| Objective: To analyze the current status of the two-way referral of medical institutions in Tongchuan City,Shaanxi Province,and to discuss the causes of the various problems in the implementation of the two-way referral system in Tongchuan City and the general solutions.Methods: 1.21 health service staff from 2 community health service centers and 115 medical staff from 5 hospitals were selected.A total of 136 questionnaires were sent to investigate the basic situation of the two-way referral in Tongchuan City.2.1300 patients admitted to the People’s Hospital of Tongchuan City from February 2015 to October 2016 were selected as the study subjects,using self-made questionnaires to collect basic patient information,knowledge of the two-way referral,whether they have received two-way referral,and the degree of satisfaction with the two-way referral service for the patient and for the two-way referral.3.The medical personnel and management personnel working in basic medical institutions and experts and scholars specializing in basic health and medical research were interviewed to find out the status quo of grassroots community health service development in each part of the country,and the basic health care units and upper level hospitals.The two-way referral work started the status quo.4.The survey results being Reviewed,invalid questionnaires werer eliminated,and a database was established for data entry using FOXPRO 6.0.SPSS 11.0 was used for statistical analysis of data.Statistical methods included statistical description,chi-square test,and LOGISTIC regression.Results: 1.The survey results showed that more than one-third of the staff of 21 community health service centers had referred patients to higher-level hospitals.The main reasons for their referral were: inability to diagnose,inability to treat,and weakness.Surgery,patients actively request,which is the most important reason for inability to diagnose.Among the 115 hospital medical staff,more than one-fifth of the patients who had been referred by the community were transferred.The main reason was that the community could not be diagnosed.The second reason was the deterioration of the patient’s condition,the community’s inability to treat and the community’s inability to Perform some type of inspection.2.The rate of knowledge awareness of two-way referral services was 43.08% in 1,300 referring patients.The main channel for acquiring knowledge was hospitals(19.08%),followed by community health service centers(14.23%);patients were willing to accept transfer of 1,253 persons,accounting for 96.38% of patients willing to accept the transfer were mainly due to superior medical technology(96.38%),higher grade hospitals(84.92%),higher level of auxiliary medical examination equipment(88.62%),and appointment of experts through referral(32.92)%);A total of 918 patients(70.62%)who are willing to return to the community for rehabilitation after a stable condition.The main reason why patients are willing to accept the next rotation is the distance(70.62%),the higher proportion of Medicare reimbursement(70.62%),the cheaper price(64.31%),and the higher-level doctors can still instruct(61.15%),and there are family doctors(57.69%);unwillingness to accept downgrades mainly due to mistrust of community health care(29.38%),complicated referral procedures(27.23%),limited reimbursement for medical insurance(25.31%),and community-free bed services(23.54%))Etc.;of the 150 patients who had received two-way referral service,73.33% were satisfied with the two-way referral,and the average accounted for 22.67% and 4.00% for those who were unsatisfied.In the evaluation of treatment effects,66.00%,26.00%,and 8.00% were satisfied,normal,and dissatisfied,respectively.3.The results of the interviews all indicated that the two-way referral is a reform direction with great prospects.More than 80% of the people think that the two-way referral is completely feasible in the current environment,but there are also more than 50% of the respondents.Considering that the current two-way referral implementation is not ideal,they put forward several problems that they saw in their work: First,there is not a standardized process that can be unified reference for two-way referral;secondly,there is too much communication between different medical units.Less;Third,the patient does not understand the two-way referral;again,the medical institution has an objective conflict of interest and struggle;and finally,the primary medical unit’s medical level is too poor.Conclusions: 1.The two-way referral service in Tongchuan City is in the development phase.The community health service center and the district hospitals have an approximate result of the division of responsibilities among each other.It can be said that the work has achieved certain results.At the same time,there are several defects in the two-way referral service in Tongchuan City: There is no unified policy document as the basis for implementation;the construction work between different urban areas is not uniform,and two-way referral does not tend towards a standardized process.There is no promotion measure for referral behavior in hospitals,and hospitals have no active initiative in referral;community health service centers lack resources and the hospitals have not provided sufficient professional help to community service centers;the public of countries and regions or The private medical insurance system also does not support the two-way referral system.2.The proportion of residents in Tongchuan City who went to the community for the first visit was relatively low.Hospitals and communities were the main channels for city residents to obtain two-way referral knowledge.Patients who received two-way referral were more satisfied with the timeliness of two-way referral and treatment results.It is suggested that related departments should increase the implementation of two-way referral,establish and improve two-way referral standards and norms,and improve the level of community health services. |
PDF Full Text Request