Clinicians Refer Patients In The Convalescent Phase Of The Chronic Phase Downward Influencing Factors

ObjectiveAccording to the theory of planned behavior to build the theoretical framework of clinical doctors downward referral intention,research the intention and its influencing factor for clinical doctors to referral down patients with chronic convalescence and to promote the clinical doctors referral down,to perfect the two-way referral system,provides the basis for promoting the construction of the grading system.Contests1.To construct the theoretical framework of influencing factor for clinicians’ intention of patients in the convalescent period of the chronic phase.2.Univariate analysis on the influence of clinicians’ intention of patients in the convalescence period of the chronic period.3.Structural equation model was used to analyze the influencing factors of clinicians’intention to convalesce patients in chronic period.4.Based on the analysis results of influencing factors,policy suggestions were put forward to promote the downward referral of clinicians.MethodsData were collected by means of cross-sectional survey,and convenient sampling was conducted among clinicians in eight tertiary general hospitals in three eastern provincial cities,namely Xuzhou,Jiangsu,Hangzhou,Zhejiang and Jining,Shandong.Based on the theory of planned behavior I have designed the superior clinical doctors downward referral intention questionnaire of medical institution "with medical qualification,experience in diagnosis and treatment of diseases,have certain referral clinic and investigate the clinical doctors in the hospital,finally,a total of 500 questionnaires,recycling effective questionnaire 442,questionnaire recovery rate 88.4%.This paper makes a descriptive analysis of the general demographic factors of doctors,and uses the chi-square test to conduct a single factor analysis on the three influencing factors of doctors’ downturn attitude,downturn subjective norm and downturn perceived behavior control.Pearson correlation was used to analyze the relationship between the influencing factors of doctors’attitude,subjective norm and perceived behavior control on downward referral of patients in convalescence period of chronic period and doctors’ downward referral behavior intention.Finally,a structural equation model was established to analyze the influence of clinicians’ downturn attitude,subjective norms,and perceived behavioral control on downturn intention and the mechanism of action.The model was continuously modified according to the correction index value,and a model with good fitness was obtained for confirmatory analysis.Results1.Based on the theory of planned behavior,the theoretical framework of influencing factors of clinicians’ intention to down referral patients in chronic period and convalesce period was preliminarily constructed.2.Among the surveyed clinicians,338(76.5%)had the intention of referral.The percentage of doctors who thought referrals should be made was 82.1%,and 70.1%who thought referrals would benefit patients.The proportion of clinicians’ expected department directors expecting patients to be referred down is the highest(72%),and the degree of compliance to the expected referral behavior of the dean is the highest(74.7%).The proportion of clinicians who thought that the current cooperative relationship was good,the down transfer standard was perfect,the information connection between the upper and lower levels was good,the diagnosis and treatment level of the lower medical institutions was high,the sickbed turnover rate was low,the medical insurance system was convenient,the referral procedure was convenient,and the workload was small was only:4.3%,34.4%,34.2%,36%,37.6%,40.7%,41.4%.Under the current workload,sickbed turnover rate,cooperative relationship,diagnosis and treatment level of lower medical institutions,information connectivity,referral standard,referral procedure,and medical insurance system,the proportion of patients who felt that it was easy to transfer was respectively:42.5%,40.2%,38.2%,37.8%,37.1%,36.7%,34.6%,33.5%.3.Chi-square test showed that 83.2%of clinicians with positive attitude and intention of down-turning accounted for positive attitude,while 54.4%of clinicians with negative attitude and intention of down-turning only accounted for statistically significant difference(χ2=31.3,p<0.001).Clinicians’ expectation of colleagues,department directors,deans,patients and their family members on patients who should be referred to the clinic had an effect on clinicians’ intention to refer patients to the clinic(p<0.05);In terms of perceived behavioral control factors,there were statistically significant differences in the downward transfer intention of clinicians under different self-efficacy,workload,referral criteria,medical insurance approval,level of lower medical institutions,information connectivity of higher and lower institutions,cooperative relationship and bed turnover rate(p<0.05).The correlation analysis results showed that attitude,subjective norms,selfefficacy,external controllable factors were positively correlated with downturn intention(p<0.05),and the correlation coefficients were 0.455,0.334,0.306,0.127.4.The results of structural equation model analysis show that the path relationship discussed in the model is the action path of behavior attitude,subjective norm and perceived behavior control on the behavior intention of the internal potential variable.The direct effect values of the three paths are 0.649,0.257 and 0.171,respectively,and the P values are all less than 0.01,which is of significant significance.All the three paths had positive promoting effects on behavioral intention.In addition,the total effect values between attitude and subjective norm,subjective norm and perceived behavioral control,and attitude and perceived behavioral control were 0.442,0.244 and 0.223,respectively,and the correlation between them was statistically significant(p<0.05).ConclusionThe attitude,subjective norm and perceived behavior control of clinicians in tertiary hospitals had a positive influence on the behavioral intention of doctors to refer patients in the convalescence period of chronic period downward.Attitudes and subjective norms are the most important factors affecting the intention to turn down,among which the most influential is the pressure from the director of the clinic,followed by the pressure from the director of the department,while the pressure from patients and their family members has little influence on the intention to turn down.External controllable factors can also affect clinicians’ downward referral intention,and the degree of influence of these factors on doctors’ referral intention from large to small is as follows:Cooperative relationship between doctors in referral institutions,information connectivity between superior medical institutions and grassroots medical institutions,diagnosis and treatment level of inferior medical institutions,and then the perfection of referral standards,workload,control of doctors’ referral,and whether doctors have the ability to evaluate patients’ referral.Moreover,these factors also had a positive impact on clinicians’ attitude and subjective norms and thus positively influenced down turning intention.According to the above conclusions,the following suggestions are put forward:firstly,to strengthen the cooperation and exchange between the higher and lower medical and health institutions;secondly,to improve the information exchange among medical institutions;thirdly,to perfect the referral standards;fourthly,to strengthen the construction of grass-roots hospitals.