基于制度关键实践者视角的分级诊疗制度感知及影响因素研究  

Perceptions of Hierarchical Medical System and Associated Factors in Key Primary Care Practitioners

作　　者：马聪 王伟[1] 袁颖 孙艳春[1] 徐芳 严非[1] MA Cong;WANG Wei;YUAN Ying;SUN Yanchun;XU Fang;YAN Fei(Key Laboratory of Health Technoloy Assessment of National Health Commission,School of Public Health,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学公共卫生学院,国家卫生健康委员会卫生技术评估重点实验室,上海市200032

出　　处：《中国全科医学》2022年第7期822-828,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(71874087)--基于建立分级诊疗制度目标的家庭医生队伍建设研究;国家卫生计生委信息统计中心委托项目--分级诊疗制度下基层卫生服务体系评估。

摘　　要：背景分级诊疗制度的建立和完善,有助于优化卫生资源配置,建立合理的就医格局。基层卫生技术人员是分级诊疗制度的关键实践者,其对分级诊疗制度的感知对于制度落实至关重要,研究其对分级诊疗的感知及影响因素具有重要意义。目的基于第六次国家卫生服务调查结果,分析基层卫生技术人员对分级诊疗的感知状况及影响因素,为进一步完善分级诊疗制度提供参考。方法于2019年4—10月,选取实施分级诊疗的6个案例省份,每个省份抽取具有代表性的1个城区和1个郊区县作为研究案例地区,然后采用分层随机抽样法在每个区(县)抽取6家左右社区卫生服务中心/乡镇卫生院,最终抽取46家社区卫生服务中心和30家乡镇卫生院,对调查当日在岗的基层卫生技术人员进行问卷调查。问卷主要内容为基层卫生技术人员的基本情况,以及其对分级诊疗制度重要性、效果、阻碍的感知。结果共回收分级诊疗制度感知部分应答完整的有效问卷1308份。其中,1231例(94.11%)对于分级诊疗有利于完善卫生服务体系的说法持正向感知,1219例(93.20%)同意分级诊疗对患者和居民有益的说法。1209例(92.43%)认为分级诊疗制度能够提高医疗服务质量,1189例(90.90%)认为分级诊疗制度能够提高医疗服务效率,1087例(83.10%)认为分级诊疗制度能够改善医患关系,786例(60.09%)认为分级诊疗制度能够减少医疗风险,611例(46.71%)认为分级诊疗制度能够降低医疗费用。982例(75.08%)不认为分级诊疗会阻碍卫生机构发展,759例(58.03%)同意分级诊疗没有得到相应激励的说法,753例(57.57%)同意患者及其家属习惯了自由就医而不愿接受分级诊疗的说法,712例(54.43%)同意目前没有统一双向转诊标准和制度的说法,451例(34.48%)同意分级诊疗使医疗机构之间存在利益冲突的说法,403例(30.81%)同意目前没有有效转诊渠道的说法,387例(29.59%)�Background The establishment and improvement of hierarchical medical system will help optimize health resource allocation and develop a sound healthcare-seeking pattern.As the key practitioners of hierarchical medical system,primary care workers'perception of the system is vital to the implementation of the system,so studying their perception of the system and associated factors is of great significance.Objective To analyze primary care professionals'perceptions of hierarchical medical system and associated factors based on the results of 2018 Sixth China National Health Survey,providing a reference for further improvement of the system.Methods From April to October 2019,one representative urban district and one suburban county were chosen from each of six selected provinces in which hierarchical medical system has been implemented.Then by stratified random sampling,about six community health centers/township health centers were extracted from each district(county)(46 community health centers and 30 township health centers in total),in which primary care professionals who were on duty on the day of survey were invited to attend a questionnaire survey for understanding their demographics,perceptions of the importance and effectiveness of,as well as barriers to the implementation of hierarchical medical system.Results Altogether,1308 cases who effectively completed the survey were included for final analysis.According to the analysis,the benefits of implementing hierarchical medical system were:improving the health service system〔approved by 1231 cases(94.11%)〕,improving the healthcare services for patients and residents〔agreed by 1219 cases(93.20%)〕;improving the quality of medical services〔1209(92.43%)〕;improving the efficiency of medical services〔1189(90.90%)〕;improving doctor-patient relationship〔1087(83.10%)〕;reducing the medical risk〔786(60.09%)〕;reducing medical expenses〔611(46.71%)〕.As for the outcome of implementing hierarchical medical system,its implementation would not hinder

关 键 词：分级诊疗 卫生人员 感知 社区卫生中心 乡镇卫生院 影响因素分析 

分 类 号：R197[医药卫生—卫生事业管理]