CAJ | 학술논문

针对北京市某社区卫生服务机构人员有关双向转诊现状及自身状况的认识进行问卷调查,结果显示,接受调查的306名工作人员绝大多数知晓双向转诊,但曾参与上转和下转患者的分别仅占51.31％(157人)和31.37％(96人)；上转的原因多为患者病情严重、社区不能诊治(73/157,占46.50％),或患者需要做社区没有的检查(76/157,占48.41％)；认为可接受的下转患者则以诊断明确、治疗方案完善的常见病(267/306,占87.25％)和病情处于康复期或恢复期(247/306,占80.72％)的患者为主.认为“医疗机构间缺乏沟通”是影响双向转诊工作开展的主要障碍(177/306,57.84％)；“转诊流程不通畅”是转诊过程中风险产生的主要原因(145/306,47.39％)；63.72％(195/306)的工作人员认为本机构目前不能够承担、或者需要提高改进后才能够承担接诊下转患者的任务.306人中只有6.87％(21人)的工作人员认为目前自身的知识水平不能够适应服务对象的要求；77.78％(238人)认为自己的工作量大,仅21.89％(66人)能较好地从目前工作中得到满足,27.78％(85人)的人员认为目前从事的工作有较好或很好的前景.调查结果从一个侧面反映了双向转诊和社区卫生服务工作的现状,提示除制度、流程等的改进以外,调动社区卫生服务人员的工作积极性,提高其认识水平、医疗服务技术水平和服务质量,实现医疗机构间以及全科医生与专科医生之间畅通的信息沟通,是克服实际障碍、顺利开展双向转诊工作的基础.
침대북경시모사구위생복무궤구인원유관쌍향전진현상급자신상황적인식진행문권조사,결과현시,접수조사적306명공작인원절대다수지효쌍향전진,단증삼여상전화하전환자적분별부점51.31％(157인)화31.37％(96인)；상전적원인다위환자병정엄중、사구불능진치(73/157,점46.50％),혹환자수요주사구몰유적검사(76/157,점48.41％)；인위가접수적하전환자칙이진단명학、치료방안완선적상견병(267/306,점87.25％)화병정처우강복기혹회복기(247/306,점80.72％)적환자위주.인위“의료궤구간결핍구통”시영향쌍향전진공작개전적주요장애(177/306,57.84％)；“전진류정불통창”시전진과정중풍험산생적주요원인(145/306,47.39％)；63.72％(195/306)적공작인원인위본궤구목전불능구승담、혹자수요제고개진후재능구승담접진하전환자적임무.306인중지유6.87％(21인)적공작인원인위목전자신적지식수평불능구괄응복무대상적요구；77.78％(238인)인위자기적공작량대,부21.89％(66인)능교호지종목전공작중득도만족,27.78％(85인)적인원인위목전종사적공작유교호혹흔호적전경.조사결과종일개측면반영료쌍향전진화사구위생복무공작적현상,제시제제도、류정등적개진이외,조동사구위생복무인원적공작적겁성,제고기인식수평、의료복무기술수평화복무질량,실현의료궤구간이급전과의생여전과의생지간창통적신식구통,시극복실제장애、순리개전쌍향전진공작적기출.
To assess the perceptions on two-way referral system and career development of community health practitioner,a cross section questionnaire survey was conducted among health practitioners in Dongcheng and Gaobeidian community health service centers of Beijing from April,2009 to July,2009.There are 306 practitioners who finished the survey.51.31％ of the practitioners had experience of referring patients to tertiary hospitals while 31.37％ of them had received the patients referring back from tertiary hospitals.The reasons of referring to tertiary hospital were severity of diseases (46.50％) or tests not available in the community (48.41％).The reasons of referring back from hospital were common diseases with confirmed diagnosis (87.25％) or patients in convalescence (80.72％).57.84％ practitioners took the poor communication between community and hospital as the major barrier for the two-way referral,while they thought unsmooth process (47.39％) and poor communication between themselves and the hospital doctors (32.35％) were the major risks during the two-way referral.63.72％ practitioners thought they would have difficulties to accept patients referring back from hospital,but less than 7％ thought themselves now incompetent for their patients needs.77.78％ of them believed that their workload was more than that they could bear.Only 21.89％ of them could get enough job satisfaction,27.78％ of them held positive opinion on their future career path.After all,to achieve smooth two-way referral,motivating the health practitioners in community to give better medical services,building better communication between practitioners in communities and in hospitals,were as important as improving referral policy and referral procedure.