银川市老年慢性病患者健康管理需求及影响因素分析

Analysis of health management needs and influencing factors of elderly patients with chronic diseases in Yinchuan city

目的了解银川市老年慢性病患者健康管理需求及其相关影响因素,为制定老年慢性病患者健康管理策略提供依据。方法2023-04-01-06-30采用自行设计问卷,以随机偶遇法对银川市社区300例老年慢性病患者进行问卷调查,包括一般人口学资料、慢性病患病状况、慢性病健康管理需求3个部分。采用单因素方差分析、t检验和多因素logistic回归分析影响因素。结果银川市老年慢性病患者患≥2种慢性病患病率为56.67%。单因素分析结果显示,年龄(χ^(2)=9.646,P=0.008)、受教育程度(χ^(2)=15.545,P<0.001)、主要收入来源(χ^(2)=8.421,P=0.038)、当前月收入(χ^(2)=8.631,P=0.013)、患病病龄(χ^(2)=6.789,P=0.034)、买药机构(χ^(2)=11.274,P=0.010)、服药年限(χ^(2)=8.857,P=0.031)、交往意愿(χ^(2)=17.019,P<0.001)、建立居民健康档案(χ^(2)=13.916,P<0.001)和家庭医生签约(χ^(2)=5.952,P=0.015)老年慢性病患者健康管理需求的差异有统计学意义。二元logistic回归分析结果显示,受教育程度为高中(OR=0.344,95%CI为0.151~0.783,P=0.011)和大专及以上(OR=0.342,95%CI为0.126~0.924,P=0.034)、收入来源为其他(OR=3.354,95%CI为1.177~9.556,P=0.023)、服药年限为5~10年(OR=0.419,95%CI为0.182~0.965,P=0.041)和>15年(OR=0.128,95%CI为0.018~0.901,P=0.039)、有交往意愿(OR=5.364,95%CI为2.068~13.913,P=0.001)、建立居民健康档案(OR=0.363,95%CI为0.165~0.801,P=0.012)对老年慢性病患者健康管理服务需求有影响。老年慢性病患者对健康管理的需求排在前5位的分别是健康档案管理(92.00%)、健康体检(90.33%)、疾病或以外受伤后的康复训练(88.67%)、体检后健康咨询和后续医疗服务(87.67%)、常规配药用药指导(85.33%)。结论老年慢性病患者健康管理需求较高,且受到受教育程度、交往意愿和居民健康档案建立与否的影响较大,应完善家庭医生团队建设,开展具有中医特色的健康管理工作,患者、家庭、社区多方协作资源整合,形成慢性病防治综合服务体系,满足老年慢性病患者多层次的健康需求。

Objective To explore the health management needs and influencing factors of elderly patients with chronic diseases in Yinchuan city,and to provide basis for formulating health management strategies for elderly patients with chronic diseases.Methods From April 1 to June 30,2023,a self-designed questionnaire was used to conduct a random encounter survey on 300 elderly chronic disease patients in the community of Yinchuan city,including general demographic data,chronic disease status,and chronic disease health management needs.Oone-way ANOVA,t-test,and multivariate logistic regression were used to analyze the influencing factors.Results The prevalence rate of elderly patients suffering from≥2 chronic diseases was 56.67%in Yinchuan city.Univariate analysis results showed that the age(χ^(2)=9.646,P=0.008),education level(χ^(2)=15.545,P<0.001),main source of income(χ^(2)=8.421,P=0.038),current monthly income(χ^(2)=8.631,P=0.013),year of illness(χ^(2)=6.789,P=0.034),drug buying institution(χ^(2)=11.274,P=0.010),medicine duration(χ^(2)=8.857,P=0.031),communication intention(χ^(2)=17.019,P<0.001),establishment of resident health records(χ^(2)=13.916,P<0.001)and family doctor contract(χ^(2)=5.952,P=0.015)on health management service demand of elderly patients with chronic diseases were statistically significant.Binary logistic analysis demonstrated that education level at high school(OR=0.344,95%CI:0.151-0.783,P=0.011),college degree or above(OR=0.342,95%CI:0.126-0.924,P=0.034),main income source as other(OR=3.354,95%CI:1.177-9.556,P=0.023),medicine duration of 5-10 years(OR=0.419,95%CI:0.182-0.965,P=0.041)and medicine duration of>15 years(OR=0.128,95%CI:0.018-0.901,P=0.039),willingness to communicate(OR=5.364,95%CI:2.068-13.913,P=0.001)and establishment of resident health records(OR=0.363,95%CI:0.165-0.801,P=0.012)had significant effects on health management service demand of elderly patients with chronic diseases.The top5 demands for health management among elderly chronic disease patients were health record management(92.00%),health examination(90.33%),rehabilitation training after illness or external injury(88.67%),health consultation and follow-up medical services after physical examination(87.67%),and routine medication guidance(85.33%).Conclusions Elderly patients with chronic diseases have a high demand for health management,which is greatly affected by education level,willingness to communicate and the establishment of health records.The team building of family doctors should be improved.The health management with traditional Chinese medicine characteristics should be carried out.And patients,families and communities should cooperate to integrate resources,and form a comprehensive service system for chronic disease prevention and treatment to meet the multi-level health needs of elderly patients with chronic diseases.