医疗改革对月坛地区居民常见症状首诊意向影响调查研究

Effect of Healthcare Reform on the Preferred Health Facility for Initial Consultation for Common Medical Symptoms among Residents in Beijing's Yuetan Area

目的调查医疗改革对月坛地区居民常见症状首诊意向的影响,观察医疗改革效果,为分级诊疗、基层首诊提供科学依据。方法 2017年1—4月随机抽取829名月坛地区满15岁的常住居民作为调查对象,采用自行设计的问卷进行调查,调查居民医疗改革前(2017-04-08前)、医疗改革1(增设医事服务费,取消挂号费,检查费有降有升)、医疗改革2(增加社区卫生服务机构药品种类)出现感冒、发热、头晕、头痛、心悸、胸闷胸痛、喘憋、腹痛、腹泻、反酸、呕吐、便秘、乏力、腰痛关节痛、下肢水肿、失眠、尿频等17项症状时首诊选择社区卫生服务中心的比例。结果共发放调查问卷829份,回收有效问卷809份,有效回收率为97.6%。医疗改革1和医疗改革2居民出现感冒、发热、头晕、头痛、心悸、胸闷胸痛、喘憋、腹痛、腹泻、反酸、呕吐、便秘、乏力、腰痛关节痛、下肢水肿、失眠、尿频症状时首诊社区卫生服务中心比例高于医疗改革前,医疗改革2居民出现心悸、胸闷胸痛、乏力、腰痛关节痛、下肢水肿症状时首诊社区卫生服务中心比例高于医疗改革1,医疗改革2居民出现喘憋症状时首诊社区卫生服务中心比例低于医疗改革1(P<0.01)。结论医疗改革促进月坛地区居民在出现常见症状时更倾向到社区卫生服务机构首诊。

Objective To investigate the effect of China's healthcare reform on the preferred health facility for initial consultation for common medical symptoms among residents in Beijing's Yuetan area,providing a scientific basis for the development of hierarchical medical system and initial consultation system in primary care.Methods From January to April 2017,we conducted a survey in a random sample of 829 permanent residents aged 15 or over in Yuetan area with a self-designed questionnaire for collecting the data about the community health center as the preferred health facility for initial consultation for 17 common medical symptoms(cold,fever,dizziness,headache,palpitation,chest tightness and pain,suffocation and wheezing,abdominal pain,diarrhea,acid reflux,vomiting,constipation,fatigue,low back pain and arthralgia,edema of lower extremity,insomnia,frequent urination)before the implementation of healthcare reform(April 8,2017)and after the implementation of the first round of healthcare reform(increasing the financing for medical service fee,cancellation of the registration fee,adjusting the examination fee)as well as the second round of healthcare reform(increasing the categories of drugs used in community health organizations).Results 809 returned responsive questionnaires,achieving a response rate of 97.6%.Compared with before the healthcare reform,after the implementation of two rounds of healthcare reform,the proportion of residents preferred community health centers(CHCs)for initial consultation for the aforementioned 17 medical symptoms increased significantly(P<0.01).Moreover,compared with after the implementation of the first round of healthcare reform,CHCs were selected for initial consultation by higher proportion of residents for palpitation,chest tightness and pain,fatigue,low back pain and arthralgia and edema of lower extremity,but by lower proportion of residents for suffocation and wheezing after the implementation of the second round of healthcare reform(P<0.01).Conclusion After the implementation of the two rounds of healthcare reform,Yuetan residents were more likely to have the initial consultation in CHCs when they developed the common medical symptoms.