北京市医联体内患者基层首诊意愿及其影响因素研究

目的:分析医联体内患者对医联体的认知与满意度评价,探讨医联体模式下患者就医选择、基层首诊情况及其影响因素,为促进医联体建设提供参考。方法:采用方便抽样法从北京市15个区抽取18个医联体,自行设计调查问卷,以1 280名医联体内就诊患者作为研究对象开展问卷调查,运用χ2检验与二元Logistic回归开展统计学分析。结果:59.12%的患者了解医联体及相关政策,39.12%的患者对医联体满意;72.32%的患者愿意基层首诊;各区医疗资源分布不均,就诊医院类型、医联体了解程度、医联体经历、医联体满意度对基层首诊意愿的影响有统计学意义。结论:北京市医联体建设取得一定的效果,基层首诊意愿初步形成,但区域医疗资源和社区卫生服务能力与患者基层首诊意愿具有相关性,相关政策宣传力度不足及现行医保政策等制约医联体的发展。

Study on influencing factors on willingness about basic initial diagnosis of patients in medical alliance in Beijing

Objective:This article analyzes the cognition and satisfaction evaluation of patients in medical alliance. Under the medical alliance mode, the present study tries to explore the choice of medical treatment of patients, the first diagnosis of primary health care institutions and its influencing factors, in order to provide reference for the construction of medical alliance. Methods:With the help of stratified sampling method, eighteen (18) medical alliances were selected from 16 districts and counties in Beijing. The survey questionnaire was designed to be used as the tool for data collection. A total of 1 280 patients in medical alliance participated in this study. The Chi-square Test and binary logistic regression model were used for statistical analysis. Results:59.12% of patients understand the medical association and related policies. 39.12% of the patients are satisfied with the medical association, 51.44% of patients are willing to take first diagnosis at primary health care institutions. The distribution of medical resources in various districts is uneven. The type of hospital visited, the degree of understanding of medical alliance, the experience of medical alliance and the satisfaction toward medical alliance will have an impact on the willingness about basic initial diagnosis, and the influence make a significant statistical sense. Conclusions:The Medical alliance construction in Beijing has achieved a certain effect, as first visit at primary health care institutions will be the initial formation. But the unbalanced distribution of medical resources in various districts, the service capacity of primary care institutions which does not meet the needs of patients, the insufficient sensitization of relevant policy and the current health insurance policy are seen as limiting factors to the development of medical alliance.