基于深圳市某医疗集团医生视角的互联网医院门诊在线诊疗推广障碍的定性分析

Qualitative Analysis of Barriers to the Promotion of Online Healthcare of Outpatient Clinics in Internet Hospitals Based on Physicians’Perspectives of a Medical Group in Shenzhen

目的:从深圳市某医疗集团医生视角分析互联网医院门诊在线诊疗服务推广中存在的障碍,为促进深圳市“互联网+医疗服务”进一步发展提供参考。方法:以深圳市某医疗集团互联网医院为研究案例,对该医疗集团24名医务人员进行深度访谈;采用NVivo 11.0对访谈资料进行编码和分析。结果:互联网医院门诊在线诊疗推广有4个方面障碍:患者因素、医生因素、技术因素和政策因素。患者层面因素包括患者对在线诊疗认知不足、对线上的医生缺乏信任、付费意愿不强以及就医习惯难改变;医生层面因素有线上和线下诊疗关系理解不当、医疗风险担忧、线上线下工作衔接不畅;技术层面因素有线上操作系统流程复杂、功能不完备以及信息系统无法互联互通;政策层面因素有诊疗范围较窄、服务定价不合理、医保支付政策不统一以及政府补偿机制不健全。结论:互联网医院门诊在线诊疗推广受到患者、医生、技术、政策层面等多因素影响。应进一步加强诊疗范围、市场推广、医疗支付以及信息建设等方面的政策优化和调整,以促进在线诊疗服务推广和落地。

Objective:To explore barriers to the promotion of online healthcare services of outpatient clinics in Internet hospitals based on physicians’perspectives of a medical group in Shenzhen,so as to provide references for promoting the further development of"Internet+medical service"in Shenzhen.Methods:The Internet hospital of a medical group in Shenzhen was taken as a case study.A total of 24 medical staff in the medical group were interviewed in depth.NVivo 11.0 was used to extract and code the key information associated with barriers throughout the interview texts.Results:Four factors affecting the promotion of online healthcare services were identified,including patient-related factors,physician-related factors,technology-related factors and policy-related factors.Patient-related factors included the patients’insufficient knowledge on online healthcare services,patients’distrust in the physicians delivering healthcare services online,patients’poor willingness to pay for online healthcare services and patients’failure in changing their habits of health seeking behaviors.Physician-related factors included physician’s misunderstanding of the relationship between the online and offline healthcare services,physician’s concerns for the safety of the online healthcare services and the inefficient schedule for online and offline working.Technology-related factors included the complex and incomplete workflow for patients’online healthcare operation system and the disconnected information system between online and offline workflows.Policy-related factors included the limited items of online healthcare services,the unreasonable pricing of online healthcare services,the inconsistent health insurance benefit between online and offline healthcare services and the lack of reimbursement for online healthcare services from government.Conclusion:The promotion of online healthcare is affected by multi-level factors such as patients-related factors,physician-related factors,technology-related factors and policy-related factors.The promotion and implementation of online healthcare services require further policy optimization and adjustment in terms of the items of services,marketing,medical payment and informatization.