综合医院医生对社区首诊制的认可度及影响因素研究

摘要

Objective To analyze recognition of general hospital physicians on gatekeeper system and explore its influencing factors. Methods From June to December of 2015,962 physicians from four municipal general hospitals in Wuhan were selected by simple random sampling method. Self - designed Questionnaires for General Hospital Physicians including basic information of physicians,their evaluation on service capability of community health service institutions( CHIs),business connection between their hospitals and CHIs and assessment of gatekeeper system were utilized to investigate the enrolled physicians. Multivariate Logistic regression analysis was used to analyze the influencing factors of the recognition of general hospital physicians on the gatekeeper system. Results A total of 953 valid questionnaires were collected with an effective response rate of 99. 1%. Of the research results,817(85. 7% )general hospital physicians approved of the implementation of the gatekeeper system,777(81. 5% )argued that its implementation can play a positive role in guiding the community residents to seek medical care in CHIs,823(86. 3% )agreed with the idea that patients transferring to CHIs when they were in a stable condition,445 (46. 7% )believed that the gatekeeper system can ease the problem of " difficulties and high cost in seeking medical care" . The results of multivariate Logistic regression analysis showed that whether the physicians believed that CHIs can undertake the responsibility of " health gatekeeper" and whether there were business connections between their hospitals and CHIs significantly influenced their recognition on gatekeeper system(P ﹤ 0. 05). Conclusion The recognition of the gatekeeper system is rather high among general hospital physicians. Whether the physicians believed that CHIs can undertake the responsibility of " health gatekeeper" and whether there are business connections between their hospitals and CHIs are the influencing factors of their recognition on gatekeeper system. It is suggested to further improve the service ability of CHIs,enhance contact between general hospitals physicians and CHIs,so as so promote further implementation of the gatekeeper system.%目的：了解综合医院医生对社区首诊制的认可度，并探讨其影响因素。方法于2015年6—12月，采用简单随机抽样法，在武汉市抽取4家市级综合医院的962例医生。采用课题组自行设计的《综合医院医生调查问卷》对纳入医生进行调查，主要内容包括医生的基本情况、对社区卫生服务机构能力的评价、所在医院与社区卫生服务机构的业务联系情况、对社区首诊制的评价。采用多因素 Logistic 回归分析探讨综合医院医生对社区首诊制认可度的影响因素。结果共回收有效问卷953份，问卷有效回收率为99.1%。其中，817例（85.7%）认可实施社区首诊制，777例（81.5%）认为社区首诊制能够积极引导居民到社区卫生服务机构就诊，823例（86.3%）赞同病情稳定患者下转至社区卫生服务机构，445例（46.7%）认为社区首诊制能够缓解居民“看病难、看病贵”问题。多因素 Logistic 回归分析结果显示，是否认为社区卫生服务机构能够承担“健康守门人”职责、所在医院与社区卫生服务机构是否有业务联系是综合医院医生对社区首诊制认可度的影响因素（P ﹤0.05）。结论综合医院医生对社区首诊制的认可度较高，是否认为社区卫生服务机构能够承担“健康守门人”职责、所在医院与社区卫生服务机构是否有业务联系是其影响因素。建议进一步提高社区卫生服务机构的服务能力，加强综合医院医生与社区卫生服务机构的联系，以推动社区首诊制的进一步实施。