王雯雯,曹艳佩,葛霄琳,胡春花.上海地区腹膜透析患者就诊现状及意向的调查分析[J].上海护理,2023,23(2):
上海地区腹膜透析患者就诊现状及意向的调查分析
Investigation and analysis of outpatient consultation status and intention to visit peritoneal dialysis patients in Shanghai
DOI:
中文关键词:  腹膜透析患者  就诊意向  现状调查  三级医院  社区医院
英文关键词:Peritoneal dialysis patients  Consultation intention  Status survey  Tertiary hospitals  Primary health care institutions
基金项目:上海市闵行区自然科学研究课题基金资助(基金编号:2019MHZ064)
作者单位E-mail
王雯雯 复旦大学附属华山医院 17211170015@fudan.edu.cn 
曹艳佩* 复旦大学附属华山医院/复旦大学附属上海第五人民医院 yanpeicao@fudan.edu.cn 
葛霄琳 复旦大学附属华山医院  
胡春花 复旦大学附属上海市第五人民医院  
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中文摘要:
      目的:调查上海地区腹膜透析患者就诊现状与意向,为今后引导腹透患者社区医院就诊提供意见。方法:方便抽取2021年7-10月上海地区6所综合医院腹透门诊规律随访的188名腹透患者,采用自设问卷,调查腹透患者就诊现状及意向,并分析影响因素。结果:共发放调查问卷188份,回收有效问卷188份,有效回收率 100.0%。腹透患者出现不适时,首选非社区和社区卫生服务机构的腹透患者比例分别为84.0%(158例)和16.0%(30例)。对于具体腹透服务项目,各级医疗机构均有提供的情况下,选择三级医院就诊患者比例为59.6%-91%,选择社区医院就诊患者比例为6.4%-34.6%,其中比例较高的服务项目是:健康教育34.6%(65例)、上门腹透34.0%(64例)、开药(包括腹透液)29.8%(56例)。腹透患者选择就诊机构主要考虑的前五位因素分别是:医务人员服务态度好72.9%(159例),医疗水平高69.7%(152例),医保定点单位51.4%(112例),就诊方便45.0%(98例),医院/医生名气高42.7%(93例)。不同随访频率(=29.204, P<0.01)的腹透患者在就诊意向上有统计学差异。结论:上海地区腹膜透析患者绝大部分倾向于选择三级医院就诊,应注重提高社区医院腹透医疗服务水平和服务态度,在考虑患者病情、随访频率等条件下,逐步引导规律腹透患者下沉社区医院。
英文摘要:
      Objective: To investigate the current status and intention of peritoneal dialysis patients' consultation in Shanghai, and to lay the foundation for future exploration of community-based management service model of peritoneal dialysis. Method: A total of 188 patients who were regularly followed up in the peritoneal dialysis clinics of six general hospitals in Shanghai from July to October 2021 were conveniently selected to investigate the current status and intention of peritoneal dialysis patients to visit the clinics using a self-administered questionnaire, and to analyze the influencing factors. Results: A total of 188 questionnaires were distributed, and 188 valid questionnaires were returned, with a valid return rate of 100.0%. The proportion of abdominal dialysis patients who preferred non-community and community health services when they were unwell was 84.0% (158 cases) and 16.0% (30 cases), respectively. For specific abdominal dialysis services, when they were available at all levels of care, the proportion of patients who chose tertiary care hospitals for consultation ranged from 59.6% to 91%, and the proportion of patients who chose community hospitals for consultation ranged from 6.4% to 34.6%, with the higher proportions of services being: health education 34.6% (65 cases), home abdominal dialysis 34.0% (64 cases), and prescription of medication (including abdominal dialysis solution) 29.8% (56 cases). The top five main factors considered by the abdominal dialysis patients in choosing a provider were: good service attitude of medical staff 72.9% (159 cases), high medical level 69.7% (152 cases), medical insurance designated unit 51.4% (112 cases), convenience of access 45.0% (98 cases), and high reputation of hospital/doctor 42.7% (93 cases). There was a statistical difference in the intention to visit peritoneal dialysis patients with different follow-up frequencies (=29.204, P<0.01). Conclusion: The majority of peritoneal dialysis patients in Shanghai tend to choose tertiary hospitals, and for patients with low follow-up frequency and stable conditions, follow-up visits to community hospitals with peritoneal dialysis medical qualifications are encouraged, and the level and attitude of peritoneal dialysis medical services in community hospitals are gradually improved to achieve a reasonable allocation of peritoneal dialysis medical resources.
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