CAJ | 학술논문

目的了解患者和社区医务人员对双向转诊工作的评价和看法,探讨开展双向转诊工作不顺利的原因及改进方法.方法针对2009年6-12月北京协和医院普通内科与北京市朝阳区高碑店社区卫生服务中心及下属4个社区卫生服务站开展的双向转诊工作进行调查,对关键人物(包括在社区预约上转的患者6例和社区医务人员16名)进行深入访谈,通过对访谈资料进行转录、整理,采用主题框架法进行描述性分析和解释性分析,以提炼存在的问题,并探讨相应的对策.结果 6例患者中只有1例患者顺利完成双向转诊过程.从患者的角度看,未能完成双向转诊的原因主要包括觉得预约时间长、交通不方便、有其他更理想的就医途径、医院内就诊流程不畅、有些医生不令人满意等.社区医务人员认为双向转诊中的困难来源则包括制度、医生、患者以及医患相互作用等诸多因素,例如医生没有赢得患者信任、医生之间或医患之间缺乏有效的沟通、患者的就医选择多而需要经社区向医院转诊的患者数量少、患者就医的期望值过高、部分患者的健康意识不足等等.关于提高双向转诊成功率所需要的改进措施,社区医务人员在政府层面、医院层面、患者层面、社区层面和医院-社区-患者沟通层面都进行了分析,特别强调自身素质提高的重要性,提出要提高专业水平、首诊能力.结论医院与社区双向转诊过程中断受多种因素影响.要实现大型综合医院与社区卫生服务机构间的衔接与合作,不仅需要相应的政策、制度及硬件设施保障,而且应该以医务人员素质的提高为重点,强调通过转诊等多种形式加强社区医生的培养.
목적 료해환자화사구의무인원대쌍향전진공작적평개화간법,탐토개전쌍향전진공작불순리적원인급개진방법.방법 침대2009년6-12월북경협화의원보통내과여북경시조양구고비점사구위생복무중심급하속4개사구위생복무참개전적쌍향전진공작진행조사,대관건인물(포괄재사구예약상전적환자6례화사구의무인원16명)진행심입방담,통과대방담자료진행전록、정리,채용주제광가법진행묘술성분석화해석성분석,이제련존재적문제,병탐토상응적대책.결과 6례환자중지유1례환자순리완성쌍향전진과정.종환자적각도간,미능완성쌍향전진적원인주요포괄각득예약시간장、교통불방편、유기타경이상적취의도경、의원내취진류정불창、유사의생불령인만의등.사구의무인원인위쌍향전진중적곤난래원칙포괄제도、의생、환자이급의환상호작용등제다인소,례여의생몰유영득환자신임、의생지간혹의환지간결핍유효적구통、환자적취의선택다이수요경사구향의원전진적환자수량소、환자취의적기망치과고、부분환자적건강의식불족등등.관우제고쌍향전진성공솔소수요적개진조시,사구의무인원재정부층면、의원층면、환자층면、사구층면화의원-사구-환자구통층면도진행료분석,특별강조자신소질제고적중요성,제출요제고전업수평、수진능력.결론 의원여사구쌍향전진과정중단수다충인소영향.요실현대형종합의원여사구위생복무궤구간적함접여합작,불부수요상응적정책、제도급경건설시보장,이차응해이의무인원소질적제고위중점,강조통과전진등다충형식가강사구의생적배양.
Objective To evaluate the current situation of two-way referral system by qualitative study.Methods The qualitative study was carried out in Department of General Internal Medicine of Peking Union Hospital and 4 clinics under Beijing Gaobeidian Community Health Center from June to December 2009.In-depth interview was conducted on 6 patients,who were referring from community health center to tertiary hospital and 16 general practitioners in the community.The method of thematic framework was used for data analysis.Results Only 1 of the 6 patients,who made the appointment,completed the two-way referral.From the view of the patients,the interrupt of the two-way referral was due to long-time waiting,inconvenient transportation to the hospital,availability of specialists,unsmooth process of referral and unsatisfied doctors.However,the community health service staff thought that difficulties of the two-way referral originated from the system,doctors,patients,and doctor-patient relationship.Sometimes patients distrusted doctors both in hospital and in community; communications between doctors or between doctors and patients were less efficient; patients had multiple choice for their primary care and they may go to any hospital freely bypass community-based referral system; patients had excessive expectation for medicine and doctors; some patients paid less attention to their own health,and so on.For improvement of the two-way referral system,the community health service staff proposed concrete measures in terms of relevant policy,the hospital,community health service,the doctors and patients; they emphasized the importance of upgrading their own communication ability and professional skills for primary care.Conclusions Many factors may influence successful implement of two-way referral,so it is necessary to improve the relevant policy and procedures and to upgrade medical staff in community.