中国患者向下转诊意愿及其影响因素的Meta分析

Willingness of Chinese patients for downward referral and its influencing factors:a Meta analysis

目的研究中国患者向下转诊意愿及其影响因素,为完善分级诊疗制度、实现双向转诊提供依据和参考。方法检索中英文数据库有关中国患者向下转诊意愿及其影响因素的文献,进行Meta分析,分别使用率和OR的95%CI作为中国居民向下转诊意愿及其影响因素的测量指标。使用漏斗图与Egger法评估发表偏倚,采用敏感性分析判断结果的稳定性。结果纳入文献20篇,患者愿意向下转诊率为60.73% 95%CI(54.43%~67.03%)。首诊或常就诊的地点(OR=0.3295%CI 0.18~0.55)、双向转诊知晓情况(OR=2.1595%CI 1.41~3.27)、附近是否有社区医疗卫生服务机构(OR=1.4395%CI 1.15~1.78)等因素是患者向下转诊意愿的主要影响因素。结论建议提高基层医疗卫生服务机构医疗水平和质量,提高患者信任度。加强政府对双向转诊的宣传和引导,提高基本医疗卫生服务可及性,促进患者向下转诊。

Objective To study the influencing factors and willingness of Chinese patients for downward referral so as to provide references for the improvement of two-way referral system.Methods Chinese and English databases were searched to collect the literatures about the influencing factors and willingness of Chinese patients for downward referral,and meta-analysis was conducted.The utilization rate and the 95% confidence interval(CI)of odds ratio(OR)were used as measures of the willingness for downward referral and its influencing factors.Funnel plots and Egger method were used to examine the publication bias.And the stability of the results was assessed by performing the sensitivity analysis.Results Twenty literatures were included,and the willingness for downward referral was rated at 60.73% 95%CI(54.43%~67.03%).Such factors as the location of the first or usual visit(OR=0.3295%CI 0.18~0.55),knowledge of two-way referrals(OR=2.1595%CI 1.41~3.27),and whether there are community health services in the vicinity(OR=1.4395%CI 1.15~1.78)were the main influencing factors affecting patients’willingness for downward referral.Conclusion We suggest that the quality of medical care in primary health care of community-level medical and health service institutions should be improved and patient trust should be bolstered.It is also recommended to strengthen the government’s communications and instructions of two-way referrals,make basic medical and health services more accessible,and promote downward referrals of patients.