山东省基层医务工作者对首诊制的认可度及影响因素分析

Recognition of primary healthcare workers on gatekeeping and influencing factors in Shandong

目的了解基层医务工作者对首诊制的认可情况,并探讨其影响因素。方法 2016年6-9月采用分层整群抽样方法,分别选取山东省青岛市、淄博市、菏泽市的基层医务工作者879例作为调查样本,采用多因素logistic回归分析分析其对基层首诊制认可的影响因素。结果 59.50%的基层医务工作者认为有必要实施基层首诊制,认为可以提高基层首诊就诊率,有利于慢性病管理(48.46%),认为可以引导优质医疗资源下沉,提高基层医疗资源使用率(36.52%),可以减少患者的诊疗费用(35.15%)。缺乏医疗设备(48.24%)、缺少全科医生(36.86%)、居民对基层医务工作者的信任度不高(36.41%)是实施基层首诊的主要阻力。年龄、工龄、文化水平、平均月收入、医疗设备、药品配备、基层医疗卫生机构就医的报销比例、业务培训、基层医疗卫生机构的业务能力在基层首诊制的认可度方面存在不同,差异有统计学意义(均P<0.05)。结论基层医务工作者对首诊制的认可较高,这表明从基层医务工作者的角度来看,我国实施基层首诊制具有一定的可行性。

Objective To investigate the recognition of primary healthcare workers(PHWs) on the gatekeeping and its influencing factors. Methods From June to September 2016, eight hundred and seventy-nine PHWs were surveyed with stratified cluster sampling method in Qingdao, Zibo and Heze, Shandong province. The multivariate logistic regression analysis was used to analyze the factors that influenced primary healthcare workers on gatekeeping. Results About 59.50% of primary healthcare workers approved of the implementation of gatekeeping. They believed that it played a positive role in guiding residents to seek medical treatment at the grassroots level, improved the consultation rate at the primary level and conducive to chronic disease management(48.46%), believed that medical resources could be optimized and rationally utilized(36.52%), reduced the cost of diagnosis and treatment of patients(35.15%). Lack of medical equipment(48.24%), shortage of general practitioners(36.86%), relatively low residents’ trust in grassroots medical and health institutions(36.41%) were main obstacles to the implementation of the gatekeeping. The result shows that the differences exist in length of employment and average monthly earnings of PHWs, the proportion of reimbursement for medical treatment in primary medical and health institutions, professional training, the professional competence of the primary medical and health. And the difference of recognition of gatekeeping by PHWs was statistically significant(all P<0.05). Conclusion The PHWs have a higher recognition of gatekeeping. This suggests that from the point of view of PHWs it is feasible to implement the gatekeeping.