Understanding of hierarchical medical mode in chronic diseases management among medical staff and residents in Xiamen / 中华全科医师杂志

ABSTRACT

Objective To estimate the status of understanding hierarchical medical mode in chronic disease management among medical staff and residents in Xiamen .Methods The multi-stage sampling was used in the study to select 49 physicians from the tertiary hospitals , 58 general practitioners ( GPs ) and health managers from 5 community health services centers , and 499 residents from 5 communities in Xiamen.We conducted a face-to-face survey to estimate their basic information , recognition for hierarchical medical mode , and patients'willingness for community first contact care .The data was described by mean value of frequency and constituent ratio , the chi-square test or Fisher's exact test was used for comparison among groups .Logistic regression was performed to analyze the factors influencing the residents 'preference for treatment in community medical institutions . Results The physicians from tertiary hospitals or community health service centers were almost all familiar with Xiamen mode (91/107, 85%), and more than half of them knew about the hierarchical medical system (67/107, 62.6%), 86.9% (93/107) of them knew about the guide of hierarchical medical system , 58.9%(63/107) of them received the relative training before .The physicians from community had higher knowledge , more frequency training , more referral experiences and more effective evaluation than the physicians from hospitals (all P<0.05).In our study, 86.2%(344/399) of residents were willing to see doctors in community health centers and 77.9%(311/399) of them were willing to return to community health service centers from tertiary hospitals for disease convalescence or chronic disease management;53.6% (214/399) of residents preferred to utilize community first contact care when they got chronic diseases , and they were more satisfied with the consultation and diagnosis process in community .The residents who knew about the hierarchical medical system were more likely to utilize community first contact care and return to community for medical care . However, the female or the higher-income residents were less likely to see doctors in community .Patients who had experienced transfer to community or had higher satisfaction to community care were more willing to return from hospitals to community for disease convalescence .The mode showed that the system was more effective in measuring and controlling blood pressure or blood glucose for patients who joined the patients 'network than for those did not join.(P<0.05).Conclusion Medical staff are familiar with hierarchical medical system , and the residents are likely to use community health service as their first contact care in Xiamen.The utilization of community first contact care is influenced by sex , family income, previous experience, knowledge of the system , and satisfaction to the system of patients .