综合型医院与社区卫生服务中心全科医生双向转诊平台的建立和应用探索

Establishment and application of general practitioners two-way referral platform between a comprehensive teaching hospital and community health centers

目的探索在综合型教学医院和社区卫生服务中心（社区中心）间建立全科医生双向转诊平台的可行性。方法复旦大学附属中山医院以全科医学科门诊为基础组建全科医生双向转诊平台（GPTRP），于2012年11月至2013年11月问与3家社区中心开展双向转诊工作，社区中心向中山医院转诊（上转）患者共65例次。对社区医生转诊合理性进行评估、归类分析需要转诊的主要疾病种类、统计分析上转目的，并自行设计满意度调查问卷，调查转诊患者对转诊流程的满意度情况。结果上转65例次中，78％（51／65）为合理转诊。由社区中心上转的疾病种类较多，其中前5位的分别为冠状动脉粥样硬化性心脏病（冠心病）占11％（7／65）、胸闷待查占11％（7／65）、糖尿病占8％（5／65）、高血压占6％（4／65）、血尿待查占5％（3／65）。转诊目的主要包括：调整治疗方案占34％（22／65），进一步明确诊断占31％（20／65），进一步检查占26％（17／65），要求住院占5％（3／65），咨询占3％（2／65），术后复查占2％（1／65）。患者对双向转诊过程的满意度为100％（65／65）。中山医院未向社区中心下转患者。结论综合型教学医院建立GPTRP可行，且有助于双向转诊制度的建设和发展。

Objective To establish a general practitioners two-way referral platform （GPTRP） between a comprehensive teaching hospital and community health centers and to assess its feasibility, Methods GPTRP was established between the department of general practice, Zhongshan Hospital, Fudan University and three community health service centers of Changning District （Hongqiao, Xinhua, Zhou Jiaqiao） from November 2012 to November 2013. The rationality, disease categories and purpose of referrals were analyzed. A questionnaire was designed to investigate the degree of satisfaction of patients. Results During this period 65 patients/times used the GPTRP for referral, 78% （51/65） of which was reasonable. The first five diseases of referral were coronary heart disease （7/65）, chest tightness of unknown origin （7/65）, diabetes （ 5/65 ）, hypertension （ 4/65 ）, hematuria of unknown origin （ 3/65 ）. The purposes of referrals were for consultation of treatment protocol （22/65）, diagnosis （20/65）, further examination （ 17/65）, admission requirement （3/65）, health consultation （2/65） and postoperative follow-up （ 1/65 ）. The satisfaction of patients was 100% （65/65）. Conclusion The general practitioners referral platform is feasible for two-way referral system between tertiary hospital and community health service centers.