摘要
目的通过对我院与成都市21个社区卫生服务中心双向转诊患者的情况分析,探讨成都市双向转诊中存在的矛盾和问题以及制约双向转诊实施的因素,提出进一步完善双向转诊制度实施的措施和方法。方法收集了2010年4月—2011年3月我院和21家社区卫生服务中心开展的双向转诊情况,对需要双向转诊的3 652例患者(需要转到社区康复2 635例,从社区转到我院1 017例)按照需要转诊的原因、未能转诊的因素进行分析。采用现场访谈的方式分别召开医院、社区医生、主任、医疗管理者座谈会,就双向转诊制度设计、政府政策支持、双向转诊现状、困扰双向转诊实施的主要因素等进行座谈。结果一年来我院需要转到社区卫生服务中心康复治疗的患者2 635例,其中转诊成功(下转)的50例,需要转诊与成功转诊的比例为52.7∶1;21个社区在一年内共转到我院(上转)治疗的患者1 017例,上转患者与下转患者的比例为20.3∶1;21家社区服务中心共有病床1 623张,床位平均使用率为70.65%,省医院床位平均使用率为112.35%。经过访谈,较多的人认为制约双向转诊的因素包括医疗信息交流不畅、目前无双向转诊标准及转诊流程、转诊双方医院互信不足、医疗行政管理部门在制订区域卫生规划过程中没有充分考虑到双向转诊的因素等。结论成都地区虽然实行了双向转诊制度,但双向转诊的成功率不高,特别是难以将患者从医院转到社区进行康复治疗。
Objective To explore and discuss contradictions and problems existing in the two -way referral system through analyzing the situation of patients＇ referral between Sichuan Provincial People＇s Hospital and 21 community health service centers in Chengdu, and propose measures and methods to further improve the two - way referral system. Methods Totally 3 652 patients required referral from April 2010 to March 2011 （2 635 patients from the hospital to community medical service centers and 1 017 in a opposite direction） were selected. The reasons for referral and the factors for successful and unsuccessful referral were analyzed. The on - site interviews were conducted among doctors, department directors, and medical administrators from both the hospital and the centers. The talking topics included the design of hi -directional referral system, policy support from the government, current status of two - way referral and the main factors restricting the implementation of hi - directional referral sys- tem. Results Among the 2 635 patients needed to have a referral from the hospital to centers （downward referral） for rehabilita- tion only 50 were successfully transferred, with a successful referral ratio of 52. 7： 1. However, concurrently 1 017 patients were transferred from the 21 centers to the hospital （upward referral） . The ratio of upward referral to downward referral was 20. 3： 1. There are a total of 1 623 beds in all the 21 centers, however, the average utilization rate of beds was only 70. 65%, as contras- ted with that of 112. 35% in the hospital. Majority of the interviewers believed that the factors impacting the implementation of two - way referral included un - smooth communication of medical information, no criteria and process of referral so far, shortage of mutual trust between the two referral parties, and non - full consideration of the two - way referral factors by the medical authori- ties in formulating the local health plan. Conclusion Although the two -way referral system has been implemented in Chengdu area, the rate of successful transfer is still lower, especially for the patients needing downward referral.
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第25期2930-2932,共3页
Chinese General Practice
关键词
双向转诊
制约因素
社区卫生服务
Two -way referral
Constraint factors
Community health services
