發(fā)布時(shí)間：2018-12-06 16:54

【摘要】：目的:醫(yī)療糾紛是醫(yī)患關(guān)系惡化的表現(xiàn)形式,當(dāng)前醫(yī)藥衛(wèi)生體制改革的深化并未使醫(yī)療糾紛的現(xiàn)狀得以明顯改善,化解醫(yī)患之間的矛盾沖突對社會(huì)的穩(wěn)定和衛(wèi)生事業(yè)的持續(xù)發(fā)展有著極為重要的作用。通過調(diào)查分析重慶市縣級醫(yī)院醫(yī)療糾紛的情況,了解現(xiàn)狀,研究醫(yī)患雙方相關(guān)因素對醫(yī)療糾紛的影響,提出現(xiàn)實(shí)可行的防范措施和建議。方法:采用文獻(xiàn)分析、案例研究、問卷調(diào)查、統(tǒng)計(jì)分析等研究方法,文字資料來源于收集CNKI、Pub Med等國內(nèi)外數(shù)據(jù)庫相關(guān)文獻(xiàn)以及國家關(guān)于醫(yī)療糾紛的相關(guān)政策文件;數(shù)據(jù)資料來自分層抽取重慶市7所縣級醫(yī)院的醫(yī)務(wù)人員和患者進(jìn)行醫(yī)患關(guān)系看法與醫(yī)療糾紛認(rèn)知情況問卷調(diào)查,收集其中一所縣級醫(yī)院2011年至2013年發(fā)生的醫(yī)療糾紛案例進(jìn)行綜合整理,對相關(guān)數(shù)據(jù)進(jìn)行歸納、分類以及統(tǒng)計(jì)分析,統(tǒng)計(jì)分析應(yīng)用Spss20.0軟件,進(jìn)行頻數(shù)、百分比描述、卡方檢驗(yàn)以及多因素Logistic回歸分析。結(jié)果:現(xiàn)狀:重慶市縣級醫(yī)院醫(yī)療糾紛發(fā)生頻次逐年上漲,引起醫(yī)療糾紛發(fā)生的前三位原因是:對治療效果不滿意、醫(yī)療費(fèi)用過高、醫(yī)患溝通障礙;醫(yī)療糾紛的處理途徑基本都以醫(yī)患雙方協(xié)商方式解決;患者對就醫(yī)時(shí)最不滿意的依次是候診時(shí)間長、費(fèi)用高、掛號(hào)難;醫(yī)務(wù)人員對醫(yī)患關(guān)系的評價(jià)消極,對醫(yī)療糾紛發(fā)生的擔(dān)心程度高,對當(dāng)前的執(zhí)醫(yī)環(huán)境評價(jià)較低。影響因素:發(fā)生醫(yī)療糾紛的患者以中年人、老年人居多;沒有參加醫(yī)療保險(xiǎn),自費(fèi)醫(yī)療的患者易發(fā)生醫(yī)療糾紛;醫(yī)療費(fèi)用高的,發(fā)生醫(yī)療糾紛的概率大;外科是發(fā)生醫(yī)療糾紛最多的科室。醫(yī)務(wù)人員發(fā)生醫(yī)療糾紛以男性、外科、高職稱、工作負(fù)荷重、對醫(yī)療風(fēng)險(xiǎn)不熟悉、對患者態(tài)度差以及選擇使用有風(fēng)險(xiǎn)的醫(yī)療技術(shù)的為高風(fēng)險(xiǎn)因素。結(jié)論:目前縣級醫(yī)院醫(yī)療糾紛形勢嚴(yán)峻,影響因素多樣,其代表的基層醫(yī)療機(jī)構(gòu)的衛(wèi)生人才缺乏、醫(yī)務(wù)人員醫(yī)療服務(wù)意識(shí)淡薄、醫(yī)療風(fēng)險(xiǎn)預(yù)防不夠等問題突出;基層患者的經(jīng)濟(jì)、文化水平與其對醫(yī)療服務(wù)的需求、維權(quán)觀念的增強(qiáng)之間形成沖突。建議通過政府部門加大對基層醫(yī)療機(jī)構(gòu)人力資源投入、加強(qiáng)醫(yī)院管理隊(duì)伍建設(shè)等合理配置基層醫(yī)療機(jī)構(gòu)人力資源;鼓勵(lì)醫(yī)方購買醫(yī)療責(zé)任保險(xiǎn);培養(yǎng)醫(yī)務(wù)人員醫(yī)療服務(wù)意識(shí),提升縣級醫(yī)院服務(wù)水平;提高醫(yī)務(wù)人員醫(yī)患溝通技巧;增強(qiáng)醫(yī)療風(fēng)險(xiǎn)防控意識(shí);發(fā)展多元化調(diào)解途徑,在基層建立醫(yī)療糾紛人民調(diào)解委員會(huì)等舉措,切實(shí)緩解緊張的醫(yī)患關(guān)系給各方帶來的壓力,減少醫(yī)療糾紛的發(fā)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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R197.323

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