上海市松江区双向转诊实施现状及对策研究

Current situation and strategy of dual referral implementation in Songjiang District of Shanghai

目的研究上海市松江区双向转诊的实施现状及存在的问题,为我国双向转诊制度的逐步完善提供参考依据。方法随机抽取上海市松江区3所医疗机构,其中一级(社区卫生中心)、二级、三级医院各1所,从中随机抽取医务人员和患者各400名进行问卷调查,回收医务人员有效问卷392份(医院工作人员176份,社区卫生工作人员216份),患者有效问卷380份。问卷调查内容包括:基本情况;患者的就诊意向;医务人员和患者对双向转诊制度的认知程度、转诊实施途径的意向、转诊最终决定权的看法和转诊指征的看法;医务人员对目前转诊难以实施原因的看法。结果 52.9%的患者选择经常到社区卫生中心就诊,57.6%的患者在病情稳定后不愿意转回社区卫生中心继续治疗。医务人员和患者对双向转诊政策的认知程度、转诊实施途径的意向、转诊最终决定权和转诊指征的看法,均存在统计学差异(P<0.05)。医务人员均认为,医疗机构经济利益驱使和缺乏信息沟通是影响双向转诊的重要原因。结论医务人员和患者对双向转诊认知不足、转诊意识不强,医疗机构的经济利益驱动成为阻碍双向转诊的重要原因。应建立可操作的配套措施和合理的补偿机制,促进双向转诊的顺利实施。

Objective To investigate the current situation and problems of dual referral implementation in Songjiang District of Shanghai,and provide references for the optimization of dual referral system in China.Methods Three medical institutions were randomly selected from Songjiang District of Shanghai,with one first-grade hospital（community health center）,one second-grade hospital and one third-grade hospital.Four hundred medical staff and 400 patients were surveyed with questionnaires,and 392 effective questionnaires from medical staff（176 from second-grade hospital or third-grade hospital and 216 from community health center）and 380 effective questionnaires from patients were recovered.The questionnaires were involved with the basic condition,dual referral willingness of patients,knowledge of medical staff and patients on dual referral policy,opinion of medical staff and patients on dual referral implementation channels,determinative right of dual referral,indications of dual referral and implementation difficulties of dual referral.Results Patients who often visited the community health center accounted for 52.9%,and 57.6% of patients with stable illness state were reluctant to be referred back to the community health center.There were significant differences in knowledge on dual referral policy,opinion on dual referral implementation channels,determinative right of dual referral and indications of dual referral between medical staff and patients（P0.05）.It was drawn from medical staff that the drive from economic benefits and lack in communications among medical institutions were the important influencing factors for dual referral.ConclusionThe inadequate knowledge of medical staff and patients on dual referral,the unwillingness of patients on dual referral and the drive from economic benefits are the obstacles for the implementation of dual referral.Rational strategies and compensation system should be adopted to facilitate the implementation of dual referral.