北京市不同级别医院患者社区首诊和双向转诊意愿及影响因素研究  

Study on the willingness and influencing factors of community first consultation and two-way referral for patients in different levels of Beijing hospitals

作　　者：李丹慧 杨佳 LI Danhui;YANG Jia(School of Public Health,Capital Medical University.No.10,Xitoutiao,You'anmen Wai,Fengtai District,Beijing,100069,PRC)

机构地区：[1]首都医科大学公共卫生学院,北京市100069

出　　处：《中国医院》2020年第10期12-16,共5页Chinese Hospitals

基　　金：国家自然科学基金青年项目(71603175)。

摘　　要：目的:探讨北京市不同级别医院患者对社区首诊和双向转诊的意愿及其影响因素分析。方法:根据北京市医疗资源分布情况,在北京市分别选取2所三级医院、3所二级医院和5家社区卫生服务中心,以就诊患者为调查对象,采取偶遇抽样的方法进行问卷调查。结果:仅13%的调查者对社区首诊较了解,23%的调查者对社区首诊制持认可态度;双向转诊方面,仅有约20%的患者对该制度比较了解。在接受过转诊服务的135人中,对转诊的满意度一般,比较满意和非常满意的人数合计仅占27%;但接受调查的患者对该制度的认可度较好,约有58%的患者对双向转诊制度比较认可和非常认可。女性患者对上转和下转意愿高于男性患者;在本市居住时间较长的患者更愿意经由社区首诊进行上转,住院患者以及对双向转诊满意度较高的患者更愿意在病情稳定之后下转。结论:患者对社区首诊和双向转诊的总体认知度不高,政策宣传没有对患者合理就医起到有力的推动作用;医疗技术水平、医保报销是影响患者社区首诊的首要原因;患者社区首诊后再上转意愿较低,三级医院诊断病情稳定后再下转意愿较高。Objective:To explore the willingness of patients at different levels of hospitals in Beijing to receive community first consultation and two-way referral and the analysis of factors influencing this willingness.Methods:According to the distribution of medical resources in Beijing,two tertiary hospitals,three secondary hospitals and five community health service centers were selected in Beijing,and the questionnaire survey was carried out using a random sampling method with patients as the respondents.Results:Only 13%of the respondents were more knowledgeable about community first consultation,and 23%of the respondents were in favor of the community first consultation system;only about 20%of the patients were more knowledgeable about the two-way referral system.Of the 135 people who had received referrals,satisfaction with referrals was moderate,with only 27%of those who were relatively and very satisfied combined;however,patients surveyed were more positive about the system,with about 58%of patients who were more and very positive about the two-way referral system.Patients who had lived in the city for a longer period of time were more willing to be referred upward through the community first referral,while inpatients and patients who were more satisfied with the two-way referral system were more willing to be referred downward when their condition was stable.Conclusion:Patients'overall awareness of community first consultation and twoway referral was not high,and policy propaganda did not play a strong role in promoting patients'reasonable medical treatment;medical technology level and medical insurance reimbursement were the primary reasons influencing patients'community first consultation;patients'willingness to be referred upward after community first consultation was low,and their willingness to be referred downward after stabilization of their condition was high in tertiary hospitals.

关 键 词：基层首诊 双向转诊 认知度 满意度 

分 类 号：R197.3[医药卫生—卫生事业管理]