徐州市社区居民分级诊疗制度知晓情况及影响因素研究

摘要

目的 了解徐州市社区居民对分级诊疗制度的知晓情况并探讨其影响因素,为促进分级诊疗制度的实施与推广提供建议.方法 于2016年7-8月,采用多阶段分层随机抽样法,在徐州市3个区县抽取社区居民750例.采用本课题组自行设计的结构式问卷对纳入居民进行调查,主要内容包括社区居民的基本信息、对分级诊疗制度的知晓情况.共发放问卷750份,有效回收710份,问卷的有效回收率为94.7％.结果 710例社区居民中,349例知晓分级诊疗制度,知晓率为49.2％,主要知晓途径为报纸、电视、网络等媒体(54.1％,189/349).不同性别、年龄、文化程度、去年平均月收入、自评健康状况、去年医疗费用、步行至最近社区卫生服务机构时间及是否患慢性病、是否有社区卫生服务机构就诊经历社区居民的分级诊疗制度知晓率比较,差异有统计学意义(P＜0.05);不同职业、婚姻状况、医疗保险类型及是否有健康体检经历社区居民的分级诊疗制度知晓率比较,差异无统计学意义(P＞0.05).多因素Logistic回归分析结果显示,性别、文化程度、自评健康状况、步行至最近社区卫生服务机构时间及是否有社区卫生服务机构就诊经历是社区居民对分级诊疗制度知晓情况的影响因素(P＜0.05).结论 徐州市社区居民的分级诊疗制度知晓率仍有待提高,性别、文化程度、自评健康状况、步行至最近社区卫生服务机构时间及是否有社区卫生服务机构就诊经历是社区居民对分级诊疗制度知晓情况的影响因素.建议卫生行政部门发挥“互联网+”、APP、公益广告等新传媒和传统宣教的力量,加大宣传力度,引导居民合理就医.%Objective To investigate the community awareness level and associated factors of the hierarchical diagnosis and treatment system in Xuzhou,China,so as to provide some suggestions for the implementation and extension of the hierarchical diagnosis and treatment system.Methods Seven hundred and fifty community residents were selected by stratified multistage random sampling from 3 subordinate counties (districts) of Xuzhou from July to August 2016.They were surveyed by a structured questionnaire designed by our research team covering demographic characteristics,and awareness of the hierarchical diagnosis and treatment system.The survey obtained a response rate of 94.7％ (710/750).Results Among the 710 community residents,349 knew the hierarchical diagnosis and treatment system,accounting for 49.2％.Most of them [54.1％ (189 /349)] knew it from newspapers,television,the internet and other media.The rate of the awareness of hierarchical diagnosis and treatment system obviously varied according to gender,age,education level,average monthly income and medical expenses of the previous year,self-perceived health status,time needed to go to the nearest community health service institution on foot,prevalence of chronic diseases,history of seeking medical services in grassroots healthcare institutions (P ＜ 0.05),while it was not associated with occupation,marital status,type of medical insurance,and history of physical examination (P ＞ 0.05).By multivariate Logistic regression analysis,the associated factors for the awareness level of hierarchical diagnosis and treatment system comprised of gender,education level,self-perceived health status,time needed to go to the nearest community health service institution on foot,and history of seeking diagnosis and treatment services in grassroots healthcare institutions (P ＜ 0.05).Conclusion It is necessary to inprove the rate of awareness of hierarchical diagnosis and treatment system in community residents in Xuzhou.It is obviously associated with gender,education level,self-perceived health status,time needed to go to the nearest community health service institution on foot,and history of seeking medical services in grassroots healthcare institutions.Therefore,the health administrative departments should combine the new media,such as internet +,APP and public-service advertisement,and the old ones to publicize the knowledge of hierarchical diagnosis and treatment system,in order to direct residents to reasonably seek medical services.