养老机构五保老人就医利用状况及影响因素分析

Medical Treatment of Elderly Five Guarantees in Pension Institutions and Its Influence Factors

目的调查养老机构五保老人的就医利用状况及影响因素,为改善医疗服务利用不足的现状提供参考。方法采用分层随机抽样法,抽取山东省某地级市≥60岁的五保老人331例,应用Barthel指数评定量表及自行设计的问卷进行调查。对拿药、住院地点选择、住院次数作单因素分析,对患病未就诊原因作描述性分析及二分类Logistic回归分析。结果年龄、文化程度、入住时间、健康自评、经济自评对五保老人住院地点选择差异有统计学意义(P<0.05)。性别、婚姻状况不同,其拿药地点选择差异有统计学意义(P<0.05)。不同性别、年龄、日常生活能力、健康自评的老人过去1年住院次数的差异有统计学意义(P<0.05)。自我感觉没有大问题和经济困难是患病未就诊的关键因素。自理状况、健康自评、经济自评好的老人会因"自我感觉没有大问题"不去就诊。结论五保老人就医主动性有待提高。应落实五保政策,强化与医疗救助的制度衔接;同时提升基层诊疗水平,强化健康宣教,提高五保老人健康管理意识,进而改善卫生服务利用。

Objective To survey the medical treatment of elderly five guarantees in pension institutions and its influence factors and to provide reference for improving the inadequate utilization of medical services. Methods With a self-designed questionnaire and the Barthel index of ADL, 331 elderly people aged 60 or above from a prefecture level city in Shandong Province were selected by stratified random sampling method. Single factor analysis was carried out for where to purchase the medication, hospital selection, and the number of hospitalization and descriptive analysis and binary logistic regression analysis for the reason of non-seeking medical service. Results Age, education background, the stay length in pension institutions, self assessment of health and economic status were the influence factors of the choice of hospital location（P〈0.05） and gender and marital status exerted influence on where to purchase the medication（P〈0.05）. Different gender, age, daily living skills, self-assessed health status were influence factors of the frequency of hospitalization in the past year（P〈0.05） and feeling well and economic difficulties were key factors affecting seeking health service. Conclusion It is necessary to strengthen the implementation of the Five Guarantees supporting system and to strengthen the cohesion between the system and medical assistance. Meanwhile, the improvement of medical service in basic hospitals, the promotion of health education and the improvement of health management awareness of the elderly are critical for the improvement of the utilization of health services.