三甲医院康复期老年慢性病患者向下转诊意愿及相关因素分析

Analysis of Downward Referral Willingness and Related Issues in Convalescent Elderly People with Chronic Diseases in Tertiary Hospitals

目的了解三甲医院康复期老年慢性病患者向下转诊意愿及影响因素。方法调查394例康复期老年慢性病患者就医意愿与行为,探究向下转诊意愿影响因素。结果256例患者“不愿意”向下转诊,主观原因为不信任医务人员技术(37.50%)和担心病情反复(30.86%),独立影响因素为不知晓分级诊疗制度、各级医疗单位功能认知差、心理弹性评分<54分、慢性病自我效能<6.1分(p<0.05)。结论康复期老年慢性病患者向下转诊意愿偏低,与其认知水平及心理弹性、自我效能有关。

Objective To understand the downward referral willingness and influencing factors of convalescent elderly people with chronic diseases in tertiary hospitals.Methods The medical willingness and behaviors of 394 convalescent elderly patients with chronic diseases were investigated and the influencing factors of downward referral willingness were also explored.Results There were 256 patients(64.97%)reporting"unwilling"to be referred downward due to the subjective reasons such as distrust of medical staff skills(37.50%)and fear of repeated illness(30.86%).The independent influencing factors of unwillingness were unawareness of hierarchical medical system,poor recognition of medical institutions'function at different level,psychological resilience score lower than 54,and self-efficacy score lower than 6.1(p<0.01).Conclusion The willingness to downward referral is generally low among convalescent elderly patients with chronic diseases,which is related to the cognitive level,psychological resilience and self-efficacy of patients.