基于计划行为理论的社区卫生服务中心老年患者频繁就诊行为影响因素的质性研究

Influencing Factors of Frequent Visits of the Elderly in a Community Health Service Center Based on the Theory of Planned Behavior:a Qualitative Study

背景在社区卫生服务中心,老年人的频繁就诊行为较为普遍,占用了较多的医疗资源。目的了解社区卫生服务中心老年患者频繁就诊行为及其影响因素。方法2018年5月通过目的性抽样和信息饱和原则抽取20例在上海某社区卫生服务中心具有3年持续频繁就诊行为(3年内就诊次数均在前10%)的老年患者进行半结构化访谈,访谈提纲的制定以计划行为理论模型为依据,主要包括认知测量、态度测量、主观规范测量、知觉行为控制测量及对本社区卫生服务中心的意见或建议。根据访谈结果,探析老年人群频繁就诊行为的影响因素。结果18例患者对自己的频繁就诊行为不自知。9例对频繁就诊有具体定义,55.6%(5/9)患者定义每月就诊≥3次为频繁就诊患者。90.0%(18/20)患者认为频繁就诊行为对自己的生活或健康无不良影响,60.0%(12/20)患者认为频繁就诊能够获得一定的心理安慰,50.0%(10/20)患者提及频繁就诊对于控制及改善病情有一定的帮助。签约政策(70.0%,14/20)、家人支持(45.0%,9/20)、他人行为(15.0%,3/20)均可影响到患者的频繁就诊行为。慢性疾病(100.0%,20/20)、社区医院的便捷性(90.0%,18/20)、医患关系较好(90.0%,18/20)、对自身健康的关心(60.0%,12/20)、急性病症(45.0%,9/20)、自觉健康状况不佳(30.0%,6/20)等均会促使患者的就诊行为,而行动不便(20.0%,4/20)、经济原因(10.0%,2/20)、家中琐事(10.0%,2/20)等原因会限制患者的就诊频次。结论老年患者的频繁就诊行为受较多因素影响,需要全科医师对患者的疾病、心理、社会等多方面进行关注并解决其真实需求。

Background The frequent visits of the elderly in community health service centers are common and occupy a large amount of medical resources.Objective To understand the influencing factors of frequent visits of elderly patients in a community health service center.Methods Through the purposive sampling and information saturation principle,20 elderly patients who had frequent medical consultations in a community health service center of Shanghai for the past three years(the number of visits within 3 years were in the top 10%)were selected for a semi-structured interview in May of 2018.Based on the theory of planned behavior,the interview outline mainly included the cognitive measurement,attitude measurement,subjective norm measurement,perceived behavior control measurement,and opinions and suggestions for the community health service center.According to the results of interviews,the influencing factors of the frequent visits of the elderly were analyzed.Results Eighteen patients were unaware of their frequent visit behaviors.Nine patients had specific definitions of frequent visits,and 55.6%(5/9)defined 3 visits or more per month as frequent visits.And 90.0%(18/20)believed that frequent visits had no adverse effect on their lives and health;60.0%(12/20)thought that frequent visits could brought them psychological comfort,and 50.0%(10/20)mentioned that frequent visits were helpful to control and improve their health condition.Policies of contracted services(70.0%,14/20),family support(45.0%,9/20),and the behavior of others(15.0%,3/20)could affect patient's frequent visit behaviors.Chronic diseases(100.0%,20/20),convenience of community hospitals(90.0%,18/20),good doctor-patient relationship(90.0%,18/20),concern for their own health(60.0%,12/20),acute illness(45.0%,9/20),and poor conscious health status(30.0%,6/20)could contribute to frequent visits,while inconvenient movements(20.0%,4/20),economic reasons(10.0%,2/20),and household chores(10.0%,2/20)may limit the frequency of patient visits.Conclusion The frequent visit behaviors of elderly patients are affected by many factors,which requires the attention of general practitioners on patient's disease,psychology,society and other aspects to meet their real needs.