AUTHOR=Ruan Yuhui , Luo Jin , Lin Hong 

TITLE=Why Do Patients Seek Diagnose Dis-accordance With Hierarchical Medical System Related Policies in Tertiary Hospitals? A Qualitative Study in Shanghai From the Perspective of Physicians

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.841196

DOI=10.3389/fpubh.2022.841196

ISSN=2296-2565

ABSTRACT=Background: 
Although the Hierarchical Medical System has been utilized in China for many years, it is inadequate for guiding patients in adopting appropriate diagnose-seeking behaviors in accordance with related policies. This study examined how patients’ diagnose-seeking behavior in tertiary hospitals that is dis-accordance with Hierarchical Medical System related policy (‘DSB-dis-accordance’) arise and ways to guide patients away from such behaviors, both from the perspective of physicians. 
Methods:
A qualitative study based on a mixed method including in-depth interviews and grounded theory. Twenty-seven physicians with more than 2 years of experience serving in tertiary hospitals of Shanghai were involved after reviewing the related purposes and requirements. Patients’ ‘DSB-dis-accordance’ was studied from the perspective of physicians. 
Results: 
Patient-related factors (habits, trust, and knowledge), physician-related factors (conservative preference, risk avoidance), and system-related factors (accessibility, operability) affected patients’ diagnose-seeking behavior. 
Conclusions: 
Patient-related, physician-related, and system-related factors affecting patients’ diagnose-seeking behaviors in tertiary hospitals should be addressed by investing more health resources in lower-level hospitals, enhancing dissemination of health-related and policy-related knowledge, refining the classification of diseases, incentivizing physicians, and developing appropriate follow-up measures. Physicians could then become more involved in guiding patients’ ‘DSB-dis-accordance’, thereby benefitting development of the Hierarchical Medical System in China.