摘要
目的探讨新疆患者选择首诊医疗机构的影响因素。方法以安德森模型为理论指导框架,构建基于个体特征、政策认知、一级医院服务可及性的评价方案,对2018年1月至2019年1月在新疆地区8所医疗机构就诊的2306名患者展开调查,分析个体特征、政策认知、一级医院服务可及性对新疆患者首诊医疗机构选择的影响。结果不同年龄、性别、民族、受教育程度、户籍、月收入、医保类别、商业补充险参保情况的患者首诊医疗机构的选择差异具有统计学意义(均P<0.05)。对双向转诊、首诊负责制、家庭医生管理、医药分开政策、分级诊疗、社会医保政策6类政策了解程度不同的患者,以及到达最近的一级医院所耗费的时间不同、候诊时间不同的患者,首诊医疗机构的选择差异具有统计学意义(均P<0.05)。多因素分析结果显示,50岁以上、维吾尔族、月收入低于3000元及对双向转诊、家庭医生管理、分级诊疗政策十分了解或比较了解的患者,选择首诊医疗机构时更倾向于一级医院;城镇居民、参加兵团医疗保险、对医药分开政策和社会医保政策有一定程度了解(十分了解、比较了解、一般了解)、到达最近的一级医院所耗费时间>40 min、候诊时间>75 min的患者,选择首诊医疗机构时更倾向于二级及以上医院。结论新疆患者的个体特征和一级医院医疗服务的可及性是其选择首诊医疗机构的基础影响因素,政策认知是其选择首诊医疗机构的决定性因素,新疆地区分级诊疗取得一定成效,但合理、科学的择医格局尚未形成。
Objective To investigate the influencing factors for patients in Xinjiang in choosing medical institutions for the first diagnosis.Methods Taking the Anderson model as the theoretical guidance framework,an evaluation protocol based on individual characteristics,policy understanding,and accessibility to medical services of ClassⅠhospitals was developed to survey 2306 patients from eight medical institutions in the Xinjiang region from January 2018 to January 2019.And the impacts of individual characteristics,policy understanding,and accessibility to medical services of ClassⅠhospitals on patients in Xinjiang in choosing medical institutions for the first diagnosis were analyzed.Results There was a statistically significant difference in patients′choice of medical institutions for the first diagnosis between patients in different age groups,with different gender,of different ethnic groups,with different educational levels,household registration,monthly incomes,medical insurance categories,or coverage of commercial supplementary medical insurance(all P<0.05).The choice of medical institutions for the first diagnosis showed a statistically significant difference between patients with different awareness of the policies regarding six aspects,including two-way referral,first diagnosis responsibility system,family doctor management,policy for separating medical treatment and drug sales,tiered diagnosis and treatment,and social health insurance policy,or between patients spending different time on visiting the nearest ClassⅠhospital or in the waiting room(all P<0.05).The results of multivariate analysis revealed that,in terms of the option of medical institutions for the first diagnosis,ClassⅠhospitals were more preferred in patients older than 50 years,of Uyghur nationality,with a monthly income lower than 3000 yuans,or who were familiar to or fairly knew the two-way referral,family doctor management,and tiered diagnosis and treatment policy;ClassⅡor above hospitals were more preferred in urban residents,patients who participated in Xinjiang Production and Construction Corps medical insurance,patients who knew(be familiar to,fairly knew,generally knew)the policy for separating medical treatment and drug sales and the social health insurance policy to some extent,or patients who had to spend over 40 minutes on visiting the nearest ClassⅠhospital or in the waiting room.Conclusion The individual characteristics of and the accessibility to medical services of ClassⅠhospitals for patients in Xinjiang are primary factors influencing patients in choosing medical institutions for the first diagnosis,and policy understanding is a determinant for patients in choosing medical institutions for the first diagnosis.Certain achievements have been made in the tiered diagnosis and treatment in the Xinjiang region,but a reasonable and scientific pattern for selecting a medical institution has not been developed yet.
作者
魏绍明
李娟
刘奎
WEI Shao-ming;LI Juan;LIU Kui(Department of Public Health,the Fifth Affiliated Hospital of Xinjiang Medical University,Urumchi 830054,China;Kazak Autonomous Prefecture of Ili Friendship Hospital,Yining 835100,China)
出处
《广西医学》
CAS
2022年第4期430-437,442,共9页
Guangxi Medical Journal
基金
新疆维吾尔自治区自然科学基金(2019D01C282)。
关键词
分级诊疗
医疗机构选择
首诊
影响因素
新疆
Tiered diagnosis and treatment
Selection of medical institution
First diagnosis
Influencing factor
Xinjiang
