摘要
目的分析临床医生向下转诊慢性期恢复期患者的意向及其影响因素。方法于2018年10月—2019年10月,利用基于计划行为理论设计的《三级医疗机构临床医生向下转诊意向调查问卷》对江苏徐州、浙江杭州和山东济宁的8所三级综合医院的临床医生进行横断面调查,回收有效问卷为442份。利用Pearson相关来分析医生对向下转诊患者的态度、主观规范、知觉行为控制3个方面的影响因素与医生的下转意向之间的关系,最后建立结构方程模型分析各因素对医生下转意向的影响程度及影响路径。结果76.5%的被调查医生有将慢性期恢复期患者下转的意向,其中,高级职称临床医生的意向较高,达92.7%。不同职称临床医生的转诊意向比较,差异有高度统计学意义(P<0.01)。态度、主观行为规范、知觉行为控制3个方面的因素对行为意向有直接影响,分别解释了52%、42%、23%行为意向的差异,态度对意向的影响最大。结论态度和主观规范是影响三级医院临床医生下转意向最重要的因素,其中态度的影响最大。其次是医生感受到的来自医院院长、科室主任和同事的社会压力,而患者及其家属的支持度对医生下转影响较小。此外,下转标准完善度越高、医保审批制度越便捷、医生高职称占比越高越有利于促进医生下转患者。
Objective To analyze clinicians’behavioral intentions and influencing factors of refer down to patients in the chronic recovery period.Methods From October 2018 to October 2019,the Questionnaire for Clinicians’Referral Intentions in Tertiary Medical Institutions designed based on the theory of planned behavior was used to evaluate the results of oxght tertiary general hospitals in Xuzhou of Jiangsu Province,Hangzhou of Zhejiang Province,and Jining of Shandong Province.Clinicians conducted a cross-sectional survey and recovered 442 valid questionnaires.Pearson correlation was used to analyze the relationship between the doctor’s attitude toward referral patients,subjective norms,and perceptual behavior control influencing factors and the doctor’s refer down intention.Finally,a structural equation model was established to analyze the degree of influence of various factors on the doctor’s refer down intention and the influence path.Results 76.5% of the surveyed doctors had the intention to refer down patients in the chronic recovery period,among which,the intention of the senior professional title clinician was the highest,reaching 92.7%.There was a statistically significant difference in the referral intention of clinicians with different professional titles(P<0.01).Attitudes,subjective behavioral norms,and perceived behavioral control had a direct impact on behavioral intentions,explaining 52%,42%,and 23% of the differences in behavioral intentions.Attitudes had the greatest influence on intentions.Conclusion Attitude and subjective norms are the most important factors influencing the downward transfer intentions of clinicians in tertiary hospitals.Attitude has the greatest impact,followed by the social pressure transfer intentions of clinicians in tertiary hospitals.Attitude has the greatest impact,followed by the social pressure that doctors feel from hospital deans,department directors,and colleagues,and patients and their families.The degree of support has little effect on the doctor's transfer.In addition,the higher the degree of completeness of the transfer standard,the more convenient the medical insurance approval system,and the higher the proportion of doctors with high professional titles,the more favorable it is to promote the refer down of doctors to patients.
作者
王侠
代涛
黄菊
WANG Xia;DAI Tao;HUANG Ju(Peking Union Medical College,Beijing 100730,China;Institute of Medical Information,Chinese Academy of Medical Sciences,Beijing 100020,China)
出处
《中国医药导报》
CAS
2021年第17期48-52,63,共6页
China Medical Herald
基金
北京市自然科学基金资助项目(9184034)
中国医学科学院医学信息研究所新冠肺炎疫情专项项目(2020XG017)。
关键词
医生
向下转诊
计划行为理论
行为意向
影响因素
Doctors
Refer down
Theory of planned behavior
Behavior intention
Influencing factors
