中部地区县乡医生与居民常见病就诊机构选择差异分析

Selection differences in medical institution for common diseases among county doctors,township doctors and residents in Central China

目的调查中部地区县乡医生及居民对常见病就诊机构选择的认知差异,探讨患者分流、疾病分诊的现状与难点。方法采用典型整群抽样调查了华中地区安徽定远、河南息县、河南淮滨3个县区的7家县级医院和20家乡镇卫生院的医生;整群抽取了定远、息县居民开展调查。调查县乡医生及居民的基本信息以及其对多种常见病就诊机构的认知,有效问卷共1099份,对比分析彼此差异及与指南的偏差。结果县级医生对急性阑尾炎、劳累性心绞痛和肺源性心脏病的认知与指南推荐就诊机构不相符合且有偏高趋势;乡镇医生对于小儿肺炎的认知与指南推荐就诊机构不相符合且有偏低趋势;居民对正常分娩、腰椎间盘突出、急性阑尾炎的认知与指南推荐就诊机构不相符合且有偏高趋势。对于相同常见病,县级医生在慢性支气管炎(P=0.028)的认知符合度上低于乡镇医生,在正常分娩(P<0.001)和急性阑尾炎(P=0.453)的认知符合度上高于居民;而乡镇医生在正常分娩和腰椎间盘突出(P<0.001)的认知符合度上比居民高,在小儿肺炎(P<0.001)上低于居民。结论县乡医生和居民对常见病就诊机构认知与指南相比较都存在一定偏差,存在县级医生推荐偏高、乡镇医生主观截留患者的情况。居民各种疾病都普遍选择到县级医院就诊,存在就诊趋高情况。

Objective To investigate the cognitive difference in the selection of medical institution for common diseases among county doctors, township doctors and residents in Central China, and to explore the status quo and problems of medical triage. Methods A typical cluster sampling survey was carried out to investigate the doctors of 7 county hospitals and 20 township health centers of Dingyuan County in Anhui Province, Xixian County and Huaibin County in Henan Province, respectively. And a cluster sampling survey was carried out among residents of Dingyuan County and Xixian County. The surveys investigated the basic information and the cognition of medical institutions for common diseases of county doctors, township doctors and residents. A total of 1099 copies of valid questionnaires were collected. Then comparative analysis was used to find out the differences among them and the deviation from the guide. Results County doctors’ cognition of medical institutions for treating acute appendicitis, angina pectoris and pulmonary heart disease did not accord with the guide and tended to transfer the patients to a medical institution of superior level which actually was unnecessary. Township doctors’ cognition of medical institutions for treating pediatric pneumonia did not accord with the guide and had a tendency to transfer patients to a medical institution at lower level. Residents’ cognition of medical institutions for normal delivery, lumbar disc herniation and acute appendicitis did not accord with the guide and had a tendency to seek associated health service in a medical institution at a higher level which actually is necessary. As for the same common diseases, the cognitive compliance of county doctors in chronic bronchitis(P=0.028) was lower than that of the township doctors, and their cognitive compliance of normal delivery(P<0.001) and acute appendicitis(P=0.453) was higher than that of residents. The cognitive compliance of township doctors was higher in normal delivery and lumbar disc herniation(P<0.001) than that of residents, and lower in pediatric pneumonia(P<0.001) than that of residents. Conclusions Compared with the guide, there is a certain deviation among county doctors, township doctors and residents in the cognition of medical institutions for common diseases. There is a tendency for county doctors to transfer patients to a medical institution at a higher level which is not necessary and township doctors not to transfer patients when necessary. In addition, residents, no matter what the disease they have, are accustomed to seeking health services in county hospitals, with a tendency to see a doctor at a medical institution of higher level.