重庆市县级医院医疗纠纷的现状及影响因素研究

发布时间：2018-12-06 16:54

【摘要】：目的:医疗纠纷是医患关系恶化的表现形式,当前医药卫生体制改革的深化并未使医疗纠纷的现状得以明显改善,化解医患之间的矛盾冲突对社会的稳定和卫生事业的持续发展有着极为重要的作用。通过调查分析重庆市县级医院医疗纠纷的情况,了解现状,研究医患双方相关因素对医疗纠纷的影响,提出现实可行的防范措施和建议。方法:采用文献分析、案例研究、问卷调查、统计分析等研究方法,文字资料来源于收集CNKI、Pub Med等国内外数据库相关文献以及国家关于医疗纠纷的相关政策文件;数据资料来自分层抽取重庆市7所县级医院的医务人员和患者进行医患关系看法与医疗纠纷认知情况问卷调查,收集其中一所县级医院2011年至2013年发生的医疗纠纷案例进行综合整理,对相关数据进行归纳、分类以及统计分析,统计分析应用Spss20.0软件,进行频数、百分比描述、卡方检验以及多因素Logistic回归分析。结果:现状:重庆市县级医院医疗纠纷发生频次逐年上涨,引起医疗纠纷发生的前三位原因是:对治疗效果不满意、医疗费用过高、医患沟通障碍;医疗纠纷的处理途径基本都以医患双方协商方式解决;患者对就医时最不满意的依次是候诊时间长、费用高、挂号难;医务人员对医患关系的评价消极,对医疗纠纷发生的担心程度高,对当前的执医环境评价较低。影响因素:发生医疗纠纷的患者以中年人、老年人居多;没有参加医疗保险,自费医疗的患者易发生医疗纠纷;医疗费用高的,发生医疗纠纷的概率大;外科是发生医疗纠纷最多的科室。医务人员发生医疗纠纷以男性、外科、高职称、工作负荷重、对医疗风险不熟悉、对患者态度差以及选择使用有风险的医疗技术的为高风险因素。结论:目前县级医院医疗纠纷形势严峻,影响因素多样,其代表的基层医疗机构的卫生人才缺乏、医务人员医疗服务意识淡薄、医疗风险预防不够等问题突出;基层患者的经济、文化水平与其对医疗服务的需求、维权观念的增强之间形成冲突。建议通过政府部门加大对基层医疗机构人力资源投入、加强医院管理队伍建设等合理配置基层医疗机构人力资源;鼓励医方购买医疗责任保险;培养医务人员医疗服务意识,提升县级医院服务水平;提高医务人员医患沟通技巧;增强医疗风险防控意识;发展多元化调解途径,在基层建立医疗纠纷人民调解委员会等举措,切实缓解紧张的医患关系给各方带来的压力,减少医疗纠纷的发生。
[Abstract]:Objective: medical disputes are the manifestation of the deterioration of doctor-patient relationship. The deepening of medical and health system reform has not improved the present situation of medical disputes. Resolving the conflicts between doctors and patients plays an important role in social stability and sustainable development of health care. Based on the investigation and analysis of medical disputes in county-level hospitals in Chongqing, this paper analyzes the current situation, studies the influence of relevant factors between doctors and patients on medical disputes, and puts forward practical and feasible preventive measures and suggestions. Methods: literature analysis, case study, questionnaire survey, statistical analysis and other research methods were used. The text data were collected from the relevant documents of CNKI,Pub Med and other domestic and foreign databases, as well as the relevant policy documents of the state on medical disputes. The data were collected from stratified medical staff and patients from 7 county-level hospitals in Chongqing to investigate the relationship between doctors and patients and the cognition of medical disputes. Collect the medical dispute cases that occurred from 2011 to 2013 in one county-level hospital, sum up, classify and analyze the relevant data, and use Spss20.0 software to analyze the data, and describe the frequency and percentage of the cases. Chi-square test and multivariate Logistic regression analysis. Results: the frequency of medical disputes in county-level hospitals of Chongqing increased year by year. The first three causes of medical disputes were as follows: dissatisfied with the therapeutic effect, high medical expenses and obstacles of communication between doctors and patients; The treatment of medical disputes is basically resolved by consultation between doctors and patients, and the most dissatisfied patients are waiting time, high cost and difficult to register. The evaluation of doctor-patient relationship by medical staff is negative, the degree of worry about medical disputes is high, and the evaluation of current medical environment is low. The influencing factors are: the middle aged patients, the old people are the majority; the patients who do not take part in the medical insurance, the patients who pay for the medical treatment are apt to have the medical dispute, the medical treatment expense is high, the probability of the medical dispute is large; Surgery is the department with the most medical disputes. The medical dissension among medical personnel were high risk factors such as male, surgery, high professional title, heavy workload, not familiar with medical risk, poor attitude towards patients, and choice of risky medical technology. Conclusion: at present, the situation of medical disputes in county-level hospitals is severe, the influencing factors are various, the health personnel in the primary medical institutions are short of health personnel, the medical staff is weak in the sense of medical service, and the prevention of medical risks is not enough. There is a conflict between the economic and cultural level of patients at the grass-roots level and their need for medical services and the strengthening of their concept of safeguarding their rights. It is suggested that the government should increase the investment of human resources in primary medical institutions, strengthen the construction of hospital management team and rationally allocate human resources of primary medical institutions, and encourage doctors to purchase medical liability insurance. To cultivate the medical service consciousness of medical personnel, to improve the level of service in county-level hospitals, to improve the communication skills of medical staff, to enhance the awareness of prevention and control of medical risks, and to improve the awareness of prevention and control We should develop diversified mediation approaches and establish people's mediation committees for medical disputes at the grass-roots level, so as to effectively alleviate the pressure brought by the tense doctor-patient relationship and reduce the occurrence of medical disputes.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.323

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