专科医生对家庭医生制度的认知与转诊行为调查

Perception of Family Doctor System and Referral Behaviors among Specialists

目的了解专科医生对于家庭医生制度的认知情况及接诊行为,分析家庭医生制度下分级诊疗平台和协同转诊机制建设的成效与问题。方法选取上海市某区作为典型样本地区,以该区某二级甲等医院全部专科医生为调查对象,共计500例。于2016年7—8月,采用自行设计的《社区家庭医生和分级诊疗制度评估——专科医生调查问卷》进行调查。问卷的主要内容有:专科医生的基本情况、对家庭医生制度的认知、转诊意愿及行为等。共发放问卷500份,回收有效问卷386份,问卷的有效回收率为77.2%。结果 41.9%(161/384)的专科医生很了解/基本了解家庭医生制度和家庭医生职能,认为其利于开展个性化、连续性、综合性服务和防治一体化者分别占48.4%(78/161)和40.4%(65/161);77.7%(150/193)的专科医生认为家庭医生转诊很有/较有必要,96.4%(186/193)的专科医生也非常乐意/比较/一般乐意接收基层转诊患者;接收过通过签约家庭医生转诊患者的专科医生为44.1%(86/195),66.2%(127/192)的专科医生对待转诊患者与普通患者一致;64.6%(248/384)和63.0%(243/386)的专科医生不清楚所在医院是否有专门转诊部门和信息化平台。结论目前专科医生对家庭医生制度和家庭医生职能的认知仍较局限。愿意接收转诊患者的专科医生比例较高。全科-专科的转诊平台已初步搭建,但转诊机制功能尚未完全发挥。应提高专科医生对家庭医生制度的认知水平,完善"全科-专科"协同转诊机制。

Objective To investigate the perception of family doctor system and referral behaviors in specialists,and based on this,to analyze the effectiveness and challenges during the implementation of network-based platform of hierarchical diagnosis and treatment and collaborative referral mechanism concurring with the family doctor system construction.Methods We enrolled all the clinical specialists(n=500)of a secondary grade A hospital located in a district of Shanghai selected representatively and surveyed them between July and August 2016 with a self-developed questionnaire of Specialist Assessment of the Implementation of Community Family Doctor System and Hierarchical Medical System consisting of demographic characteristics,perception of family doctor system,attitude toward the referrals from family doctors,and referral behaviors.The survey achieved a response rate of 77.2%(386/500).Results 41.9%of the respondents(161/384)had a fair/good understanding of family doctor system and the responsibilities of family doctors,78 of whom(48.4%)thought the implementation of the system was conducive to the delivery of personalized,continued and comprehensive services,and 65(40.4%)thought the implementation of the system was beneficial to both the prevention and treatment of diseases.77.7%(150/193)of the respondents considered referrals made by family doctors were very/relatively necessary;96.4%(186/193)were quite/relative/fair willing to receive patients transferred from the primary care settings;44.1%(86/195)had received patients transferred by the contracted family doctor;66.2%(127/192)treated transferred and non-transferred patients the same;64.6%(248/384)and 63.0%(243/386)did not know whether the hospital that they worked had a referral department,network-based referral platform,respectively.Conclusion The clinical specialists demonstrate a limited perception of the family doctor system and the responsibilities of family doctors,but most of them are willing to receive the transferred patients;The construction of the network-based general-special referral platform is still in the initial stage,and the referral mechanism has not fully played its due role.In view of this,specialists'level of perception of family doctor system should be improved and the general-special collaborative referral mechanism should be perfected.