| Objective:To learn the knowledge,attitudes and implementation of doctors in Xinjiang urban and rural areas on hierarchical medical services(HMS),analyzing the problems and difficulties in the implementation of HMS in Xinjiang,and providing suggestions and strategies for the operation and development of the system.Methods:From May to September in 2018,the questionnaire survey about HMS was conducted among 2160 doctors of 135 hospitals from 32 counties/districts in 14 prefecture s/cities in Xinjiang,2,119 questionnaires were collected and 2,092 valid ones were collected.The efficiency of the questionnaire was 98.73%.Path analysis and key insider Interview were used for Data collection and analysis.Results:(1)The awareness rate of clinicians on the connotation of HMS was 87.19%.the awareness rate of doctors in the primary-level hospitals was the lowest;the awareness rate of work content was 82.65%.the awareness rate of doctors in the secondary hospitals was the highest,and the awareness rate of the target was 78.33%,the tertiary hospitals doctors have the highest awareness rate;the awareness rate of the primary diagnosis of the primary level is 84.08%,the secondary hospitals doctors have the highest awareness rate;the awareness rate of the two-way referral connotation is 52.92%.the difference of doctors' awareness rate at all levels of hospitals Not much;the awareness rate of hospital functions at all levels is 39.11%,43.38%and 36.56%,respectively.The primary source of doctors' access to HMS information is "unit organization learning",accounting for 31.29%.(2)59.08%of doctors believe that Xinjiang has the conditions for HMS,and the proportion of doctors in the secondary hospitals is the highest;52.39%of the doctors believe that the primary doctors can be qualified for the first consultation,and the proportion of doctors in the primary-level hospitals is the highest;68.79%of the doctors think that urban and rural areas The doctor is qualified for referral work,and the secondary hospitals has the highest proportion of doctors.(3)79.06%of the doctors believe that the unit has started to implement the HMS,and the proportion of doctors in the tertiary hospitals is the lowest;87%of the doctors have the experience of referral,the rate of change and the rate of conversion are 35.64%and 14.65%,respectively.M ain infectious factors of HMS were manpower shortage and weak service capacity of primary hospitals,inadequate standards of two-way referral and inadequate systems of government and medical insurance department.(4)The doctors' knowledge of HMS affected their attitudes towards HMS and the behavior of performing HMS.The influential effects were 0.165 and 0.068 respectively.The doctors' attitudes towards HMS also affected their behavior of performing HMS,and the effect was 0.126.(5)Doctors thought difficulties and obstacles influencing implementation of HMS were manpower shortage of primary hospitals,weak capacity of primary diagnosis,insufficient kinds of medicine,inconvenient attitudes of residents toward primary hospitals,imperfect medical information system,and imperfect referral system and medical insurance system.Conclusion:Urban and rural doctors in Xinjiang have lower knowledge awareness rate about HMS.During the implementation of HMS,the rate of conversion is low.The higher doctor s knowledge awareness of HMS,the higher degree of recognition of HMS,and the better implementation of HMS.The influence factors of HMS are weak capacity and manpower shortage of primary hospitals,and imperfect systems.Strategies,such as improving systems of HMS and medical insurance,increasing medical manpower in primary hospitals,promoting doctors knowledge awareness rate,improving supervision mechanism and strengthening publicity should be used to promote the implementation of HMS. |
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