华中地区乡镇医生分级诊疗协作现状与意愿调查  

Investigation on Status Quo and Will of Township Doctors in Hierarchical Diagnosis and Treatment Collaboration in Central China

作　　者：张翔[1,2] 闫朝阳 张研 叶青跃[3] Zhang Xiang(School of Medicine and Health Management,Tongji Medical College,HUST,Wuhan,43003)

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,武汉430030 [2]湖北省人文社科重点研究基地农村健康服务研究中心,武汉430030 [3]武汉科技大学附属天佑医院,武汉430064

出　　处：《医学与社会》2018年第9期4-7,共4页Medicine and Society

基　　金：国家自然科学基金;编号为71373091;国家青年自然科学基金;编号为71603088

摘　　要：目的:调查分级诊疗背景下乡镇医生开展县乡服务协作的现状,为促进分级诊疗制度建设提供依据。方法:以华中地区三县67名乡镇医生为研究对象,采用典型地区随机抽样法,以知信行的角度调查分级诊疗制度下乡镇医生县乡服务协作的现状。结果:一般了解县级医院对应科室诊疗能力的占43.3%,64.2%的乡镇医生接受过转诊制度和程序的相关培训,只有33.8%的乡镇卫生院了解和使用转诊信息系统;19.4%的乡镇医生与县级医生无业务交流;认为县乡两级医生分工协作中存在困难的占61.2%,其中检查诊断结果互不相认、信息无法有效传递和双方合作不积极的分别占比43.3%、38.8%和40.3%;平均而言,县乡服务协作给乡镇医生带来的影响是医疗风险增加(-0.33)。结论:乡镇医生对县乡服务协作分流患者程序和相关配套措施认识不足;协作中困难较多且乡镇医生在协作中所做有限;县乡两级医生业务交流不足且相互了解程度不高;县乡医生协作给乡镇医生带来医疗风险增加等影响。Objective： To investigate the status quo of township doctors in carrying out county-town service cooperation under the background of hierarchical diagnosis and treatment, and provide the basis lot promoting the construction of hierarchical medical system. Methods： 67 township doctors in three counties in Central China were selected as research objects. The random sampling in a typical area was used to investigate the current situation of township doctors＇ service coordination under hierarchical diagnosis and treatment from three dimensions of cognition, belief and behavior. Results： 43.3% of township doctors knew about the diagnosis and treatment ability of county-level hospitals and 64.2% received training on the relerral system and procedures. Only 33.8% of township hospitals knew and used the relerral system, and 19.4% of township doctors and county doctors had no business exchange. 61.2% of them thought that there were difficuhies in the division of labor. Among them, the diagnosis results were mutually exclusive, the information can not be effectively transmitted and the cooperation between both parties was not active, accounting lot 43.3% ,38.8% and 40.3%. On average, the effect of county-town service collaboration on township doctors brought about an increase in medical risks （-0.33）. Conclusion： There was lack of understanding among township doctors about how to shift the service coopera- tion between counties and towns and related supporting measures. There were more difficuhies in cooperation and the doctors in township hospitals had limited cooperation. The communication between doctors at county and township level was not enough and the mutual understanding was not high. County and township doctors＇ cooperation brought medical risks to the doctors in town.

关 键 词：乡镇医生 分级诊疗制度 医疗服务协作 知信行模型 

分 类 号：R190[医药卫生—卫生事业管理]