山东省城乡居民基层医疗机构首诊和转诊意愿及其影响因素分析  

Willingness and its influential factors for initial medication-seeking at grassroots institution and referral among urban and rural residents with medical insurance in Shandong province

作　　者：王丽君 鲁志鸿[1] 李友卫 王颖[1] 郭栋[1] WANG Li-jun;LU Zhi-hong;LI You-wei(Shandong University of Traditional Chinese Medicine,Ji'nan,Shandong Province 250000,China)

机构地区：[1]山东中医药大学,山东济南250000

出　　处：《中国公共卫生》2021年第3期465-469,共5页Chinese Journal of Public Health

基　　金：山东省社科规划研究(19BJCJ24);山东中医药大学优秀青年科学基金[社会科学类(2018sk13)];山东省中医药科技发展计划项目(2019–0004);国家中医药管理委托课题(zy–2016–11)。

摘　　要：目的了解山东省居民基层医疗机构首诊和转诊意愿及其影响因素,为更好地推动分级诊疗制度提供政策建议。方法于2017年1月采用分层随机抽样方法在山东省17个地市抽取2965名城乡居民进行基层医疗机构首诊和转诊意愿的面访调查。结果山东省2965名城乡居民中,1922名(64.8%)居民有基层医疗机构首诊意愿,1599名(53.9%)居民愿意向上级医疗机构转诊,1901名(64.1%)居民在病情稳定后愿意向下级医疗机构转诊。多因素非条件logistic回归分析结果显示,家附近有基层医疗机构、赞同分级诊疗制度、认为分级诊疗可行、有过社区(乡镇医院)就医经历的山东省城乡居民基层首诊意愿较高,家庭年均收入≥20000元、有城镇居民医保和商业保险及其他医保、经历过转诊的山东省城乡居民基层首诊意愿较低;年龄≥65岁、家庭年均收入≥10000元的山东省城乡居民向上级医疗机构转诊意愿较高,女性、居住在农村、家附近有基层医疗机构、赞同分级诊疗制度、有过社区(乡镇医院)就医经历的山东省城乡居民向上级医疗机构转诊意愿较低;女性、居住在农村、赞同分级诊疗制度、认为分级诊疗可行、经历过转诊的山东省城乡居民向下级医疗机构转诊意愿较高,家庭年均收入≥40000元的山东省城乡居民向下级医疗机构转诊意愿较低。结论山东省城乡居民对分级诊疗制度认识不足,基层医疗机构首诊意愿较低,性别、年龄、家庭年均收入、居住地、医疗保险类型及是否家附近有基层医疗机构、赞同分级诊疗制度、认为分级诊疗可行、有过社区(乡镇医院)就医经历、经历过转诊是影响该地区城乡居民基层医疗机构首诊和转诊意愿的主要因素。Objective To examine the willingness for initial medication-seeking at grassroots institutions and referral and their influential factors among residents participating in different medical insurance in Shandong province for providing references to improve hierarchical diagnosis and treatment system.Methods Face-to-face questionnaire surveys were carried out during January 2017 among 2969 residents with different medical insurance randomly recruited with stratified sampling in urban and rural regions of 17 municipalities/prefectures across Shandong province.Results Of the 2965 respondents with valid information,1922(64.8%)reported the willingness to seek medication first at grassroots institutions;1599(53.9%)selected higher medical institutions for their referrals if necessary but 1901(64.1%)selected lower medical institutions for their referrals under the condition when their illness being stable.The results of unconditional multivariate logistic regression analysis demonstrated that the respondents with following characteristics were more likely to report a higher willingness to seek medication first at grassroots institutions:with a grassroots medical institution near the home,agreeing with hierarchical diagnosis and treatment,considering hierarchical diagnosis and treatment being practicable,and ever taking medical services in community healthcare centers or township hospitals;while,the respondents with a mean annual household income of≥20000 yuan(RMB),with medical insurance for urban residents or commercial medical insurance,and ever having a referral were likely to report a lower willingness to seek medication first at grassroots institutions.The results also revealed that the respondents aged≥65 years and with a mean annual household income of≥10000 yuan were more likely to have a higher willingness for a referral to higher grade medical institutions,while those with following characteristics were more likely to have a lower willingness for a referral to higher grade medical institutions:being female,

关 键 词：基层医疗机构 首诊 转诊 意愿 影响因素 城乡居民 

分 类 号：R193[医药卫生—卫生事业管理]