上海市杨浦区双向转诊的实施现状与思考

Current situation and thinking of the two-way referral in Yangpu District of Shanghai

目的:了解目前杨浦区的居民双向转诊现况,为杨浦区家庭医生如何更好开展区域性双向转诊提供对策。方法:分别采用抽签法和系统随机抽样的方法选取杨浦区5家社区卫生服务中心的99名家庭医生和211位签约患者,采用统一设计的问卷进行调查。结果:签约患者对双向转诊知晓率较高,且具有详细了解双向转诊政策的意愿,多数被调查者身体不适会首选社区卫生服务中心或家庭医生工作站,超过六成的被调查者支持双向转诊,半数以上的被调查者主动提出回到社区卫生服务中心接受护理或后续治疗。限制双向转诊的主要因素为接受渠道不够通畅、缺少良好转诊反馈、缺乏具体统一的转诊标准等。结论:杨浦区患者对双向转诊支持率和依从率都较高,但在目前的具体实施中尚存在许多瓶颈,制定考核指标体系,体现转诊通道的优越性,建立统一的资源共享平台有助于渠道通畅、手续简便、反馈性好的双向转诊模式早日形成。

Objective： To investigate the current situation of two-way referral of the residents in Yangpu District to provide the countermeasures for how to carry out the regional two-way referral in Yangpu District better for the family doctors. Methods： A total of 99 family doctors and 211 patients who signed the contracts in the five community health service centers in Yangpu District were selected by means of lottery method and systematic random sampling method. The questionnaire was used to carry out the survey. Results： The contracted patients had a higher awareness rate of the two-way referral and had a willingness to learn more about the two-way referral policy. Most respondents who were ill firstly chose the community health service center or the family doctor working station. More than 60% supported the two-way referral, and more than half of the respondents would take the initiative to return to the community health service center to receive nursing or follow-up treatment. The main factors that limited the two-way referral were channels that were not smooth enough to accept, lack of good referral feedback and lack of specific unified referral criteria. Conclusion： The support rate and compliance of the two-way referral of the patients in Yangpu District of Shanghai are higher, but there are many bottlenecks in the implementation. Formulating a specific assessment index system, reflecting the superiority of referral channels and establishing the unified resource sharing platform are conducive to theearly formation of the two-way referral mode with channels open, simple procedures and good feedback as soon as possible.