| Objective: In recent years,the Chinese government has promoted the practice and exploration of the integrated health care system nationwide to deepen the medical and health reform,improve the capability of community-level health services,and integrate medical resources.As grassroots practitioners of the integrated health care system,general practitioners(GPs)play an irreplaceable role in the health service network,so it is necessary to evaluate the development of integrated health care system from the perspective of GPs.The purpose of this study is to explore the cognition and evaluation status of the integrated health care system among GPs,and to provide the reference for promoting the development of integrated health care system and hierarchical medical system.Methods: A cross-sectional survey was conducted among 764 GPs who participated in the training of general practitioners in Hubei province of China from April to June 2017.On the basis of literature research and expert consultation,a questionnaire was designed to collect the basic information of GPs,evaluation on the service capacity of community health service institutions(CHSIs),business contacts with superior hospitals,and GP’s cognition and evaluation information on the integrated health care system.On-site investigation was conducted by investigators with unified training through centralized investigation and on-site quality control and questionnaire review.SPSS 22.0 software was used for statistical analysis of the data.GPs’ basic information was analyzed descriptively.For GPs’ cognition and evaluation information on the construction of integrated health care system:chi-square test or Fisher’s exact probability method was used for the correlation analysis of disordered classification.Spearman rank correlation analysis was usedfor correlation test of rank data.Kendall’s correlation was used for consistency detection of both ordered categorical variables.Wilcoxon signed-rank test was used to compare the non-parametric test of two related samples.Multinominal Logistic regression was conducted to analyze the factors influencing the degree of GPs’ support to the construction of integrated health care system.Results: A total of 764 questionnaires were distributed in this survey,and 749 questionnaires were finally recovered with an effective recovery rate of 98.0%.Of the 749 GPs,470 were males(62.75%).GPs’ cognition of the integrated health care system promoting the realization of hierarchical medical treatment pattern was related to the frequency of admitted downward referral patients(ρ=0.204,P<0.001),but not to their professional titles and the frequency of participation in upward referral patients(P>0.05).60.92% of the 749 GPs were familiar with the integrated health care system,and 88.25% of the GPs were apt to support the development of integrated health care system.The GPs’ familiarity with the integrated health care system was statistically correlated with the professional guidance(ρ = 0.328,P<0.001)and visits(ρ =0.257,P<0.001)of doctors from superior hospitals,and with consistency(Kendall’s tau-b =0.305,P<0.001;Kendall’s tau-b=0.236,P<0.001),but not job titles of GPs(P>0.05).The results were similar to the analysis of GPs’ support for the integrated health care system.Multivariate Logistic regression analysis showed that even if GPs believed that the integrated health care system might reduce the source of diseases in CHSIs,they would not strongly disagree with it(P<0.001).There was no statistically significant difference in the influence of working years and medical circumstances of CHSIs on the degree of GPs’ support for the integrated health care system(P>0.05).Comparing the role of integrated health care system in two-way referral,GPs believed that the promoting role of integrated health care system in guiding community hospitals to upward referral patients(86.3%)was higher than that of guiding superior hospitals to downward referral patients(70.1%),and the difference was statistically significant(P<0.001).Comparing the influence of integrated health care system on the work of CHSIs and superior hospitals,GPs thought that the integrated health care system increased the workload of CHSIs more than that of superior hospitals(P<0.001),but there was no significant statistical difference in the increase of patients and doctors’ income between the CHSIs and the superior hospitals(P>0.05).70.1% believed that themost difficulty was insufficient publicity.87.7% suggested that superior hospitals should regularly arrange doctors to CHSIs for professional guidance.Conclusions: GPs’ overall cognition of the integrated health care system was mediocre.Most of the GPs supported the integrated health care system,but its promoting effect on downward referral patients was not considered as good as that of upward referral,and there was less professional guidance for CHSIs.Insufficient publicity and imperfect two-way referral mechanism were the main obstacles to its development.It is necessary to strengthen the publicity of related policies of the integrated health care system,improve the basic medical service capacity,and promote the realization of hierarchical medical treatment pattern. |
