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目的为进一步了解目前上海市民首诊愿望,并深入分析这些流向和首诊愿望产生的原因,为上海市医改提出政策建议,特进行该研究。方法随机整群分层抽取上海市中心地区(徐汇区)、上海市城乡结合区(闵行区)、上海市郊区(金山区)。每个地区研究800名门诊(住院)居民(医院和社区卫生服务中心各400人)共计2400人,回收问卷2082份,问卷回收率为86.75%。结果①上海市居民首选社区医院情况:门诊病人65.4%首选社区医院,20.8%首选三级医院;住院患者57.4%首选社区医院,27.8%首选三级医院。60～74岁人群首选社区医院达72.0%,≥75岁老人高达73.0%,门诊病人、年龄大者、退休人员和新型农村合作医疗人员首选社区医院比例较高。②上海市居民首选社区医院原因分析:门诊病人选择社区医院的主要原因是价格便宜和交通方便,住院病人选择社区医院的主要原因是价格便宜和服务态度;在年龄方面,不管是哪个年龄组,都认为选择社区医院是有价格便宜和交通方便的原因。其他项目的人群也基本如此,选择社区医院的原因主要是价格便宜、交通方便、就医流程便捷。结论上海市社区首诊势头较好,要因势利导,制定相关政策,保证家庭医生制度的顺利实现。
Objectives To further understand the current desire of Shanghai residents for first visit and to analyze in depth the causes of these trends and the desire of the first visit, and make policy recommendations for the Shanghai Medical Reform, the study is carried out in a special way. Methods Random cluster stratified extraction of downtown Shanghai (Xuhui District), Shanghai urban and rural areas (Minhang District), Shanghai suburbs (Jinshan District). A total of 2,400 residents (400 in hospitals and community health centers) were outpatient (inpatient) residents in each area. 2,082 questionnaires were collected, and the questionnaire recovery rate was 86.75%. Results ①The preferred community hospital in Shanghai: Outpatient 65.4% preferred community hospital and 20.8% preferred tertiary hospital; Inpatients 57.4% preferred community hospital and 27.8% preferred tertiary hospital. The community hospitals of 60-74 years of age preferred 72.0% of primary hospitals and 73.0% of those over 75 years of age. The proportion of outpatients, older patients, retirees and new rural cooperative medical personnel was the highest among community hospitals. (2) Analysis of the reasons why Shanghai residents preferred community hospitals: outpatients chose community hospitals mainly because of their cheap prices and convenient transportation. Inpatients’ selection of community hospitals was mainly due to their cheap prices and service attitude. In terms of age, regardless of the age group, All think that choosing a community hospital is cheap and easy to transport. Other projects are basically the same crowd, the main reason for choosing community hospitals is cheap, convenient transportation, medical treatment process is convenient. Conclusion Shanghai community first momentum is better, should make the best use of the situation, formulate relevant policies to ensure the smooth realization of the family doctor system.