Study On The Operating Status Related To Two Way Referral In Wuhou District Of ChengDu

Objective: By investigating and analyzing the operating status of the two way referral, outpatient service and category of disease related to referral in Wuhou district of ChengDu, to discuss the main problem of two way referral in Wuhou district, and to study the security system of two way referral. Based on it, to provided more detailed, uniform and exercisable process and standard for two way referral, and supply references to develop the two way referral in all over the district ,the city ,the province, and even the country. Methods: To survey the managers in the department related to two way referral in Wuhou district by method of in-depth interviews. To survey the institutions, staffs related to two way referral and 450 community residents by the questionnaire survey. To collect the records of outpatient service in January, April, July and October of the community health service center, the 1st people's hospital and the people's hospital of Wuhou district in 2003 by sampling. To collect the referral records of the community health service center and the people's hospital of Wuhou district. To discuss the main problems in the operation and investigate the process, the standard and the Security mechanism of the two way referral.Result: The health bureau of Wuhou district didn't establish the standard and process for the two way referral although it designated the people's hospital as the hospital for two way referral of community. 8 of 11 community health service centers surveyed developed the service of two way referral, of which 5 community centers could transfer the patient to hospitals designated, and 4 centers signed a contract with the hospitals designated and transferred 73 person to higher-up hospitals. But only 2 community health service centers received 8 patients transferred from the higher-up hospitals. No more than 20% health staffs in the community health centers and hospitals knew two way referral, and 9.1% never heard it. The single factor analysis was conducted for the factor that can influence the referral to the higher-up hospital, and then the multi-facter logistic regression was also conducted based on the single analysis. The results showed that the community health staffs, who knew the two way referral, received the training of relative knowledge and received the patient transferred from the higher-up hospital, tended to accept the referral to the higher-up hospital. 326 of the residents surveyed would choose the big hospital firstly when they suffered a disease, and only 169persons heard about the two way referral. The factors that influence people's choice was studied as the dependent variable by the single factor analysis. The variable which were significant both in single factor analysis and in profession were analyzed by non-conditional logistic regression. The result showed that the persons who had good education, high income, did not see a doctor in the community health service centers, and did not hear of the two way referral tended to go to big hospital firstly. On the contrary, the persons who had poor education, low income and wasn't content of the two way referral trended to go to community health service center firstly. There were 21 273 valid cases sampled in community health service centers and 9 510 cases sampled in the district hospital. The difference of the distribution of patients was significant between the community health service centers and the hospital. The therapy peak of the community health service centers was in October, and the hospital's was in April. Respiratory tract infection, hypertension and bronchitis took the first three places in the centers, and in the hospital were respiratory tract infection, premature pregnancy and traumatism respectively. Conclusion: The two way referral service developed initially in Wuhou district, the different orientation of function of the community health service center and the hospital was primarily formed. But there were some problems. There were no clear policy support, and lack of uniform standard, systerm and surveillance mechanism. There was no active mechanism to inspirit or restrict the behavior of the hospitals. The human resource of the centers was not rational. The hospital's technical instruction and training to the centers was seldom. The support to the referral from the system of medical insurance was weak. The workers' and residents' cognition to the two way referral was inadequate, and the residents were lack of health service information, they did not trust the community health service. Based on the relative study and the analysis, we fingered out the condition what is necessary to develop the two way referral in Wuhou district, and discussed the process and the standard of the two way referral.