医患双方对双向转诊管理及其影响因素看法的调查分析

Management and Influential Factors of the Two- way Referral: from the Perspective of Patients and Doctors

目的调查参与双向转诊的医生和患者对双向转诊管理及其影响因素的看法。方法 2009年3月—2010年3月随机抽取首都医科大学附属复兴医院的医院医生75名及患者166名,月坛地区10个社区卫生服务站的社区医生44名及患者103名,采用自行设计的《复兴医院与月坛社区卫生服务站双向转诊调查问卷》,对医患双方对双向诊管理的看法、医生认为必要的转诊指征、接受过转诊的患者对转诊过程的看法及医患双方认为影响向下转诊的因素进行调查。结果对于转诊的决定权,有73.3%(55/75)的医院医生、88.6%(39/44)的社区医生及65.8%(177/269)的患者认为转诊最终应由医生决定。66.7%(50/75)的医院医生、70.5%(31/44)的社区医生和56.9%(153/269)的患者认为有必要建立专门负责转诊的机构和人员对双向转诊工作进行协调和管理。医院医生与社区医生对转诊指征的看法基本一致,居前3位的向上转诊指征为:诊断不明确需进一步治疗;急危重症;条件所限无法治疗。居前3位的向下转诊指征是:诊断明确、治疗方案完善的常见病;病情稳已定,处于康复期或恢复期;仅需定期复查的慢性病。83.8%(109/130)的接受过转诊的患者对转诊过程满意。医院医生和社区医生均认为缺乏有效激励和监督机制;没有明确的转诊标准;医疗机构间缺乏信息沟通的平台是影响向下转诊工作的前3个因素,但对首位影响因素的看法不一致。患者愿意转回社区卫生服务中心的最主要原因是离家近,就医方便;不愿意转回社区卫生服务中心的主要原因是不信任社区卫生服务中心的医疗水平。结论医生和患者对转诊决定权的看法一致,社区医生与医院医生对转诊指征把握一致,医生和患者对影响向下转诊的因素看法不一,故今后还需要从医患双方的角度出发完善转诊管理。

Objective To investigate the opinions of the patients and doctors about the two -way referral management and its influential factors. Methods There were 75 doctors and 166 patients of Fuxing Hospital, 44 doctors and 103 patients of ten Yuetan community health service institutions randomly enrolled. All subjects completed the questionnaire on two -way refer- ral. The questionnaire included the awareness of doctors and patients about the two - way referral, the indicators of referral, pa- tient＇s view on the process of referral, and the influential factors of the downward referral. Results The idea that decision of ref- erral should be made by doctors was supported by 73. 3% （55/75） hospital doctors, 88.6% （39/44） community doctors, and 65.8% （177/269） patients. About 66.7% （50/75） hospital doctors, 70.5% （ 31/44 ） community doctors, and 56. 9% （153/269） patients thought it was necessary to establish special organization to manage and coordinate the work related to the two - way referral. Hospital doctors were in general accord with community doctors on the view of referral indicators. The top three upward referral indicators included requirement of further treatment without clear diagnosis, critical illness, and insufficiency of necessary treatment conditions; while the top three downward referral indicators included common disease with clear diagnosis and complete therapeutic regimen, stable condition in the recovery and rehabilitation stage, chronic disease under periodic review. Among the patients who had been referred, 83.83% （109/130） of them were satisfied with the process of referral. In both hos- pital doctors＇ and community doctors＇ opinion, lack of the effective reward- punishment system, no exiting specific referral standard, and absence of the information communication platform among medical institutions were considered as the top three fac- tors which influenced downward referral. The patients preferred a referral to community hospital mainly because of the short dis- tance between the community hospital and their home and the convenience of treatment. On the other hand, many patients did not choose to go on with the treatment in community mainly because they were not confident with the quality of medical care in community. Conclusion There was no difference between doctors and patients on the attitude towards the decision rights, and between the doctors in hospital and the doctors in community on the indicators of referral, but some difference between doctors and patients on the influential factors for downward referral. It is suggested that some aspects of the two - way referral management should be improved.