北京市朝阳区居民社区首诊制信访风险评估研究

Petition Risk Assessment of Community First Diagnosis System in Chaoyang District of Beijing

目的评估北京市朝阳区居民的社区首诊制信访风险。方法于2014年9—11月,采用目的性抽样法根据城乡区别、地理位置、区域内医疗资源分布情况在北京市朝阳区抽取8家社区卫生服务中心,采用方便抽样法在该8家社区卫生服务中心抽取非患者居民518例。采用自行设计的问卷对居民进行调查,主要内容包括居民的基本情况、健康状况、社区卫生服务可及性、是否知晓社区首诊制、是否接受社区首诊制及不接受原因、就诊体验、卫生服务重要性认识,以及对实施社区首诊制的建议。结果共回收有效问卷511份,居民的社区首诊制信访风险为43.1%(220/511)。不同性别、年龄、文化程度、家庭人均月收入、年医疗支出、医保类型居民的社区首诊制信访风险比较,差异无统计学意义(P>0.05);不同婚姻状况居民的社区首诊制信访风险比较,差异有统计学意义(P<0.05)。不同自评健康状况及两周内是否患病、是否患慢性病居民的社区首诊制信访风险比较,差异无统计学意义(P>0.05)。不同离家最近医疗机构居民的社区首诊制信访风险比较,差异无统计学意义(P>0.05);不同步行至相应社区卫生服务机构所需时间居民的社区首诊制信访风险比较,差异有统计学意义(P<0.05)。不同社区首诊制认知情况居民的社区首诊制信访风险比较,差异有统计学意义(P<0.05)。不同就诊过程方便程度、医疗设备、就诊环境、报销比例、药品种类满意度居民的社区首诊制信访风险比较,差异有统计学意义(P<0.05);不同服务态度、就诊时间、离家距离、医务人员技术水平、医疗费用、药品费用、治疗效果满意度居民的社区首诊制信访风险比较,差异无统计学意义(P>0.05)。不同交通便利性重要性认识居民的社区首诊制信访风险比较,差异有统计学意义(P<0.05);不同服务态度、就诊过程方便程度、就诊时间、医务人员技术水平、医疗设备、就诊环境、医疗费用、药品费用、报销比例、转诊过程、与医生熟悉程度、治疗效果重要性认识居民的社区首诊制信访风险比较,差异无统计学意义(P>0.05)。居民认为社区本身能力建设和服务水平有待改善,转诊机制有待完善。结论朝阳区居民的社区首诊制信访风险较高,相关政策和社区卫生服务能力建设尚有待加强。

Objective To evaluate the community petition risk of residents in Chaoyang District of Beijing. Methods According to the difference between the urban and rural areas, geographical locations, and distribution of intra- regional medical resources,8 community health service centers in Chaoyang District of Beijing from September to November 2014 by purposive sampling method. 518 residents who were not patients were selected by convenient sampling method from these 8community health service centers. Self- designed questionnaire was made to investigate the following main aspects of the residents：basic information,health status,community health services accessibility,whether community first diagnosis system was known or not,whether community first diagnosis system was accepted or not,and reasons for not accepting,see- a- doctor experience,cognition of importance of health services and suggestions of implementing community first diagnosis system. Results 511 valid questionnaires were collected; petition risk of the first diagnosis system of community residents was 43. 1%（ 220 /511）. The comparison of petition risk of community first diagnosis system of community among residents with different genders, ages,educational levels,family monthly income per person,annual health spending,types of medical insurance was not significantly different（ P 〉0. 05）; The comparison of petition risk of first diagnosis system of community among residents with different marital status was significantly different（ P 〈0. 05）. The comparison of petition risk of first diagnosis system of community among residents of different self- evaluated physical conditions,residents whether got sick in two weeks,and residents whether suffering from chronic was not significantly different（ P 〉0. 05）. There was no significant difference in petition risk of first diagnosis system of community among residents with different distances from their home to the nearest medical institutions（ P 〉0. 05）; there was significant difference in petition risk of first diagnosis system of community among residents with different walking times to the corresponding community health service institutions（ P 〈0. 05）. The comparison of petition risk of community first diagnosis system of community among residents with different cognitions of this system was significantly different（ P 〈0. 05）. There was significant difference in petition risk of first diagnosis system of community among residents with different satisfaction degrees of comfort level of visiting doctors,medical equipments,medical environment,proportion of reimbursement and drug varieties（ P 〈0. 05）; there was no significant difference in petition risk of first diagnosis system of community among residents with different satisfaction degrees of service attitude, visiting time, distance from home, medical personnel＇ s technological level,medical costs,drug costs,treatment effects（ P 〉0. 05）. The comparison of petition risk of first diagnosis system of community among residents with different cognitions of importance of traffic convenience was significantly different（ P 〈0. 05）; the comparison of petition risk of first diagnosis system of community among residents experiencing different service attitudes,comfort levels of diagnosis processes,visiting times,technological levels of medical personnel,medical equipments,medical environment,medical costs,drug costs,proportions of reimbursement,referral processes,degrees of familiarity with doctors,and treatment effects was not significantly different（ P 〉0. 05）. Community residents believed that community＇ s capacity building and service level needed to be improved,and referral system needed to be perfected. Conclusion The petition risk of community first diagnosis system in Chaoyang District is relatively high,and relevant policies and ability construction of community health service remains to be enhanced.