网格化管理布局下紧密型医疗联合体内患者基层首诊现况调查

Exploration of Strategies to Promote Primary Care First Consultation for Patients within Tightly-Knit Medical Treatment Alliances under a Grid-Based Management Layout

目的 了解紧密型医疗联合体内患者基层首诊的现况和关键因素,提出网格化管理布局下推进紧密型医疗联合体内患者基层首诊的对策建议。方法 在我国东、中、西部9个城市各抽取1个紧密型城市医疗集团和1个紧密型县域医共体,调查当日,在牵头医院门诊对就诊患者进行拦截调查,了解其基层首诊的意愿和就诊行为以及对基层医疗卫生机构的相对满意度。结果 73.0%的受访者表示患病时愿意在基层首诊;53.9%的受访者表示在被调查时间的前1年新发病首诊在基层,城市的比例高于县域。服务可及性和医疗技术水平是患者基层首诊时的主要考虑因素。结论 在医疗联合体网格化管理布局下要重视优质资源合理布局,提高基层服务利用可及性;强化家庭医生签约服务,提高网格化管理粘性;强化医保政策精准实施,并以慢性病为抓手开展接续性健康服务来引导患者到基层首诊。

Objective To propose countermeasures and suggestions for promoting primary care first consultation for patients within closely-knit medical treatment alliances under a grid-based management layout,based on the current situation and key factors of primary care first consultation for patients within closely-knit medical treatment alliances. Methods One closely-knitted urban medical group and one closely-knitted county medical community were selected in nine cities in east, central, and west China. Patients attending the outpatient clinic of the lead hospital on the day of the survey were intercepted and surveyed to understand their willingness and attendance behaviors for primary care first consultation,as well as their relative satisfaction with the primary health care institutions. The key factors influencing their primary care first consultation within the medical treatment alliance were investigated. Results 73.0% of respondents indicated that they were willing to seek primary care first consultation when they were ill;53.9% of respondents indicated that their first consultation for a new illness in the year before the time of the survey was at the primary level,with a higher proportion in cities than in counties. Accessibility of services and the level of medical technology were the main considerations for patients when seeking first consultation at the primary level. Conclusion Under the grid-based management layout of medical treatment alliances,emphasis should be placed on the rational layout of quality resources to improve the accessibility of service utilization at the primary level;strengthening family doctor contracting services to improve the engagement of grid-based management;strengthening the precise application of medical insurance policies,and using chronic diseases as leverage to carry out continuing health services to guide patients to seek the first consultation at the primary level.