医院直管模式下社区卫生服务机构就诊患者对二者服务协作的认知评价研究

Cognition Appraisal of Patients in CHS Centers on the Collaboration Between Hospitals and CHS Centers Under Hospital Direct-management Model

目的了解医院直管模式下社区卫生服务机构就诊患者对二者服务协作的认知评价及利益相关者的态度与看法,为完善医疗服务协作提供实证依据。方法于2012年9月17—23日,采用自行设计的问卷对武汉市第五医院直管社区卫生服务中心的512例高血压和糖尿病患者进行调查,内容包括患者基本情况和服务协作知晓情况、认知评价情况及满意度情况,并对利益相关者(包括患者、医生、护士、社区卫生服务中心负责人以及武汉市第五医院负责人)进行了个人深度访谈分析。结果 19.5%(100/512)的患者表示知道社区卫生服务机构与医院有协作,32.8%(37/113)表示对服务协作满意,其中不同文化程度、慢性病治疗结果患者对服务协作满意度评价间差异有统计学意义(P<0.05);50%以上的患者认为在社区卫生服务机构看病不能得到医院医生的诊治、医院开的药不能在社区卫生服务机构买到、医院与社区医生提供的医疗服务并没有连续性、两类机构医生对病情总体沟通情况差等。从访谈结果可以看出,目前还存在信息交流平台不完善等阻碍协作的一些问题。结论患者对两类机构协作的知晓率、认知评价和满意度均偏低。建议应加强信息化建设,建立信息平台;完善转诊制度,尽快完善配套的医保政策,保证医疗服务连续性;健全基本药物制度,满足基层用药需求。

Objective To investigate the cognitive appraisal of patients in CHS centers on the collaboration betWeen hospitals and CHS centers under hospital direct - management model and to examine the attitude and perception of relevant personnel,in order to provide evidence-based references for the improvement of health service collaboration. Methods From September 17 to September 23 in 2012,We enrolled 512 patients With hypertension and diabetes mellitus from the community health service centers under direct management of Wuhan Fifth Hospital. Self-designed questionnaire Was used to investigate the subjects about the basic information, aWareness of the collaboration in health service, cognition appraisal and satisfaction degree. In-depth individual intervieWs Were carried out on relevant personnel（ including patients,doctors,nurses,people in charge of CHS centers and people in charge of Wuhan Fifth Hospital）. Results Among the included patients,19. 5%（100/512） kneW about the collaboration betWeen CHS centers and the hospital,32. 8% （ 37/113 ） Were satisfied With their collaboration. Patients With different education degrees and treatment outcomes of chronic diseases Were significantly different（ P〈0. 05）in the satisfaction degree With the collaboration. More than 50% of the patients thought that they could not receive the treatment of doctors in CHS centers as in hospitals,medication that subscribed in hospital Was not available in CHS centers,the service provided by doctors in hospitals and CHS centers Were not in continuity and doctors in hospitals and those in CHS centers had poor communication. The results of intervieWs shoWed that some problems Which hindered collaboration still existed,such as imperfect information exchanging platform. Conclusion Patients have loW level in the aWareness rate,cognition appraisal and satisfaction degree With the collaboration betWeen hospital and CHS centers. Informatization should be strengthened, and information platform should be built. Referral system and related health insurance policies should be improved in order to ensure continuity of health services. Essential medicine system should be improved in order to meet the medication needs of CHS centers.