| BackgroundIn recent years,with the continuous development of the social economy,the phenomenon of population aging in China has become more and more obvious,and the number of chronic diseases has also shown a trend of increasing year by year.By the end of 2018,the number of chronic diseases in China had reached 300 million,the number of patients with cardiovascular and cerebrovascular diseases exceeded 200 million,the number of obese patients exceeded 125 million,the number of patients with hypertension reached 160 million,and the number of patients with diabetes reached 114 million.The number of deaths caused by chronie diseases has accounted for 86.6%of the total number of deaths in China.The burden of disease caused by chronic diseases has accounted for 70%of the total burden of disease in China.At the same time,the imbalance of medical resources allocation,the division of labor in medical institutions is not clear,and patients with chronic diseases are willing to go to large hospitals,making it difficult to effectively use limited medical resources in medical services,and there is serious waste.Patients with chronic diseases go to hospitals for treatment,which on the one hand causes a large waste of resources;on the other hand,it is not conducive to the treatment and management of diseases.It is necessary to sink the threshold for prevention and treatment of chronic diseases to primary medical institutions.ObjectiveThe significance of two-way referral is to provide continuous and standardized medical and health services for patients with chronic diseases,so that patients can get better guidance and rehabilitation during the remission period,and reduce the disease burden of patients with chronic diseases.This study investigated the cognitive,behavioral,and willingness of the first-time and two-way referral of patients with chronic diseases in Guangzhou,and constructed a structural equation model for the two-way referral behavior and willingness analysis of patients with chronic diseases.After that,the influencing factors and mechanism of the behavior and willingness of patients with chronic diseases were analyzed.Finally,the countermeasures and suggestions for improving the two-way referral mechanism in Guangzhou are discussed,which provides a reference for the improvement and promotion of the two-way referral service in Guangzhou.MethodsPatients with chronic diseases in Guangzhou were sampled by multi-stage sampling.According to the economic and demographic conditions,11 cities in Guangzhou were divided into 4 floors,and each district was selected as a survey unit.Each district randomly selected 2 general hospitals and 2 community health service centers as survey samples,and selected 8 hospitals and 8 community health service centers.Patients with chronic diseases were selected as samples of investigation by means of convenient sampling.The selected patients were hospitalized chronic patients in the hospital and outpatient chronic patients in the community health service center.800 patients with chronic diseases were investigated and 773 valid questionnaires were recovered.The effective recovery rate was 96.63%.Descriptive analysis was used to analyze the basic conditions of patients with chronic diseases.Exploratory factor analysis was used to extract latent variables.The structural equation model was used to analyze the influencing factors and related mechanisms of the willingness of two-way referral of patients with chronic diseases.Results1.The patients with chronic diseases interviewed in Guangzhou are mainly middle-aged and elderly women,and the main chronic diseases are hypertension,diabetes,respiratory diseases and cardiovascular diseases.The coverage rate of family doctors' contracted services is low.2.The awareness rate of two-way referral system for patients with chronic diseases in Guangzhou is low.57.83%of patients with chronic diseases have never heard of the two-way referral system.Patients with chronic diseases have fewer ways to know the two-way referral system.3.The first-time medical institutions for chronic diseases in Guangzhou are mainly provincial/municipal hospitals(48.25%).The rate of lower referrals for patients with chronic diseases is low,and 80.60%of patients with chronic diseases have no experience of going down.Among the patients who had experienced the downturn,only 38.67%of the patients were satisfied with the two-way referral system,and the satisfaction of the two-way referral service was lower.4.After having a certain understanding of the two-way referral system,43.08%of the patients are willing to refer to the community health service organization.The hospital patients are less willing to refer to the community health service organization than the community patients.5.Through factor analysis,the latent variables are obtained:community health service organization resource allocation,patient perception,referral service accessibility,medical staff participation,referral behavior and willingness.By modifying the structural equation model,the model fit degree index conforms to the adaptation criterion,and the constructed structural equation model is reasonable,and the path coefficients between the latent variables were statistically significant.Community health service organization resource allocation,patient perception,referral service accessibility and medical staff participation have an impact on the behavior and willingness of patients with chronic disease to refer to it.The total effect of standardization is 0.11,0.40,0.04,and 0.61.Medical staff participation and patient perception are the main influencing factors.There is a correlation between different influencing factors.The correlation coefficients between resource allocation and service accessibility,medical staff participation,and patient perception were-0.178,0.130,and-0.072.The correlation coefficients between service accessibility,medical staff participation,and patient perception were 0.133 and 0.148.The correlation coefficient between medical staff participation and patient perception was 0.256.Conclusion1.There are fewer ways for patients with chronic diseases in Guangzhou to know the two-way referral system.The awareness rate of the two-way referral system is low.There are fewer patients with chronic diseases who have had a referral experience.The actual development of the two-way referral system is not good.The consultation rate is low and the referral satisfaction is not high.After having a certain understanding of the two-way referral system,the willingness of patients with chronic diseases to refer to community health service centers is higher.2.The paper constructs a structural equation model for the two-way referral of the behavior and willingness of patients with chronic diseases,and the model is fitted with a test.The conclusions of the study indicate that the behavior and willingness of the two-way referral of patients with chronic diseases in Guangzhou is mainly affected by the resource allocation of community health service organizations,patient perception,accessibility of referral services and participation of medical staff.Different factors have different effects on the behavior and willingness of two-way referrals in patients with chronic diseases in Guangzhou.The participation of medical staff has the greatest impact on the referral behavior and willingness of patients with chronic diseases,followed by patient perception.The impact of resource allocation and service access on patient referral behavior and willingness is relatively weak.At the same time,there are mutual influences among various factors,which cause direct and indirect influences within the model.3.Proposed the suggestions and countermeasures for promoting the implementation of the two-way referral mechanism for patients with chronic diseases in Guangzhou.First,take common chronic diseases as a breakthrough and implement precise interventions for suitable people.Second,strengthen the construction of primary medical institutions,and improve the ability of community medical institutions to conduct primary and two-way referrals.Third,through a variety of channels for policy propaganda,and gradually change the concept of medical treatment for patients with chronic diseases.Fourth,clarify the standards for two-way referral,simplify the referral process,and standardize the implementation of two-way referral.Fifth,strengthen the active guidance of doctors and improve the willingness of patients to refer.Sixth,the use of Internet technology to open two-way referral channels to achieve integrated diagnosis and treatment of chronic diseases.Seventh,rationally allocate the interests of different medical institutions and improve the enthusiasm of referrals among all relevant parties. |
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