基于家庭医生制度的上海市居民社区首诊服务现况及因素分析(待续)

First Choice Hospital and Affective Factors by Shanghai City Residents Based on Family Doctor System

目的为进一步了解目前上海市民首诊愿望,并深入分析这些流向和首诊愿望产生的原因,为上海市医改提出政策建议,特进行该研究。方法随机整群分层抽取上海市中心地区(徐汇区)、上海市城乡结合区(闵行区)、上海市郊区(金山区)。每个地区研究800名门诊(住院)居民(医院和社区卫生服务中心各400人)共计2400人,回收问卷2082份,问卷回收率为86.75%。结果①上海市居民首选社区医院情况:门诊病人65.4%首选社区医院,20.8%首选三级医院;住院患者57.4%首选社区医院,27.8%首选三级医院。60～74岁人群首选社区医院达72.0%,≥75岁老人高达73.0%,门诊病人、年龄大者、退休人员和新型农村合作医疗人员首选社区医院比例较高。②上海市居民首选社区医院原因分析:门诊病人选择社区医院的主要原因是价格便宜和交通方便,住院病人选择社区医院的主要原因是价格便宜和服务态度;在年龄方面,不管是哪个年龄组,都认为选择社区医院是有价格便宜和交通方便的原因。其他项目的人群也基本如此,选择社区医院的原因主要是价格便宜、交通方便、就医流程便捷。结论上海市社区首诊势头较好,要因势利导,制定相关政策,保证家庭医生制度的顺利实现。

Objective To further understand Shanghai city residents＇ choice hospital for their first diagnosis, analyze its rea- sons,＇ and bring up the policy suggestion for the medicine reforms in Shanghai city. Methods A cluster random sampling method was used to survey the intentions of residents for their first diagnosis. 2400 people from three districts were enrolled in this study. 2082 valid questionnaires were returned （86.75%）. Results （1）The first choice hospital by Shanghai city resident： the community hospital was 65.4% by outpatients and 57.4% by hospitalized patients;tertiary hospitals was 20.8% by outpatients and 27. 8% by hospitalized patients. 72% of patients aged 60 to 74 years and 73% of patients over 75 years selected the community hospital firstly. The rate of selecting community hospitals was higher in outpatients, aged patients, retirees and patients enjoying newtype rural cooperative medical service. （2）Analysis of reasons ： a low cost service and convenient transportation affected the outpa- tients, the low cost and better service attitude were the factors for the hospitalized patients to select the community hospital. All populations agreed the lower price, convenient transportation and simple process. Conclusion The community hospitals are ac- cepted by Shanghai city residents for their first diagnosis. Based on this situation, more encouragement policies should be made to ensure the family doctor system to come into effect.