分级诊疗背景下康复患者双向转诊现状及对策研究

Study on the status quo and countermeasures of bi-directional referral of patients in rehabilitation under the background of tiered diagnosis and treatment

[目的]探明双向转诊的现状和患者对双向转诊态度的影响因素,为促进分级诊疗政策的有效实施提供参考。[方法]对2023年9-11月纳入深圳市5家机构中具有康复需求的门诊患者进行问卷调查,问卷内容包括社会人口学特征、医保及医疗费用情况、诊疗情况等。[结果]共发放问卷1173份,回收有效问卷1013份,患者平均年龄(48.47±16.84)岁;47.6%的患者认可双向转诊。单因素分析结果显示患者对双向转诊的态度与年龄、下转存在问题等因素之间存在相关性(P<0.05)。多因素Logistic回归模型结果显示,患者年龄、学历、家庭年收入、是否了解下转、是否满意基层医院环境设施、是否满意基层医院医疗费用和报销水平,是患者双向转诊态度的影响因素。[结论]患者对双向转诊态度受到患者年龄、学历、家庭年收入、下转存在问题等因素的影响,针对重点人群加强分级诊疗的宣传、改善基层医院的卫生服务能力可以在一定程度上提高患者对双向转诊的认可度,有利于巩固并促进当前我国分级诊疗模式。

Objective To explore the status quo of bi-directional referral and influencing factors of patientsattitude towards it,and to provide the reference for promoting the effective implementation of tiered diagnosis and treatment.Methods Outpatients with rehabilitation needs in five institutions in Shenzhen were included in the questionnaire survey from September to November 2023,including sociodemographic characteristics,health insurance and medical costs,and diagnosis and treatment.Results A total of 1,173 questionnaires were distributed and 1,013 valid questionnaires were collected,with an average age of(48.47±16.84).47.6%of patients approved bidirectional referral.The results of univariate analysis showed that there was a correlation between patients'attitudes towards bi-directional referral and the age,problems of downward referral and other factors(P<0.05).The results of multivariate logistic regression model showed that patientsage,educational background,annual household income,understanding of downward referral,satisfaction with the environment and facilities of primary hospitals,and satisfaction with the medical expenses and reimbursement level of primary hospitals were the influencing factors of patients'attitudes towards bi-directional referral.Conclusions Patients'attitudes towards bi-directional referral are affected by patients'age,educational background,annual household income,and problems of downward referral.It is conducive to improving patients'recognition of bi-directional referral and consolidating and promoting the current tiered diagnosis and treatment mode in China to propagandize tiered diagnosis and treatment for key groups and improve the health service capacity of primary hospitals.