袁志敏+滕海晶+赵雪岩+何燕玲+白朝辉

摘 要 目的：分析慢性病预约门诊中预约患者的失约原因，探索提高门诊预约履约率的方法。方法：对2014年3月1日—3月31日在家庭医生预约门诊中失约后再次就诊的230例患者进行失约原因问卷调查，分析失约原因，采取相对应的综合干预措施，对其实施效果进行分析。结果：患者失约的直接原因排序为药物因素、不愿配合、怕就诊限制、遗忘、候诊时间长、改到其他医生处就诊等。针对这些失约原因采取干预措施后，预约履约率从4月的45.53%上升到8月的72.31%。结论：针对失约因素，采取综合干预措施可提高患者预约门诊率。

关键词 预约门诊 失约 履约

中图分类号：R197.323 文献标志码：A 文章编号：1006-1533（2016）12-0052-02

Analysis of reasons of missed appointments of the patients in the general out-patient clinic and effect of intervention in a community health service center in Shanghai

YUAN Zhimin， TENG Haijin， ZHAO Xueyan， HE Yanlin， BAI Chaohui

（Xinhua Community Health Service Center of Changning District， Shanghai 200052， China； 2. Mental Health Center affiliated to Jiao Tong University， Shanghai 200052， China）

ABSTRACT Objective： To analyze the reasons of missed appointments of the appointed patients in the chronic disease outpatient appointment clinic to explore the improvement of outpatient appointment compliance rate. Methods： From March 1 to 31， 2014， 230 cases who revisited the clinic after they missed the appointment in the chronic disease outpatient appointment clinic were selected and their reasons were investigated and analyzed. The comprehensive intervention measures corresponding to the reasons were taken and the results were analyzed. Results： The direct reasons of the patients missed appointment were drug factor， unwilling cooperation， fear of treatment restrictions， forgotten， long waiting time， changing to another doctor service. After taking the intervention measures for these reasons， the appointment compliance rate increased from 45.53% in April to 72.31% in August. Conclusion： According to the reasons of missed appointments， taking the targeted comprehensive intervention measures can improve the appointment rate of the patients.

KEY WORDS outpatient appointment； missed appointment； perform an appointment

随着家庭医生制服务改革的深入，社区医务人员承担着居民健康守门人的角色，责任重大。社区就诊的人数不断增加，患者候诊时间延长，拥挤现象严重，对管理和服务满意度带来很大负面影响。实行预约门诊，不仅可以安排错峰就医，更能引导患者合理就医、有序就医，同时有利于提高社区卫生服务管理水平、工作效率和医疗质量[1]，也是对传统就医模式的改革，最终受益的是社区卫生服务机构、医生和患者三方[2]。但在预约门诊推进初期，失约现象严重，大大挫伤了医生和患者对预约的信心和积极性，也浪费医疗资源，制约了预约门诊的健康发展。本文通过对失约患者的调查，分析失约原因，发现和规避各种不利因素，采取对应措施，积极推进预约门诊的健康发展。……