沈阳市某区居民患病首诊医疗机构选择意向影响因素分析

Factors affecting the residents’ choices of first-visited hospitals in a district of Shenyang

目的通过对沈阳市某区居民首诊医院选择意向的调查研究,了解影响其就医选择的因素,探求如何优化社区居民就医行为,发挥分级诊疗制度优势。方法2018-06-01-2018-12-31选择沈阳某区的居民进行问卷调查,调查内容包括居民基本情况、患病时就诊首诊医疗机构和人群中选择首诊医院时考虑的主要因素等。根据首诊医院选择意向将调查对象分为3组,即基层医院组、三级医院组和选择未明确组。组间比较使用方差分析和χ^(2)检验。结果调查人群的年龄组间差异有统计学意义(F=4.24,P=0.02),性别分布组间差异无统计学差异(χ^(2)=5.39,P=0.07)。居民考虑的因素按占比排行由高到低依次为医生诊疗水平(χ^(2)=26.32,P<0.01)、疾病严重程度(χ^(2)=40.96,P<0.01)、设备水平(χ^(2)=39.01,P<0.01)、距离较近(χ^(2)=48.64,P<0.01)、服务态度好(χ^(2)=7.63,P=0.02)、是否有熟悉的医生(χ^(2)=38.59,P<0.01)、就诊等候时间短(χ^(2)=8.58,P=0.01)、价格便宜(χ^(2)=60.78,P<0.01)。多元Logistics回归分析显示,年龄(OR=1.02,95%CI为1.00~1.04,P=0.03)、受教育程度(高中/中专OR=1.85,95%CI为1.03~3.31,P=0.04;大专OR=2.89,95%CI为1.47~5.65,P<0.01;本科及以上OR=2.24,95%CI为1.10~4.59,P=0.03)、家庭经济收入(30000元~,OR=1.17,95%CI为0.69~1.97,P=0.56;50000元~,OR=1.29,95%CI为0.74~2.24,P=0.37;70000元~,OR=2.18,95%CI为1.11~4.30,P=0.02)、医生诊疗水平(OR=1.73,95%CI为1.06~2.82,P=0.03)、疾病严重程度(OR=0.64,95%CI为0.43~0.96,P=0.03)、设备水平(OR=1.70,95%CI为1.13~2.57,P=0.01)、距离较近(OR=0.01,95%CI为0.38~0.87,P=0.58)、就诊等待时间短(OR=0.04,95%CI为0.32~0.97,P=0.56)、价格便宜(OR=0.12,95%CI为0.05~0.27,P<0.01)是影响居民患病首诊医疗机构选择意向的因素。结论影响沈阳市某区居民选择首诊医院的主要因素包括医生诊疗水平、疾病严重程度和设备水平等。同时其选择意向也与受教育程度、家庭经济收入情况有一定的相关性。因此,提高基层医疗机构医生诊疗水平及设备水平,实现各级医院诊疗同质化,将有利于优化居民就诊医院选择。

Objective To investigate the factors affecting the residents’choices of first-visited hospitals in a district of Shenyang,and to explore how to optimize the behavior of seeking medicine,which may help to exploit the advantages of hierarchical medical system.Methods The survey was conducted by aquestionnaire which included information of basic situation of the residents and the 13 factors considered affecting their choices of first-visiting hospitals when falling ill.The respondents were randomly chosen from residents in a district of Shenyang from Jun.1 st to Dec.31 st 2018,whom were divided into 3 groups according to the chosen hospital(Unclear,Primary Hospital,and Tertiary Hospital).ANOVA and Chisquare test were used for comparison among groups.Results A total of 820 questionnaires were collected with the response rate of 70.57%.There were statistically significant differences in age,education levels and incomes among the3 groups(P<0.05);Eight factors showed differences among the groups,listed according to the percentages of being considered in the respondents,including doctor’s skills,severity of diseases,medical equipment,distance,service attitude,familiar doctors,time costs,and prices(P<0.05).Multiple Logistics regression analysis showed that age,education levels,incomes,and doctor’s skills,severity of diseases,medical equipment,distance,time costs,and prices were the factors that affected residents’choices of medical institutions for first consultations(P<0.05).Conclusions The main affecting factors on the residents’choices of first-visited hospitals are doctor’s skills,severity of diseases,and medical equipment,etc.At the same time,the choices are also related to education levels and family incomes.Therefore,it is important to improve the doctor’s skills and medical equipment in primary hospitals,and to realize the homogeneity of diagnosis and treatment in hospitals at different levels,which may help to optimize the choices of hospitals in the residents.