Research On The Problems And Countermeasures Of The Implementation Of The Policy Of Multi-point Practice Of Physicians In The Medical Alliance Of Guizhou Provinc

Objective:In this study,doctors,patients and managers in Guizhou Medical Union were taken as the research,to explore the understanding of three major stakeholders ’cognition of doctors’ multi-point practice policy and the willingness to implement policies in the medical association,so that to grasp the dynamic and resistance factors influencing their implementation of the multi-point practice policy.And put forward compensation measures for those who are damaged in the process of policy implementation,improve the willingness of the policy implementation subject.It is great significance to promote the sinking and sharing of high-quality medical human resources and improve the current situation of the medical and health service system in Guizhou Province.Methods: With the help of literature research method,using CNKI,WANFANG,VIP,Pub Med and other database resources,learn from three theoretical models,build the paper analysis framework.Through the focus group interviews,relevant experts from the government,universities and hospitals were invited to interview them to improve the research framework and the initial questionnaire scale.Through the questionnaire survey method,select the medical association led by a general hospital of Western medicine and a general hospital of Traditional Chinese medical in Guizhou Province respectively,a total of 115 medical institutions to carry out the questionnaire survey.Finally,1,065 valid questionnaires were obtained from doctors,286 from managers and 216 from patient group.Data processing and statistical analysis were performed using the SPSS 25.0software.Distributions on demographic characteristics were expressed by count and percentage;The chi-square test was used to compare differences in demographic characteristics,policy perception and willingness;The binary classification Logistic regression model was used to study the factors affecting policy cognition and implementation willingness,and the test level =0.05.Results:(1)Physician: The awareness rate of the multi-point practice policy in Traditional Chinese Physicians(TCP)was significantly lower than that of Western Medicine Physicians(WMP<0.001);The way to know the multi-point practice policy in the first-time has statistical significance between Traditional Chinese Physicians and Western Medicine Physicians(P=0.028),and the awareness rate of Western Medicine Physicians was higher than that of Traditional Chinese Physicians by the authoritative way(17.5%> 15.7%);The attitude of Traditional Chinese Physicians and Western Medicine Physicians towards multi-point practice policies was relatively significant(P=0.033).The disapproval rate of TCM was lower than that of WMP(1.2% <2.6%),and the wait-and-see rate was higher than that of WMP(25.7%> 18.5%);There are differences in the influencing factors of Chinese Medicine Physicians and Western Medicine Physicians on multi-point practice policy cognition.Sex,formulation and title are the factors influencing the policy cognition of WMP,and professional title and work unit level are the factors influencing factors of policy cognition of Traditional Chinese Physicians;Income range,unit level and policy cognition are the negative influencing factors of physicians’ policy willingness;The willingness of Chinese Medicine Physicians and Western Medicine Physicians to implement the multi-point practice policy was not significant(P> 0.05).(2)Manager:The awareness rate of multi-point practice policy of manager in medical association is lower than that of physicians(19.9%> 18.7%),and the support rate for multi-point practice policy is lower than that of physicians(63.8% <77.3%);Managers’ cognition of the multi-point practice policy is positively related to their working years,and the longer the working years,the higher the awareness of the multi-point practice policy;The willingness of managers to carry out multi-point practice in their own unit is affected by their income and policy cognitive approach,showing that the higher the income,the lower the policy willingness;The more authoritative the way to know this policy,the lower the policy willingness.(3)patient:High unknown rate of multi-point practice policy for patients in medical union,It reached 44.0%,and show that the policy publicity work for this group needs to be strengthened.The support rate of patients who know the multi-point practice policy is as high as 90.9%,indicating that the policy is more recognized by patients.The level of the medical institution that the patient visits is a positive influencing factor of his policy perception,that is,the higher the level of the medical institution that a patient visit,the higher the policy perception.There is a causal relationship between the patients’ awareness method of the multi-point practice policy and their willingness to implement the policy.The more authoritative the policy awareness method is,the higher their willingness to implement the multi-point practice policy.(4)A survey which about the concerns of the implementation of multi-point practice policy found that increased management difficulty(4.19±0.69),loss of disease sources(3.98±0.47)and weakened competitive advantage(3.97 ± 0.56)are the top three concern factors for managers to implement the multi-point practice policy.The working conditions of multi-point practice hospitals(4.51 ± 0.38),lack of protection for their own interests(4.49 ± 0.16),and the increased risk of medical management(4.26 ± 0.53)are the top three worrying factors for doctors to conduct multi-point practice.Medical safety issues(3.64±0.34),the difficult to guarantee the homogeneity of medical quality(3.55±0.19),and the delay in doctor-patient communication(3.47±0.41)are the top three worrying factors for patients to implement the multi-point practice policy.(5)According to the results of survey that the adverse conditions of the multi-point practice policy was implement in the medical union,it are ranked in the order of matrix scores:Medical institutions in the medical union have not yet established a mature benefit-sharing mechanism(4.51± 0.73),immature referral mechanism among medical institutions in the medical union(4.45 ±0.14),the rights and obligations of the medical institutions within the medical union have not yet been clarified(4.44±0.27),interconnection of medical information system is not realized(4.42±0.69),the supervision system and mechanism of medical consortium are not perfect(4.40±0.38).Conclusion:The implementation of the multi-point practice policy in the medical union involves different operational staff,which have different cognition and value pursuit of the policy.Each subject shows different degrees of willingness to implement the multi-point practice policy by weighing the advantages and disadvantages in the process of policy implementation.In addition,as a policy environment for multi-point practice,all the natural and social factors in the existence and development of the medical union will have an inevitable impact on the multi-point practice policy.Therefore,it is necessary to take compensation measures for the benefit-damaged parties in the process of policy implementation to avoid and improve the adverse factors of the policy environment,so as to promote the effective implementation of the multi-point practice policy.