天津市慢性阻塞性肺疾病分级诊疗实施现状及负面影响因素质性研究

Qualitative Research on the Implementation and the Adverse Influencing Factors of Hierarchical Medical System of COPD in Tianjin City

目的:厘清天津市慢性阻塞性肺疾病分级诊疗的实施现状和负面影响因素,为该制度的完善提供科学依据。方法:对天津市慢性阻塞性肺疾病分级诊疗试点机构的医护人员及其辖区内患者进行半结构式深度访谈,采用现象学Colaizzi七步法对资料进行整理和分析。结果:目前分级诊疗的服务内容丰富但双向转诊不畅,实践效果欠佳。导致分级诊疗运行不畅的影响因素包括:患者的认知水平较低;基层医院专科服务能力不足;医联体结构不合理,优质医疗资源有限;分级诊疗相关制度不健全。结论:天津市慢性阻塞性肺疾病分级诊疗在实施过程中存在诸多困难,管理者可从宣传力度、基础设施建设和人才培养、专科医联体建设和政策体系等角度探讨解决对策,促进分级诊疗秩序的建立,提高此类疾病的综合管理水平。

Objective:To investigate the implementation of the hierarchical medical system of COPD,and the adverse influencing factors influencing it,so as to provide a scientific reference for improving the system.Methods:Semi-structured in-depth interviews were conducted with the medical staff and patients of the pilot medical institutions within the hierarchical medical system of COPD in Tianjin.The data were collated and analyzed with Colaizzi's method of phenomenology.Results:Although the hierarchical medical services were plentiful,the Two-way Referral didn't function well and its effect was limited.The adverse factors included insufficient understanding of COPD among the patients,low capability of specialized healthcare of grassroots medical institutions,unreasonable structure and limited healthcare resources of medical consortium and organizational flaws of hierarchical medical system.Conclusion:There existed many difficulties in the operation of COPD of hierarchical medical system in Tianjin city.The administrators can explore solutions from the aspects of propagation,infrastructure construction and personnel training,medical consortium development and policy system,so as to improve the hierarchical medical system of COPD and better the comprehensive management of this disease.