分级诊疗制度下慢性病患者门诊服务利用分析*——某三甲医院门诊慢性病患者调查

Outpatient service and utilization analysis of patients with chronic diseases under hierarchical diagnosis system——A survey of patients with chronic diseases in a third-grade class-A hospital

目的:基于典型调查,分析在分级诊疗制度下慢性病患者门诊服务的利用情况。方法:选取合肥市某三甲医院心血管内科、风湿免疫科、内分泌科和呼吸内科的门诊就诊患者为对象,利用自行设计的调查问卷进行面对面访谈或自行填写调查问卷收集资料,回收有效问卷806份,结果:(1)就该次就诊的健康问题,43.5%的患者来该三甲医院就诊是首诊,其中居住于本市患者首诊比例为49.3%,高于来自于省内其他城市和省内农村地区居民,差异有统计学意义(P<0.05);(2)就该次就诊的健康问题曾就诊过患者中,60.4%曾在省级医院就诊过,39.4%曾在市级医院就诊过,在县(区)级医院和基层医疗机构就诊过的比例分别为31.6%、18.9%。结论:慢病患者基层首诊比例不高,在分级诊疗制度下基层医疗机构的作用并没有得到发挥;改革公立医院人事制度,引导优质人力资源下沉,切实提高基层服务能力是推进分级诊疗制度得以落到实处的关键。

Objective To analyze the utilization of outpatient service among patients with chronic diseases under hierarchical diagnosis system based on a typical investigation.Methods A third-grade class-A hospital in Hefei city was selected with outpatients of its departments of cardiovascular medicine,rheumatism,endocrine and respiratory medicine as the research objects of this investigation.A self-designed questionnaire was used to conduct face-to-face interviews or for the subjects to fill out by themselves.There were 806 copies of valid questionnaire returned.Results（1） It was the first visit for 43.5% of the patients to consult a doctor in this third-grade class-A hospital,among whom49.3% were residents living in Hefei,which was more than those from other cities or from rural areas of Anhui province.The difference was statistically significant（P0.05）.（2）Among patients who had consulted a doctor before,60.4% had medical consultation in provincial hospitals,39.4% in municipal hospitals,31.6% in county（district）health centers and 18.9% in grassroots medical institution.Conclusions The primary diagnosis rate of patients with chronic diseases is not high in grassroots medical institutions,and the role of primary medical institutions in the hierarchical medical system is not given full play.The key to the promotion of the hierarchical diagnosis system covers reforming personnel system of public hospitals,guiding the use of high-quality human resources in grassroots medical institutions,and improving the service capacities in grassroots medical institutions.