医联体内双向转诊下转意愿及其影响因素研究

Study on Down-Referral Willingness and Influencing Factors of Two-Way Referral in a Medical Treatment Partnership

目的调查深圳市某医联体内医患双方下转意愿及影响因素。方法自行设计问卷,采用整群抽取和简单随机抽样方法于2020年6—7月对深圳市某医联体医院147名医生和371名高血压患者进行问卷调查。调查内容包括基本信息、对双向转诊制度态度、下转意愿等。结果当病人病情稳定不需住院治疗时,83.67%的医生愿意将其下转,16.33%的医生不愿意或不确定,Logistic回归进行分析显示,对双向转诊制度越了解的医生更愿意下转病人,认为转诊制度有必要的医务人员下转意愿是其对立态度的8.992倍。82.70%的患者愿意下转,17.30%不愿意或不确定,Logistic回归结果显示,认为转诊制度有必要的患者下转意愿是其对立态度的4.155倍,医生的建议会影响患者的下转意愿。结论双向转诊制度实施中存在的问题主要为医患双方认同度不高,基层医疗机构服务水平低,缺乏医生对患者的引导和统一的转诊指南及机制。

Objective To understand the willingness and influencing factors of down-referral in two-way referral for patients in a medical treatment partnership in Shenzhen.Methods 147 doctors and 371 patients with hypertension were collected using cluster sampling and simple random sampling and investigated by self-designed questionnaire in a regional medical consortium in Shenzhen from June to July 2020.The self-designed questionnaire included basic information,attitude to two-way referral system,willingness to transfer,etc.Results When the patient did not require hospitalization,83.67%of the physicians were willing to transfer the patient and 16.33%were not or unsure.Logistic regression analysis showed that doctors who know more about the two-way referral system were more willing to transfer patients.The willingness to transfer was 8.992 times higher than the negative attitude.82.70%of the patients were willing to be transferred to community health service centers,17.30%were not or unsure.Logistic regression analysis showed that patients who thought the referral system was necessary had 4.155 times more wi-llingness to transfer than their opposition attitudes.Conclusion The main problem of two-way referral system implementation are mainly focused on the doctor and patient's low degree of recognition.the low health service level of grass-roots medical institutions,and lack of guidance from doctors and unified referral guidelines and mechanisms.