海口地区康复门诊患者分级诊疗现状初步调查及向下转诊影响因素分析  

Preliminary Survey of Graded Diagnosis and Treatment of Rehabilitation Outpatients and Influencing Factors for Downward Referral in Haikou Area

作　　者：林夏妃 潘晶晶 吴海霞 随燕芳 黄英媛 曾骥 宋振华[1] 王玉龙[2] LIN Xiafei;PAN Jingjing;WU Haixia;SUI Yanfang;HUANG Yingyuan;ZENG Ji;SONG Zhenhua;WANG Yulong(Haikou Affiliated Hospital of Central South University Xiangya School of Medicine(Haikou People's Hospital),Haikou,Hainan 570208,China;Shenzhen Second People'Hospital(First Affiliated Hospital of Shenzhen University),Shenzhen,Guangdong 518000,China)

机构地区：[1]中南大学湘雅医学院附属海口医院(海口市人民医院),海南海口570208 [2]深圳市第二人民医院(深圳大学第一附属医院),广东深圳518000

出　　处：《康复学报》2025年第1期83-90,共8页Rehabilitation Medicine

基　　金：卫生发展专项资金-海南省省级重点临床专科建设项目(0202067)。

摘　　要：目的 调查了解海口市居民对分级诊疗模式的认知情况,并分析向下转诊的影响因素。方法 使用便利抽样的方法,选取2023年10—12月在中南大学湘雅医学院附属海口医院(海口市人民医院)康复科门诊就诊的311例患者作为研究对象,采用自设问卷进行调查,收集患者的一般资料,了解其对分级诊疗制度的认知情况及就医选择、向下转诊经历等。结果 311例患者中,分级诊疗知晓率仅为31.83%。急诊就医的机构选择中,82.32%的患者选择综合医院,2.89%选择专科医院,7.40%选择中医院,5.14%选择卫生服务站,7.40%选择基层医疗机构;日常就医的机构选择中,81.67%的患者选择综合医院,2.89%选择专科医院,9.00%选择中医院,6.43%选择基层医疗机构。311例患者中,仅有67例患者有过向下转诊的经历,为21.54%。单因素分析结果显示学历、医保类型、家庭年收入、所在居住地、最近基层机构距离是患者向下转诊的相关影响因素(P<0.05)。多因素Logistic回归分析结果显示,影响居民向下转诊经历的因素主要有学历和所在居住地。小学文化水平的居民向下转诊经历最多,是没有接受过文化教育居民的1.598倍(OR=1.598,P=0.037)。所在居住地位于城乡结合区(OR=0.155,P=0.005)、镇乡结合区(OR=0.125,P=0.004)、乡镇中心(OR=0.090,P<0.001)的居民向下转诊经历依次降低。结论 海口地区患者对分级诊疗整体认知度偏低,基层机构就诊率低,应加强分级诊疗政策宣教,提高患者对分级诊疗制度信息知晓率,引导合理就医行为,完善分级诊疗制度相应的推行措施,促进分级诊疗制度落实。Objective To investigate the awareness of graded diagnosis and treatment model among residents in Haikou City,and analyze the influencing factors of downward referral.Methods A total of 311 patients treated in the rehabilitation clinic of Haikou Affiliated Hospital of Central South University Xiangya School of Medicine(Haikou People's Hospital)from October to December 2023 were selected as the research subjects by convenience sampling method.A self-designed questionnaire was used to collect the general information of the patients,understand their awareness of the gradede diagnosis and treatment system,their choice of medical treatment,and their experience of downward referral.Results Among the 311 patients,the awareness rate of graded diagnosis and treatment was only 31.83%.In the choice of institutions for emergency medical treatment,82.32%of patients chose general hospitals,2.89%chose specialized hospitals,7.40%chose traditional Chinese medicine hospitals,5.14%chose health service stations and 7.40%chose primary medical institutions.In the choice of institutions for routine medical treatment,81.67%of patients chose general hospitals,2.89%chose specialized hospitals,9.00%chose traditional Chinese medicine hospitals and 6.43%chose primary medical institutions.Of the 311 patients,only 67(21.54%)had experiences of downward referral.Univariate analysis showed that educational background,type of medical insurance,annual family income,place of residence and distance to the nearest primary medical institution were the related factors for downward referral of patients(P<0.05).The results of multivariate Logistic regression analysis showed that the main factors affecting the downward referral experience of residents were education background and place of residence.Residents with primary school education had the most downward referral experience,1.598 times that of those without education(OR=1.598,P=0.037).The downward referral experience of residents who lived in urban rural fringe areas(OR=0.155,P=0.005),town rural frin

关 键 词：康复门诊 分级诊疗 基层首诊 问卷调查 海口地区 

分 类 号：R195[医药卫生—卫生统计学]