医联体模式下各级医疗机构人员对分级诊疗的认知调查

摘要

目的:了解上海市普陀区西部医联体各级医疗机构医务人员对分级诊疗制度的认知现状,分析分级诊疗在实施过程中存在的问题并提出建议.方法:对上海市普陀区西部医联体内10所成员单位进行问卷调查,回收有效问卷637份.结果:普陀区西部医联体医务人员对分级诊疗的总体了解程度高,三级医疗机构对分级诊疗的了解率最高(46.1％);社区卫生服务中心的医务人员对前来就诊患者介绍分级诊疗制度的比率最高.双向转诊对本医疗机构就诊患者的数量改变方面,社区卫生服务中心＞二级医疗机构＞三级医疗机构,差异具有统计学意义(P＜0.05).在推进分级诊疗举措的认知方面,三级医疗机构对绩效考核激励机制可提高医务人员积极性以及加强培训、改变就医习惯的认可度最高(P＜0.05).结论:各级医疗机构内医务人员对分级诊疗的认知和支持程度是分级诊疗能否顺利开展的关键.区域医联体在推进分级诊疗制度的进程中,成效已初步显现,但面临困难仍然很多,需要政府及各级医疗机构共同探索,明确职责分工,构建合理医疗新格局.%Objective:To understand the medical staffs understanding of hierarchical healthcare system in the western medical association of Shanghai Putuo district,analyze the problems emerged during the implementation of hierarchical healthcare system,and propose possible solutions.Method:A questionnaire survey was conducted for 10 members of the western medical association of Shanghai Putuo district,and 637 valid questionnaires were collected.Results:The medical staff of the western medical association of Putuo district had a high level of understanding of hierarchical healthcare system.The tertiary medical institutions had the highest knowledge rate of the hierarchical medical system (46.1％).Medical staff from the community health centers had the highest rate of introducing hierarchical medical system to patients.The change of patient numbers affected from the two-way referral mechanism among the various levels of medical institutions are significantlydifferent (community health centers ＞ secondary medical institutions＞ tertiary medical institutions,p＜0.05).It showsthat staff in tertiary hospital gets the highest agreement on countermeasures of performance assessment and strengtheningtraining(p＜0.05).Conclusion:The degree of cognition and support of the medical staff at various levels of medical institutionsis the key to the successful development of the hierarchical medical system.Regional medical integration's efforts onadvancing the process of the classification system had appeared.Difficulties needed government,medical institutes at eachlevels made joint affects and clear responsibilities to construct a new and rational healthcare system.