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[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。
[Objective] To investigate the status of cancer prevention and two-way referral in southern area of Hubei Province and to explore how to combine the new rural cooperative medical system with tumor prevention and two-way referral to construct a win-win model of cancer prevention and two-way referral for society, hospitals and patients . [Methods] Twelve people from NCMS, health law, oncology and related professions were invited to interview and discuss. A total of 127 city-level doctors, 111 county-level doctors, 141 township hospitals and community health service centers doctors, 681 new rural cooperative medical workers; sampling site survey of 27 towns and community health centers electronic medical records use. [Results] The experts agreed that the model of tumor prevention and two-way referral could be in line with the current NCMS and graded diagnosis and treatment system; tumor experts believe there is no substantial obstacle to cancer prevention and two-way referral under the current system; It is concluded that there is no contradiction between this model and the current laws and regulations. The linkage between senior and subordinate doctors and technical support can reduce disputes between doctors and patients. 211 doctors at all levels agree on the two-way referral model (55.67%), There was no significant difference in attitude (χ ~ 2 = 1.900, P = 0.754); 79.44% of the participating farmers thought that the referral procedure of the NRCMS was troublesome, 86.81% of the doctors considered that there were more NRCMSs and the doctors and patients There was a statistically significant difference between the factors of dissatisfaction with the NRCMS (χ ~ 2 = 243.915, P = 0.000). The share of all electronic records in the township and community health service centers in this area was 66.67%. [Conclusion] Taking E’nan as a pilot project and establishing a model of cancer prevention and two-way referral centering on preservation and nonprofit sharing, it needs to be further improved in terms of infrastructure and system management.