全科医生对社区首诊制的认可度及影响因素研究

Recognition of General Practitioners on Gatekeeper System and Influencing Factors

目的了解全科医生对社区首诊制的认可度,并探讨其影响因素。方法选取2014年8月—2015年3月参加"湖北省社区全科医生服务团队培训班"的全科医生916例。采用本课题组自行设计的《社区卫生服务机构医生调查问卷》对纳入全科医生进行调查,主要内容包括全科医生的基本情况、对社区卫生服务机构能力的评价、所在社区卫生服务机构与上级医院业务联系情况、对社区首诊制的评价。采用多因素Logistic回归分析探讨全科医生对社区首诊制认可度的影响因素。结果共回收有效问卷907份,问卷有效回收率为99.0%。其中906例全科医生对"对社区首诊制的评价"部分进行了回答,489例(54.0%)认为社区首诊制能够缓解"看病难、看病贵"问题,532例(58.7%)认为社区首诊制的实施能够在引导居民去社区卫生服务机构就医方面起积极作用,755例(83.3%)认为社区首诊制的实施会影响社区卫生服务机构的病源和医生收入,848例(93.6%)赞同患者病情稳定后下转至社区卫生服务机构,849例(93.7%)认可实施社区首诊制。多因素Logistic回归分析结果显示,是否认为社区卫生服务机构能够承担"健康守门人"职责、是否收治过下转患者、是否认为社区首诊制的实施能够在引导居民去社区卫生服务机构就医方面起积极作用、是否赞同患者病情稳定后下转至社区卫生服务机构是全科医生对社区首诊制认可度的影响因素(P<0.05)。结论全科医生对社区首诊制的认可度较高,是否认为社区卫生服务机构能够承担"健康守门人"职责、是否收治过下转患者、是否认为社区首诊制的实施能够在引导居民去社区卫生服务机构就医方面起积极作用、是否赞同患者病情稳定后下转至社区卫生服务机构是其影响因素。建议不断提高全科医生的服务意识和能力、加强社区卫生服务机构与上级医疗机构的联系,以促进社区首诊制的进一步实施。

Objective To investigate the recognition of general practitioners（ GPs） on the gatekeeper system and its influencing factors.Methods Nine hundred and sixteen GPs attending ＂ The training classes for general practitioners service team in Hubei province＂ from August 2014 to March 2015 were selected.The Questionnaires for Doctors in the Community Health Service Institutions designed by the research group were adopted to investigate the enrolled subjects.The main contents contained the fundamental state of the GPs,their assessment of the ability of community health service institutions（ CHIs）,business connection between their institutions and the superior hospitals,and their assessment of the gatekeeper system.Multivariate Logistic regression analysis was used to analyze the influencing factors of the recognition of GPs on the gatekeeper system.Results A total of 907 valid questionnaires were collected with an effective response rate of 99.0%.Of the research results,906 GPs responded to the ＂ evaluation of the gatekeeper system＂ section,489（ 54.0%） believed that the gatekeeper system can ease the problem of ＂ difficulties and high cost in seeking medical care ＂,532（ 58.7%） argued that its implementation can play a positive role in leading the community residents to CHIs to seek medical care,755（ 83.3%） GPs deemed that the implementation of the system would affect the source of patients and the income of doctors,848（ 93.6%） agreed with the idea that patients transferring to CHIs when they were in a stable condition,and 849（ 93.7%） approved of the implementation of the gatekeeper system.The multiple Logistic regression analysis showed that whether GPs believed that the CHIs can undertake the responsibility of ＂ health gatekeeper ＂,whether they have received and treated those patients who transferred from superior hospitals to CHIs,whether they believed that implementation of the gatekeeper system can play a positive role in guiding residents to seek medical care in CHIs,and whether they approved patients transferred to CHIs from the superior hospitals when they were in a stable condition significantly influenced GPs＇ recognition of gatekeeper system（ P〈0.05）.Conclusion The recognition of the gatekeeper system in community is rather high among GPs.Whether GPs believe that the CHIs can undertake the responsibility of ＂ health gatekeeper＂,whether GPs receive and treat those patients who transferred from superior hospitals to CHIs,whether GPs believe that implementation of the gatekeeper system can play a positive role in leading residents to seek medical care in CHIs,and whether they approve patients transferred to CHIs from the superior hospitals when they were in a stable condition are its influencing factors.It is suggested to continuously improve the service awareness and ability of GPs,enhance cooperation between CHIs and superior hospitals,so as to promote further implementation of the gatekeeper system.