A Study On The Current Status And Influencing Factors Of Doctor-patient Cognition In Nanjing

Background and purposeAt present,the mode of independent medical treatment in our country makes patients preferentially choose large-scale tertiary hospitals regardless of the severity of the disease,resulting in overcrowding in large-scale medical institutions and almost nobody in primary medical institutions.Because of long-term disorderly medical treatment,the doctors in tertiary hospitals are becoming more and more busy and the ability of primary medical institutions is becoming weaker and weaker;the comprehensive efficiency of the medical service system is difficult to reflect,which has become one of the important fuses of "Difficulty and High Cost of Getting Medical Service".In recent years,the government has introduced the relevant policies of grading diagnosis and treatment,but the effect is not very obvious,the mature mechanism of division of labor and cooperation amongdifferent levels of medical institutions has not yet formed,the overall efficiency of the medical service system remains to be improved.By investigating the cognition of doctors and patients on grading diagnosis and treatment policy in different levels of medical institutions in Nanjing,this study aims to understand the views and attitudes of doctors and patients on the gradingdiagnosis and treatment,and to analyze the factors of the intention of doctors and patients about participation in two-way referral,So that the reasons for restricting the implementation of grading treatment system at the stage would be found and suggestions for further implementation of grading treatment would be provided.MethodsA convenient sampling method was used to investigate doctors and patients in 65 medical institutions in 11 administrative regions of Nanjing,which included 18 general hospitals and 47 community health service centers.The data were collected andfurther entered by usingEpidata 3.1 software and double entry mode.Descriptive analysis,chi-square test,rank sum test and logistic regression analysis were performed by usingSPSS 19.0 software.ResultsA total of 651 questionnaires were distributed to doctors in general hospitals and community health service centers,and 647 valid questionnaires were collected.The valid rate was 99.4%.Andthere were 459 doctors in general hospitals and 188 doctors in community.Doctors in general hospitals are younger than those in community health service centers.And their educational level is significantly higher than that of the doctors in community health service centers.28.8% of the general hospital doctors and 5.9% of the community doctors were well aware of the policy of grading diagnosis and treatment.The difference between them was statistically significant(Z=-6.81,P< 0.001).The success rate of the community doctor’s referral was higher than that of the general hospital doctor’s(P<0.001,OR(95%CI)=7.380(3.450~15.790)).42.9% of the community doctors and 53.6% of the general hospital doctors believed that the current factors affecting the two-way referral were the lack of referral standards.73.9% of the community doctors and 64.1% of the general hospital doctors believed that reforming the payment mode of medical insurance and increasing the proportion of reimbursement at the grass-roots level were beneficial to the implementation of grading diagnosis and treatment(P< 0.05).62.8% of the doctors in the community health service centers and 62.5% of the doctors in general hospitals believed that doctors in community medical institutions should treat the diseases with a prevalence rate of over 5%.A total of 594 questionnaires were distributed to patients in community and general hospitalsand 551 valid questionnaires were collected with the valid rate of 92.8%.68.2% of the surveyed patients chose general hospitals for their first visit after suffering from common diseases.Age,education level and type of medical insurance affected the first visit of the patients.56.8% of the respondents knew the policy of grading diagnosis and treatment,and the factors such as educational level and medical insurance type werestatistically significant.."The closeness of the community health service centerto the home and convenience of medical treatment"(86.4%)were the main reasons for the respondents’ willingness to transfer to the community health service centers,while distrust of the doctors in the community health service centers(64.5%)and the same charges as general hospitals(46.8%)were the main reasons for the respondents’ unwillingness to transfer to the community health service centers.The main reasons for patients’ reluctance to transferto higher hospitals through community medical institutions were cumbersome procedures and the inability to transfer to hospitals by themselves(47.9%).ConclusionThe first consultation rate in community health service centers was low,and the core link of grading diagnosis and treatment was blocked;the cognition of grading diagnosis and treatment policy was different;the two-way referral system was imperfect;and the regulation of differential payment of medical insurance was not effective.Suggestions are as follows: 1.Continue to improve the gradingmedical service system;improve the understanding of service and demand positioning between the supply and demand sides;improve the grass-roots talent team andservice capacity building,enhance patient experience;establish a close medical association to promote two-way referral;2.Strengthen the gradingmedical support system: strengthen the information construction and innovate sharing platform We should reform and improve the relevant medical insurance system and payment methods,rationally disperse the medical risks that may exist in upper and lower medical institutions.