南昌市城区和农村就诊居民对基层卫生服务的反应性研究

Responses of Urban and Rural Nanchang Residents to Grassroots Health Services

目的了解南昌市就诊居民对基层卫生机构新型服务模式及服务意识的反应性,为卫生行政部门提出适宜的政策建议。方法采用偶遇法,对从南昌市城区(青云谱区)和农村(新建县)2个国家级基层综合改革示范点中随机抽取的3个基层卫生机构就诊居民进行基层卫生新型服务模式和服务意识的反应性调查,并进行分析。结果本调查中,75.0%的就诊居民以基层卫生机构作为就诊首选机构,不作为首选的主要原因是:技术水平低、设施设备差,新建县就诊居民首选基层医疗机构所占比例与青云谱区比较差异有统计学意义(P<0.001)。6.1%的就诊居民认同去大医院就诊需要通过基层转诊,2.6%的就诊居民与团队签约;56.6%的就诊居民认为就诊时医生一定能充分了解病情,55.6%的就诊居民认为一定有充足时间向医生提问,40.8%的就诊居民认为开高价药时一定会征求患者的意见。新建县就诊居民对基层卫生机构技术水平中非常满意、基本满意,报销比例中非常满意、比较满意、基本满意、不太满意,一般诊疗费中非常满意、比较满意、基本满意的满意率均高于青云谱区(均P<0.05)。就诊居民认为基层卫生机构需要完善的前3位依次为:基础设施和设备(43.4%)、药品品种和质量(23.5%)、报销比例和范围(23.0%)。结论南昌市就诊居民转诊率、签约率较低,满意率较高。建议加强机构建设,积极推行社区首诊制和双向转诊制,落实团队签约,增强自身服务意识。

Objective To understand the responses of Nanchang visiting residents to new service mode and service awareness of grassroots health institutions,and to provide appropriate policy suggestions for health administration departments.Methods Using encounter method,3grassroots health institutions were randomly selected from two national comprehensive reform pilots of Nanchang(Qingyunpu district and Xinjian county)to investigate the responses of visiting residents to new service mode and service awareness.Results Grassroots health institutions were selected as the preferred institutions by 75.0% of visiting residents.The main reasons for not selecting grassroots health institutions were low technical levels and poor facilities and equipments.There was a significant difference in the proportion of residents preferring grassroots health institutions between Xinjian county and Qingyunpu district(P<0.001).Among these visiting residents,6.1% consented that visiting the higher-level hospital needed to be transferred by grassroots health institutions,2.6% had signed the contract with a general practitioner team,56.6%thought that doctors could understand disease definitely,55.6% thought that they had enough time to ask the doctors,40.8% thought that doctors would ask for their permission when prescribed expensive medicine.The rates of high satisfaction and basic satisfaction with technical levels,rates of high satisfaction,moderate satisfaction,basic satisfaction and low satisfaction with the proportion of reimbursement,and rates of high satisfaction,moderate satisfaction and basic satisfaction with general medical costs in Xinjian county residents were significantly higher than those in Qingyunpu district residents(P<0.05).The visiting residents thought that infrastructures and equipments(43.4%),drug varieties and quality(23.5%),and reimbursement proportion and range(23.0%)should be improved.Conclusion The hospital referral rate and contract signing rate are low and the satisfaction rate is high in Nanchang visiting residents.Therefore,institutional construction should be strengthened to implement the community first diagnosis system,twoway hospital referral system and team signing and to enhance the service awareness.