基于计划行为理论的主观转诊意见对三级医院医生转诊意向的影响分析

Analysis of the influence of subjective referral opinions based on the theory of planned behavior on doctors′ referral intentions in tertiary hospitals

目的分析医院领导、科室主任、同事、患者及家属的转诊意见对医生转诊意向的影响。方法利用计划行为理论建立理论分析框架和调查问卷。于2018年10月10日~17日,对5个医联体内的三级医院的251名医生进行横断面调查,采用χ2检验分析数据。结果调查发现分别有76.8%(192名)被调查医生已计划接收急危重症、疑难杂症的患者转诊,72.0%(180名)计划接收常见病多发病患者转诊,78.4%(196名)被调查医生计划将治疗后病情稳定患者下转。针对不同疾病,除患者以外,在医院领导、科室主任、科室同事的不同转诊意见下,医生的转诊意向差异均有统计学意义(P < 0.05)。特别是在科室主任的意见上,不同的转诊意见及顺从情况下,医生的转诊意向差异有统计学意义(P < 0.01)。结论科室主任、医院领导的转诊意见对医生转诊意向影响较大,患者的转诊意见对医生的转诊意向无影响。

Objective To analyze the influence of referral opinions of hospital leaders, department directors, colleagues, patients and family members on doctors′ referral intentions Methods Using the theory of planned behavior to establish the theoretical analysis framework and questionnaire. From October 10 to 17, 2018, a cross-sectional survey was conducted among 251 doctors in grade tertiary hospitals in five medical combinations, and data were analyzed by chi-square test. Results The survey found that 76.8%(192) of the surveyed doctors had planned to receive referrals for patients with acute, severe and complicated diseases, 72.0%(180) planned to receive referrals for patients with common and frequently-occurring diseases, and 78.4%(196) planned to transfer patients with stable conditions after treatment. For different diseases, with the exception of patients, under the different opinions of hospital leaders, department directors and department colleagues, the difference of doctors′ referral intention was statistically significant (P < 0.05). Especially in the opinion of the department director, there were statistically significant differences in doctors′ referral intentions in the case of different referral opinions and compliance (P < 0.01). Conclusion The opinion of department director and hospital leader has great influence on doctors′ intention of referral, while the opinion of patients has no influence on doctors′ intention of referral.