分级诊疗制度下南京市社区医疗机构儿科现状调查

Investigation on the Current Situation of Pediatrics in Community Medical Institutions in Nanjing under the Grading Diagnosis and Treatment System

目的了解南京市社区医疗机构儿科现状,从社区医疗机构角度分析儿科分级诊疗的影响因素,为完善该市儿科分级诊疗体系的策略与建议提供参考。方法采用多阶段随机抽样的方法,于2017年8—12月,选取南京市11个区的社区医疗机构的全科及儿科医生为调查对象,共发放调查问卷500份,回收456份,回收率91.2%。调查问卷采用EpiData 3.1软件录入,采用SPSS 18.0统计学软件进行统计学分析行数据分析,对于计数资料采用描述性统计分析,对于影响双向转诊的单因素分析采用χ2检验(检验水准α=0.05),对于影响双向转诊的多因素分析采用有序二分类Logistics回归分析。结果 (1)该次调查人口学特征,其中年龄段以36～45岁比例最高,占42.5%;学历以本科比例最高,占70.4%;职称以中级比例最高,占51.3%;专业情况全科医学比例最高,占37.9%;工作年限以6～10年者比例最高,占37.5%。(2)双向转诊影响因素在单因素分析的基础上进行二分类Logistics回归分析结果显示社区分类、职称、工作年限、儿科培训需求、信息共享、居民缺乏医疗常识、转诊标准和流程是双向转诊的影响因素。结论大力加强社区医疗机构儿科服务体系和人才队伍建设,在强化社区医疗机构服务能力的同时完善相互衔接的转诊服务机制和健康医疗网络信息共享建设,引导基层首诊,便于双向转诊,最终形成分级诊疗的就医新秩序。

Objective To understand the current situation of pediatrics in community medical institutions in Nanjing,and to analyze the influencing factors of pediatric grading diagnosis and treatment from the perspective of community medical institutions,and to provide reference for improving the strategies and recommendations of pediatric grading diagnosis and treatment system.Methods A multi-stage random sampling method was used.From August to December 2017,the general practitioners and pediatricians of community medical institutions in 11 districts of Nanjing were selected as survey subjects.A total of 500 questionnaires were distributed and 456 copies were collected.The recovery rate was 91.2%.The questionnaire was entered using EpiData 3.1 software,statistical analysis was performed using SPSS 18.0 statistical software,descriptive statistical analysis was used for counting data,andχ^2 test was used for single factor analysis affecting two-way referral(test levelα=0.05),an ordered two-category logistic regression analysis was used for multivariate analysis of two-way referrals.Results 1.The demographic characteristics of this survey,the age group with the highest proportion of 36 to 45 years old,accounting for 42.5%;the highest degree of undergraduate education,accounting for 70.4%;the highest proportion of professional titles,accounting for 51.3%;professional situation proportion of medicine was the highest,accounting for 37.9%;the proportion of working years was 6 to 10 years,accounting for 37.5%.2.Influencing factors of two-way referral Based on the single factor analysis,the results of two-category logistic regression analysis showed that community classification,job title,working years,pediatric training needs,information sharing,lack of medical common sense of residents,referral standards and procedures were two-way factors influencing referrals.Conclusion Vigorously strengthen the pediatric service system and talent team construction of community medical institutions,improve the service capacity of community medical institutions,improve the referral service mechanism and health care network information sharing construction,guide the first diagnosis at the grassroots level,facilitate two-way referral,and finally form a new order for medical treatment.