上海市患者分级诊疗认知调查

Investigation on Recognition of Hierarchical Diagnosis and Treatment among Patients in Shanghai

目的调查上海市患者对分级诊疗的认知认可情况,分析分级诊疗实施面临的问题,并提出相应的对策。方法通过多阶段分层随机概率抽样结合偶遇抽样等非概率抽样,对上海市24家不同级别医疗机构的480名患者进行问卷调查。结果患者对分级诊疗了解度偏低,明确愿意在基层首诊的患者仅有32.31%,“小病大医”情节严重;患者对分级诊疗实施情况满意度较差(12.99%),突出体现在对基层医疗机构不信任。结论要进一步加大分级诊疗宣传力度,尤其是卫生工作者的宣传作用;提高基层医疗水平,增强居民基层就医信心;建立健全激励约束机制,调动医院落实分级诊疗积极性;改革医保报销制度,充分发挥医保调控作用。

Objective To investigate the cognition and recognition of hierarchical diagnosis and treatment among patients in Shanghai,analyze the problems in the implementation of graded diagnosis and treatment system,and propose corresponding countermeasures.Methods Through multi-stage stratified random probability sampling combined with accidental sampling,480 patients from 24 different levels of medical institutions in Shanghai were investigated through questionnaires.Results The patients had a low understanding of hierarchical diagnosis and treatment,and the proportion of people who were clearly willing to be first diagnosed at the grassroots level was only 32.31%,and the situation of“minor diseases and major diagnosis”was serious.The satisfaction with the implementation of graded diagnosis and treatment was poor(12.99%),which was highlighted in the distrust of grassroots medical institutions.Conclusion It is necessary to further strengthen the publicity of hierarchical diagnosis and treatment,especially to highlight the publicity role of health workers.It is important to improve the level of grassroots medical treatment,and improve the confidence of residents in seeking medical treatment at the grassroots level.The incentive and restraint mechanism should be established and improved to mobilize the enthusiasm of hospitals to implement hierarchical diagnosis and treatment.The medical insurance reimbursement system should be reinforced to give full play to the regulatory role of medical insurance.