北京市社区常见疾病转诊现状及指征需求调查

The Status of Referral and the Demand of Referral Criteria for Diseases and Symptoms in Community in Beijing

目的了解北京市社区卫生服务机构转诊现状、存在的问题及转诊指征的需求情况,为相关政策及转诊标准的制定提供参考。方法对2009年3月参加全科医生培训的199名北京市各区、县社区医生实施问卷调查;使用Epidata3.02数据库进行数据双录入,SPSS13.0软件进行频数及卡方检验分析。结果 76.6%的医生认为双向转诊运行情况一般或较差;86.0%的被调查者曾向上级医院转诊过病人,42.5%的医生曾接收上级医院转下来的病人;转诊存在转上不转下(64.8%)、病人盲目要求转诊(60.1%)等问题;47.2%的全科医生对疾病转诊把握度不高;转诊依据主要为依靠有关诊断资料和信息(53.9%)及自我决定(48.2%);全科医生认为最需要的转诊症状是气短和胸痛(88.6%);最需要转诊的疾病是慢性阻塞性肺病(85.5%)。结论北京市社区卫生服务机构转诊现状不容乐观,社区医生对双向转诊的了解情况不尽如人意,对转诊指征或标准需求迫切。应加强社区卫生建设及全科医师培训,扩大宣传,提高双向转诊的知晓率,制定完善的转诊标准及转诊规范,增加医疗机构间的沟通交流。

OBJECTIVES To investigate the present situation of referral in community health service（CHS）institutions,the main problems and the demand for referral criteria,and to provide reference for the establishment of referral criteria.METHODS A questionnaire survey was conducted in community practitioners who came from several regions of Beijing to participate in the training program in 2009.RESULTS 76.6% of the responders considered that the status of referral was unsatisfactory.86.0% of them transferred patients to the higher-up hospitals,but 42.5% receipted patients from superior hospitals.53.9% and 48.2% of the responders transferred the patients according to some references and self-decision separately.The symptom of dyspnea（88.6%）and the chronic obstructive pulmonary diseases（85.5%）were thought as the first referral in community separately.CONCLUSIONS Present situation of referral was not optimistic and there were no unified regulations and guidelines for referral and communications were not sufficient between CHS institutions and hospitals.The demand of community practitioners for referral guidelines was urgent.The training for community practitioners should be reinforced and two-way referral should be known by more people through enlarged promotion.Referral regulations and guidelines in detail should be established and there should be more communications among clinical institutions.