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目的:收集江苏省苏北地区6所县级医院就诊的常见病、多发病,调研患者对农村三级医疗卫生网就诊的选择和影响因素,为分级诊疗的实施提供理论依据。方法:收集苏北地区6所县级医院451 319例就诊患者的疾病,通过随机发放调查问卷120份调研患者对农村三级医疗卫生网就诊的选择和影响因素,收回103份;访谈医务人员20人次。结果:被调查人员中平均年龄为50.23岁,其中男性占50.12%,女性占49.88%;苏北地区县级医院常见就诊的疾病前10位为急性上呼吸道感染、胃炎、盆腔炎、支气管肺炎、阴道炎、子宫颈炎、结膜炎、糖尿病、慢性阻塞性肺疾病、急性脑血管病;就诊的前10位疾病中80%以上的疾病可以在基层的乡镇卫生院解决。结合患者家属调研及医院管理人员访谈发现:目前患者首诊大多在县级医院,县级医院不堪重负,关键还在于基层医疗卫生机构的医疗服务水平和信任度不足,而受服务的方便性,服务费用、服务态度影响因素很低。结论:健全以县级医院为龙头、乡镇卫生院和村卫生室为基础的农村医疗卫生服务“网络”还需要进一步的完善,带动乡镇卫生院和村卫生室医疗服务水平的提升是形成“村卫生室-乡镇卫生院-县级医院”分诊有序,实现“双向转诊”畅通的关键,是解决医疗资源合理配置和公平性的根本。
OBJECTIVE: To collect common diseases and frequently-occurring diseases in 6 county-level hospitals in northern Jiangsu province and investigate the choice and influencing factors of the patients on the tertiary health care network in rural areas, so as to provide a theoretical basis for the implementation of grading diagnosis and treatment. Methods: A total of 451 319 cases of illness were collected from 6 county-level hospitals in northern Jiangsu Province. The questionnaires were randomly divided into 120 questionnaires to investigate the selection and influencing factors of rural third-level medical and health nets, and 103 medical workers were interviewed. Interviewed medical staff 20 Person times. Results: The average age of respondents was 50.23 years old, of which 50.12% were men and 49.88% were women. The top 10 common diseases in county-level hospitals in northern Jiangsu were acute upper respiratory tract infection, gastritis, pelvic inflammatory disease, bronchopneumonia, Vaginitis, cervicitis, conjunctivitis, diabetes, chronic obstructive pulmonary disease, acute cerebrovascular disease; more than 80% of the top 10 diseases in the treatment can be solved in the township hospitals at the grassroots level. Based on the investigation of family members and interviews with hospital administrators, it is found that most patients are mostly overwhelmed by county-level hospitals and county-level hospitals. The key lies in the lack of medical service and trust in primary health care institutions. However, Service costs, service attitude influencing factors is low. Conclusion: To improve rural health services based on county-level hospitals, township hospitals and village clinics, “Network” needs to be further improved to promote the improvement of medical services in township health centers and village clinics “Village clinics - township hospitals - county hospitals ” triage order, to achieve “two-way referral ” the key to smooth, is to solve the rational allocation of medical resources and fairness of the fundamental.