Investigating The Dual Referral Mechanism Of Urban Medica Service In Community Health Service Institution Of BeiChen District In Tianjin

Objective:By investigating the community residents and community medical workers, this paper aims to study the implementation of the two-way referral, and specifically to discuss the constraints which influence the implementation effects of two-way referral in the community health service institution. Then it provides suggestions from a more objective and practical way to practice the two-way referral and deal with issue of difficulty and expensive to get medical service.Methods:The informants are the community residents and community medical workers from four community health service centers (CHSC) in Beichen District in Tianjin, including300questionnaires for the residents and130for the staff. With the help of Epidata3.1and SPSS17.0, the data is analysed by different methods including percentage, chi-square test and logistic regression, and so on. In the research the level of test is a=0.05(two-side).,Results:The data shows that the awareness of the two-way referral is42.3%among the community residents, and the main channel to understand two-way referral is from hospitals and community health centers.77.8%community residents are willing to choose the CHSC as the initial diagnosis institution. The others never regard CHSC as the first option. The major factors that affect the options above are about two aspects, respectively, distrusting the skill of community medical workers (93.5%) and dissatisfied with the facilities (80.6%) in the CHSC. Residents who are younger, more likely to seek treatments, and those with lower level of income and education, are more willing to accept the two-way referral.38.0%residents do not like to referral to the higher level hospital from the CHSC. Mainly because they have no idea about the process and standard of referral.65.2%Residents show the willing to participate in the referral from CHSC to higher level hospital, the main reason of which is the low cost and short distance between the CHSC and their home. Finally,34.8%residents do not accept the referral from higher level health service institutions to CHSC. Distrusting the skills of the community medical workers, primitive and old-fashioned medical facilities in the community health center,are regarded as the top reasons.Among the community medical workers,21.7%of them are quite familiar with two-way referral and8.3%of them have no idea about it. At the same time,32.5%of the community medical workers have the experiences of two-way referral and the rest have never participated in the two-way referral. By analyzing the influence factors of the referral from CHSC to higher level hospital among the medical staff, the study finds that lack of referral norms and standards(58.3%), and community medical workers lack of the medical skill of general practitioner(54.2%) rank top tow. In the process of the higher level hospital referral to community health service center,the major influence factors are lack of the unified system and standards of the two-way referral and the information platform between all levels of medical institutions,70.0%and67.5%separately.Conclusions:The government should continue to play a leading role in the two-way referral,and gradually strengthen the system of the two-way referral,perfect the policies of the two-way referral, increase the fund to the two-way referral,build the shared regional health information system based on the medical information and the supervision system of the two-way referral, strengthen the security effect of the superiority medical resources in the two-way referral, build the seamless joint between the hospital and the community medical service institution, and enhance the quality and ability of community health workers. Meanwhile it should focuses on improving the awareness of community residents in the health education and health promotion, exploring the long-term development mechanism of the two-way referral, especially bringing the fundamental role of two-way referral into full play in the medical serve, and realizing the maximum and rational utilization of medical resources.