| 摘要: |
| 目的 通过了解患者视角下基层首诊制实施的主要影响因素，为促进分级诊疗背景下基层首诊的顺利推行提供政策建议。方法 选择北京市实施分级诊疗试点区县之一，并选择该区县实施分级诊疗的4所乡镇卫生院，每所乡镇卫生院随机选择8名就诊患者进行半结构性访谈，共访谈患者32名。根据理论饱和依据和扎根理论，资料分析采用Nvivo10软件进行质性分析。结果 从患者视角出发，影响基层首诊制实施最主要的因素是“认知”因素，患者不愿意基层首诊主要的原因是不认可、不信任基层医疗卫生服务机构医务人员的技术水平，认为上级医疗机构的医务人员具有更高的医疗技术水平。这种观念深入人心。其次，“技术”是另一主要影响因素，基层医疗机构在硬件和软件上都无法满足患者的医疗卫生需求。值得注意的是，“政策”因素在引导患者基层首诊方面影响力度有限，提高基层医疗保险比例、设置基层转诊制度很难实现患者的有序就医。结论 在分级诊疗背景下，实现基层首诊制的关键在于转变患者对基层医疗机构医疗卫生服务能力的认知，在准确定位基层医疗机构医疗卫生服务范围的基础上，提高基层医务人员的技术水平，最终实现“小病进社区”，解决“看病难、看病贵”问题。 |
| 关键词: 基层首诊 影响因素 患者视角 质性研究 |
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| Influence Factors of the First Treatment in Community of One District of Beijing Based on the Perspective of Patients |
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| Abstract: |
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Objective
To provide policy recommendations for the promotion of the primary diagnosis and the primary care in the background of grading and diagnosis by understanding the main influence factors of the primary care system in the patients. Methods One of the pilot country has implemented hierarchical diagnosis and treatment in Beijing was chose, and 4 town hospitals were selected from this country. Each township hospital was randomly selected eight patients to accept semi-structured interviews, were interviewed 32 patients. According to theoretical saturation and grounded theory, the Nvivo10 was used to analyze content. Results The most important factors for effect of the first treatment in community is cognitive factors. Second, "technique" is another main influence factors. It is worth noting that the strength of "policy" factors is limited on guiding patients to contact the first treatment in the community. Conclusion The cognition change of patients on the aspect of basic medical and health services ability is the key point to implement the first treatment in community. The skill level of the doctor should be improved, finally, to realize "slight illness into the community", to solve the problem of "difficulty and high cost of the doctor". |
| Key words: first treatment in the community,influence factors,patient perspective,qualitative research |
