推进分级诊疗制度背景下北京市不同级别医院患者就医选择行为研究  

Study on healthcare seeking behavior of patients in different levels of hospital in Beijing under the promotion of hierarchical medical system

作　　者：李梦龙 杨佳[2] 

机构地区：[1]首都医科大学公共卫生学院,北京市100069 [2]首都医科大学卫生管理与教育学院,北京市100069

出　　处：《中国医院》2018年第3期I0002-I0002,1-4,共5页Chinese Hospitals

基　　金：国家自然科学基金青年项目(71603175);北京市社会科学基金项目(14SHC032)

摘　　要：目的:对不同级别医疗机构患者在不同情景模拟下的就医行为及影响因素开展调查分析,提出对策建议,为推进分级诊疗制度建设提供依据。方法:根据北京市发展水平、医疗资源分布等特征,选取社区卫生服务中心、二级医院和三级医院各2所,每所医院采取偶遇抽样方法对110名患者进行问卷调查。结果:不同人口学特征(如学历、收入水平、户口、医疗费用支出)患者就医选择行为的差异具有统计学意义(P<0.05)。在不同病情程度情景模拟下患者就医选择行为的差异具有统计学意义(P<0.001)。就医选择行为影响因素分布显示,医疗服务水平、医保政策和药品政策等对就医行为的影响较大。结论:就医选择行为是由患者的就医需求、个人特征、医疗服务和卫生政策共同决定,因此为实现患者的有效分流,除了要转变患者自身的就医习惯,更需要从政策上细化分级诊疗首诊范围、首诊原则以及慢性病分级诊疗方案。Objectives： To investigate and analyze the behavior and influencing factors of patients in different medical institutions under different situations, and put forward suggestions to provide basis for promoting the construction of hierarchical medical system. Methods： According to the development level of Beijing city, the distribution of medical resources and other characteristics, to select 2 samples of each community health service center, secondary hospitals and tertiary hospitals. Each hospital takes the case of occasional sampling of 110 patients to conduct a questionnaire survey and scenario simulation, using SPSS to analyze the data. Results： There were statistically significant differences in the characteristics of individual patients such as education, income, account and medical expenses in different medical treatment （P 〈0.05）. Patients with different degrees of disease treatment behavior are different, the difference was statistically significant （P 〈0.001）. The distribution of factors affecting the behavior of medical treatment shows that medical staff, medical institutions, the external environment, health insurance policy and drug policy are also influencing factors of medical treatment. Conclusions： The health seeking behavior is determined by individual characteristics, the medical needs of patients, medical service and health policy decision together. In order to realize the effective shunt of patients, in addition to changing their own medical treatment habits, it is more necessary to refine the scope of the first consultation, the principle of first diagnosis and the classification of chronic diseases, and further standardize the classification of diagnosis and treatment follow-up services.

关 键 词：分级诊疗 就医行为 患者就医 患者首诊 

分 类 号：R197.1[医药卫生—卫生事业管理]