A Study Of Awareness,Influential Factors And Countermeasure To Two-way Referral

Background:Increasing the investment of community health services, improving the development level of community health services is the trend of China's health services. Two-way referral is the contact between community health services and major medical institutions, the essential in the entire health service network. Studying both doctor and patient attitude towords two-way referral to provide a basis for health decision-making is an important and urgent issue.Objective:To know the awareness,utilization for community health services and two-way referral between doctors and patients; to survey the views and attitude to a two-way referral between doctors and patients; to explore the influential intention factors for them to participate two-way referral; to find the reasons for referral obstacle and to propose measures for improvement; To provide theoretical and policy basis on The successful implementation of two-way referral.Materials and Methods:Conducting a questionnaire survey among 53 hospitals and 30 community health service institutions in Taiyuan for doctors and patients. Database was established with FoxPro software after finishing the raw data. Statistical analysis was finished with SPSS version 13.0.600 subjects were investigated, and 594 valid questionnaires were returned. The return rate is up to 99 percent.Results:(1) The main educational background of doctors in community health service institutions is technical college and university, acounting for 48.57 percent and 42.86 percent. Mainly on primary and secondary titles, accounting for 51.43 percent and 40.00 percent. (2) The awareness of community health service for hospital outpatient is different. The general understanding accounting for 36.25 percent, but accounted for 41.22 percent had heard of, there are 12.16 percent of people did not understand. Half of doctors had heard of community health services. There are 8.99 percent of people did not understand. (3) Hospital doctors who never heard of the concept of a two-way referral accounted for 23.75 percent, who had heard of but do not understand accounted for 50.63 percent. The community doctors proportion of knowing how to operate two-way referral is higher than hospital doctors. (4) Two-way referral attitudes survey reflects that 41.48 percent of hospital patients and 56.90 percent of the community patients agreed with a two-way referral,53.71 percent of hospital patients and 39.66 percent of community patients do not agree with. (5) The factors influencing patient's will to trasferation between different degree hospital:â‘ patient's attitudes to transferation between different degree hospital;â‘¡patient's attitude to return local hospital for rehabilitation if a cooperation between higher degree and local hospital is built.â‘¢whether the patients choose community-based treatment when the community providing concessions. The factors influencing patient's will:â‘ the sectionsâ‘¡years of health sector work. (6) According the survey, the medical staff think that the main reasons for the existing two-way referral difficult to implement are:Medical institutions is for their own interests rather than referral, community health service quality is relatively low, policy is not in place, the poor implementation of community health insurance, lack of information communication, the patient did not understand the referral system. For the above reasons combined with the two-way referral status in Taiyuan city, to improve two-way referral recommendation. The most important thing is to adjust the interests of inter-referral agency reasonably; to improve community health service medical quality; to enhance information communication.Conclusion:The low qualifications, low title, low level of technology, the poor conditions of community doctors are the major factor that affect the patients medical treatment in community; many patients are not aware of the community services; most patients agree with the two-way referral system; patients are more willing to seek medical treatment in the community if the community offer concessions or in cooperation with hospitals; policy support, balance of interests among medical institutions or increasing the community's traditional Chinese medicine can improve the two-way referral.