Intention Survey Of Medical Personnel And Residents In Taiyuan City On Hierarchical Medical Ystem

Objective:The cognition,attitude and suggestion of Medical Personnel in hospitals and residents in the 10 areas of Taiyuan City were investigated,to find out the problems of the hierarchical medical system.Combined with the hierarchical medical system,the aim of the study was also to improve the service capacity of primary medical institutions,and to put forward the effective recommendations and policy for the good pattern of "slight illness into the community,serious illness into the hospital,Recovery back to the community." Methods:This study selected 5 Tertiary hospitals in Taiyuan City,5 Second-level hospitals,All 10 districts and counties,a total of 10 community health service center or hospitals in towns and townships,Involved to the consolidated hospital,Specialist hospital,primary hospital,a total of 1200 questionnaires to investigate medical staff,give each grade hospital 400 questionnaires,retrieve 942 effective questionnaires,the effective rate was 78.5%%.Extraction of Taiyuan City conducted a questionnaire survey of 10 areas' residents,a total of 1200 questionnaires,1134 valid questionnaires,the effective rate was 94.5%%.Statistical methods include: descriptive analysis,rank sum test,Chi-square analysis,Select meaningful variables to establish classification model was used for multivariate analysis.Results:More than 90% of the medical staff and only 54.7% of residents have understood the hierarchical medical system.96.4% of the medical staff and more than 90% of residents in favor of hierarchical medical system.The factors that affected the approval on hierarchical medical system of medical staff were: the degree of understanding of the hierarchical medical system,diagnosis and treatment propaganda power,the impact of hierarchical medical system on the medical institutions,their income.The Factors that affected the approval of residents were: family monthly income,education,medical insurance type,hierarchical medical system publicity,local hierarchical medical system publicity,the experience to primary hospital.46.8% of resident were willing to visit,and 53.2% of residents do not want to visit primary hospitals at first.The factors affecting the first visit to primary hospitals were: education,family monthly income,the degree of understanding of the hierarchical medical system,the degree of favor,the expierence to go primary hospitals,the satisfaction of the primary hospital,expert clinic in primary hospitals,primary hospital treatment reimbursement ratio.48.1% of residents were willing to and 51.9% of residents do not want to sign with the the general practitioners in primary hospitals.The influencing factors of residents to sign up general practitioners were: family monthly income,medical insurance type,the degree of medical treatment,the degree of understanding of the hierarchical medical system,the degree of favor,hierarchical medical system publicity,local hierarchical medical system publicity,the expierence to go primary hospitals,the satisfaction of the primary hospital(,primary hospitals first visit willing,Primary hospital treatment reimbursement ratio.66.1% of residents said they were willing to turn down to primary hospital,and 33.9% of residents were reluctant to turn down.The factors that affected residents' willingness to turn down were: family income,the degree of understanding of hierarchical medical system,the degree of favor,the satisfaction of the primary hospital for treatment,primary hospitals first visit willing,expert clinic in primary hospitals,primary hospital treatment reimbursement ratio.two-way referral approval degree.75.5% of the medical staff thought that the two-way referral implementation was common or not good.Residents believed that medical union can provide six aspects of help: laboratory tests,experts' clinic,critically ill patients can be transformed to an upper hospital timely,improving the level of primary hospital medical care,rationalizating primary hospital treatment process,registering from large hospital.But 85 % hospital medical staff of all levels of hospitals thought that medical union contaction was loose.More than 70% of the hospital medical staff thought that the effect of medical association was no effect.Conclusion:(1)The propaganda of hospital doctors and local about hierarchical medical system is the influencing factor of residents' understanding and approval degree.Therefore,the current propaganda work is an important prerequisite for the implementation of hierarchical medical system.(2)To improve the first visit rate of primary hospital is the primary link to the implementation of hierarchical medical system,sign with the general practitioners in primary hospitals.to improve the primary hospital medical satisfaction,improve the proportion of primary hospital reimbursement to promote primary hospital first visit.(3)More than three quarters of the medical staff think that the effect of the two-way referral,linkage from top to bottom are general or bad linkage.So the Hierarchical Medical System need to develop a strict two-way referral standards and forms to ensure the smooth transfer of the upper and lower referral work;and establish close Medical union,improve the primary hospital service capacity.(4)To speed up the cultivation and construction of general practitioners.