长三角地区高血压患者向下转诊意愿及其影响因素分析

Analysis of the willingness and influencing factors of downward referral among hypertension patients in the Yangtze River Delta region

目的:探讨长三角地区高血压患者的向下转诊意愿及影响因素,为促进双向转诊、提升医疗资源的利用效率提供证据。方法:2020年11—12月对江苏省和上海市的高血压患者进行调查,调查内容包括患者基本情况、既往病史、欧洲生命质量学会5维5水平健康量表(EuroQol-5-domains-5-levels health questionnaire,EQ-5D-5L)评分及向下转诊意愿等。采用Logistic回归进行影响因素分析。结果:703例患者中,68.3%愿意接受向下转诊。对医保报销满意(OR=4.03,P=0.004)、没有伴发其他类型的慢性病(OR=2.13,P<0.001)、经常在基层医疗机构就诊(OR=3.00,P<0.001)、EQ-5D-5L评分低(OR=1.64,P=0.007)的高血压患者具有较强的向下转诊意愿。结论:高血压患者的向下转诊意愿有待提高,建议强化患者的分级诊疗意识,提供以患者为中心的优质整合式医疗服务,通过以价值为导向的医保支付激励基层医疗服务的质量提升。

Objective:To investigate the willingness and influencing factors about downward referral among hypertension patients in the Yangtze River Delta region,thus providing evidence for promoting the two-way referral and improving the efficiency of medical resources utilization.Methods:A survey for hypertension patients was carried out in Jiangsu Province and Shanghai from November to December 2020.The questionnaire consisted of the demographic information of the patients,past medical history,EuroQol-5-domains-5-levels health questionnaire(EQ-5D-5L)index values,and willingness to downward referral.Logistic regression was used to analyze influencing factors.Results:Among the 703 patients,68.3%had the willingness to receive the downward referral.Hypertension patients who were satisfied with health insurance reimbursement(OR=4.03,P=0.004),did not have other types of chronic diseases(OR=2.13,P<0.001),often visited primary healthcare institutions(OR=3.00,P<0.001),and with low EQ-5D-5L index values(OR=1.64,P=0.007)had stronger preferences for the downward referral.Conclusion:The willingness to be referred downwards among hypertension patients still needs to be improved.Patients′awareness of hierarchical diagnosis and treatment should be strengthened.Patient-centered,high-quality integrated healthcare services should be provided.Value-oriented health insurance payment methods should be applied to further improve the quality of primary healthcare services.