转诊患者对分级医疗服务体系构建的认知行为分析  

Cognitive Appraisal on Hierarchical Medical Service System in China on the Side of the Referral Patients

作　　者：邹晓旭[1] 姚瑶[2] 李威[1] 赵明钢 刘征[4] 

机构地区：[1]中山大学附属第一医院,广东广州510080 [2]中山大学附属第三医院,广东广州510630 [3]国家卫生计生委医疗管理服务指导中心,北京100044 [4]重庆医科大学附属第一医院,重庆400016

出　　处：《中国医院管理》2015年第7期18-21,共4页Chinese Hospital Management

基　　金：原卫生部医改办委托项目"加强医疗服务机构监管策略研究";广东省科技计划项目(2011B060500043);广东省医学科学技术基金(B2014067)

摘　　要：目的探讨转诊患者对上下级医疗机构医疗服务、转诊服务的认知行为及其影响因素,以期明确"患者角度"医疗服务体系存在的问题,并提出构建与优化分级医疗服务体系的建议。方法分别在东、中、西地区选择有转诊经验的患者为样本,收集其基本情况、健康状况、就诊行为、对双向转诊的认知、满意度情况及其评价等信息,运用卡方检验、秩和检验和Ordinal Logistic进行分析。结果 82.7%的患者赞成疾病首诊应在基层医疗机构,但缺乏对基层医疗机构的信任。在患者看来,提高基层医务人员水平和医疗费用报销比例是影响其择医的主要因素。患者对医疗机构间转诊制度满意程度受地区、患者年龄、就医方便程度、转诊过程的方便程度等因素影响。结论患者对于分级医疗的认识存在误区,且对基层医疗机构明显缺乏信任感,应从改善基层医疗机构服务能力、加强信息引导和健康教育、梯度化医疗保险制度等方面优化分级医疗体系建设。Objective To investigate the referral patients＇ cognitive behavior and its affecting factors about medical services in superior and subordinate medical institutions,in order to clear the health care system problems and propose construction and optimization recommendations grading health care system through a patient＇s point of view.Methods Selecting patients who have referral experienced in eastern,central and western regions as samples to collect the information of basic situation,health status,seeking behavior,perception of two-way referral,satisfaction and its evaluation,using chi-square test,rank sum test and ordinal logistic analysis. Results 82.7% of patients are in favor of the disease first option of the primary health care institutions, but they lack of trust in it. From patients＇ perspective, improving the quality of human resources in primary health care system and medical expenses reimbursement level are major factors in their selection. The extent of patient satisfaction about referral system between medical institutions depends on region,age,convenience,comfort level in the referral process,and other factors.Conclusion Patients have misunderstanding in hierarchical medicine and do not trust primary health care institutions.Optimization hierarchical medical service system should improve service capacity of primary health care institutions;strengthen information guide,health education and promotion,the gradient of the medical insurance system and other aspects.

关 键 词：分级医疗 转诊 患者 认知行为 

分 类 号：R197.1[医药卫生—卫生事业管理]