Research On The Implementation Strategies Of Hierarchical Medical Services Of Doctors In Xinjiang Urban And Rural Hospitals

Objective:By understanding the knowledge,attitude and implementation of the hierarchical medical services by doctors in urban and rural hospitals at all levels,analyze the decision-making and influencing factors of the implementation of the hierarchical medical services by urban and rural doctors,explore the bottleneck of the implementation of the hierarchical medical services in Xinjiang,and propose to improve the recommendations and implementation strategies of hierarchical medical services to promote the implementation of hierarchical medical services in Xinjiang.Methods:Using a typical sampling method,A total of 2,160 questionnaires on knowledge,attitude and practice of hierarchical medical services for urban and rural doctors in Xinjiang were distributed to on-job doctors in 135 hospitals in 33 counties and urban areas of 14 prefectures in Xinjiang from May to September 2018.2,119 questionnaires were collected and 2,092 valid ones were collected,The efficiency of the questionnaire was 98.73%.Use prospect theory,path analysis,fuzzy set qualitative comparative analysis and other methods for data analysis.Results:(1)The cognition of urban and rural doctors on the connotation,work content,and purpose of the hierarchical medical services were 87.19%,82.65%,and 78.33%,respectively;the cognition of primary consultation and two-way referral was 84.08% and 52.92%,respectively.(2)59.08% of urban and rural doctors believe that they have the conditions to carry out hierarchical medical services.52.39% of the grassroots doctors are qualified for the first consultation at the grassroots level,and77.15% of the urban and rural doctors are qualified for the referral work.(3)79.06% of doctors in urban and rural hospitals at all levels believe that their unit has begun to implement a hierarchical medical services.35.64% of urban and rural doctors have experience of transferring patients;14.65% of urban and rural doctors have experience of transferring patients;36.70% of urban and rural doctors have experience of receiving transferred patients.(4)Doctors in third-level and urban and rural second-level hospitals have the highest prospects for implementing decision-making when they "transfer patients",which are 0.0805,0.0385,and-0.0041,respectively.The doctors in the urban first-level hospitals have the highest prospect value of implementing decision-making for "first consultation at the grassroots level + receiving and transferring patients",which is0.0167.The doctors in the rural first-level hospitals have the highest prospect value for the decision-making of "accepting and transferring patients",which is 0.0118.(5)The behavior of doctors in the implementation of hierarchical medical services is affected by variables such as their urban and rural areas,hospital level,education level,etc.The influencing effects are-0.14,-0.35,and-0.06,respectively.(6)The basic drug system is imperfect and the referral standard is fuzzy,the referral standard is fuzzy and the medical institution is not clearly positioned.The two routes have the highest original coverage,which are 0.745 and 0.549 respectively.Conclusion:(1)The awareness of urban and rural doctors on the hierarchical medical services needs to be further improved.The rate of recognition of the hierarchical medical services by urban and rural doctors is low,and rural doctors are slightly higher than those in urban areas.(2)The implementation of the hierarchical medical services for doctors in urban and rural hospitals is not good,and the implementation of the hierarchical medical services in rural hospitals is better than that in cities,and the work of upward transfer is better than downward transfer.Doctors in second-tier and third-tier hospitals are more inclined to perform "upgrade" work,doctors in urban first-level hospitals are more inclined to perform "primary first consultation +receiving transfer patients",and doctors in rural first-level hospitals are more inclined to perform "receiving transfer patients" work.(3)The higher the level of the hospital where urban doctors are located,the higher their education level,the lower their qualifications and professional titles,the more they understand the hierarchical medical services,and the lower their recognition of the hierarchical medical services,the less satisfactory their implementation of hierarchical medical services.(4)The imperfect basic drug system,vague referral standards,and unclear positioning among medical institutions are bottlenecks that affect the implementation of the hierarchical medical services by doctors at all levels of urban and rural hospitals.