分级诊疗制度下徐州市社区居民的社区卫生服务机构首诊情况及影响因素研究

Status and Associated Factors for Receiving First Contact Care Delivered by Community Health Institutions in Community Residents in Xuzhou During the Implementation of the Hierarchical Diagnosis and Treatment System

目的了解分级诊疗制度下徐州市社区居民的社区卫生服务机构首诊情况并探讨其影响因素,从而为合理分流患者、优化社区居民就医行为、发挥分级诊疗制度作用提供建设性建议。方法于2016年7—8月,采用多阶段分层随机抽样法,在徐州市3个区县抽取社区居民750例。采用本课题组自行设计的结构式问卷对纳入居民进行调查,主要内容包括社区居民的基本信息、对分级诊疗制度的知晓情况、分级诊疗制度下的就诊选择情况。共发放问卷750份,有效回收710份,问卷有效回收率为94.7%。结果 710例社区居民中,1年内患病614例(86.5%),最近1次患病后就诊480例(78.2%),其中首选社区卫生服务机构就诊255例,社区居民的社区卫生服务机构首诊率为53.1%。不同文化程度、职业、去年平均月收入、自评健康状况、去年医疗费用及是否患慢性病、是否知晓分级诊疗制度社区居民的社区卫生服务机构首诊率比较,差异有统计学意义(P<0.05);不同性别、年龄、婚姻状况、步行至最近社区卫生服务机构时间社区居民的社区卫生服务机构首诊率比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,文化程度、去年平均月收入、去年医疗费用及是否知晓分级诊疗制度是社区居民首选社区卫生服务机构就诊的影响因素(P<0.05)。结论徐州市社区居民的就诊率、社区卫生服务机构首诊率均有待提高,文化程度、去年平均月收入、去年医疗费用及是否知晓分级诊疗制度是社区居民首选社区卫生服务机构就诊的影响因素。

Objective To investigate the status and community health institutions in community residents in Xuzhou, associated factors for receiving first contact care delivered by China during the implementation of hierarchical diagnosis and treatment system, in order to provide some constructive suggestions for diverting patients reasonably, optimizing their health - seeking behavior and improving the role of the hierarchical diagnosis and treatment system. Methods Seven hundred and fifty community residents were selected by stratified multistage random sampling in 3 subordinate counties （districts） of Xuzhou from July to August in 2016. They were surveyed by a structured questionnaire designed by our research team consisting of questions about demographic characteristics, awareness level of the hierarchical diagnosis and treatment system and the choice of medical treatment during the implementation of the hierarchical diagnosis and treatment system. The survey achieved a response rate of 94. 7% （710/750） . Results Of the participants, 86. 5% （614/710） had a history of illness in 1 year, 78.2% of them （480/614） sought medical services when they had an illness recently, and 53. 1% （255/480） first received the care provided by community health service institutions. The rate of receiving first contact care delivered by community health service institutions varied significantly by education level, occupation, average monthly income and medical expenses of the preceding year, self- perceived health, prevalence of chronic diseases, and awareness level of the hierarchical diagnosis and treatment system （ P 〈0. 05 ）, but not by gender, age, marital status, and time needed to go to the nearest community health service institution on foot （ P 〉0. 05 ） . By multivariate Logistic regression analysis, the identified associated factors for seeking first contact care delivered by community health institutions in community residents consisted of education level, average monthly income and medical expenses of the preceding year, and awareness level of the hierarchical diagnosis and treatment system （ P 〈 0. 05 ） . Conclusion The rate of seeking medical services and that of receiving first contact care delivered by community health institutions in community residents in Xuzhou should be improved. Education level, average monthly income and medical expenses of the preceding year, and awareness level of the hierarchical diagnosis and treatment system are the associated factors for seeking first contact care delivered by community health institutions in these residents.