分级诊疗认知影响因素研究

Study on acknowledge influencing factors about hierarchical diagnosis and treatment

目的通过调查部分患者对分级诊疗的认知现状,分析分级诊疗在实施过程中存在的问题及影响因素。方法对南京市某三级医院住院的564名患者进行问卷调查,运用SPSS 16.0软件对定量资料进行描述性分析、χ2检验及Logistic回归分析。结果 43.1%的调查对象知晓分级诊疗制度,分级诊疗知晓率与文化程度呈正相关,有"城镇职工基本医疗保险"的患者相对于有"城镇居民基本医疗保险"和"无医疗保险及其他"患者的分级诊疗知晓程度更高。31.6%的调查对象首诊选择基层医院。职业状况、学历、医保类型的不同,首诊选择类型差异有统计学意义(P<0.05)。初中及以下学历的被调查对象相比于大专或本科学历的被调查对象更愿意首诊选择社区医疗机构。患者接受转上的比例(78.5%)高于接受转下的比例(59.2%),普遍存在转上容易转下难;不知道分级诊疗制度的被调查对象更不愿意转下。结论建议继续引导提高居民对分级诊疗知晓度和社区医疗机构的信任度,提高社区首诊率,加大双向转诊"下转"驱动力,形成良好就医秩序,促进分级诊疗政策的施行。

Objective To analyze the problems and influencing factors on implementing the process of hierarchical diagnosis and treatment through the investigation on some patients＇ acknowledge of hierarchical diagnosis and treatment. Methods The questionnaires survey was conducted among 564 inpatients in a third-level class hospital in Nanjing. Descriptive analysis,χ~2 test and logistic regression analysis were used to analyze the quantitative data by using SPSS 16 software. Results 43. 1% of the respondents knew the classification treatment system and the grading treatment awareness rate was positively related to educational level. The patients with basic medical insurance for urban employees had higher awareness of classified medical treatment than those with basic medical insurance for urban residents and without medical insurance or other. 31. 6%of the respondents chose primary hospitals at first diagnosis. There were differences in choosing hospitals at first diagnosis which varies with different occupations,education backgrounds,different types of health care（ P〈0. 05）. The respondents with junior high school degree and below tended to choose community medical institutions at first diagnosis compared with those with college degree or undergraduate. The proportion of patients（ 78. 5%） who accepted to transfer to the advanced medical institutions was more than the proportion of those who accepted transfer to lower medical institutions（ 59. 2%）. Generally,upward transfer treatment were easier than that of downward. Furthermore,respondents whom have no idea of the diagnosis and classification system were reluctant to transfer treatment downward. Conclusion It is recommended to continue to guide residents to improve awareness of hierarchical diagnosis and treatment,enhance the confidence of the community medical institutions,improve the first diagnosis rate in community,increase＂transfer down＂ force in two-way referral,form a good medical order and promote the implementation of classified diagnosis and treatment policy.