Abstract:

Objective To investigate the current situation and problems of dual referral implementation in Songjiang District of Shanghai, and provide references for the optimization of dual referral system in China. Methods Three medical institutions were randomly selected from Songjiang District of Shanghai, with one first-grade hospital (community health center), one second-grade hospital and one third-grade hospital. Four hundred medical staff and 400 patients were surveyed with questionnaires, and 392 effective questionnaires from medical staff (176 from second-grade hospital or third-grade hospital and 216 from community health center) and 380 effective questionnaires from patients were recovered. The questionnaires were involved with the basic condition, dual referral willingness of patients, knowledge of medical staff and patients on dual referral policy, opinion of medical staff and patients on dual referral implementation channels, determinative right of dual referral, indications of dual referral and implementation difficulties of dual referral. Results Patients who often visited the community health center accounted for 52.9%, and 57.6% of patients with stable illness state were reluctant to be referred back to the community health center. There were significant differences in knowledge on dual referral policy, opinion on dual referral implementation channels, determinative right of dual referral and indications of dual referral between medical staff and patients (P<0.05). It was drawn from medical staff that the drive from economic benefits and lack in communications among medical institutions were the important influencing factors for dual referral. Conclusion The inadequate knowledge of medical staff and patients on dual referral, the unwillingness of patients on dual referral and the drive from economic benefits are the obstacles for the implementation of dual referral. Rational strategies and compensation system should be adopted to facilitate the implementation of dual referral.

Key words: dual referral, community health, strategy