Research On Doctors’ Two-way Referral Intention And Influencing Factors In The Q Medical Alliance

BackgroundIn October 2020,the General Office of the State Council issued "The Fourteenth Five-Year Plan",emphasizing the need to speed up the construction of a two-way referral system,build a hierarchical diagnosis and treatment system,and guide patients to seek medical treatment in an orderly manner.The medical alliance is a realistic path to smooth two-way referrals and promote hierarchical diagnosis and treatment.At present,during the implementation of the medical alliance,there is still the problem of poor operation of the two-way referral system,which seriously hinders the construction of a rational and orderly hierarchical diagnosis and treatment pattern.Therefore,this study explores the intention and influencing factors of doctors’two-way referral in the medical alliance,which meets the policy and practical needs,in order to provide data support and policy suggestions for promoting the two-way referral in the medical alliance.ObjectiveTaking the Q medical alliance as an example,using the theory of planned behavior,we analyze the two-way referral intention and influencing factors of doctors in hospitals at all levels in the medical alliance,and provides scientific basis and policy suggestions for promoting the two-way referral in the medical alliance.MethodsData collection methods:(1)Literature research:Using the search terms planned behavior theory,two-way referral,doctor,medical alliance,and from databases such as CNKI and PubMed,collect domestic and foreign doctors’ referral factors and research on planned behavior theory,status quo.(2)Qualitative research:Following the principle of "information saturation",doctors,patients,hospital managers,and health administrators were selected as interview subjects to understand the influencing factors of doctors’ referral and the problems existing in referral from different perspectives.(3)Site investigation:Questionnaires were distributed to doctors in primary,secondary and tertiary hospitals in the medical alliance by means of random stratified sampling.Data analysis methods:SPSS25.0 was used to conduct descriptive statistical analysis,chi-square test and logistic regression analysis on doctors’ referral intention,referral attitude,subjective norm and perceived behavioral control,and the test level was α=0.05.ResultsFirst,the results of qualitative analysis of the influencing factors of doctors’two-way referral intention:According to the qualitative interview results,the influencing factors of doctors’ participation in two-way referral include the patient’s disease condition,their own work income,opinions of others around them,and external objective conditions.Referral attitude,subjective norm and perceived behavioral control of the theoretical analysis framework of diagnosis intention.Second,doctors’ two-way referral intentions:doctors from tertiary hospital have high referral intentions for four types of patients:common diseases,critical illnesses,difficult and complicated patients,and convalescent patients,and more than 85.0%of doctors have intentions;Doctors in secondary hospital have the lowest intention to refer patients with common diseases,accounting for 21.6%,and the two-way referral intention of the other three types of patients accounted for more than 79.2%;Doctors in primary hospital have a higher intention to transfer patients with critical illnesses,difficult and complicated patients,accounting for more than 93.0%,and the intention to receive downward transfer of convalescent patients accounted for 83.4%.Third,univariate analysis:variables in doctor’s referral attitude and subjective norm all had an impact on the two-way referral intention of doctors in tertiary hospital to participate in the four types of patients,and variables in perceptual behavior control and the intention of critically ill patients;each variable in the doctor’s referral attitude has an impact on the two-way referral intention of doctors in secondary and primary hospital to participate in the four types of patients.The intention of referring critically ill and convalescent patients all had an impact.Different variables in perceptual behavioral control had an impact on the intention of referring doctors in secondary and primary hospital to four types of patients,and the difference was statistically significant(P<0.05).Fourth,binary logistic regression analysis:when doctors in tertiary hospital accept critical patients,department directors agree(OR=4.40)will promote doctors’referral intention;when transferring convalescent patients,referral intention will be promoted when referral criteria are clear(OR=7.20);When doctors in secondary hospital refer convalescent patients for referral,the approval of department director(OR=9.55)and clear referral criteria(OR=5.41)will promote the intention of referral;When doctors in primary hospital accept down-referral patients in the convalescence period,the sound medical insurance incentive mechanism(OR=2.98)will promote doctors’ acceptance intention.Conclusion and SuggestionsReferral attitudes were mainly based on doctors’ judgment of the expected outcomes of patients’ disease treatment and doctors’ work income after referral.When doctors at all levels of hospitals referred patients,doctors’ intention to refer was higher when they believed that referral would benefit patients’ disease treatment or their own work income.The intention to refer was higher for doctors in tertiary and secondary hospital when the department head endorsed the referral relative to when he or she did not;the intention to refer was higher for doctors in primary hospital when the patient and family endorsed the referral.The intention of doctors at all levels of hospitals to participate in two-way referrals is increased when the referral process is convenient,the referral criteria are clear,and the health insurance approval is efficient in perceptual behavior control.In turn,the proposal to improve the medical alliance is to strengthen the policy propaganda for both doctors and patients on two-way referral,develop two-way referral procedures that are compatible with the medical alliance,and improve the incentives for two-way referral within the medical alliance.