崇州市医联体模式下分级诊疗现状调查及对策

Current Situation Investigation and Countermeasures of Hierarchical Medical System Under Medical Treatment Alliance Mode in Chongzhou City

目的了解崇州市医联体模式下分级诊疗推行现状,探讨医联体模式下深入推动分级诊疗的对策。方法调查崇州市各级医院319名医务人员对分级诊疗的认可率、关注率、满意度、基层首诊认同率,分级诊疗参与方式及对分级诊疗的影响因素认识等,为分级诊疗对策制定,提供决策参考。结果医务人员认可率高于90%,关注率为62.7%;对双向转诊的满意度仅为52.1%,社区首诊认可率50.3%;获得分级诊疗知识途径,75.2%通过培训,49.2%通过宣传资料,不足30%通过新闻、网络等;不同科室对转诊模式的满意度有影响,差异有统计学意义(P<0.05);满意度的非条件logsitic回归模型结果显示:一级医院满意度较三级医院/二级医院更高,为1.540(1.073~2.209)倍;妇科满意度较内科更高,为5.577(2.034~15.296)倍。结论需要改进分级诊疗体系,加强分层诊疗模式的宣传,提高医务人员对分层诊疗模式的认知和支持,强化各级医疗机构之间的协作。

Objective Toinvestigate the current implementation status of hierarchical medical system under medical treatment alliance mode in Chongzhou and to discuss countermeasures to further promote hierarchical medical system under medical treatment alliance mode. Methods 319 medical staffs in hospitals at all levels in Chongzhou were investigated for approval,concern and satisfaction of hierarchical medical system, identification rate of basic initial diagnosis, participatory approach of hierarchical diagnosis and treatment and cognition for influence factors of hierarchical diagnosis and treatment, so as to provide references for enacting. Results The recognition rate of medical staffs was higher than 90% , the concern rate was 62. 7% , satisfaetion rate for dual referral was 52. 1% and identification rate for community initial diagnosis was 50. 3%. 75.2% of the inform- ants acquired knowledge of hierarchical diagnosis and treatment through training courses,49. 2% through publicity materials and less than 30% through news or network. Satisfaction rates for referral patterns differed between different departments, the difference being statistically significant （P 〈 0. 05 ）. Non-conditional Logistic regression analysis of satisfaction showed that satisfaction rate of first-class hospital was higher than tertiary and second-class hospital,the former being 1. 540（ 1. 073 to 2. 209） times of the latter, and satisfaction rate of gynecology department was higher than internal medicine department, the former being 5. 577 （ 2. 034 to 15. 296 ） times of the latter. Conclusion It is necessary to improve the hierarchical medical system, strengthen publicity of hierarchical medical mode, promote cognition and support of the medical staffs for hierarchical medical mode, and enhance collaboration among medical institutions at all levels.