北京市朝阳区施行“双诊制”的影响因素分析  

Influential Factors on the Practice of "Dual Referral System" in Chaoyang District of Beijng

作　　者：张亚兰 王雷 徐超 李炜 李艳 高运生 

机构地区：[1]北京市朝阳区社区卫生服务管理中心,100025

出　　处：《中国全科医学》2010年第31期3507-3509,共3页Chinese General Practice

基　　金：北京市朝阳区科委课题(RK0908)

摘　　要：目的从社区卫生服务中心和二三级医院两个方面探讨影响北京市朝阳区"双诊制"深入开展的因素。方法随机抽取100名二三级医院医生和210名社区卫生服务中心医生,采取医生自填问卷的方式进行调查。结果社区医生与二三级医院医生的学历、职称间差异均有统计学意义(P<0.01)。二三级医院有下转经历的医生比例(54.00%)显著低于社区有向上转诊经历的医生比例(89.95%),差异有统计学意义(P<0.01);双向转诊的原因主要为技术、设备条件限制和社区不能确诊的疑难复杂病例;医疗机构缺乏信息沟通、没有统一的转诊制度和标准、患者不理解双向转诊制度和患者不相信社区的医疗水平是双向转诊的主要影响因素。社区医生认为首诊制存在困难的原因为:社区卫生服务机构整体医疗水平有限,难以承担首诊重任(70.33%),社区医疗机构和医院间转诊不顺畅(65.07%)。结论社区首诊制的完善需要人才政策的进一步调整;加强医疗机构间的协作沟通机制,建立规范顺畅的双向转诊制度;需要进一步加强社区首诊制的制度建设和宣传工作。Objective To analyze the influential factors on the first treatment and ＂dual referral system＂ in Chaoyang district of Beijng from the angle of both hospitals and the community health service centers.Methods Totally 100 doctors from hospitals and 210 doctors from community health service centers were randomly selected,and among them questionnaire survey was conducted.Results There were significantly differences in education level and professional title between doctors in the community centers and the doctors in the hospitals （P〈0.01）.The ratio of doctors who had transfer experience in the hospitals was significantly lower than that of doctors in the community centers （54.00% vs 89.95%）（P〈0.01）.The reasons of transferred patients both in hospitals and community centers were mainly technical and equipment conditions,difficult and complex cases that cannot be diagnosed in community center.The main factors influential the dual referral are lack of communication between medical institutions,no unified regulations and standards on referral,not understanding the dual referral system and not believing in the medical level of community centers by the patients.Community doctors believed that the main reasons affecting the first treatment was that the general medical level of the community health services centers was limited（70.33%）,and that the referral was not smooth between the communities and hospitals（65.07%）.Conclusion It is necessary to improve the system of first treatment in the community through adjusting personnel policies,enhancing the mechanism of coordination and communication among the medical institutions,so as to establish a standard and smooth two-way referral system.And the work on establishment and propaganda of the first treatment system in the community needs to be strengthened.

关 键 词：社区卫生服务 社区首诊制 双向转诊 

分 类 号：R197[医药卫生—卫生事业管理]