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Survey of Referal System Influenced Factors from The

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Survey of Referal System Influenced Factors from The ﻣﺮاﺟﻌﻴﻦ ﺑﻪ ﺑﻴ ﻤﺎرﺳﺘﺎنﻫﺎي دوﻟﺘﻲ اﺳﺘﺎن اﺻﻔﻬﺎن در ﺧﺼﻮص ﻋﻮاﻣﻞ ﻣﺆﺛﺮ ﺑﺮ ﻣﻴ ﺰان ﺗﺤﻘﻖ ﻧﻈﺎم ارﺟﺎع ﭼﻪ ﻣﻲ ﮔﻮﻳﻨﺪ؟ * اﺳﺪاﻟﻪ ﺷﻤﺲ1، ﻣﺮﻳﻢ ﻣﻔﻴﺪ2 ، ﻓﺮزاﻧﻪ رﺟﺎﻟﻴ ﺎن 3 3 ﭼﻜﻴﺪه ﻣﻘﺪﻣﻪ: از ﺟﻤﻠﻪ ﻣﺤﺎﺳﻦ ﺗﺤﻘﻖ ﻓﺮاﻳﻨﺪ ﻧﻈﺎم ارﺟﺎع، ﻛﻢ ﻛﺮدن ﭘﺮﺳﻨﻞ و ﺗﺠﻬﻴﺰات و ﺻﺮﻓﻪ ﺟﻮﻳﻲ در ﻣﺨﺎرج و وﺳﺎﻳﻞ، ﺗﻘﺴﻴﻢ ﻣ ﺘﻨﺎﺳﺐ ﻣﻨﺎﺑﻊ ﺟﻬﺖ اﺳﺘﻔﺎده ي ﺑﻬﻴﻨﻪ ي آن ﻫﺎ و ﻋﺪم اﻳﺠﺎد ﻫﺰﻳﻨﻪ ﻫﺎي ﻏﻴﺮ ﻣﻨﻄﻘﻲ ﺑﺮاي ﺑﻴﻤﺎران ﻣﻲ ﺑﺎﺷﺪ . در اﻳﻦ راﺳﺘﺎ ﻫﺪف ﭘﮋوﻫﺶ ﺣﺎﺿﺮ ﺗﻌﻴﻴﻦ ﻋﻮاﻣﻞ ﻣﺆﺛﺮ ﺑﺮ ﻣﻴﺰان ﺗﺤﻘﻖ ﻧﻈﺎم ارﺟﺎع از ﻧﻈﺮ ﻣﺮاﺟﻌﻴﻦ ﺑﻪ ﺑﻴﻤﺎرﺳﺘﺎن ﻫﺎي دوﻟﺘﻲ اﺳﺘﺎن اﺻﻔﻬﺎن ﺑﻮد ﺗﺎ ﺑﺎ دﺳﺘﻴﺎﺑﻲ ﺑﻪ آن ﺑﺘﻮان ﺑﺮ اﻳﻦ ﻣﻬﻢ ﻓﺎﻳﻖ آﻣﺪ و ﻧﻈﺎم ﺳﻼﻣﺖ را از ﻣﺰاﻳﺎي آن ﺑﻬﺮه ﻣﻨﺪ ﺳﺎﺧﺖ. روش ﺑﺮرﺳﻲ: ﻧﻮع ﻣﻄﺎﻟﻌﻪ ﺗﻮﺻﻴﻔﻲ– ﺗﺤﻠﻴﻠﻲ و ﭘﻴﻤﺎﻳﺸﻲ ﺑﻮد . ﻣﻄﺎﻟﻌﻪ در ﺷﺶ ﻣﺎﻫﻪ ي دوم ﺳﺎل 1387 اﻧﺠﺎم ﺷﺪ و ﺟﻤﻌﻴﺖ ﻣﻮرد ﻣﻄﺎﻟﻌﻪ، ﻣﺮاﺟﻌﻴﻦ ﺑﻪ ﺑﻴﻤﺎرﺳﺘﺎن ﻫﺎي دوﻟﺘﻲ اﺳﺘﺎن اﺻﻔﻬﺎن ﺑﻮده اﺳﺖ . از اﻳﻦ ﻣﻴﺎن 5 ﺑﻴﻤﺎرﺳﺘﺎن ﺗﺎﺑﻌﻪي ﺷﺒﻜ ﻪي ﺑﻬﺪاﺷﺖ و درﻣﺎن ﺷﻬﺮﺳﺘﺎن ﻫﺎي ﻓﻼورﺟﺎن، ﺷﺎﻫﻴﻦ ﺷﻬﺮ، ﺷﻬﺮﺿﺎ و ﻧﺎﻳﻴﻦ و ﻧﻴﺰ 5 ﺑﻴﻤﺎرﺳﺘﺎن دوﻟﺘﻲ ﺷﻬﺮﺳﺘﺎن اﺻﻔﻬﺎن ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﻗﺮار ﮔﺮﻓﺘﻪ اﺳﺖ . ﻧﺤﻮ ه ي ﻧﻤﻮﻧﻪ ﮔﻴﺮي ﺑﻴﻤﺎرﺳﺘﺎن ﻫﺎ ﺧﻮﺷﻪاي ﺑﻮد و در ﻧﻬﺎﻳﺖ ﺑﻪ ﺻﻮرت ﻧﻤﻮﻧﻪ ﮔﻴﺮي ﺳﺎده، ﺗﻌﺪاد 400 ﻧﻔﺮ از ﻣﺮاﺟﻌﻴﻦ ﺑﻪ ﺑﻴﻤﺎرﺳﺘﺎن ﻫﺎ ﻣﻮ رد ﺑﺮرﺳﻲ ﻗﺮار ﮔﺮﻓﺘﻨﺪ . اﺑﺰار ﮔﺮدآوري اﻃﻼﻋﺎت، ﭘﺮﺳﺶﻧﺎﻣﻪ ي ﻣﺤﻘﻖ ﺳﺎﺧﺘﻪ ﺑﻮد ﻛﻪ رواﻳﻲ آن ﺗﻮﺳﻂ ﺻﺎﺣﺐ ﻧﻈﺮان ﺗﺄﻳﻴﺪ ﺷﺪ و ﭘﺎﻳﺎﻳﻲ آن ﺑﺮاﺑﺮ 85 درﺻﺪ ﺑﻪ دﺳﺖ آﻣﺪ . ﻳﺎﻓﺘﻪ ﻫﺎ: آﮔﺎﻫﻲ و رﺿﺎﻳﺖ در ﺟﻮاﻣﻊ ﺷﻬﺮي و اﻧﮕﻴﺰه در ﺟﻮاﻣﻊ ﻏﻴﺮ ﺷﻬﺮي از ﺳﻄﺢ ﺑﺎﻻﺗﺮي ﺑﺮﺧﻮردارﺑﻮد. 9/51 درﺻﺪ از اﻓﺮ اد ﺗﺤﺖ ﭘﻮﺷﺶ ﺗﺄﻣﻴﻦ اﺟﺘﻤﺎﻋﻲ ﺑﻪ ﺳﻄﺢ اول اراﻳﻪ ي ﺧﺪﻣﺎت ﻣﺮاﺟﻌﻪ ﻣﻲ ﻛﺮدﻧﺪ، در ﺣﺎﻟﻲ ﻛﻪ اﻳﻦ ﻣﻴﺰان در اﻓﺮاد ﺗﺤﺖ ﭘﻮﺷﺶ ﺑﻴﻤﻪ ي ﺧﺪﻣﺎت درﻣﺎﻧﻲ 09/89 درﺻﺪ ﺑﻮده اﺳﺖ . ﻣﻴﺎﻧﮕﻴﻦ آﮔﺎﻫﻲ ﻣﺮاﺟﻌﻴﻦ از ﺳﻴﺴﺘﻢ ارﺟﺎع در ﺑﻴﻦ ﺑﻴﻤﺎرﺳﺘﺎن ﻫﺎي ﻣﻮرد ﻣﻄﺎﻟﻌﻪ، داراي ﺗﻔﺎوت ﻣﻌﻨﻲ داري ﻧﺒﻮد. در ﺣﺎﻟﻲ ﻛ ﻪ ﻣﻴﺎﻧﮕﻴﻦ رﺿﺎﻳﺖ و اﻧﮕﻴﺰه ي ﻣﺮاﺟﻌﻴﻦ از ﺳﻴﺴﺘﻢ ارﺟﺎع در ﺑﻴﻦ ﺑﻴﻤﺎرﺳﺘﺎن ﻫﺎي ﻣﻮرد ﻣﻄﺎﻟﻌﻪ داراي ﺗﻔﺎوت ﻣﻌﻨﻲ داري (P ≤ 0/05) ﺑﻮد. ﻧﺘﻴﺠﻪ ﮔﻴﺮي: ﻣﻴﺰان آﮔﺎﻫﻲ و رﺿﺎﻳﺖ از ﻧﺤﻮه ي اراﻳﻪ ي ﺧﺪﻣﺎت ﺳﻼﻣﺖ در ﺳﻄﻮح اوﻟﻴﻪ ي اراﻳﻪ ي ﺧﺪﻣﺎت، ﺑﺮ ﺗﺤﻘﻖ ﻓﺮاﻳﻨﺪ ﺳﻴﺴﺘﻢ ارﺟﺎع از ﻧﻈﺮ ﺳﺎﻛﻨﻴﻦ ﺷ ﻬﺮي و اﻧﮕﻴﺰه از ﻧﻈﺮ ﺳﺎﻛﻨﻴﻦ ﻏﻴﺮ ﺷﻬﺮي، ﻋﺎﻣﻞ ﻣﺆﺛﺮ در ﺳﻴﺴﺘﻢ ارﺟﺎع ﺑﻮد. از اﻳﻦ رو ﺑﺎ ﺳﺮﻣﺎﻳﻪ ﮔﺬاري در ارﺗﻘﺎي اﻳﻦ ﻋﻮاﻣﻞ ﻣﻲ ﺗﻮان اﻃﻤﻴﻨﺎن ﺣﺎﺻﻞ ﻛﺮد ﻛﻪ ﺳﻴﺴﺘﻢ ﺑﻪ ﺷﻜﻞ ﻣﻔﻴﺪﺗﺮي ﻋﻤﻞ ﺧﻮاﻫﺪ ﻛﺮد . واژه ﻫﺎي ﻛﻠﻴﺪي: آﮔﺎﻫﻲ؛ اﻧﮕﻴﺰش؛ رﺿﺎﻳﺖ؛ ﺑﻴﻤﺎرﺳﺘﺎن ﻫﺎي آﻣﻮزﺷﻲ . ﻧﻮع ﻣﻘﺎﻟﻪ: ﺗﺤﻘﻴﻘﻲ و ﺻﻮل ﻣﻘﺎﻟﻪ: 13/4/89 اﺻﻼح ﻧﻬﺎﻳﻲ: 3/11/89 ﭘﺬﻳﺮش ﻣﻘﺎﻟﻪ: 89/11/12 ارﺟﺎع: ﺷﻤﺲ اﺳﺪاﻟﻪ، ﻣﻔﻴﺪ ﻣﺮﻳﻢ، رﺟﺎﻟﻴ ﺎن ﻓﺮزاﻧﻪ . SID ﻣﺮاﺟﻌﻴﻦ ﺑﻪ ﺑﻴof ﻤﺎرﺳﺘﺎن ﻫﺎي دوﻟﺘﻲ اﺳﺘﺎن اﺻﻔﻬﺎن در ﺧﺼﻮص Archiveﻋﻮاﻣﻞ ﻣﺆﺛﺮ ﺑﺮ ﻣﻴﺰان ﺗﺤﻘﻖ ﻧﻈﺎم ارﺟﺎع ﭼﻪ ﻣﻲ ﮔﻮﻳﻨﺪ؟. ﻣﺪﻳﺮﻳﺖ اﻃﻼﻋﺎت ﺳﻼﻣﺖ 1389؛ 7 (وﻳﮋه ﻧﺎﻣﻪ ): 678-669. ﻣﻘﺪﻣﻪ * اﻳﻦ ﻣﻘﺎﻟﻪ ﺣﺎﺻﻞ ﭘﺎﻳﺎن ﻧﺎﻣﻪ ي ﺗﺤﻘﻴﻘﺎﺗﻲ ﻣﺼﻮب ﺷﻤﺎره ي 287284 ﺗﻮﺳﻂ ﺳﻼﻣﺘﻲ ﺑﺎ ارزش ﺗﺮﻳﻦ ﻧﻌﻤﺖ ﺑﺮاي ﻫﺮ ﻣﻮﺟﻮدي اﺳﺖ. ﺑﺎ ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺸﻲ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ اﺻﻔﻬﺎن ﻣﻲﺑﺎﺷﺪ. 1 . اﺳﺘﺎدﻳﺎر، ﻣﺪﻳﺮﻳﺖ ﺑﻬﺪاﺷﺖ، ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت ﻣﺪﻳﺮﻳﺖ و اﻗﺘﺼﺎد ﺳﻼﻣﺖ، اﻓﺰاﻳﺶ ﺳﻦ ارزش ﺳﻼﻣﺘﻲ و واﺑﺴﺘﮕﻲ آن ﺑﻪ دوران ﺟﻮاﻧﻲ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ اﺻﻔﻬﺎن، اﺻﻔﻬﺎن، اﻳﺮان . ( ﻧﻮﻳﺴﻨﺪه ي ﻣﺴﺆول). ﺑﻴﺶ از ﭘﻴﺶ ﻧﻤﺎﻳﺎن ﻣﻲ ﮔﺮدد . ﻛﻤﺘﺮ ﻛﺴﻲ در دوران ﺟﻮاﻧﻲ ﺑﻪ Email: [email protected] 2 . داﻧﺸﺠﻮي ﻛﺎرﺷﻨﺎﺳﻲ ارﺷﺪ، ﻣﺪﻳﺮﻳﺖ ﺑﻬﺪاﺷﺖ، داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ اﺻﻔﻬﺎن، اﺻﻔﻬﺎن، اﻳﺮان . 3 . ﻛﺎرﺷﻨﺎس، ﻣﺪﻳﺮﻳﺖ ﺑﻬﺪاﺷﺖ، داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ اﺻﻔﻬﺎن، اﺻﻔﻬﺎن، اﻳﺮان. ﻣﺪﻳﺮﻳﺖ اﻃﻼﻋﺎت ﺳﻼﻣﺖ / وﻳﮋه ﻧﺎﻣﻪ / زﻣﺴﺘﺎن 89 669 www.SID.ir ﺑﺮرﺳﻲ ﻧﻈﺮ ﻣﺮاﺟﻌﻴﻦ ﺑﻪ ﺑﻴ ﻤﺎرﺳﺘﺎنﻫﺎي دوﻟﺘﻲ اﺳﺘﺎن اﺻﻔﻬﺎن ... ﻓﻜﺮ اﻳﻦ ﺳﺮﻣﺎﻳﻪ ﮔﺬاري ﻋﻈﻴﻢ اﺳﺖ . ﺑﺎ ﭘﻴﺸﮕﻴﺮي ﺻﺤﻴﺢ ﺑﻪ ﺑﻬﺪاﺷﺖ، ﺑﻬﺘﺮ اﺳﺖ ﺑﻪ ﻃﻮر ﻣﺴﺘﻘﻴﻢ ﺑﻪ ﻣﺮﻛﺰ ﺑﻬﺪاﺷﺘﻲ درﻣﺎﻧﻲ ﺧﺼﻮص در دوران ﻗﺒﻞ از ﻛﻬﻨﺴﺎﻟﻲ ﻣﻲ ﺗﻮ ان ﻋﻼوه ﺑﺮ ﺑﻴﻤﻪ ﻣﺮاﺟﻌﻪ ﻛﻨﺪ و ﻓﻘﻂ 0/7 درﺻﺪ ﻣﻌﺘﻘﺪﻧﺪ ﻛﻪ ﺑﻬﻮرز ﺑﺮاي ﻧﻤﻮدن دوران ﺳﺎﻟﻤﻨﺪي از اﻧﺮژي ﺑﺴﻴﺎر ﺑﺎﻻي ﺟﻮاﻧﻲ در ﺟﻬﺖ ﺳﻼﻣﺘﻲ ﻣﻔﻴﺪ اﺳﺖ . در ﭼﻨﻴﻦ ﺷﺮاﻳﻄﻲ اﻏﻠﺐ ﺳﻴﺴﺘﻢ ارﺟﺎع را ﺑﻬﺮه وري ﻓﺮدي و اﺟﺘﻤﺎﻋﻲ ﺑﻬﺮه ﺑﺮد . ﺳﻄﻮح اوﻟﻴﻪ ي ﺧﺪﻣﺎت ﻧﺎﻣﻮﻓﻖ و داراي اﺛﺮﺑﺨﺸﻲ و ﻛﺎراﻳﻲ ﭘﺎﻳﻴﻦ ﻣﻲ داﻧﻨﺪ و در ﻋﻤﻞ ﺑﻬﺪاﺷﺘﻲ ﺑﺮاي ﺗﺄﻣﻴﻦ، ﺣﻔﻆ و ارﺗﻘﺎي ﺳﻼﻣﺘﻲ اﻓﺮاد ﺳﺎﻟﻢ و اﺑﺮاز ﻣﻲ دارﻧﺪ ﻛﻪ اﮔﺮ ﻣﺮدم ﺑﻪ ﻃﻮر ﻣﺴﺘﻘﻴﻢ ﺑﻪ ﺑﺨﺶ ﺧﺼﻮﺻﻲ ﺟﻮان و ﺳﻄﻮح ﺑﺎﻻﺗﺮ آن ﺑﺮاي ﻏﺮﺑﺎﻟﮕﺮي و ﺑﺮﮔﺮداﻧﺪن ﻣﺮاﺟﻌﻪ ﻛﻨﻨﺪ، ﻧﺘﻴﺠﻪي ﺑﻬﺘﺮي ﻣﻲ ﮔﻴﺮﻧﺪ و از ﻃﺮﻓﻲ اﺑﺮاز ﺳﻼﻣﺘﻲ ﺳﺎﻟﻤﻨﺪان و ﺑﻴﻤﺎران ﻃﺮاﺣﻲ ﮔﺮدﻳﺪه اﺳﺖ . ﻣﺘﺄﺳﻔﺎﻧﻪ ﺑﺎ ﻣﻲ دارﻧﺪ ﻣﺮدم ﺑﺮاي ﻣﻨﻔﻌﺖ ﻣﺎﻟﻲ ﺑﻪ ﺧﺎﻧﻪي ﺑﻬﺪاﺷﺖ ﻣﺮاﺟﻌﻪ ﻓﺮﻫﻨﮓ ﻏﻠﻂ ﺑﻌﻀﻲ اراﻳﻪ دﻫﻨﺪﮔﺎن و ﮔﻴﺮﻧﺪﮔﺎن ﺧﺪﻣﺎت و ﻋﺪم ﻣﻲ ﻛﻨﻨﺪ و ﺑﻬﻮرز را ﻓﺎﻗﺪ ﺻﻼﺣﻴﺖ ﺑﺮاي ﺗﺸﺨﻴﺺ و درﻣﺎن اﺳﺘﻔﺎده ي ﻛﺎﻣﻞ از ﺳﻄﻮح اول ﺧﺪﻣﺎت، ﺑﺎر ﺳﻄﻮح ﺑﺎﻻﺗﺮ از ﺧﻮد ﻣﻲداﻧﻨﺪ (6). ﺟﻤﻠﻪ ﺑﻴﻤﺎرﺳﺘﺎن ﻫﺎ اﻓﺰاﻳﺶ ﻳﺎﻓﺘﻪ اﺳﺖ و ﻫﺰﻳﻨﻪ ﻫﺎي ﻓﺮدي و در ﻣﻄﺎﻟﻌﻪ اي ﺗﺤﺖ ﻋﻨﻮان « ﺑﺮرﺳﻲ ﺳﻴﺴ ﺘﻢ ارﺟﺎع در ﻧﻈﺎم ﻣﻠﻲ ﺑﺎ ﮔﺮاﻳﺶ ﻣﻄﻠﻖ ﺑﻪ ﺳﻤﺖ درﻣﺎن روز ﺑﻪ روز در ﺣﺎل ﻣﺮاﻗﺒﺖ ﻫﺎي ﺑﻬﺪاﺷﺘﻲ درﻣﺎﻧﻲ و راه ﺣﻞ ﻫﺎي اﺻﻼح آن در اﻓﺰاﻳﺶ و ﺳﻼﻣﺘﻲ واﻗﻌﻲ ﺑ ﺎ ﺗﺠﺎرت ﭘﺰﺷﻜﻲ ﺑﻪ ﺳﻮي ﺷﺒﻜﻪ ي ﺑﻬﺪاﺷﺖ و درﻣﺎن ﻛﺎﺷﺎن»، 23 ﻣﺮﻛﺰ ﺑﻬﺪاﺷﺘﻲ ﺑ ﻲ ﻋﺪاﻟﺘﻲ ﻳﻌﻨﻲ در ﺧﺪﻣﺖ ﻣﺘﺨﺼﺼﺎن ﺑﺎﻻ و ﺛﺮوﺗﻤﻨﺪان و آن درﻣﺎﻧﻲ در ﺳﻄﻮح ﻣﺨﺘﻠﻒ ﺳﻴ ﺴﺘﻢ ﻋﺮﺿﻪ ي ﻣﺮاﻗﺒﺘﻲ ﺷﺎﻣﻞ ﻫﻢ ﺑﺪون ﺗﺄﻣﻴﻦ واﻗﻌﻲ ﺳﻼﻣﺘﻲ ﺳﺮﮔﺮدان اﺳﺖ . ﺳﻼﻣﺘﻲ ﺧﺎﻧﻪ ي ﺑﻬﺪاﺷﺖ و ﻣﺮﻛﺰ ﺑﻬﺪاﺷﺘﻲ درﻣﺎﻧﻲ روﺳﺘﺎﻳﻲ و ﺷﻬﺮي واﻗﻌﻲ ﺑﺎ ﺳﻴﺴﺘﻢ ارﺟﺎع و آن ﻫﻢ ﺑﻪ ﺻﻮرت واﻗﻌﻲ و ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ در ﻣﻮرد ﭼﮕﻮﻧﮕﻲ ﻣﺮاﺟﻌﻪ ﺑﻪ ﻣﺮاﻛﺰ ﺑﻴﻤ ﺎرﺳﺘﺎﻧﻲ ﺑﺮرﺳﻲ ﮔﺮدﻳﺪ. ﭘﻴﺸﮕﻴﺮي ﻗﺎﺑﻞ ﺗﺤﻘﻖ ﻋﺎدﻻﻧﻪ اﺳﺖ ).1( در اﻳ ﻦ ﻣﻄﺎﻟﻌﻪ 1783 ﺑﻴ ﻤﺎر از ﻧﻈﺮ ﻋﻤﻠﻜﺮد ارﺟﺎع ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﺑﺮ ﻃﺒﻖ ﻣﻄﺎﻟﻌﺎت Brown و McCool ﺟﺪا ﻣﺎﻧﺪن ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﻧﺘﺎﻳﺞ اﻳ ﻦ ﺑﺮرﺳﻲ ﺣﺎﻛﻲ از آن اﺳﺖ ﻛﻪ ﻣﻴ ﺰان ﻧﺴﺒﻲ ﺑﻴ ﻤﺎرﺳﺘﺎن از ﻣﺸﻜﻼت وﺳﻴ ﻊ ﺑﻬﺪاﺷﺘﻲ در ﺟﺎﻣﻌﻪ، در ارﺟﺎع ﺑﻴ ﻤﺎران ﺑﻪ ﻣﺮاﻛﺰ ﺳﻄﻮح ﺑﺎﻻﺗﺮ 20 درﺻﺪ از ﺧﺎﻧﻪﻫﺎي ﮔﺮو اﺟﺮاي ﺻﺤﻴﺢ ﺳﻴ ﺴﺘﻢ ارﺟﺎع اﺳﺖ ).2( ﺑﺮ ﻃﺒﻖ ﻣﻄﺎﻟﻌﺎت ﺑﻬﺪاﺷﺖ، 9/11 درﺻﺪ از ﻣﺮاﻛﺰ ﺑﻬﺪاﺷﺘﻲ درﻣﺎﻧﻲ روﺳﺘﺎﻳﻲ و WHO ﺑﻴ ﻤﺎرﺳﺘﺎنﻫﺎي ﻋﻤﻮﻣﻲ ﻧﻤ ﻲ ﺗﻮاﻧﻨﺪ ﺑﻪ ﻃﻮر ﻣﺠﺰا ﻋﻤﻞ 9/1 درﺻﺪ از ﻣﺮاﻛﺰ ﺑﻬﺪاﺷﺘﻲ درﻣﺎﻧﻲ ﺷﻬﺮي ﺑﻮده اﺳﺖ . ﻻزم ﻧﻤﺎﻳﻨﺪ و ﺑﺎﻳ ﺪ ﺑﻪ ﻋﻨﻮان ﺑﺨﺸﻲ از ﺧﺪﻣﺎت ﺑﻬﺪاﺷﺘﻲ اراﻳﻪ ﺑﻪ ذﻛﺮ اﺳﺖ ﻃﻲ اﻳ ﻦ ﻣﻄﺎﻟﻌﻪ 3/46 درﺻﺪ از ﺑﻴ ﻤﺎران ﺑﻪ ﻃﻮر ﻛﻨﻨﺪه ي ﻣﺮاﻗﺒﺖﻫﺎي ﻛﺎﻣﻞ ﺑﻬﺪاﺷﺘﻲ ﺑﺮاي ﺟﺎﻣﻌﻪ ﻛﺎر ﻛﻨﻨﺪ ﻣﺴﺘﻘﻴ ﻢ ﺑﻪ ﺑﻴ ﻤﺎرﺳﺘﺎن ﺧﻮد - ارﺟﺎﻋﻲ داﺷﺘﻪ اﻧﺪ ﻛﻪ ﺑﻴﺎ ﻧﮕﺮ ).3( در اﻳ ﻦ ﻣﻄﺎﻟﻌﻪ ﻧﻴ ﺰ ﺗﺄﻛﻴﺪ ﺑﺴﻴ ﺎر ﺑﺮ ارﺟﺎع ﺑﻮده اﺳﺖ؛ ﭼﺮا ﺿﺮورت ﺑﺎزﻧﮕﺮي و اﺻﻼح ﺳﺎﺧﺘﺎر ﺳﻴ ﺴﺘﻢ ﻋﺮﺿﻪ ي ﺧﺪﻣﺎت ﻛﻪ ﺟﺪا ﻣﺎﻧﺪن ﺑﻴ ﻤﺎرﺳﺘﺎن ﻫﺎ از ﺳﻴ ﺴﺘﻢ ﺑﻬﺪاﺷﺘﻲ ﻧﻘﻄﻪ ي ﺿﻌﻒ ﺑﻬﺪاﺷﺘﻲ ﻣﻲ ﺑﺎﺷﺪ .)7( .)7( ﺑﺰرﮔﻲ ﺑﻪ ﺷﻤﺎر ﻣ ﻲرود (4). ﻧﻈﺎم ﺧﺪﻣﺎت ﺑﻬﺪاﺷﺘﻲ اوﻟﻴ ﻪ ﺗﺎ ﻓﺮﺑﺪ ﻋﺒﺎدي ﻓﺮد آذر ﻣﻄﺎﻟﻌﻪ اي ﻣﻘﻄﻌﻲ ﺗﺤﺖ ﻋﻨﻮان وﻗﺘﻲ ﻛﻪ ﭘﺸﺘﻴﺒﺎﻧﻲ ﻣﺆﺛﺮ از ﺟﺎﻧﺐ ﺑﻴ ﻤﺎرﺳﺘﺎن ﺑﺮاي ﺑﺮ آوردن «ﭘﺬﻳ ﺮش ﺑﻴ ﻤﺎران و رﻋﺎﻳ ﺖ ﻧﻈﺎم ارﺟﺎع در ﭘﻨﺞ ﻣﺮﻛﺰ آﻣﻮزﺷ ﻲ ﻧﻴ ﺎزﻫﺎي ﺑﻴ ﻤﺎران ارﺟﺎﻋﻲ ﻧﺪاﺷﺘﻪ ﺑﺎﺷﺪ، ﻧﻤﻲ ﺗﻮ اﻧﺪ SIDﺑﻪ ﺧﻮﺑﻲ ﻛﺎر of درﻣﺎﻧﻲ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ Archiveاﻳﺮان»، در 5 ﺑﻴ ﻤﺎرﺳﺘﺎن ﻋﻤﻮﻣﻲ ﻛﻨﺪ. ﺑﺎ اﻳ ﻦ روﻧﺪ، ﺑﻴ ﻤﺎرﺳﺘﺎن ﺗﻨﻬﺎ ﻧﻘﺶ ﺑﻴﻤﺎر ي ﻧﮕﺮ ﻧﺪارد، ﺑﻠﻜﻪ واﺑﺴﺘﻪ ﺑﻪ داﻧﺸﮕﺎه اﻧﺠﺎم داده اﺳﺖ ﻛﻪ در آن 372 ﺑﻴ ﻤﺎر ﺑﻪ در ﭘﺰﺷﻜﻲ ﭘﻴﺸﮕﻴﺮي ، ﻣﺮاﻗﺒﺖﻫﺎي ﺑﻬﺪاﺷﺘﻲ و ارﺗﻘﺎي ﺳﻄﺢ ﻃﻮر اﺗﻔﺎﻗﻲ و ﻣﺘﻨﺎﺳﺐ ﺑﺎ ﺣﺠﻢ ﻫﺮ ﺑﻴ ﻤﺎرﺳﺘﺎن اﻧﺘﺨﺎب ﺷﺪﻧﺪ. ﺑﺮ ﺑﻬﺪاﺷﺖ ﻧﻴ ﺰ ﺳﻬﻴ ﻢ ﺧﻮاﻫﺪ ﺑﻮد .)5( ﭘﺎﻳﻪ ي اﻳ ﻦ ﺑﺮرﺳﻲ، ﻣﺸﺎﻫﺪه ﺷﺪه اﺳﺖ ﻛﻪ 5/18 درﺻﺪ از ﺑﺮ اﺳﺎس ﻧﻈﺮ ﻛﺎرﺷﻨﺎﺳﺎن 5/78 درﺻﺪ ﻣﻌﺘﻘﺪﻧﺪ ﻛﻪ وﻗﺖ ﺑﻴ ﻤﺎران ﺧﻮد - ارﺟﺎع ﺑﻮده اﻧﺪ و از ﺳﺎﻳﺮ ﻣﺮاﺟﻌﻴﻦ 8/66 درﺻﺪ ﺑﺎ ﭘﺰﺷﻚ در ﺻﻮرت اﺟﺮاي ﺻﺤﻴﺢ ﺳﻴﺴﺘﻢ ارﺟﺎع ﺗﻠﻒ ﻧﻤﻲﺷﻮد؛ ﺑﺮﮔﻪ ي ارﺟﺎع و 2/32 درﺻﺪ ﺑﺪون ﺑﺮﮔﻪ ي ارﺟﺎع ﻣﺮاﺟﻌﻪ ﻛﺮده اﻣﺎ 21 درﺻﺪ ﻣﻌﺘﻘﺪﻧﺪ ﻛﻪ ﺑﻴﻤﺎر ﺑﻪ ﺟﺎي ﻣﺮاﺟﻌﻪ ﺑﻪ ﺧﺎﻧﻪي ﺑﻮدﻧﺪ. ﻧﺘﻴﺠﻪ ي ﺣﺎﺻﻞ ﻣﺒﻨﻲ ﺑﺮ اﻳ ﻦ ﺑﻮد ﻛﻪ ﺟﺮﻳ ﺎن اﻃﻼع دو 670 ﻣﺪﻳﺮﻳﺖ اﻃﻼﻋﺎت ﺳﻼﻣﺖ / وﻳﮋه ﻧﺎﻣﻪ / زﻣﺴﺘﺎن 89 www.SID.ir اﺳﺪاﻟﻪ ﺷﻤﺲ و ﻫﻤﻜﺎران ﺳﻮﻳ ﻪ در ﺑﻴ ﻦ ﺳﻄﻮح ﺧﺪﻣﺎت ﺷﺒﻜﻪ ﺑﻬﺪاﺷﺖ و درﻣﺎن وﺟﻮد اﻃﻼﻋﺎت ﭘﺮﺳﺶﻧﺎﻣﻪ ي ﻣﺤﻘﻖ ﺳﺎﺧﺘﻪ ﺑﻮده اﺳﺖ . اﻳﻦ ﻧﺪارد .)8( ﭘﺮﺳﺶ ﻧﺎﻣﻪ ﺣﺎوي ﺳﺆاﻻﺗﻲ درﺑﺎره ي ﻣﺘﻐﻴﺮﻫﺎي ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﻣﻄﺎﻟﻌﻪي Palmer ﻧﻴﺰ ﻧﺸﺎن ﻣﻲ دﻫﺪ ﺳﻄﺢ ﭘﺎ ﻳﻴﻦ ﻛﻴﻔﻴﺖ ﺷﺎﻣﻞ ﺳﺆاﻻﺗﻲ درﺑﺎرهي آﮔﺎﻫﻲ، رﺿﺎﻳﺖ و اﻧﮕﻴﺰهي ﻣ ﺮاﺟﻌﻴﻦ ﺧﺪﻣﺎت اوﻟﻴﻪ، ﻋﺪم ﻣﻬﺎرت ﭘﺮﺳﻨﻞ ، ﻋﺪم اﻣﻜﺎﻧﺎت ﻣﻨﺎﺳﺐ ﺟﻬﺖ در درﻳﺎﻓﺖ ﺧﺪﻣﺎت از ﻣﺴﻴﺮ ﺳﻴﺴﺘﻢ ارﺟﺎع ﺑﻮد . ﻃﺮاﺣﻲ ﺣﻤﻞ و ﻧﻘﻞ و ﻣﺮاﺟﻌﻪ ، ﻋﺪم ﻧﻈﺎرت و ﭘﺎﻳﺶ ﺑﺮ ﺳﻄﻮح اول ﭘﺮﺳﺶ ﻧﺎﻣﻪ ﺑﻪ ﺷﻴﻮهي ﻟﻴﻜﺮت ﺑﻮده اﺳﺖ . رواﻳﻲ ﭘﺮﺳﺶ ﻧﺎﻣﻪ از ﺧﺪﻣﺎت و ﻣﺸﻜﻼت ﻣﻮﺟﻮد در ﺗﺄﻣﻴﻦ داروﻫﺎي ﻣﻮرد ﻧﻴ ﺎز ﻣﺮاﻛﺰ ﻧﻈﺮ ﺻﻮري، ﻣﺤﺘﻮاﻳﻲ و ﺳﺎﺧﺘﺎري ﺗﻮﺳﻂ ﻣﺘﺨﺼﺼﻴﻦ ﻣﺮﺑﻮط و ﻧﻴﺰ ﻗﻴ ﻤﺖ ﺧﺪﻣﺎت، ﻣﻮاﻧﻊ ﻋﻤﺪه ي ﻣﻮﺟﻮد ﺑﺮ ﺳﺮ راه ﺗﺤﻘﻖ ﺗﺄﻳﻴﺪ ﮔﺮدﻳﺪ . ﭘﺲ از ﺟﻤﻊ آوري اﻃﻼﻋﺎت از ﻃﺮﻳﻖ ﭘﺮﺳﺶﻧﺎﻣﻪ، ﺳﻴ ﺴﺘﻢ ارﺟﺎع ﻣﻲ ﺑﺎﺷﺪ .)9( در ﻳﻚ ﻣﻄﺎﻟﻌﻪ ي راﻫﻨﻤﺎ و در ﻳﻚ ﺟﻤﻌﻴﺖ 50 ﻧﻔﺮي ا ﻳﻦ ﻣﻄﺎﻟﻌﻪ اي ﻛﻪ در ﺷﻬﺮ رﻳﺎض ﻋﺮﺑﺴﺘﺎن اﻧﺠﺎم ﮔﺮﻓﺖ ﻧﻴﺰ اﻃﻼﻋﺎت وارد ﻧﺮم اﻓﺰار آﻣﺎري SPSS ﮔﺮدﻳﺪ . ﭘﺎﻳﺎﻳﻲ ﺣﺎﻛﻲ از آن ﺑﻮد ﻛﻪ ﺑﻪ ﻛﺎر ﺑﺮدن ﺳﻴﺴﺘﻢ ارﺟﺎع ﻣﻮﺟﺐ ﻛﺎﻫﺶ ( Reliability ) ﭘﺮﺳﺶ ﻧﺎﻣﻪ ﺑﺎ ﻛﻤﻚ روش ﻫﺎي آﻣﺎري ﻣﺤﺎﺳﺒﻪ 6/40 درﺻﺪ در ﺑﻴﻤﺎران ﺳﺮﭘﺎﻳﻲ ﺑﻴﻤﺎرﺳﺘﺎن و اﻓﺰاﻳﺶ 9/11 ﺷﺪ. ﺑﺎ ﻗﺒﻮﻟﻲ Cronbach’s alpha ﺑﺎﻻي 80 درﺻﺪ ﺗﻮﺳﻂ درﺻﺪي در ﻣﺮاﺟﻌﻴﻦ ﺑﻪ ﻣﺮاﻛﺰ ﻣﺮاﻗﺒﺖ ﻫﺎي ﺑﻬﺪاﺷﺘﻲ اوﻟﻴﻪ و ﻣﺸﺎور آﻣﺎري ، اﺻﻼﺣﺎت ﻻزم در ﺳﺆ اﻻت ﺑﺎ اﺳﺘﻔﺎده از ﺗﺠﺰﻳﻪ و ﻫﻤﭽﻨﻴﻦ اﻓﺰاﻳﺶ 2/19 درﺻﺪ در ارﺟﺎﻋﺎت ﺷﺪه ﺑﻮد و ﺗﺤﻠﻴﻞ ﻣﻮردي ( Scale if item deleted ) و ﺑﻪ راﻫﻨﻤ ﺎﻳﻲ ﻧﺘﻴﺠﻪ ﮔﻴﺮي ﺷﺪ ﻛﻪ ﺑﺮاي داﺷﺘﻦ ﻳﻚ ﺳﻴﺴﺘﻢ ارﺟﺎع ﺧﻮب آن ﻫﺎ اﻧﺠﺎم و ﻣﺮﺣﻠﻪ ي ﻛﺎﻣﻞ ﺗﻮزﻳﻊ ﭘﺮﺳﺶ ﻧﺎ ﻣﻪ آﻏﺎز ﮔﺮدﻳﺪ. در ﺑﺎﻳﺴﺘﻲ ﻳﻚ ارﺗﺒﺎط ﻗﻮي ﺑﻴﻦ ﻣﺮاﻛﺰ ﺑﻬﺪاﺷﺘﻲ اوﻟﻴﻪ و ﺷﻴﻮه ي ﺗﺠﺰﻳﻪ وﺗﺤﻠﻴﻞ داده ﻫﺎ، ﺳﺆ اﻻت ﻣﺮﺑﻮط ﺑﻪ آﮔﺎﻫﻲ، ﺑﻴﻤﺎرﺳﺘﺎن ﻫﺎ ﺑﺮﻗﺮار ﺷﻮد (10).
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