北京市四区县医院农民患者首诊原因的调查分析

摘要

Objective To analyze the reasons that rural residents from 4 suburb counties or district of Beijing to see a doctor in county hospitals as their first visiting.Methods The questionnaire survey was conducted among the outpatients randomly chosen from the rural residents who seek for medical care in the 4 country hospitals of Beijing as their first visiting.Results Some 63.4％ of the outpatients in country hospitals could seek for medical care in township hospitals.The primary reasons for the rural residents see a doctor firstly in country hospitals were higher medical level ( 69.8％ ), advanced facilities (31.4％ ), and complete clinical units ( 28.6％ ).The primary reasons for them to see a doctor firstly not in township hospitals were lower level of medical skills ( 59.4％ ), laggard facilities ( 27.8％ ), and lack of service items ( 25.3％ ).It was held that medical skills ( 54.2％ ) and equipments ( 52.5％ ) in township hospital were far worse than those in country hospitals; items and sorts of service ( 48.1％ ), busying degree of the medical staff ( 46.5％ ), the distinct degree of explaining disease condition by the staff ( 44.4％ ), medical environment ( 43.1％ ), and medical price level ( 26.6％ ) in township hospitals were little worse than those in country hospitals; however the waiting time ( 42.4％ ) in township hospitals was better than that in country hospitals.Conclusion It is suggested to improve financial policy, increase construction investment for rural primary health care, distribute rationally regional medical and health resources; strengthen the construction of township primary health professionals, implant manpower resources, intensify assessment and incentive mechanisms; shift service mode and increase service efficiency.%目的 分析北京市四区县医院门诊首诊农民患者未到乡镇卫生机构就诊的原因.方法 对北京市四区县医院门诊首诊农民患者随机拦截,并进行问卷调查.结果 北京市四区县医院门诊首诊农民患者中有63.4%的患者可以在乡镇卫生机构治疗.农民首诊选择区县医院的主要原因为医疗水平高(69.8%)、设备/设施先进(31.4%)和诊疗科室齐全(28.6%)等;首诊未选乡镇卫生机构的主要原因为医疗技术不好(59.4%)、设备/设施落后(27.8%)和服务项目少(25.3%)等.认为乡镇卫生机构远差于区县医院的项目是医疗技术(54.2%)和医院硬件设施配备状况(52.5%);乡镇卫生机构略差于区县医院的是服务项目和种类(48.1%)、医务人员总体忙碌程度(46.5%)、医护人员解释病情清晰程度(44.4%)、就诊环境及卫生状况(43.1%)及收费水平(26.6%);而在候诊时间上乡镇机构优于区县医院(42.4%).结论 建议完善财政政策,增加农村基层卫生建设投入,并合理配置区域医疗卫生资源;加强乡镇基层卫生人才队伍建设,强化考核激励机制;转变服务模式,提高服务效率.