需方对分级诊疗制度的认识与态度调查分析

Analysis on the Demand Side's Cognition and Attitude to the Hierarchical Medical Service Delivery System

目的了解青海地区需方(患者及家属)对分级诊疗制度的认识与态度。方法应用统计分析与定性相结合的研究方法对需方进行问卷调查和访谈。结果需方认为实施分级诊疗制度是为了降低患者的医疗费用(53.7%)和解决大医院看病难问题(50.0%);落实分级诊疗的关键是提高基层医疗机构服务能力(64.9%);存在的困难主要是基层缺少适宜的医务人员(58.6%),需要改进的是增加药品品种(43.4%)。结论患者首选基层医疗机构的理念逐步建立,部分地区医疗机构出现"两升两降"趋势。同时存在基层医疗机构卫生人员能力不足、医疗保障制度设计不尽合理、基本药物制度未能满足基层医疗服务需求等问题。因此,通过改进用人机制,调动基层工作人员的积极性;加大培训和对口帮扶力度,提升基层卫生人员业务水平;应用经济杠杆,引导患者合理就医;适当放宽基层医疗机构的用药种类等措施,改进分级诊疗制度的有效实施。

Objective To understand the cognition and attitude of the demanders （patients and family members） to the Hierarchical Medical Service Delivery System in Qinghai province.Methods Questionnaire survey and interviews were conducted on the demand side with the combination of statistical and qualitative methods. Results The demanders considered that the aim of the implementation of hierarchical medical service delivery system were decreasing patients＇ medical expenses（ 53.7% ） and solving the difficulty of getting medical service in larger hospi- tals （50.0%）;the key of solving this problem was to improve the services of primary health care institutions （64.9%） ;the major difficulty was the lack of suitable medical staffs at the primary level（ 58.6% ）as well as the varieties of medicine need to be enlarged（43.4%） .Conclusion Patients＇ preference on primary health care institutions established gradually,medical institutions in some areas displayed a ＂two liters and two down＂ trend.Insufficient capacity of health personnel in primary health care institutions, inadequate design of medical security system, basic medicine system still cannot meet basic medical service demands.Therefore, some items should be emphasized as follows：mobilizing the enthusiasm of primary medical staff according to improving the employment mechanism;enhancing the professional skill level of health workers by taking great efforts on training and counterpart assistance ; guiding the patients to take reasonable medical treatment with the economic leverage and improving the effectiveness of the systems＇ implementation based on taking measures （ e. g., easing the types of medication in primary health care institutions）.