供方视角下慢性病分级诊疗与双向转诊障碍研究

Qualitative Study on the Barriers of Hierarchical Diagnosis and Dual Referral in Chronic Disease Based on a Supply-Side Perspective

目的:分析广东省部分地区慢性病分级诊疗与双向转诊存在的问题及其成因。方法:基于宏观、中观和微观3个层面,对广州市、清远市的基层卫生机构的41名医护人员就分级诊疗与双向转诊的实施情况开展深入访谈。结果:基层卫生机构存在转诊缺乏标准流程、病人下转较少、基层病人失访等问题。宏观层面的问题包括转诊体系缺乏规范等;中观层面包括医疗机构间的利益冲突等;微观层面包括医护个人态度对双向转诊的影响。结论:慢性病的长期管理对医疗体系协作有着较高要求,目前转诊体系和具体实施层面存在的问题影响了慢性病管理的连续性。应通过加强对双向转诊的监管、完善医保规则等措施优化慢性病分级诊疗与双向转诊的运行机制,增强慢性病管理的连续性,更好地满足基层群众的慢性病诊疗和管理需求。

Objective:To analyze the current problems and causes of the hierarchical diagnosis and dual referral of chronic diseases in selected regions of Guangdong Province.Methods:Based on macro,meso and micro perspectives,41 primary healthcare staff in Guangzhou and Qingyuan were interviewed on the implementation of medical workers in hierarchical diagnosis and dual referral.Results:The primary health care institutions surveyed had problems in lacking regular referral process,low downward transfer of patients,and missed visits from primary care patients.Macro included the lack of regulation of the system,Meso included the issue of interests between healthcare institutions,and Micro included the influence of medical workers’attitudes.Conclusion:The long-term management of chronic diseases requires a high level of collaboration in the healthcare system,and the current barriers at the system and implementation levels affect the continuity of chronic disease management.The operational mechanism of hierarchical?diagnosis and dual referral of chronic diseases should be optimized by strengthening the regulation of dual referral and improving the rules of medical insurance,so as to enhance the continuity of chronic disease management and better meet the needs of the grassroots for chronic disease treatment and management.