新医改环境下我国医患信息沟通状态调查

Doctor-patient information communication under new healthcare reform context in China:a cross-sectional survey

目的了解新医改环境下医患双方信息沟通的状态,分析影响因素,为改善当前医患信息沟通的效果提供对策性依据。方法 2016年3-5月,采取整群随机抽样方法,抽取全国范围内4 508名三甲医院的医患群体,应用基本情况表、信息表达需求表、政府媒体和行业协会评价表、医患信息沟通平台需求表,进行问卷调查和数据分析。结果 1 251名(45.9%)医方和786名(44.1%)患方非常希望进行医患信息沟通;医患在信息沟通的表达场合和方式的选择上差异均有统计学意义(P <0.01);2 070名(75.9%)医方和1 271名(71.4%)患方认为政府反馈非常必要,1 336名(49.0%)医方和969名(53.9%)患方认为媒体参与非常必要,差异均有统计学意义(P <0.01),医患在媒体有利条件的影响范围、影响程度和宽松程度的评价方面差异均有统计学意义(P <0.05),媒体的透明度和独立性差异无统计学意义(P> 0.05);589名(21.6%)医方和320名(18.0%)患方认为医药协会很有代表性,395名(14.5%)医方和477名(26.7%)患方认为消费者协会很有代表性,差异均有统计学意义(P <0.01);影响医患信息沟通的组织机构分为人代会、政协和各党派、媒体、医院协会和研究机构(P <0.01);医患信息沟通平台的评价选项包括多方座谈、听证会、报刊讨论、学术研讨(P <0.01)。结论医患信息沟通的意识需要加强,政府、媒体、协会应发挥联动作用,构建多种方式并存的医患信息沟通综合平台。

Objective To examine the situation and influencing factors of information communication between doctors and patients under the new medical reform context and to provide evidences for developing strategies to improve doctorpatient information communication(DPIC). Methods We selected grade A tertiary hospitals in 22 cities across China as the study sites with random cluster sampling. Then we randomly recruited 2 727 doctors and nurses of various departments(D group) and 1 781 outpatient patients and their relatives(P group) at the selected hospitals for a questionnaire survey on general situation, expression and platform demands, and role of governmental agencies and relevant associations for DPIC between March and May 2016. Results The proportion of the participants being very much to conduct DPIC was 45.9%(n = 1 251) in D group and 44.1%(n = 786) in P group, with a significant difference(P < 0.001). There were significant differences in the selection of occasion and DIPC between D group and P group(both P < 0.01). The proportions of the participants considering that feedback from government agencies is necessary for DPIC were 75.9%(n = 2 070) in D group and 71.4%(n = 1 271) in P group;while the proportions of the participants regarding media involvement in DPIC as necessary were 49.0%(n = 1 336) in D group and 53.9%(n = 969) in P group, with significant differences(both P < 0.01).There were significant differences in evaluations on the range, degree, and flexibility of positive influences of medias on DPIC between D group and P group(P < 0.05 for all);but there were no significant differences in cognition on medias′transparency and independence between the two groups(both P > 0.05). More participants(21.6%, n = 589) in D group reported the approval of representative role of medical associations in DPIC than those(18.0%, n = 320) in P group;but more participants(26.7%, n = 477) in P group than those(14.5%, n = 395) in D group reported the approval of representative role of consumers ′ associations, with significant differences(both P < 0.01). The organizations having impact on the implementation of DPIC included People’s Congress, the Chinese People’s Political Consultative Conference, political parties and groups, public media, hospital associations, and research institutions. The platforms for DPIC listed by the participants included multilateral discussion, public hearings, news papers and journals, and academic seminars. Conclusion Doctorpatient information communication should be further improved under the collaboration of governmental agencies, medias,and professional associations and various platforms for doctor-patient information communication need to be established in China.