徐州市城乡居民对分级诊疗制度的评价及影响因素研究

Studying on The Evaluation of Hierarchical Diagnosis and Treatment System from Urban and Rural Residents in Xuzhou City and Its Influencing Factors

目的:调查徐州市城乡居民对分级诊疗制度的评价及差异,分析其影响因素,为促进制度实施提供建议。方法:按经济水平分层随机抽取徐州市6个社区和8个村庄的1550名居民进行问卷调查,采用χ^2检验、多因素Logistic回归分析等进行统计对比和因素分析。结果:徐州市城市居民制度认可率(65.9%)低于农村居民(75.8%),基层首诊赞成率(51.4%)高于农村(42.3%),65.1%的城市居民和68.8%的农村居民认为增强基层服务是促进分级诊疗的首要措施;影响城乡居民制度评价的相同因素有基层服务能力医保制度,不同因素的有经济因素、健康状况和健康体检。结论:城乡对制度评价的影响因素存在差异,应根据城乡现实差异和居民实际需求,从基层建设、医保改革、农村援助、健康管理等方面,提高城乡居民对制度的认可,提升分级诊疗制度实施效果。

Objective To investigate the evaluation and difference between urban and rural residents of Xuzhou on hierarchical diagnosis and treatment system, analyze its influencing factors, and provide suggestions for promoting the system implementation. Methods 1,550 residents were randomly sampled from 6 communities and 8 villages of Xuzhou City stratified by economic level and surveyed with questionnaires. Data was analyzed with chi-square tests, and multi-factor logistic regression. Results The recognition rate of urban residents(65.9%) was lower than that of rural residents(75.8%), and the approval rate of first visit at grassroots level(51.4%) was higher than that of rural residents(42.3%). 65.1% of urban residents and 68.8% of rural residents thought that the primary measure to promote hierarchical diagnosis and treatment was to improve the grassroots services. The same factors to influence the evaluation in urban and rural residents were grassroots service ability and medical insurance system, and the different factors to influence the evaluation between urban and rural residents were economic factors, health status and physical examination. Conclusion There had differently influencing factors of system evaluation between urban and rural areas. It is suggested to improve the recognition of system of urban and rural residents from aspects of grassroots construction, medical insurance reform, rural assistance and health management, according to the actual differences between urban and rural areas and their actual needs, which can improve the implementation effect of hierarchical diagnosis and treatment system.