分级诊疗制度下急慢性伤口患者就诊医院选择及其影响因素分析

Medical-seeking behaviors and its influencing factors of patients with acute and chronic wounds under the hierarchical diagnosis and treatment system

目的分析急慢性伤口患者就诊医院选择及影响因素,为伤口分级诊疗提供参考。方法 2020-06-07在四川大学华西医院(以下简称"三级医院")及其3个联盟社区医院(以下简称"社区医院")就诊的伤口患者进行问卷调查,采用SPSS 23.0软件分析其就诊医院选择及影响因素。结果有效调查420例,其中三级医院就诊患者为211例(50.3%),社区医院就诊患者为209例(49.7%)。三级医院中,术后常规换药伤口占比最高,为80.1%,其次是术后感染伤口,占比为8.1%;社区医院中,术后常规换药伤口最高,占比为47.4%,其次是急性创伤伤口,占比为28.2%。三级医院就诊患者伤口持续时间>1月占23.2%,基层医院就诊患者伤口持续时间>1月占10.5%。退休、术后常规换药伤口、居住地在农村、公费医疗、伤口持续时间>1月的患者更倾向于选择三级医院就诊(P<0.05),而急性创伤伤口患者更倾向于选择社区医院就诊(P<0.05)。患者选择三级医院就诊的前3原因为:技术水平高、服务态度好、产品齐全。选择基层医院就诊的前三原因为:就近方便、服务态度好、挂号方便。结论结合伤口患者就医选择及影响因素,提出伤口分级诊疗策略,有助于更好地落实伤口就诊分级诊疗。

Objective To analyze the medical-seeking behaviors and influencing factors of patients with acute and chronic wounds to provide references for wound hierarchical diagnosis and treatment.Methods From June to July 2020, wounded patients treated in West China Hospital of Sichuan University(hereinafter referred to as the “tertiary hospital”) and its three alliance community hospitals(hereinafter referred to as “community hospitals”) were selected for questionnaire survey.SPSS 23.0 was used to analyze the characteristics of medical behaviors and influencing factors,and P<0.05 indicated that the difference was statistically significant. Results Totally, 420 cases were effectively investigated, including 211 patients(accounting for 50.3%) from tertiary hospitals, and209 patients(accounting for 49.7%) from community hospitals. In tertiary hospitals, the most common type of wound was conventional dressing change wound after surgery, accounting for80.1%;then followed by infections after surgery,accounting for 8.1%. In community hospitals,the most common type of wound was also wound with conventional dressing change after surgery,accounted for 47.4%;then followed by acute traumatic wounds,accounted for 28.2%. The duration of wound in patients over 1 month accounted for 23.2% and 10.5% in tertiary hospitals and primary hospitals, respectively. Patients who were retired, underwent conventional dressing change after surgery,lived in rural areas,free medical service,and wound duration >1 month were more inclined to choose tertiary hospitals(P<0.05), while acute trauma wound patients were more inclined to choose community hospitals(P<0.05). The top three reasons for choosing a tertiary hospital for treatment are as follows: high technical level, good service attitude, and complete products. The top three reasons for choosing a primary hospital for treatment are as follows:convenient proximity, good service attitude, and convenient registration. Conclusions Based on the medical treatment behaviors and influencing factors of patients with acute or chronic wounds, we can provide strategies,which is helpful to the implementation of the wound classification diagnosis and treatment.