苏北农村地区县级医院门诊慢性咳嗽患者就医行为和医疗可及性的影响因素探讨

Health seeking behavior and access to health care among patients with chronic cough diagnosed by county general hospitals in northern parts of Jiangsu province

目的 评价社会经济因素和人口学因素对于慢性咳嗽患者(潜在结核病患者)就医行为的影响。方法 描述慢性咳嗽患者从开始咳嗽至就诊的首诊延误以及从开始咳嗽至正规医疗机构就诊的正式就诊延误情况,通过x^2检验、Kaplan-Meier生存分析、Cox回归和logistic多元回归等方法分析影响患者就诊延误的因素,并对患者的首诊医疗机构选择和痰检情况进行分析。结果 结核病控制项目县和非项目县在慢性咳嗽患者延误时间上存在差异,职业,医疗制度是影响患者就医行为的主要因素,其中未成年人与农民相比到医疗机构(RR=1.66,95％CI:1.16～2.38)尤其是乡以上医院就诊的机会多(RR=1.90,95％CI:1.27～2.84);未成年人相对农民多选择乡及乡以上医院作为首诊机构(RR=2.06,95％CI:1.12～3.80);公费比自费患者有更多的机会去乡及乡以上医院就诊(RR=1.64,95％CI:1.35～2.10)。在综合医院就诊的咳嗽满2周的患者中仅有约2.5％获得痰检建议。结论 职业和医疗保险是影响慢性咳嗽患者就医行为和医疗可及性的重要因素。无论是在结核病控制项目县还是非项目县,慢性咳嗽尚未成为综合医院医生诊断结核病的一个重要警示症状。

Objective To analyze the impact of socioeconomic and demographic factors on healthseeking behavior among patients with long-term chronic cough. Methods 310 patients with chronic cough, identified in two county general hospitals from the study sites were involved in a cross-sectional study. Questionnaire and personal interview were used for data collection. Binary logistic regression, Kaplan-Meier method and Cox analysis were applied in multivariate analysis to identify and quantify the impact of individual factors regarding the delay of reaching primary health care provider and the choice of health facility selection. Results Delay caused by patients themselves showed a difference between the counties with or without the programes. Occupation and medical insurance were associated with patients' health-seeking behavior. Patients under 18 years old had an earlier chance to access the health facility (RR=1.90,95% CI:1.27-2.84), and choosing the general hospital as their first preference when seeking healthcare (RR=2.06,95 % CI:1.12-3.80). Patients with medical insurance were more likely to seek health care service in the general hospitals (RR=1.64,95 % CI:1.35-2.10). Only 2.5% of the patients with cough longer than two weeks had received sputum smear tests in the general hospitals. Conclusion Occupation, medical insurance had great importance to the health seeking behaviors of patients with chronic cough which had not been viewed as an'on-the-alert' symptom to be included in the tuberculosis control programs at the general hospitals either in the Programmed or Non-programmed counties in Jiangsu province.