摘要
[目的]调查鄂南地区肿瘤预防及双向转诊现状,探讨如何将新农合制度与肿瘤预防及双向转诊相结合,构建社会、各级医院、患者共赢的肿瘤预防及双向转诊模式。[方法]邀请新农合管理、卫生法学、肿瘤及相关专业专家12人进行访谈及讨论;采用自制问卷调查肿瘤预防及双向转诊模式主体市级医院医生127人次,县级医院医生111人次,乡镇卫生院及社区卫生服务中心医生141人次,新农合农民681人;抽样现场调查27家乡镇及社区卫生院电子病历使用情况。[结果]专家一致认为肿瘤预防及双向转诊模式与现行新农合制度及分级诊疗制度可以接轨;肿瘤专业专家认为在现行制度下实现肿瘤防治及双向转诊模式无实质性障碍;卫生法律专家认为该模式与现行法律法规均不矛盾,上下级医师联动、技术扶持能减少医患纠纷;各级医院医生共有211名赞成双向转诊模式(55.67%),各级医院医生对双向转诊模式态度无统计学差异(χ~2=1.900,P=0.754);79.44%的参合农民认为目前农合制度转诊手续麻烦,86.81%的医生认为农合限制药品多,恶性肿瘤相关医患双方对新农合制度的不满因素间有显著统计学差异(χ~2=243.915,P=0.000);本地区乡镇及社区卫生服务中心医嘱和病程记录全部电子化所占比率为66.67%。[结论]以鄂南为试点,以保本让利为核心,建立肿瘤预防及双向转诊模式具备现实基础,在基础设施、制度管理等方面需进一步完善。
[Purpose] To survey the current situation of cancer prevention and two-way referral under new rural cooperative medical system（NRCMS） in Southern Hubei Province as a pilot region.[Methods] Twelve experts in various fields were invited for interview and discussion. A self-made questionnaire survey was conducted among 379 physicians from different levels of health institutions and 681 local rural residents. The use of electronic medical records was surveyed in 27 township and community health centers. [Results] Experts agreed that cancer prevention and twoway referral model were effectively applied under the current new rural cooperative medical system. Among 379 physicians 211 were in favor of two-way referral model（55.67%）,there was no significant difference among doctors in all levels（χ^2=1.900,P=0.754）;79.44% of rural residents considered that the current referral procedures were too cumbersome;86.81% doctors thought that there were too much restrictions in drug prescription under NRCMS. There was significant difference in cancer management-related dissatisfaction under NRCMS between physicians and residents（χ^2=243.915,P=0.000）;the proportion of electronic physician＇s orders and progress notes in local township and community health service centers was 66.67%. [Conclusion] The establishment of cancer prevention and two-way referral model under NRCMS is feasible;however,the infrastructure,institutional management and other aspects need to be further improved.
出处
《中国肿瘤》
CAS
CSCD
2017年第5期327-332,共6页
China Cancer
基金
湖北省卫生计生科研基金资助(WJ2015MB233)
关键词
新型农村合作医疗
双向转诊模式
肿瘤预防
湖北
new rural cooperative medical system
two-way referral
cancer prevention
Hubei
