广西某市医联体内患者对医疗服务的满意情况及对医联体相关政策的知晓情况

Patients′satisfaction with medical services in medical alliance and their awareness of policies related to medical alliance in a city of Guangxi

目的了解广西某市医联体内患者对医疗服务的满意情况及对医联体相关政策的知晓情况。方法采用方便抽样法,选取在广西L市医联体内就诊的199例患者(就诊于L市某三甲医院97例,就诊于S县人民医院102例)作为研究对象。采用自制问卷调查患者的基本情况,患者对医疗服务的满意情况,患者对医联体、基层首诊、分级诊疗相关政策的了解情况、态度和评价,以及住院患者对回基层医疗机构康复的意愿。结果(1)S县人民医院的患者中,59.8%(61/102)为外地居民。L市某三甲医院、S县人民医院患者的满意率分别为99.0%(96/97)、83.3%(85/102);L市某三甲医院患者最满意之处是医院服务态度好,其次为技术水平高,S县人民医院患者最满意之处是医院服务态度好。(2)L市某三甲医院、S县人民医院分别有60.8%(59/97)、44.1%(45/102)的患者不了解医联体,S县人民医院中了解医联体的患者比例相对高于L市某三甲医院(分别34.3%、8.2%)。L市某三甲医院、S县人民医院患者了解医联体政策的最主要途径分别是“听周围人诉说”(39.5%)、“医务人员告知”(45.6%)。(3)L市某三甲医院、S县人民医院中愿意接受基层首诊的患者比例分别为67.0%(65/97)、79.4%(81/102),主要原因为“离家较近”和“习惯使然”。L市某三甲医院中不愿意接受基层首诊的患者比例相对高于S县人民医院(分别为32.0%、20.6%),其中L市某三甲医院患者不愿意接受基层首诊的原因主要为基层医疗机构的医生能力不高和数量不足、药品品种数量不足。(4)L市某三甲医院、S县人民医院仅分别有24例、5例患者曾有过转诊经验,且多数患者是通过“医生口头建议”的方式进行转诊。多数患者对转诊服务较满意,造成少数患者不满意的原因主要是“不清楚转诊流程和标准”。(5)S县人民医院、L市某三甲医院分别有53.7%(22/41)、31.6%(12/38)住院患者愿意在病情稳定后转回基层医疗机构继续康复。不愿意接受回基层医疗机构康复的原因主要为患者不信任卫生院/社区中心的医疗技术水平。结论医联体对周边患者具有一定的吸引作用,医联体内患者对医疗服务的满意率整体较高,大部分患者均表示愿意接受基层首诊,但大部分患者对医联体不了解。今后需进一步规范医联体内双向转诊的流程,提升基层医疗机构的诊疗水平,加强对医联体的宣传,以进一步提高医联体内患者的满意度和对医联体政策的知晓率,推动分级诊疗模式的有效实施,促进资源的合理利用。

Objective To understand patients′satisfaction with medical services and their awareness of the policies related to the medical alliance in the medical alliance in a city of Guangxi.Methods A total of 199 patients visiting the medical alliance in City L of Guangxi were enrolled as research subjects by the convenience sampling method,including 97 cases visiting a 3A-grade hospital of City L and 102 cases visiting the people′s hospital of County S.A self-made questionnaire survey was conducted on patients′basic information,patients′satisfaction with medical services,patients′awareness,attitude and assessment on the policies related to medical alliance,first contact services provided by grassroots medical institutions,and tiered diagnosis and treatment,as well as hospitalized patients′desire to return to grassroots medical institutions for rehabilitation.Results(1)About 59.8%(61/102)of patients in the people′s hospital of County S were not local residents.Patients′satisfaction rate was 99.0%(96/97)in the 3A-grade hospital of City L and 83.3%(85/102)in the people′s hospital of County S;patients in the 3A-grade hospital of City L were satisfied most with the good service attitude of the hospital staff,followed by the high technical level,and patients in the people′s hospital of County S were satisfied most with the good service attitude of the hospital staff.(2)About 60.8%(59/97)of patients in the 3A-grade hospital of City L and 44.1%(45/102)of patients in the people′s hospital of County S were not familiar with medical alliance,the proportion of patients in the people′s hospital of County S who were familiar with medical alliance was relatively higher than that in the 3A-grade hospital of City L(34.3%and 8.2%,respectively).Patients′main approaches to learning about the policies concerning medical alliance in the 3A-grade hospital of City L and the people′s hospital of County S were"introduction from the people around them"(39.5%)and"medical staff′s informing"(45.6%),respectively.(3)The patients,who were willing to receive first contact services provided by grassroots medical institutions,in the 3A-grade hospital of City L and the people′s hospital of County S accounted for 67.0%(65/97)and 79.4%(81/102),respectively,with the leading causes of"nearer home"and"habits".The 3A-grade hospital of City L had a relatively higher proportion of patients who were unwilling to receive first contact services provided by grassroots medical institutions than the people′s hospital of County S(32.0%and 20.6%,respectively);as for patients in the 3A-grade hospital of City L,the main reasons for their unwillingness to receive first contact services provided by grassroots medical institutions were doctors′inferior abilities,doctor understaffing,and insufficiency in categories of medicines in grassroots medical institutions.(4)Patients had referral experiences in the 3A-grade hospital of City L and the people′s hospital of County S amounted to 24 and 5,respectively,and most patients received referral following oral advices from doctors.The majority of patients were fairly satisfied with referral services,and the main reason leading to some patients′dissatisfaction was that they were uncertain of referral procedure and standard.(5)Hospitalized patients who were willing to return to grassroots medical institutions for further rehabilitation after their condition was stable accounted for 53.7%(22/41)in the people′s hospital of County S and 31.6%(12/38)in the 3A-grade hospital of City L.The reason for patients′unwillingness to return to grassroots medical institutions for rehabilitation was that they did not trust the medical technical level of health centers/community centers.Conclusion medical alliance has certain attraction to patients from surrounding areas.Patients of medical alliance have a higher overall satisfaction rate with health services,and most patients are willing to receive first contact services provided by grassroots medical institutions,but the majority are not familiar with medical alliance.In future,it is necessary to further standardize the procedure of the two-way referral in medical alliance,increase the level of diagnosis and treatment in grassroots medical institutions,and intensify the propagandization of medical alliance,thus further raising medical alliance patients′satisfaction with and their awareness rate of the policies concerning medical alliance,promoting the effective implementation of the tiered diagnosis and treatment model and facilitating the reasonable utilization of the resources.