Analysis Of Doctors' Referral Intention And Influencing Factors Based On The Theory Of Planned Behavior

Objectives:According to the Theory of Planned Behavior,construct the theoretical framework of doctors' referral behavioral intention.Design the referral behavioral intention questionnaire and collect data.Analyze the influence of attitudes,subjective norms,and perceived behavioral control on the referral intention,in order to provide empirical basis and policy recommendations for promoting the transfer of patients in medical association.Contests:First,construct a theoretical analysis framework for doctors,referral intention and its influencing factors.Secondly,according to the theoretical analysis framework and the theory of planned behavior,the questionnaire for doctors' intentions and their influencing factors are constructed,and the questionnaire is revised and improved through experts consultation.After that,the self-made questionnaire was used to conduct research,analyze the intention of doctors in the survey area and its influencing factors,and supplemented by qualitative interviews with clinical referral doctors.Finally,according to the status quo,existing problems and influencing factors of doctors' referral intentions in the investigation,suggestions for improvement are put forward.Methods:This study contains qualitative and quantitative studies.Firstly,the literature research and interviews with insiders were carried out to construct the theoretical analysis framework of Doctor's referral intention based on the Theory of Planned Behavior.According to the theoretical analysis results,the questionnaire of doctors referral intention and its influencing factors is constructed,and the expert consultation was conducted to ensure the content of the questionnaire was reasonable and effective.Taking 251 clinical referral doctors from 5 tertiary hospitals in a city as the research object,through questionnaire survey,information on basic conditions of doctors(socio-demographic indicators),referral intention,and referral influencing factors was collected.SPSS22.0 statistical software was adopted for descriptive statistics,and Chi-square tests and regression analysis of basic conditions of doctors,referral intention,and the relationship and difference between influencing factors.Results:1.Theoretical analysis results:The attitude of doctor referral behavior is mainly affected by therapeutic effect of disease,doctor's income,doctor workload;the referral pressure mainly comes from hospital leaders,department directors,colleagues,patients and family members,health administrative departments;referral motivation and resistance are mainly affected by the patient's condition,doctor's ability level,doctor workload,bed resources,health care system,internal incentive mechanism and referral process.2.Descriptive analysis and univariate analysis results:It was found that 76.8%of the surveyed doctors plarned to receive referrals with acute and severe disease,same as the reception rate of referrals with difficult and miscellaneous disease,and 72.0%planned to receive patients with frequently-occurring diseases,78.4%planned to transfer patients in stable condition after treatment to lower-level hospitals.Chi-square analysis showed that the referral intention of acute and severe disease patients was related to hospital leadership,s opinion(P<0.01),department head's opinion(P<0.01),colleague's opinion(P<0.01),and direct control factor(P<0.01);The referral intention of difficult and miscellaneous disease patients was related to academic qualifications,professional titles,work places(P<0.05),hospital leadership's opinion(P=0.03),department head's opinion(P<0.01),colleague's opinion(P<0.01),and direct control factor(P<0.01);The referral intention of frequently-occurring diseases patients was related to doctor's attitude(P=0.01),hospital leadership's opinion(P=0.02),department head's opinion(P<0.01),colleague's opinion(P<0.01),direct control factor(P<0.01),doctors' cooperation relationship(P=0.03),referral procedure(P<0.01),bed rotation rate(P=0.02);The downward referral intention was related to doctor's attitude(P<0.01),hospital leadership's opinion(P<0.01)),department head's opinion(P<0.01),colleague's opinion(P=0.02),direct control factor(P=0.01),referral procedure(P=0.04),and lower-level hospital's diagnosis and treatment ability(P<0.05).3.Logistic regression analysis results:For acute and severe disease patients' referral,hospital leaders' approval(OR=2.841)will promote doctors' referral intention;For the difficult and miscellaneous disease patients' referral,colleagues' approval(OR=2.414)will promote doctors' referral intention;For frequently-occurring diseases patients'referral,colleagues' approval(OR=2.816),and convenient referral procedure(OR=2.575)will promote doctors' referral intention;For downward referral,doctors positive attitude(OR=4.540)will promote doctors' referral intention.Conclusions:The study found that subjective norms have a great impact on doctors' referral intention,and may even exceed the impact of behavioral control.The referral opinions of hospital leaders,department heads and colleagues are the main factors affecting the doctors intention.Their approval will greatly increase the doctors referral intention,especially whether the common disease has a greater impact on the referral.The bed turnover rate will affect the doctor to transfer the patients in the recovery and stable period after treatment to the lower-level medical institutions.