Research On The First Diagnostic Countermeasures Of Rural Residents In Henan Province

BackgroundOn September 11,2015,the General Office of the State Council promulgated the Opinions on Promoting the Construction of a Tiered Diagnosis and Treatment System(hereinafter referred to as “Opinions”),and promoted the implementation of “hierarchical diagnosis and treatment” as a top-level design method across the country.The "Opinions" proposed the 16-character principle of "first-level clinic visits,two-way referral,emergency management,and vertical linkage".The "primary clinic at the grass-roots level" is the primary premise and the basis for the implementation of classification and treatment.Since the implementation of the policy,there has not been a clear understanding of the implementation results of the first-level clinics at the grass-roots level,the awareness of the public at the grass-roots level for the first visit,and the factors constraining the function of the primary clinic.ObjictiveInvestigate the doctors' knowledge of the first-level clinic visits,the tendency of the rural residents to seek medical treatment and the willingness of the rural residents to understand the current status of the implementation of the first-level clinics in rural areas,and explore the obstacles existing in the first-stage diagnosis of rural residents in Henan Province,and put forward specific countermeasures and suggestions.MethodIn accordance with the stratified cluster random sampling method,comprehensively consider the geographical location of the sample area and the economic development level of the rural areas,randomly select five cities such as Kaifeng,Nanyang,Xinxiang,Sanmenxia and Hepingdingshan.A total of 15 counties,30 townships,and 60 administrative villages were selected to conduct questionnaire surveys on doctors and rural residents in the medical institutions at the county,township and village levels.A total of 1,500 doctor questionnaires and 3,000 questionnaires for rural residents were issued,and 1382 and 2678 valid questionnaires were retrieved,respectively.The recovery rates were 92.13% and 89.2% respectively.SPSS 22.0 statistical software was used to conduct statistical analysis of survey data.Result(1)Doctors' knowledge of the first primary clinic in rural areas: The survey found that 84.8% of doctors understand the first-level primary care system;69.61% of doctors believe that the first-level primary care system is necessary;74.96% of doctors believe that primary health institutions have the ability to complete Grassroots public service projects.(2)From the doctor's point of view,the implementation of the first-level primary diagnosis system has problems: The study found that 62.38% of doctors believe that the “basic health service system and policies formulated are not perfect,” and 48.40% believe that “promotion is insufficient”,42.75% Considering that “the state's investment in basic health services and measures have not kept pace”,30% believe that the primary health insurance policy is “unreasonable”;54.71% of doctors have not participated in corresponding business training,and 35.20% of doctors have not participated in general practitioners Training.(3)Existing problems at the grass-roots level from the perspective of rural residents: The survey shows that rural vulnerable groups(rural residents with poor health and poor economic conditions)tend to be the first-level clinics,and 87.47% of farmers identify with primary-level medical institutions.With a low degree,64.85% of farmers “distrusted the doctors at the grassroots level”,which was reflected in fears of doctors' technology,imperfect equipment,lack of medicines,poor hygiene,etc.ConclusionThe problems existing in the first clinic in rural areas in Henan Province:(1)The policy guarantee is not in place,and the medical insurance system is not perfect;(2)The lack of strength of primary medical institutions weakens the first diagnosis at the primary level;(3)Business training is not in place,and doctors' ability is limited.Countermeasures and Suggestions:(1)Grass-roots long-term compensation mechanism to speed up the improvement of the medical insurance system;(2)Two-pronged approach to enhance the strength of basic medical institutions;(3)Suggest to strengthen the doctor training system.