武汉市基层医务人员对分级诊疗制度的认知研究

Research on the Cognition of Primary Healthcare Workers on Hierarchical Medical System in Wuhan

目的:本研究运用扎根理论分析武汉市基层医疗卫生机构服务人员对分级诊疗制度的认知情况及其影响因素,为该地区巩固和完善分级诊疗制度提供参考和借鉴。方法:本研究在目的抽样的基础上,对湖北省武汉市2个辖区内18家社区卫生服务中心和6家社区卫生服务站共65名医疗卫生服务人员进行半结构化访谈,通过开放性、关联性和选择性编码对分级诊疗制度的认知情况进行整合分析。结果:本研究经三级编码梳理出与分级诊疗制度认知相关的60个初始概念,28个范畴,9个主范畴和2个核心范畴,明确了分级诊疗制度认知的3项内容(制度内容、制度执行和制度效果)及5个影响因素(条件、能力、发展、政策和患者因素)。结论:基层医务人员对分级诊疗制度本身持肯定态度,但对制度的落实和效果持负向态度。条件、能力等五个核心因素可直接或间接地影响基层医疗卫生服务人员对分级诊疗制度的认知情况。

Objective:Based on Grounded Theory,the objective of this study is to analyze the cognition of primary healthcare workers on hierarchical medical system in Wuhan,and provide references for the improvement of hierarchical medical system.Methods:Premised on purposive sampling,65 healthcare workers from 16 Community Health Service Centers of two District and 6 Community Health Stations in Wuhan of Hubei Province were interviewed by using semi-structural interview syllabus.Thus,the cognition of hierarchical medical system was integrated via open coding,association coding and selective coding.Results:After three-grade coding,60 concepts,28 categories,9 main categories and 2 core categories of the cognition of primary healthcare workers on hierarchical medical system were summarized.And then,three contents and five influencing factors of cognition for primary healthcare workers on hierarchical medical system were formed,including the cognition of policy contents,policy implementation and policy effects,as well as conditional,ability,developmental,policy and patient factors.Conclusion:The positive attitudes of primary healthcare workers on hierarchical medical system itself were found,and they took the opposite attitude to policy implementation and effects.Five influencing factors could directly or indirectly affect the cognition and attitudes of primary healthcare workers on hierarchical medical system.