新疆城乡医生分级诊疗制度执行情况及影响因素研究

鲁珊, 马少伟, 谢慧玲

卫生软科学 ›› 2021, Vol. 35 ›› Issue (4) : 18-22.

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卫生软科学 ›› 2021, Vol. 35 ›› Issue (4) : 18-22. DOI: 10.3969/j.issn.1003-2800.2021.04.005
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新疆城乡医生分级诊疗制度执行情况及影响因素研究

  • 鲁珊, 马少伟, 谢慧玲
作者信息 +

Study on implementation situation and influencing factors of urban and rural hierarchical diagnosis treatment for doctors in Xinjiang

  • LU Shan, MA Shao-wei, XIE Hui-ling
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摘要

目的 了解新疆城乡医生执行分级诊疗制度的情况。方法 2018年5-9月,在新疆14个地州32个县市区135所医院,面向在岗临床医生发放新疆临床医生分级诊疗制度执行情况调查问卷共2160份,回收2119份,有效问卷2092份,有效率为98.73%。结果 79.06%的医生认为本单位已开始执行分级诊疗制度,其中城市医生比例明显低于农村医生,差异有统计学意义(P<0.05)。35.64%的医生处理过“上转患者”,14.65%的医生处理过“下转患者”,36.70%的医生“接收转入患者”。城市和农村一级医院上转率高,达50%左右,主要原因是患者为急危重症、病因不明、需要接受特殊检查或治疗。三级、城市二级、农村县级医生将病情好转及终末期患者下转的比例均不足30%。47.56%的医生有过应转诊而未转诊的情况,农村县级医院医生比例最高,差异有统计学意义(P<0.05),患者及家属盲目选择就诊机构、医保/卫生行政部门对转诊制度执行情况监督、处罚的制度不健全/执行力度不够是医生应转而未转患者的主要原因。结论 农村医院分级诊疗开展情况好于城市医院;上转工作好于下转工作。患者及其家属盲目选择就诊机构、医保/卫生行政部门对转诊制度执行情况监督、处罚的制度不健全、执行力度不够是制约新疆城乡医生转诊工作的主要原因。

Abstract

Objective To understand the implementation of hierarchical diagnosis treatment for urban and rural doctors in Xinjiang. Methods From May to September 2018, a total of 2,160 implementation of hierarchical diagnosis treatment questionnaires were distributed to on-the-job clinicians from 135 hospitals in 32 counties and urban areas in 14 prefectures of Xinjiang, 2,119 questionnaires were received back and 2,092 were valid, with an effective rate of 98.73%. Results 79.06% of doctors believed that their unit had started to implement hierarchical diagnosis treatment system, and the proportion of urban doctors was significantly lower than that of rural doctors, there was statistically significant in difference (P<0.05). 35.64% of doctors had dealt with “up referral”, 14.65% of doctors had dealt with “down referral”, and 36.70% of doctors received referrals. The first-level hospitals in urban and rural areas had high up referral rate which reached about 50%, mainly because of emergency and severe disease, etiology unknown, special examination or treatment. The proportion of down referral on improvement of the disease and terminate stage patient by third-level, urban second-level and rural county-level doctors was less than 30%. 47.56% of the doctors had the situation of that should be referred but failed, it had high proportion in rural county level doctors, there was statistically significant in difference (P<0.05). Main reasons of patients should be referred but failed were that patients and their families blindly chose medical institutions, unsound of implementation of referral system supervise and punishment system by medical insurance/health administration departments, and insufficient enforcement power. Conclusions The implementation of hierarchical diagnosis treatment in rural hospitals is better than that in urban hospitals, up referral is better than down referral. Patients and their family members blindly choose medical institutions, unsound of implementation of referral system supervise and punishment system by medical insurance/health administration departments, and insufficient enforcement power are main reasons of restricting referral work of urban and rural doctors in Xinjiang.

关键词

城乡 / 医生 / 转诊行为 / 影响因素

Key words

urban and rural / doctor / referral behavior / influence factor

引用本文

导出引用
鲁珊, 马少伟, 谢慧玲. 新疆城乡医生分级诊疗制度执行情况及影响因素研究[J]. 卫生软科学, 2021, 35(4): 18-22 https://doi.org/10.3969/j.issn.1003-2800.2021.04.005
LU Shan, MA Shao-wei, XIE Hui-ling. Study on implementation situation and influencing factors of urban and rural hierarchical diagnosis treatment for doctors in Xinjiang[J]. Soft Science of Health, 2021, 35(4): 18-22 https://doi.org/10.3969/j.issn.1003-2800.2021.04.005

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基金

新疆维吾尔自治区自然科学基金-供方视角下农牧区分级诊疗制度落实及完善策略研究:基于前景理论(2017D01C184)
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