传染病患者在社区卫生服务机构和专科医院间双向转诊的可行性探讨

Two-way Referral of Patients with Infectious Diseases between Community Health Care Organizations and Specialized Hospitals in Beijing

目的探讨传染病患者在社区卫生服务中心(站)和传染病专科医院间双向转诊的可行性,了解目前推行双向转诊工作存在的问题,并提出改进措施。方法由首都医科大学附属北京地坛医院组织实施调查,选取北京市四个城区(东城区、西城区、朝阳区、顺义区)所属社区卫生服务中心(站)的社区医生为研究对象,分为干预组(进行传染病管理培训)和对照组,进行问卷调查。结果干预组和对照组整体的传染病防治知识的知晓程度间差异无统计学意义(P>0.05),但干预组对个别问题的知晓程度有所提高。在过去1年中,有82.5%的社区医生没有向专科医院转诊过传染病患者。未上转的主要原因是"没有遇到符合转诊标准的患者"和"没有上转通道";干预后未上转的主要原因选择"未遇到符合传染病上转标准的患者"的比例有所增加。干预组和对照组中认为转诊专科医院的方便程度一般和不太方便者占63.25%,原因主要是"患者不接受转诊"和"受医保制约"。结论实施双向转诊需要建立一整套系统的双向转诊制度、流程,加强不同形式的传染病防治知识的培训,并要有相关领导专门负责,建立一个专门的管理部门来完成转诊任务。

Objective To investigate the two-way referral of patients with infectious diseases between community health care organizations（CHCOs） and specialized hospitals in Beijing. Methods Community doctors were selected from CHCOs in four districts of Beijing（Dongcheng,Xicheng,Chaoyang and Shunyi） using simple random sampling.These doctors were randomly divided into an intervention group and a control group.The doctors in the intervention groups were given six-month training of infectious disease management.All the doctors were asked to complete the same self-designed questionnaire at baseline and the end of the study. Results No significant difference was observed in the total awareness of infectious disease control between the two groups（P0.05）.However,an increase of awareness of the doctors in the intervention group regarding certain questions was observed.In the past year,82.5% of the community doctors did not refer any patient with infectious diseases to the specialized hospital mainly because ＂no patient meets the referral criteria＂ or ＂there is no upward referral channel＂.The number of doctors choosing ＂no patient meets the referral criteria＂ increased after the intervention.About 63.25% of the doctors considered two-way referral as ＂not so convenient＂ or ＂inconvenient＂ mainly because of ＂patient＇s refusal＂ and/or ＂health insurance constraints＂. Conclusion A standardized two-way referral system needs to be established and the training in infectious disease control to the community doctors needs to be enhanced.