分级诊疗背景下患者对“下-上-下”转诊的满意度及影响因素研究

Level and Associated Factors of Patients' Satisfaction with the Procedures for Upward Referral-to-Downward Referral during the Implementation of Hierarchical Medical System

目的探讨分级诊疗背景下患者对"下-上-下"转诊的满意度及影响因素。方法于2016年11月—2017年5月,从下级医疗机构转至西安市某医学院附属医院就诊的患者中选取415例患者为调查对象。采用自行设计的调查问卷进行调查。问卷主要内容有:患者的基本情况、患者对下级医疗机构的满意度、对上级医疗机构的满意度、对"下-上"转诊过程的满意度以及对"上-下"转诊过程的满意度情况。共发放问卷415份,回收有效问卷400份,问卷的有效回收率为96.4%。结果患者对下、上级医疗机构,"下-上"和"上-下"转诊过程的满意度依次为30.0%(120/400)、81.8%(327/400)、65.5%(262/400)、48.3%(28/58)。多因素Logistic回归分析结果显示,患者年龄及对医疗技术水平、医疗服务态度、就诊费用是否满意是对下级医疗机构的满意度的影响因素(P<0.05);患者人均月收入、参加医疗保险类型及对医疗技术水平、医疗服务态度、就诊费用、就医环境是否满意是对上级医疗机构的满意度的影响因素(P<0.05);患者年龄、文化程度及对转诊手续便捷度、转诊花费的时间是否满意是对"下-上"转诊过程的满意度的影响因素(P<0.05);患者文化程度及对转诊手续便捷度、转诊花费的时间是否满意是对"上-下"转诊过程的满意度的影响因素(P<0.05)。结论患者对上级医疗机构和"下-上"转诊过程的满意度较高,对"上-下"转诊过程的满意度较低,对下级医疗机构的满意度最低;年龄、文化程度、医疗技术水平、医疗服务态度、就诊费用、转诊手续便捷度、转诊花费的时间等是患者对"下-上-下"转诊满意度的影响因素。

Objective To investigate the level and associated factors of patients'satisfaction with the procedures for upward referral-to-downward referral during the implementation of hierarchical medical system.Methods We conducted a survey in a sample of 415 patients from those who were transferred to an affiliated hospital of a medical college in Xi'an from lower-level institutions between November 2016 and May 2017 with a self-designed questionnaire for obtaining the data about sociodemographic characteristics,levels of satisfaction with the services delivered by the lower-level and upper-level medical institutions,level of satisfaction with the procedures for upward and downward referrals.A total of 400 returned responsive questionnaires,achieving a response rate of 96.4%.Results The patients'satisfaction was found to be 30.0%(120/400),81.8%(327/400),65.5%(262/400),48.3%(28/58),for services delivered by the lower-level and upper-level medical institutions,the procedure for upward referrals,and the procedure for downward referrals,respectively.Multivariate logistic regression analysis showed that patients'age,satisfaction with the capabilities of healthcare professionals,service attitude of health workers and healthcare cost were associated factors for patients'satisfaction with the services delivered by lower-level medical institutions(P<0.05);patients'mean monthly income and type of medical insurance,patients'satisfaction with the capabilities of healthcare professionals,service attitude of health workers,healthcare cost and the environment in healthcare settings were associated factors for patients'satisfaction with the services delivered by upper-level medical institutions(P<0.05);patients'age and educational level,patients'satisfaction with the convenience of referral procedure and duration of referral were associated factors for their satisfaction with the procedure for upward referrals(P<0.05);patients'educational level,satisfaction with the convenience of referral procedure and duration of referral were associated factors for their satisfaction with the procedure for downward referrals(P<0.05).Conclusion The services delivered by the upper-level medical institutions and the procedure for upward referrals achieved high levels of patients'satisfaction,but the procedure for downward referrals achieved low level of patients'satisfaction,the services delivered by the lower-level medical institutions,even worse,achieved the lowest level of patients'satisfaction.Patients'age and educational level,capabilities of healthcare professionals,service attitude of health workers toward patients,healthcare cost,convenience of the referral procedure,and duration of the referral were associated factors for patients'satisfaction with the procedures for upward referral-to-downward referral.