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Practices and attitudes of doctors and patients to downward referral in Shanghai, China
OBJECTIVES: In China, the rate of downward referral is relatively low, as most people are unwilling to be referred from hospitals to community health systems (CHSs). The aim of this study was to explore the effect of doctors' and patients' practices and attitudes on their willingness for d...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387945/ https://www.ncbi.nlm.nih.gov/pubmed/28373247 http://dx.doi.org/10.1136/bmjopen-2016-012565 |
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author | Yu, Wenya Li, Meina Nong, Xin Ding, Tao Ye, Feng Liu, Jiazhen Dai, Zhixing Zhang, Lulu |
author_facet | Yu, Wenya Li, Meina Nong, Xin Ding, Tao Ye, Feng Liu, Jiazhen Dai, Zhixing Zhang, Lulu |
author_sort | Yu, Wenya |
collection | PubMed |
description | OBJECTIVES: In China, the rate of downward referral is relatively low, as most people are unwilling to be referred from hospitals to community health systems (CHSs). The aim of this study was to explore the effect of doctors' and patients' practices and attitudes on their willingness for downward referral and the relationship between downward referral and sociodemographic characteristics. METHODS: Doctors and patients of 13 tertiary hospitals in Shanghai were stratified through random sampling. The questionnaire surveyed their sociodemographic characteristics, attitudes towards CHSs and hospitals, understanding of downward referral, recognition of the community first treatment system, and downward referral practices and willingness. Descriptive statistics, χ(2) test and stepwise logistic regression analysis were employed for statistical analysis. RESULTS: Only 20.8% (161/773) of doctors were willing to accept downward referrals, although this proportion was higher among patients (37.6%, 326/866). Doctors' willingness was influenced by education, understanding of downward referral, and perception of health resources in hospitals. Patients' willingness was influenced by marital status, economic factors and recognition of the community first treatment system. Well-educated doctors who do not consider downward referral would increase their workloads and those with a more comprehensive understanding of hospitals and downward referral process were more likely to make a downward referral decision. Single-injury patients fully recognising the community first treatment system were more willing to accept downward referral. Patients' willingness was significantly increased if downward referral was cost-saving. A better medical insurance system was another key factor for patients to accept downward referral decisions, especially for the floating population. CONCLUSIONS: To increase the rate of downward referral, the Chinese government should optimise the current referral system and conduct universal publicity for downward referral. Doctors and patients should promote understandings of downward referral. Hospitals should realise the necessity of downward referral, effectively reduce workloads and provide continuing education for doctors. Increasing monetary reimbursement is urgent, as is improving the medical insurance system. |
format | Online Article Text |
id | pubmed-5387945 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-53879452017-04-13 Practices and attitudes of doctors and patients to downward referral in Shanghai, China Yu, Wenya Li, Meina Nong, Xin Ding, Tao Ye, Feng Liu, Jiazhen Dai, Zhixing Zhang, Lulu BMJ Open Health Services Research OBJECTIVES: In China, the rate of downward referral is relatively low, as most people are unwilling to be referred from hospitals to community health systems (CHSs). The aim of this study was to explore the effect of doctors' and patients' practices and attitudes on their willingness for downward referral and the relationship between downward referral and sociodemographic characteristics. METHODS: Doctors and patients of 13 tertiary hospitals in Shanghai were stratified through random sampling. The questionnaire surveyed their sociodemographic characteristics, attitudes towards CHSs and hospitals, understanding of downward referral, recognition of the community first treatment system, and downward referral practices and willingness. Descriptive statistics, χ(2) test and stepwise logistic regression analysis were employed for statistical analysis. RESULTS: Only 20.8% (161/773) of doctors were willing to accept downward referrals, although this proportion was higher among patients (37.6%, 326/866). Doctors' willingness was influenced by education, understanding of downward referral, and perception of health resources in hospitals. Patients' willingness was influenced by marital status, economic factors and recognition of the community first treatment system. Well-educated doctors who do not consider downward referral would increase their workloads and those with a more comprehensive understanding of hospitals and downward referral process were more likely to make a downward referral decision. Single-injury patients fully recognising the community first treatment system were more willing to accept downward referral. Patients' willingness was significantly increased if downward referral was cost-saving. A better medical insurance system was another key factor for patients to accept downward referral decisions, especially for the floating population. CONCLUSIONS: To increase the rate of downward referral, the Chinese government should optimise the current referral system and conduct universal publicity for downward referral. Doctors and patients should promote understandings of downward referral. Hospitals should realise the necessity of downward referral, effectively reduce workloads and provide continuing education for doctors. Increasing monetary reimbursement is urgent, as is improving the medical insurance system. BMJ Publishing Group 2017-04-03 /pmc/articles/PMC5387945/ /pubmed/28373247 http://dx.doi.org/10.1136/bmjopen-2016-012565 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Health Services Research Yu, Wenya Li, Meina Nong, Xin Ding, Tao Ye, Feng Liu, Jiazhen Dai, Zhixing Zhang, Lulu Practices and attitudes of doctors and patients to downward referral in Shanghai, China |
title | Practices and attitudes of doctors and patients to downward referral in Shanghai, China |
title_full | Practices and attitudes of doctors and patients to downward referral in Shanghai, China |
title_fullStr | Practices and attitudes of doctors and patients to downward referral in Shanghai, China |
title_full_unstemmed | Practices and attitudes of doctors and patients to downward referral in Shanghai, China |
title_short | Practices and attitudes of doctors and patients to downward referral in Shanghai, China |
title_sort | practices and attitudes of doctors and patients to downward referral in shanghai, china |
topic | Health Services Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387945/ https://www.ncbi.nlm.nih.gov/pubmed/28373247 http://dx.doi.org/10.1136/bmjopen-2016-012565 |
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