.29)	20(12.58)	102(34.58)
职称				9.739	0.008
初级及以下	50(36.76)	87(54.72)	137(46.44)
中级	64(47.06)	56(35.22)	120(40.68)
高级	22(16.18)	16(10.06)	38(12.88)

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表 2 290名患者基本情况[例(%)]

Table 2. Basic information of 290 patients [cases (%)]

项目	医院患者	社区患者	合计	χ²值	P值
性别				0.549	0.459
男性	123(60.00)	47(55.29)	170(58.62)
女性	82(40.00)	38(44.71)	120(41.38)
年龄				0.416	0.519
＜60岁	117(57.07)	52(61.18)	169(58.28)
≥60岁	88(42.93)	33(38.82)	121(41.72)
文化程度				55.941	< 0.001
初中及以下	55(26.83)	63(74.11)	118(40.69)
高中/中专	105(51.22)	17(20.00)	122(42.07)
大专及以上	45(21.95)	5(5.89)	50(17.24)
医疗费用支付方式				0.265	0.876
城镇医保	102(49.76)	44(51.76)	146(50.34)
新农合	85(41.46)	35(41.18)	120(41.38)
自费	18(8.78)	6(7.06)	24(8.28)

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表 3 医务人员认为双向转诊难以实施的原因[例(%)]

Table 3. Reasons why medical staff think two-way referral difficult to implement [cases (%)]

双向转诊难以实施的原因	医院医生(n=136)	社区医生(n=159)	合计	χ²值	P值
没有统一的双向转诊制度和标准	93(68.38)	78(49.06)	171(57.97)	11.236	0.001
医疗机构经济利益驱使	79(58.09)	88(55.35)	167(56.61)	0.224	0.636
医疗机构缺乏信息沟通	67(49.26)	104(65.41)	171(57.97)	7.841	0.005
患者不了解转诊制度	59(43.38)	91(57.23)	150(50.85)	5.626	0.018
患者不信任社区的医疗技术服务	53(38.97)	68(42.77)	121(41.02)	0.437	0.509
患者缺乏医疗服务信息	45(33.09)	70(44.03)	115(38.98)	3.686	0.055
医疗机构觉得麻烦不愿意转	25(18.38)	35(22.01)	60(20.34)	0.596	0.440
其他	10(7.35)	23(14.47)	33(11.19)	6.195	0.013

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表 4 患者认为双向转诊难以实施的原因[例(%)]

Table 4. Reasons why patients think it is difficult to implement two-way referral [cases (%)]

双向转诊难以实施的原因	医院患者(n=205)	社区患者(n=85)	合计	χ²值	P值
没有统一的双向转诊制度和标准	116(56.59)	30(35.29)	146(50.34)	10.896	0.001
医疗机构经济利益驱使	121(59.02)	37(43.53)	158(54.48)	5.817	0.016
医疗机构缺乏信息沟通	88(42.93)	33(38.82)	121(41.72)	0.416	0.519
患者不了解转诊制度	131(63.90)	40(47.06)	171(58.97)	7.045	0.008
患者不信任社区的医疗技术服务	140(68.29)	26(30.59)	166(57.24)	34.900	< 0.001
患者缺乏医疗服务信息	79(38.54)	24(28.24)	103(35.52)	2.784	0.095
医疗机构觉得麻烦不愿意转	46(22.44)	13(15.09)	59(20.34)	1.893	0.169
其他	20(9.76)	14(16.47)	34(11.72)	2.617	0.106

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