新医改背景下医患双方对合理医疗检查认知差异比较

Difference in cognition on rational medical examination between doctors and patients under new health care reform:a comparison study

目的了解医方与患方对医疗检查行为的认知差异,探讨差异产生的原因,为形成合理检查观提供参考。方法于2016年11—12月通过方便抽样的方式对广东省深圳市和广州市的8家大学附属三甲医院的门诊、急诊、住院部的医务人员和患者进行问卷调查,共调查医务人员523人、患者1 384例。结果在合理检查的内涵上,210名医务人员(40.2%)和412例患者(29.8%)选择多重评价标准,差异有统计学意义(P=0.000);105名医务人员(20.1%)和446例患者(32.2%)仅考虑患者需求,差异有统计学意义(P=0.000)。医患双方对合理检查意义的理解大体一致,都认为改善医患关系(医生59.1%、患者55.5%)是合理检查最大的意义。对费用的评价上,分别有25.8%(135/523)、39.18%(208/523)的医务人员和33.3%(461/1 384)、39.1%(541/1 384)的患者认为医疗检查的费用过高和偏高;340例患者(24.6%)表示承担这些医疗费用有些吃力,有59例患者(4.3%)表示很难承担医疗检查费用。针对合理医疗检查应考虑的因素调查中,294名医务人员(56.2%)和698例患者(50.4%)选择医疗安全,差异有统计学意义(P=0.024);183名医务人员(35.0%)和396例患者(7.3%)选择医院管理,差异有统计学意义(P=0.007)。医患双方均认为诊疗需要是检查上首先考虑的问题(医务人员62.5%、患者63.9%);在过度检查的原因上,分别有33.7%(176/523)的医务人员和30.1%(417/1 384)的患者认为不合理检查的首要原因是伦理性问题。结论医患双方需形成合理检查的正确认知,明确多维度的合理检查内涵与标准;建立一个由第三方监督的医疗检查定价机制,控制合理检查价格;加强医学伦理道德的建设,增强患者对医疗检查行为的信任。

Objective To examine differences in cognition on medical examination between doctors and patients and to explore causes of the differences for providing references to conduct rational medical examination. Methods We conducted a questionnaire survey among 523 doctors and 1 384 patients selected with convenience sampling at outpatient clinics, emergency and inpatient departments of 8 grade A tertiary hospitals affiliated to universities in Shenzheng and Guangzhou city, Guangdong province between November and December 2016. Results In terms of the connotation of the rational medical examination, 210 doctors （40.2%） and 412 patients （29.8%） selected multiple evaluation criteria, with a statistically significant difference （P 〈 0.001）; 105 doctors （20.1%） and 446 patients （32.2%） considered only the needs of patients, also with a statistically significant difference （P 〈 0.001）. The doctors and the patients had a similar understanding on the significance of rational medical examination and among both of them, more than a half （309[59.1%] doctors and 768 patients[55.5%]） considered that the most important significance for rational medical examination is for improving the relationship between doctors and patients. Among the doctors, 25.8% （135/523） and 39.18% （208/523） considered the cost of medical examination being too high or slightly high; while among the patients, 33.3% （461/1 384） and 39.1% （541/1 384） regarded the cost as too or slightly high. There were 340 patients （24.6%） reporting difficulties in paying their medical expenses and 59 patients （4.3%） stating that it was too difficult for them to cover the cost. As to factors that should be taken into consideration in promoting rational medical examination, significantly higher proportion of doctors （56.2%, 294） than that of patients （50.4%, 698） chose medical safety （P=0.024） and hospital management （35.0%[183] vs. 7.3%[396]） （P=0.007）. The majority of the doctors （62.5%） and patients （63.9%） expressed that diagnosis and treatment should be considered first in medical examination. About one third of the doctors （33.7%） and patients （30.1%） considered that the primary reason for irrational medical examination is related to ethical issues. Conclusion Correct cognition on rational medical examination should be established and the connotation and standard for multi-dimensional reasonable medical examination should be clarified among both doctors and patients. A pricing mechanism with third-party supervision is needed to control the cost of rational examination and education on medical ethics needs to be strengthened to enhance the patients＇ trust in medical examination.