An Analysis Of Outpatients’ Awareness Of The Two-way Referral System And Influential Factors Of Their Opinions

ObjectiveIncreasing the investment in community health service and improving the service level have become the development trends of health service in China. But further development of community health service has been hindered by the lack of effective two-way referral system. Patients, as the demand and initiative side in health service, play an important role in further development and improvement of this system. Under the current situation, through surveying patients experienced the system, analyzing the outpatients’awareness of the system and studying the influential factors of their willingness towards the system, existing problems and its causes can be found, and solutions can be given. All of these offers theoretical and political basis for the smooth implementation of the two-way referral in Yunnan province.Materials and methods1.Quantitative research:I used questionnaires to survey619outpatients in three provincial hospitals and four community health service institutions in Kunming, three county hospitals in Chuxiong yi Autonomous Prefecture in Yunnan province, and one municipal hospital in Honghe Hani&Yi Autonomous Prefecture in Yunnan province. And I retrieved600valid questionnaires, which accounts for97%of the total number.2.qualitative research:I referred to relevant treatises, academic papers, professional periodicals and magazines, and relevant literature on the internet. And I conducted personal interviews with related officials, medical personnels and some patients in all levels of medical institutions. I also abstracted relevant supplementary information to the quantitative material. After rearranging original questionnaires I set up a database of them and did some statistical analysis by using SPSS17.0software.Result1.Among the600surveyed outpatients,39.7%of them know about the two-way referral system, according to the outpatients’awareness of community health service.2.The factors that influence result ncludes:age, educational level, monthly income, career, forms of health insurance, the existence of community health service institutions in their residences, preferred medical institutions, attitudes towards the system and so on.3.Among the outpatients who know about the two-way referral system,90.8%of them are willing to be transferred to more advanced hospitals when it is necessary,9.2%of them holding negative answers. And79.8%are willing to be transferred to lower-level hospitals,20.2%refusing the offer.4.The factors that influence the outpatients’attitudes towards two-way referral system includes:how much do the outpatients know about two-way referral, treatment technology of the medical institutions (52%of the outpatients chose it as the primary influence), geographical factors (chosen by43.1%of the outpatients), pathogenic condition(chosen byl8.5%),medica ltreatment experiences(chosen by15%),expenses(chosen by9%), the amount of the types of pharmaceuticals and their curative effects(chosen by8.3%),and the patients’level of trust towards doctors and so on.5.The factors that influence the medical personnel’s attitude towards two-way referral system includes:their consciousness of initial diagnosis in community medical institutions and the system, infrastructure and department settings in medical institutions, governments’opinion of community medical service, relevant investment and publicity, political support, improvement of two-way referral system and so on.Conclusion1. At present, in general, all levels of medical institutions share a low awareness of two-way referral from outpatients.2.The fact, that transferring outpatients to advanced hospitals is easier than the reverse, shows the importance of the demand side’s will in medical service.3. Patients’ tendency to receive initial diagnosis in community medical institutions can promote the implementation of the two-way referral system.4.It is significant for the implementation of the system to enhance the publicity of initial diagnosis in community medical institutions.5.The effective operation of the two-way referral system demands the enhancement of government support, political guarantee, investment in infrastructure construction of the community medical institutions, training to the general practitioner, and more interactions between medical institutions in different level.