医联体内医务人员对分级诊疗的态度及其影响因素的调查研究
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摘要
目的了解医联体内医务人员对分级诊疗的认知与态度现状,探讨影响医务人员对分级诊疗态度的影响因素。方法随机抽取两家医联体集团内17所成员单位,以医务人员为调查对象派发调查问卷,共回收有效问卷1012份。结果医务人员对分级诊疗的认知程度较高,总体认知率达75.98%;不同级别医务人员对分级诊疗的认知情况存在差异(P<0.05);相比而言,一级医疗机构中的医务人员对分级诊疗建设的态度更积极;分级诊疗的认知情况是影响医务人员对分级诊疗态度的重要因素,认知情况越好,对分级诊疗的赞同程度越高。结论要进一步提高医务人员对分级诊疗的认知水平,完善医联体模式下各级医疗机构长效合作机制,重视调动医务人员参与分级诊疗的工作积极性,推进绩效考核与薪酬机制改革,保障分级诊疗的可持续发展。
Objective: To explicit the status of cognition and attitude of medical staff in the medical alliances to hierarchical diagnosis and treatment, and to explore the influencing factors affecting the attitude of medical staff to hierarchical diagnosis and treatment. Methods: In the study, 17 medical institutions of the two medical alliances were randomly selected, and the questionnaire was distributed to the medical staff for investigation. A total of 1012 effective questionnaires were collected. Results: The cognitive level of the medical staff was higher in hierarchical diagnosis and treatment, and the overall cognitive rate was 75.98%. There were significant differences in the cognition of different levels of medical staff(P<0.05). In contrast, the attitude of the medical staff from the primary medical institutions were more positive for the construction of hierarchical diagnosis and treatment. The cognition of hierarchical diagnosis and treatment was an important factor that affected the attitude of medical staff to construct hierarchical diagnosis and treatment. The better the cognitive situation, the higher the level of approval for hierarchical diagnosis and treatment. Conclusion: To further improve the level of medical staff for hierarchical diagnosis and treatment, to improve the long-term cooperation mechanism of medical institutions at all levels under the mode of medical alliances, to pay attention to mobilize the enthusiasm of medical staff to participate in hierarchical diagnosis and treatment, and to promote the reform of performance appraisal and salary mechanism to ensure the sustainable development of hierarchical diagnosis and treatment.
Objective: To explicit the status of cognition and attitude of medical staff in the medical alliances to hierarchical diagnosis and treatment, and to explore the influencing factors affecting the attitude of medical staff to hierarchical diagnosis and treatment. Methods: In the study, 17 medical institutions of the two medical alliances were randomly selected, and the questionnaire was distributed to the medical staff for investigation. A total of 1012 effective questionnaires were collected. Results: The cognitive level of the medical staff was higher in hierarchical diagnosis and treatment, and the overall cognitive rate was 75.98%. There were significant differences in the cognition of different levels of medical staff(P<0.05). In contrast, the attitude of the medical staff from the primary medical institutions were more positive for the construction of hierarchical diagnosis and treatment. The cognition of hierarchical diagnosis and treatment was an important factor that affected the attitude of medical staff to construct hierarchical diagnosis and treatment. The better the cognitive situation, the higher the level of approval for hierarchical diagnosis and treatment. Conclusion: To further improve the level of medical staff for hierarchical diagnosis and treatment, to improve the long-term cooperation mechanism of medical institutions at all levels under the mode of medical alliances, to pay attention to mobilize the enthusiasm of medical staff to participate in hierarchical diagnosis and treatment, and to promote the reform of performance appraisal and salary mechanism to ensure the sustainable development of hierarchical diagnosis and treatment.
引文
[1] 国务院办公厅.国务院办公厅关于推进医疗联合体建设和发展的指导意见[EB/OL].(2017-04-26) [2018-07-20].http://www.gov.cn/zhengce/content/2017-04/26/content_5189071.htm.
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[15] 李英梅,殷佩浩,朱轶群,等.医联体模式下各级医疗机构人员对分级诊疗的认知调查[J].中国医院,2017,21(7):18-20.
[16] 张强,吴少玮,方鹏骞.我国社区卫生人力流动影响因素鱼骨图分析[J].医学与社会,2012,25(1):54-57.
[17] 李茜,李凤如,史培娜,等.北京市某医联体医务人员工作积极性现况分析[J].医学与社会,2016,29(1):43-46.
[2] 王虎峰,刘芳,廖晓诚.适应分级诊疗新格局创新医保支付方式[J].中国医疗保险,2015(6):12-15.
[3] 胡安霞,闫娟娟.山西省医务人员对分级诊疗认知、态度及影响因素分析[J].卫生软科学,2017(11):6-9.
[4] 卢国强.分级诊疗须防陷入利益博弈僵局[N].经济参考报,2016-11-15(005).
[5] 高美兰.太原市医务人员和居民对分级诊疗的意向调查[D].太原:山西医科大学,2017.
[6] 杨阳,方国瑜,崔华欠,等.广州市医护人员分级诊疗模式认知及其影响因素分析[J].中国卫生事业管理,2015,32(1):22-26.
[7] 许栋,王国斌,张明,等.公立医院与基层医疗卫生机构分工协作的现状及策略[J].中国医院管理,2013,33(4):11-13.
[8] 王玲,赵琨,赵锐,等.分级诊疗实施后对医务人员的影响及其认知状况调查[J].中国卫生政策研究,2018,11(1):53-57.
[9] 余红星,姚岚,李莹,等.基于分级诊疗的医疗机构分工协作机制探究[J].中国医院管理,2014,34(7):1-3.
[10] 宋之杰,郭燕平,吉增良,等.分级诊疗下二三级医院服务资源整合的演化博弈分析[J].中国卫生政策研究,2018,11(2):44-51.
[11] 卢慧,魏来,余昌胤,等.分级诊疗相关利益主体的损益分析[J].卫生经济研究,2018(2):31-35.
[12] 高鹏,范君晖.协同视域下医联体的生成逻辑与路径优化研究[J].卫生经济研究,2018(9):18-20.
[13] 陈玲丽,余昌胤,魏来,等.博弈论视角下的医疗联合体运行模式探讨[J].中国医药导报,2016,13(21):131-133,145.
[14] 黄培,易利华.博弈论视角下双向转诊路径选择研究[J].中国初级卫生保健,2013,27(11):3-5.
[15] 李英梅,殷佩浩,朱轶群,等.医联体模式下各级医疗机构人员对分级诊疗的认知调查[J].中国医院,2017,21(7):18-20.
[16] 张强,吴少玮,方鹏骞.我国社区卫生人力流动影响因素鱼骨图分析[J].医学与社会,2012,25(1):54-57.
[17] 李茜,李凤如,史培娜,等.北京市某医联体医务人员工作积极性现况分析[J].医学与社会,2016,29(1):43-46.