重庆市慢病患者分级诊疗认知和就医意向现状调查研究

Survey on status quo of cognition of hierarchical diagnosis and treatment and intention of seeking doctor among patients with chronic disease in Chongqing City

目的探讨重庆市慢病患者对于分级诊疗的认知、态度和就医意向。方法采用多阶段分层随机抽样的方法抽取重庆市9所公立医院及9个区县基层医疗卫生机构的1 125例慢病患者进行调查,分析患者就医意向的差异及对分级诊疗认知情况。结果基层医疗卫生机构慢病患者比公立医院慢病患者更易选择在基层医疗卫生机构就诊,差异有统计学意义(χ2=190.051,P<0.01)。1 125例慢病患者中有31.2%从未接触过分级诊疗。基层医疗卫生机构患者和公立医院患者在基层医疗机构的医疗技术能力满足治疗需求、医疗条件和服务水平的逐步改善和提高、倾向基层医疗机构看病方面差异均有统计学意义(P<0.01)。基层医疗卫生机构患者和公立医院患者在了解目前医疗机构间的转诊制度情况、向下转诊有利于使疾病得到连续长期的治疗方面差异有统计学意义(P<0.01)。结论为更好地实施分级诊疗,需完善分级诊疗配套政策,引导慢病患者基层首诊,同时在医联体内建立高效双向转诊机制,扩大分级诊疗政策宣传。

Objective To explore the cognition,attitude and intention of seeking doctor on hierarchical diagnosis and treatment among the patients suffering from chronic diseases in Chongqing City.Methods A multistage stratified sampling method was adopted to investigate 1 125 patients with chronic diseases extracted from 9 public hospitals as well as basic medical and health institutions in 9 districts and counties of Chongqing City.Meanwhile,the differences of intentions of seeking doctor and cognition situation of hierarchical diagnosis and treatment were analyzed.Results The patients with chronic diseases in basic medical and health institutions were more likely to choose the basic medical and health institutions for seeking doctor than the patients treated in public hospitals,the difference was statistically significant（χ2=190.051,P〈0.01）;31.2% of the patients with chronic diseases never contacted the hierarchical diagnosis and treatment.The technical capabilities of basic medical and health institutions meeting treatment needs,gradual improvement of medical condition and service level and trending to seeking doctor in basic medical and health institutions had statistical difference between the patients in public hospitals and patients in basic medical and health institutions（P〈0.01）.The aspects of understanding the current referral system between medical institutions and downward referral conducing the disease to obtain continuous long tern treatment had statistical difference between the patients in public hospitals and patients in basic medical and health institutions（P〈0.01）.Conclusion In order to better carry out hierarchical diagnosis and treatment in Chongqing City,it is necessary to perfect the supporting polices of hierarchical diagnosis and treatment for guiding the primary diagnosis in the patients with chronic disease,meanwhile establish an efficient dual referral mechanism and enlarge the propaganda of hierarchical diagnosis and treatment policy.