摘要
目的基于知信行与期望理论,探究、构建及验证基层医生开展首诊意愿的驱动因素理论模型与形成机制。方法运用随机整群抽样方法,于2019年4—5月,对杭州市20家基层医疗卫生服务机构的医生进行问卷调查,调查内容包括基层医生的首诊认知水平、首诊能力自评、政策制度评价、首诊工作期望、工作满意度等。采用描述性统计、多重线性回归、结构方程模型分析等方法,探究基层医生首诊意愿的驱动因素与形成机制。结果基层医生开展首诊意愿率为76.4%(308/403);首诊工作正面期望(β=0.309)、首诊认知水平(β=0.216)、政策制度评价(β=0.184)、首诊能力自评(β=0.170),均直接影响基层医生开展首诊意愿;5类驱动因素对首诊意愿的影响总效应依次为首诊认知水平(0.536)、政策制度评价(0.494)、首诊能力自评(0.436)、首诊工作正面期望(0.186)、工作满意度(0.146)。结论首诊认知、首诊能力、政策制度、正向期望分别是驱动基层医生开展首诊意愿的重要前提、关键动力、有力保障、激发力量。建议政府及医疗机构进一步提高基层医生首诊认知水平,系统提升首诊服务能力,协同完善财政投入、医保报销、转诊制度等政策引导措施,建立健全基层医生职业发展、绩效考核、薪酬福利等激励措施。
Objective Based on the KAP and Prospect theory,to explore,construct and verify the theoretical model and formation mechanism of driving factors of primary care doctors′willingness to carry out the primary diagnosis.Methods Using the random cluster sampling method,from April to May 2019,a questionnaire survey was conducted among doctors at 20 primary medical and health service institutions in Hangzhou.The survey covered the primary care doctors′cognition level of primary diagnosis,their self-evaluation of primary medical care capabilities,evaluation of policies and systems,expectation of primary medical care,and their job satisfaction.Descriptive statistic,multiple linear regression and structural equation model were used to analyze and explore the driving factors and formation mechanism of their willingness to carry out the primary diagnosis.Results Primary care doctors′willingness rate for primary diagnosis was 76.4%(308/403).Positive expectation(beta=0.309),cognition level(beta=0.216),evaluation of policies and systems(beta=0.184),and self-evaluation of primary diagnosis capability(beta=0.170),all of which directly affect the said willingness.The total effect of the five types of driving factors on the willingness of the primary diagnosis was as follows:cognitive level of the primary diagnosis(0.536),evaluation of the policy system(0.494),self-evaluation of the primary diagnosis capability(0.436),positive expectations of the primary diagnosis work(0.186),job satisfaction(0.146).Conclusions The cognition of the primary diagnosis,the capability of the primary diagnosis,the policy system and the positive expectation are the important premises,key driving forces,and a strong guarantee and motivation to drive primary care doctors to carry out the primary diagnosis.It is suggested that the government and medical institutions should further improve the cognition level of primary care doctors,focusing on systematically improving the service capability of primary care doctors′primary consultation,coordinating to
作者
钱宇
王小合
陈洁
任佳焌
程港镁
潘文文
Qian Yu;Wang Xiaohe;Chen Jie;Ren Jiajun;Cheng Gangmei;Pan Wenwen(Health Service Management Faculty of Medical School,Hangzhou Normal University,Hangzhou 311121,China;The First Affiliated Hospital of Medical School of Zhejiang University,Hangzhou 310003,China;The Second Affiliated Hospital of Medical School of Zhejiang University,Hangzhou 310009,China)
出处
《中华医院管理杂志》
CSCD
北大核心
2020年第1期66-71,共6页
Chinese Journal of Hospital Administration
基金
国家自然科学基金面上项目(71673075,71974050)。
关键词
基层首诊
首诊意愿
驱动因素
形成机制
结构方程模型
Initial diagnosis at primary level
Intention of initial diagnosis
Driving factors
Mechanism
Structural equation model
