三级医院与社区卫生服务机构双向转诊的实践与体会

Practice and discussion on two-way referral between third-level hospital and community health services organization

目的:了解三级医院与社区卫生服务机构双向转诊中存在的问题并探讨其解决方法。方法:选取2012年1月—2012年6月山西医科大学第二医院与其对口支援的社区卫生服务机构双向转诊的患者(上转241例,下转78例)为研究对象,通过问卷调查了解双向转诊中存在的主要问题。双向转诊工作由山西医科大学第二医院的社区卫生服务指导中心负责。结果:患者对双向转诊的总体满意度得分为(57.91±9.53)分,总体满意度水平不高。上转患者的满意度得分、对社区医务人员技术水平的认可度高于下转患者(P<0.01);但下转患者对药物和医保使用便利情况的得分高于上转患者(P<0.01),差异有统计学意义。上、下转诊患者对三级医院的技术水平、社区医疗环境的认可度差异无统计学意义(P>0.05)。结论:三级医院与社区卫生服务机构双向转诊呈现上转容易下转难的现象,主要与双向转诊制度不健全、患者对社区卫生服务机构的医疗技术水平认可度低、医保和药物的区域性限制等因素有关。因此,健全相关政策法规、完善社区卫生指导中心的双向转诊职能、建立三级医院与社区卫生服务机构良性互动机制是落实双向转诊的关键。

To investigate the problems in two-way referral between the third-level hospital and com- munity health services organization and explore the solution. Methods ：The patients needed to be referral from the sec ond hospital of shanxi medical university to the community health services organization or oppositely were enrolled from January to June in 2012（241 upward referral of patients and 78 downward referral of patients）. The main prob- lems during the referral were investigated by questionnaire survey. The community health instruction center of second hospital of shanxi medical university was in charge of two-way referral. Results ：Two-way referral of patients＇ overall satisfaction score was （57.91±9.53）,the overall satisfaction level is not high. The upward referral of patients＇ satis- faction scores ,the degree of approval about workers in community hospital was higher than downward referral of pa- tients （P〈0.01）;but the downward referral of patients think the convenience of drugs and the medical insurance than the upward referral of patients （P〈0. 01）,the difference was statistically significant. The two-way referral of patient think medical technical level of the third-level hospital,medical environment of the community were no significant dif- ference （P〉0. 05） ,the difference was not statistically significant. Conclusion ：The work was easy for upward referral of the inpatients,but difficult for downward referral. This was mainly because the two-way referral system was not perfect, the degree of approval about medical personnel in community hospital was lower, the regional restriction about drugs and medical insurance ,etc. Therefore ,perfecting policy ,law ,the structure of two-way referral by commu- nity health instruction center,realizes the third-level hospital and community health services organization＇s benign in- teraction. They are the key whether the two-way referral system will be carried out.