Objective To investigate the status of vertical communication among doctors in rural medical service system and to provide references for the vertical integration of medical services. Methods From July 11 to July 26 in 2012,self- designed questionnaire was employed in the field investigation conducted in Qinjiang District of Chonqing. The respondents included doctors of outpatient department and resident doctors in county - level and township medical settings that had established cooperative relationship and rural doctors in village health centers where the integration of rural health service was implemented. We distributed 510 questionnaires,and 510 questionnaires were all returned. After the exclusion of 30 unqualified questionnaires,we at last included 480 effective questionnaires in the research,among which 215 were from county - level hospitals,129 were from township health centers and 136 were from village health centers. Results (1) The one - year practice communication between village health centers and township hospitals was significantly different from that between village health centers and county - level hospitals(P < 0. 05);the one - year practice communication between township health centers and village health centers was significantly different from that between township health centers and county - level hospitals(P <0. 05);the one - year practice communication between county - level hospitals and village health centers was not significantly different from that between county - level hospitals and township health centers( P > 0. 05). (2) The times of practice communication between village health centers and township hospitals within nearly three months was significantly different from that between village health centers and county - level hospitals( P < 0. 05);the times of practice communication between township health centers and village health centers within nearly three months was significantly different from that between township health centers and county - level hospitals(P < 0. 05);the times of practice communication between county - level hospitals and village health centers within nearly three months was not significantly different from that between county - level hospitals and township health centers( P > 0. 05). (3) Ⅴillage health service centers were significantly different from township health service centers and county - level hospitals in the proportions of face - to - face communication and communication by telephone, fax,QQ or E - mail among doctors(P < 0. 05);township health service centers were significantly different from village health service centers and county - level hospitals in the proportions of face - to - face communication and communication by telephone or fax among doctors(P < 0. 05). (4)The numbers of doctors who had consulted to doctors in superior medical settings were 111 (81. 6% )and 102(79. 1% )for village health centers and township hospitals,and the numbers of doctors who had provided knowledge and experiences to doctors in lower - level medical settings were 102(79. 1% )and 139(64. 7% )for township health centers and county - level hospitals. (5) Pertaining to the primary obstacles for vertical communication,the number of doctors who chose a lack of long - term mechanism in technical cooperation,a lack of incentive mechanism and a lack of platform for the information communication among medical settings of different levels were 99 ( 72. 8% ),91 ( 66. 9% ) and 68 (50. 0% )in village health centers,101 (78. 3% ),97 ( 75. 2% ),103 ( 79. 8% )in township health centers and 101 (47. 0% ),136(63. 3% ),31(14. 4% )in county - level hospitals. Conclusion The vertical communication among doctors in rural medical service system is at a low level. The communication between medical settings of township level and village level is better than that between township level and county level and between village level and county level. Doctors face with many obstacles in vertical communication. We suggest the health resources should be better allocated,effective incentive mechanism should be established and information communication platforms should be improved.%目的：了解农村医疗服务体系中医生的纵向交流现状，为促进医疗服务纵向整合提供依据。方法于2012年7月11—26日，采用自行设计的调查表在重庆市黔江区进行现场调查。调查对象为建立了合作关系的县、乡级医疗机构中的门诊和住院医生，以及实行了乡村卫生服务一体化的村卫生室中的乡村医生。共发放问卷510份，回收510份，剔除不合格问卷30份，最终获得有效问卷480份。其中县级医院215份，乡镇卫生院129份，村卫生室136份。结果（1）村卫生室与乡镇卫生院、县级医院间医生1年内业务交流情况比较，差异有统计学意义（P ＜0.05）；乡镇卫生院与村卫生室、县级医院医生间1年内业务交流情况比较，差异有统计学意义（P ＜0.05）；县级医院与村卫生室、乡镇卫生院医生间1年内业务交流情况比较，差异无统计学意义（P ＞0.05）。（2）村卫生室与乡镇卫生院、县级医院医生间近3个月业务交流次数比较，差异有统计学意义（P ＜0.05）；乡镇卫生院与村卫生室、县级医院医生间近3个月业务交流次数比较，差异有统计学意义（P ＜0.05）；县级医院与村卫生室、乡镇卫生院医生间近3个月业务交流次数比较，差异无统计学意义（P ＞0.05）。（3）村卫生室与乡镇卫生院和县级医院医生间采用面对面、电话或传真、QQ 或 E - mail 方式进行交流的比例比较，差异有统计学意义（P ＜0.05）；乡镇卫生院与村卫生室和县级医院医生间采用面对面、电话或传真方式进行交流的比例比较，差异有统计学意义（P ＜0.05）。（4）村卫生室、乡镇卫生院中有向上级医疗机构医生咨询经历的医生数分别为111名（占81.6％）、102名（占79.1％），乡镇卫生院、县级医院中有为下级医疗机构医生提供疾病诊疗知识经历的医生数分别为102名（占79.1％）、139名（占64.7％）。（5）针对纵向交流的主要障碍，村卫生室医生选择技术合作缺乏长效机制、缺少激励机制、上下级医疗机构缺少信息沟通平台的医生数分别为99名（占72.8％）、91名（占66.9％）、68名（占50.0％）；乡镇卫生院中选择上述条目的医生数分别为101名（占78.3％）、97名（占75.2％）、103名（占79.8％）；县级医院中选择上述条目的医生数分别为101名（占47.0％）、136名（占63.3％）、31名（占14.4％）。结论农村医疗服务体系中医生的纵向交流程度较低，乡、村两级好于乡、县两级和村、县两级。医生纵向交流面临诸多障碍，建议优化卫生资源配置、建立有效激励机制、加强信息交流平台建设。
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