基层医务人员对分级诊疗制度实施的认知调查及影响因素分析  

Cognitive Investigation and Influencing Factors Analysis of Primary Medical Staffs on the Implementation of Hiera chical Diagnosis and Treatment System

作　　者：马海峰 应晓华[1] Ma Haifeng(School of Public Health,Fudan University,Shanghai,P.R.China)

机构地区：[1]复旦大学公共卫生学院,上海200032

出　　处：《中国卫生事业管理》2023年第6期422-430,共9页Chinese Health Service Management

基　　金：国家自然科学基金面上项目“按疾病诊断相关分组支付与大数据病种组合分值付费的比较研究”(72074051)。

摘　　要：目的:了解基层医务人员对分级诊疗制度的认知程度并剖析影响因素,提出促进分级诊疗制度更好落实的合理化建议。方法:在海安市采取分层整群随机的抽样方法抽取40家基层医疗机构468名基层医务人员进行问卷调查,采取描述性分析、多组独立样本秩和检验和有序多分类Logistic回归进行统计对比和因素分析。结果:29.49%、54.49%及16.02%的基层医务人员非常了解、比较了解及不太了解分级诊疗;46.79%、47.44%及5.77%的基层医务人员对分级诊疗持非常认可、比较认可、不太认可态度;年龄、科室、在编情况、参加分级诊疗制度培训情况,机构是否有明确转诊指南是影响了解程度的主要因素(P<0.05);所在地区、科室、职称、参加分级诊疗制度培训情况、对工作量的影响、提供的医疗服务满足需求的程度、转诊渠道通畅程度是认可程度的影响因素(P<0.05)。结论:基层医务人员对分级诊疗制度认知程度总体较高,需要明确转诊指南并辅以针对性宣传培训以提高了解程度,政府等相关部门应对分级诊疗在农村的落实与发展给予更多关注,应重视较高职称医务人员,平衡工作量与薪酬待遇,并加强基层医疗机构能力建设,畅通转诊渠道以提升认可程度。Objective To understand the cognition of primary medical staffs on the hierarchical diagnosis and treatment sys-tem,analyze its influencing factors,and put forward reasonable suggestions to promote the implementation of hierarchical diagnosis and treatment system.Methods A total of 468 primary medical staffs were selected from 40 primary medical institutions in Hai'an City by stratified cluster random sampling method for questionnaire survey.Descriptive analysis,multi-group independent sample rank sum test and ordered multiple logistic regression were used for statistical comparison and factor analysis.Results There were 29.49%,54.49%and 16.02%of the primary medical staffs who knew very well,relatively well,and did not knew much about the hierarchical diagnosis and treatment system.There were 46.79%,47.44%and 5.77%of grassroots medical staffs who had very recognized,relatively recognized and less recognized attitude towards the hierarchical diagnosis and treatment system.Age,depart-ment,staffing category,whether to participate in the training on the diagnosis and treatment system,and whether having a clear ref-erral guide in institutions were the main factors to influence the degree of understanding(P<0.05).The main factors to influence the degree of recognition were region,department,professional title,participation in diagnosis and treatment system training,impact from workload,degree of medical services to meet the demand,and the referral channels.Conclusion Primary medical staffs had a high degree of awareness of hierarchical diagnosis and treatment system.It is necessary to clarify the referral guidelines and provide targeted publicity and training to improve their understanding.The government and other relevant departments should pay more at-tention to the implementation and development of hierarchical diagnosis and treatment system in rural areas,pay more attention to medical staffs with higher professional titles,balance the workload and remuneration,strengthen the capacity-building of primary medical ins

关 键 词：分级诊疗制度 基层医务人员 认知程度 影响因素 

分 类 号：R197.1[医药卫生—卫生事业管理]