中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2014年
1期
88-92
,共5页
姚慧卿%熊昌辉%晏强%黄莉%张莉%颜艳
姚慧卿%熊昌輝%晏彊%黃莉%張莉%顏豔
요혜경%웅창휘%안강%황리%장리%안염
社区卫生服务%慢性病
社區衛生服務%慢性病
사구위생복무%만성병
Community health services%Chronic disease
目的 了解长沙市某社区老年慢性病患者患病首选就诊机构的现状及影响因素. 方法 采用系统抽样的方法于2012年6-8月对长沙市某社区400例老年慢性病患者用自行设计的调查问卷,以面对面询问的方式进行入户调查,并依据反应变量数目不同分别采用二分类或多分类Logistic回归模型分析老年人慢性病患者首选就诊机构的影响因素. 结果 老年慢性病患者自觉病情较轻时,206例(51.5％)患者就诊首选社区卫生服务中心,首选私人诊所、市级医院、三甲医院者分别为67例(16.8％)、92例(23.0％)和35例(8.8％);而当自觉病情较重时,择医倾向全部集中在市级医院(162例,40.5％)和三甲医院(238例,59.5％),无患者首选私人诊所或社区卫生服务中心(x2=443.24,P=0.000).自觉病情较重时首选就诊机构的影响因素分析显示,与市级医院比较,在岗人员(OR=32.38)和离退休人员(OR=15.17)、收入在5000元/月及以上者(OR=134.28)、农村合作医疗患者(OR=661.42)、对社区卫生服务机构信任度高者(OR=4.23)、测血压血糖等健康指标频率在1～3个月者(OR=83.93)、不知道社区卫生服务机构电话者(OR=3.02)及距社区医疗卫生服务机构较远者(OR=15.70)、对社区医疗卫生服务机构不太了解者(OR=1.62)更愿意选择到三甲医院接受诊治;患者自觉病情较轻时首选就诊机构的影响因素分析显示,与去私人医院就诊比较,小学文化程度者(OR=0.15)、离退休者(OR=0.14)、对健康重视程度较高者(每周测量血压血糖等健康指标)(OR=0.26)更倾向首选社区卫生服务中心,而对健康不太重视者(体检频率在两年以上)(OR=10.65)和距离社区卫生服务中心距离较远者(OR=5.22)则更愿意选择私人医院. 结论 患者选择就诊机构主要受自觉病情轻重影响,此外还受到年龄、文化程度、就业状况、收入、医保类型、对社区卫生服务机构的信任和了解程度、对健康的重视程度以及与社区卫生服务机构距离的影响.
目的 瞭解長沙市某社區老年慢性病患者患病首選就診機構的現狀及影響因素. 方法 採用繫統抽樣的方法于2012年6-8月對長沙市某社區400例老年慢性病患者用自行設計的調查問捲,以麵對麵詢問的方式進行入戶調查,併依據反應變量數目不同分彆採用二分類或多分類Logistic迴歸模型分析老年人慢性病患者首選就診機構的影響因素. 結果 老年慢性病患者自覺病情較輕時,206例(51.5％)患者就診首選社區衛生服務中心,首選私人診所、市級醫院、三甲醫院者分彆為67例(16.8％)、92例(23.0％)和35例(8.8％);而噹自覺病情較重時,擇醫傾嚮全部集中在市級醫院(162例,40.5％)和三甲醫院(238例,59.5％),無患者首選私人診所或社區衛生服務中心(x2=443.24,P=0.000).自覺病情較重時首選就診機構的影響因素分析顯示,與市級醫院比較,在崗人員(OR=32.38)和離退休人員(OR=15.17)、收入在5000元/月及以上者(OR=134.28)、農村閤作醫療患者(OR=661.42)、對社區衛生服務機構信任度高者(OR=4.23)、測血壓血糖等健康指標頻率在1～3箇月者(OR=83.93)、不知道社區衛生服務機構電話者(OR=3.02)及距社區醫療衛生服務機構較遠者(OR=15.70)、對社區醫療衛生服務機構不太瞭解者(OR=1.62)更願意選擇到三甲醫院接受診治;患者自覺病情較輕時首選就診機構的影響因素分析顯示,與去私人醫院就診比較,小學文化程度者(OR=0.15)、離退休者(OR=0.14)、對健康重視程度較高者(每週測量血壓血糖等健康指標)(OR=0.26)更傾嚮首選社區衛生服務中心,而對健康不太重視者(體檢頻率在兩年以上)(OR=10.65)和距離社區衛生服務中心距離較遠者(OR=5.22)則更願意選擇私人醫院. 結論 患者選擇就診機構主要受自覺病情輕重影響,此外還受到年齡、文化程度、就業狀況、收入、醫保類型、對社區衛生服務機構的信任和瞭解程度、對健康的重視程度以及與社區衛生服務機構距離的影響.
목적 료해장사시모사구노년만성병환자환병수선취진궤구적현상급영향인소. 방법 채용계통추양적방법우2012년6-8월대장사시모사구400례노년만성병환자용자행설계적조사문권,이면대면순문적방식진행입호조사,병의거반응변량수목불동분별채용이분류혹다분류Logistic회귀모형분석노년인만성병환자수선취진궤구적영향인소. 결과 노년만성병환자자각병정교경시,206례(51.5％)환자취진수선사구위생복무중심,수선사인진소、시급의원、삼갑의원자분별위67례(16.8％)、92례(23.0％)화35례(8.8％);이당자각병정교중시,택의경향전부집중재시급의원(162례,40.5％)화삼갑의원(238례,59.5％),무환자수선사인진소혹사구위생복무중심(x2=443.24,P=0.000).자각병정교중시수선취진궤구적영향인소분석현시,여시급의원비교,재강인원(OR=32.38)화리퇴휴인원(OR=15.17)、수입재5000원/월급이상자(OR=134.28)、농촌합작의료환자(OR=661.42)、대사구위생복무궤구신임도고자(OR=4.23)、측혈압혈당등건강지표빈솔재1～3개월자(OR=83.93)、불지도사구위생복무궤구전화자(OR=3.02)급거사구의료위생복무궤구교원자(OR=15.70)、대사구의료위생복무궤구불태료해자(OR=1.62)경원의선택도삼갑의원접수진치;환자자각병정교경시수선취진궤구적영향인소분석현시,여거사인의원취진비교,소학문화정도자(OR=0.15)、리퇴휴자(OR=0.14)、대건강중시정도교고자(매주측량혈압혈당등건강지표)(OR=0.26)경경향수선사구위생복무중심,이대건강불태중시자(체검빈솔재량년이상)(OR=10.65)화거리사구위생복무중심거리교원자(OR=5.22)칙경원의선택사인의원. 결론 환자선택취진궤구주요수자각병정경중영향,차외환수도년령、문화정도、취업상황、수입、의보류형、대사구위생복무궤구적신임화료해정도、대건강적중시정도이급여사구위생복무궤구거리적영향.
Objective To investigate the status of treatment institution selection and its influencing factors in elderly patients with chronic diseases in a community in Changsha.Methods By using systematic sampling,400 elderly patients with chronic diseases from June to August 2012 were included in the investigation by questionnaires.The influencing factors were analyzed by binary logistic regression model or multinomial logistic regression model on the basis of the numbers of response variables.Results In mild conditions in self-consciousness,more than half of the elderly patients with chronic diseases (206 cases,51.5％) preferred community health service centers including private clinics (67 cases,16.8％),municipal hospitals (92 cases,23.0％),third-grade class-A hospitals (35 cases,8.8％).In serious conditions in self-consciousness,patients preferred third-grade class-A hospital (238 cases,59.5％) and municipal hospitals (162 cases,40.5％),no one selected the private clinics or community health service center (x2=443.240,P＜0.001).The analysis of impact factors for the first treatment institution selection in patients with serious conditions in self-consciousness showed that,compared with patients selecting the municipal hospital,the following personnel preferred to choose third-grade class-A hospital:patients in the staff remaining in positions (OR=32.38) and retirees (OR=15.17),patients with monthly income more than 5,000 yuan (OR=134.28),rural cooperative medical patients (OR=661.42),patients with highly trusting in community health service centers (OR=4.23),patients with BP and serum glucose determination at a frequency of once a month to every three months (OR=83.93),patients unknowing the telephone numbers of community health service centers(OR=3.02)and patients living far away from community health service centers (OR=15.70),patients with little information about community health service centers (OR=1.62).The analysis of impact factors for the first treatment institution selection in patients with mild conditions in self-consciousness showed that,compared with patients selecting the private hospitals,the following personnel preferred to choose community health service centers:patients with primary education level (OR=0.15),retired persons (OR=0.14),patients with higher health attention (OR=0.26),while persons with less health attention (OR-10.65) and patients living far away from community health service center (OR =5.22) were more willing to choose the private hospitals.Conclusions Patient selection for treatment agencies is affected mainly by the perceived severity,in addition,age,education level,employment status,income,health insurance type,trust and understanding on community health services centers,and the emphasis on health and the distance from community health services centers.
