四川省城乡患者选择私人诊所的原因调查及影响因素分析

Causes and Influential Factors of Urban and Rural Patients in Sichuan Province Choosing Private Clinics

目的了解四川省城乡患者选择私人诊所的原因和影响因素,为促进我国私人诊所持续健康发展提供客观依据。方法 2013年3月—2014年12月,采用分层抽样法,分别在成都、宜宾、遂宁3个地区的市区随机抽取私人诊所各10家、社区卫生服务站各1家;分别在3个地区所辖县随机选取1个县(简称农村地区),抽取私人诊所各9家、社区卫生服务站各1家、医疗服务开展相对较好的乡镇卫生院各1家、村卫生室各2家以及医疗服务开展相对较差的乡镇卫生院各1家、村卫生室各2家,最终选取上述卫生机构中符合纳入标准的患者940例。采用自行设计的调查问卷调查患者的基本情况、疾病类型、疾病严重程度以及患者选择私人诊所、社区卫生服务站/乡镇卫生院/村卫生室的原因,采用多因素Logistic回归分析患者选择私人诊所的影响因素。结果共发放问卷940份,剔除不完整问卷后回收问卷919份,有效回收率为97.8%。市区,私人诊所患者占12.3%(113/919),社区卫生服务站患者占13.8%(127/919);农村地区,私人诊所患者占12.4%(114/919),社区卫生服务站/乡镇卫生院/村卫生室患者占61.5%(565/919)。市区,不同职业、家庭人均年收入患者医疗机构选择情况不同,差异有统计学意义(P<0.05);农村地区,不同性别、年龄、婚姻状况、文化程度、职业、家庭人均年收入患者医疗机构选择情况不同,差异有统计学意义(P<0.05)。市区,不同疾病类型患者医疗机构选择情况不同,差异有统计学意义(P<0.05);农村地区,不同疾病类型、疾病严重程度患者医疗机构选择情况不同,差异有统计学意义(P<0.05)。市区,因"技术高""有熟人""有信赖医生"选择私人诊所的患者分别为47.8%、11.5%、39.8%;农村地区,因"有信赖医生"选择私人诊所的患者为45.6%。市区,患者因"技术高""有熟人""有信赖医生"选择私人诊所的比例较选择社区卫生服站的比例高,因"定点单位"选择私人诊所的比例较选择社区卫生服务站的比例低(P<0.05);农村地区,患者因"价格合理""设备好""定点单位"选择私人诊所的比例较选择社区卫生服务站/乡镇卫生院/村卫生室的比例低,因"有信赖医生"选择私人诊所的比例较选择社区卫生服务站/乡镇卫生院/村卫生室的比例高(P<0.05)。多因素Logistic回归分析结果显示,职业为离退休人员〔OR=0.234,95%CI(0.089,0.615)〕、无业人员〔OR=0.300,95%CI(0.118,0.759)〕、农民〔OR=0.273,95%CI(0.095,0.788)〕以及慢性病〔OR=0.477,95%CI(0.243,0.933)〕是市区患者选择私人诊所的影响因素(P<0.05);职业为工人〔OR=0.383,95%CI(0.170,0.861)〕、家庭人均年收入为10 000~<30 000元〔OR=2.886,95%CI(1.365,6.105)〕、50 000~<100 000元〔OR=4.172,95%CI(1.323,13.160)〕以及慢性病〔OR=0.272,95%CI(0.140,0.529)〕是农村地区患者选择私人诊所的影响因素(P<0.05)。结论市区患者因"技术高""有熟人""有信赖医生"选择私人诊所的情况较多,农村地区患者因"有信赖医生"选择私人诊所的情况较多,职业为离退休人员、无业人员、农民以及慢性病是市区患者选择私人诊所的影响因素,职业为工人、家庭人均年收入为10 000~<30 000元、50 000~<100 000元以及慢性病是农村地区患者选择私人诊所的影响因素。

Objective To observe the causes and influential factors of urban and rural patients in Sichuan province choosing private clinics, and to provide objective basis for the sustainable and healthy development of private clinics in China. Methods From March 2013 to December 2014,stratified sampling method was used to randomly select 10 private clinics and one community health service station in the downtowns in Chengdu,Yibin and Suining respectively;one county（ a rural area for short in the following passage）was randomly selected from the dominions of the 3 areas respectively,from which 9 private clinics,one community health service station,one health clinics in towns and townships with relatively good development of medical services,two village clinics and one health clinics in towns and townships with relatively bad development of medical services were selected respectively. Eventually 940 patients who met the inclusion criteria of those health institutions were selected. Self― designed questionnaires were applied to investigate patients＇ basic information, type of diseases, severity of diseases,and reasons for patients choosing private clinics, community health service station, health clinics in towns and townships;multivariate logistic regression was used to analyze the influencing factors of patients choosing private clinics. Results A total of 940 questionnaires was sent to patients,finally the effective response rate was 97. 8﹪ after excluding 919 incomplete questionnaires. In downtown,patients in private clinics covered 12. 3﹪ （ 113/919 ）, patients in community health service station covered 13. 8﹪（127/919）;in rural areas,the proportion of patients in private clinics covered 12. 4﹪（114/919）, that of patients in community health service station/health clinics in towns and townships/village clinics covered 61. 5﹪（ 565/919）. In downtown,there was significant difference in the status of patients choosing medical institutions among patients with different occupations and annual family income （ p 〈0. 05 ）;in rural areas, there was significant difference in the status of patients choosing medical institutions among patients with different genders, age, marital status, educational degrees, occupations and annual family income （ p 〈0. 05 ） . In downtown, there was significant difference in the status of patients choosing medical institutions among patients with different types of diseases（p〈0. 05）;in rural areas,there was significant difference in the status of patients choosing medical institutions among patients with different types of diseases and severity of diseases（ p〈 0. 05 ） . In downtown, the proportions of patients choosing private clinics due to ＂ high skills＂ ＂ having acquaintances＂ and ＂ having trusted doctors＂ were 47. 8﹪,11. 5﹪ and 39. 8﹪ respectively;in rural areas,the proportion of patients choosing private clinics due to ＂ having trusted doctors＂ was 45. 6﹪. In downtown,the proportion of patients choosing private clinics due to ＂ high skills＂ ＂ having acquaintances＂ and ＂ having trusted doctors＂ was higher than that of patients in community health service stations. The proportion of patients choosing private clinics due to ＂ fixed units＂ was lower than that in community health service stations （ p 〈 0. 05 ）;in rural areas, the proportion of patients choosing private clinics due to＂ reasonable price＂ ＂ good equipments＂ and ＂ fixed units＂ was higher than that of patients in community health service stations/health clinics in towns and townships/village clinics,the proportion of patients choosing private clinics due to ＂ having trusted doctors＂ was higher than that of patients in community health service stations/health clinics in towns and townships/village clinics（p〈0. 05）. Multivariate logistic regression analysis showed that occupations being the emeritus and retired people〔OR﹦0. 234,95﹪CI（0. 089,0. 615）〕,the unemployed〔OR ﹦0. 300,95﹪CI（0. 118,0. 759）〕,farmers〔OR ﹦0. 273, 95﹪CI（0. 095,0. 788）〕,and chronic diseases〔OR ﹦0. 477,95﹪CI（0. 243,0. 933）〕significantly influence urban patients in choosing private clinics（p〈0. 05）;occupation being the workers〔OR﹦0. 383,95﹪CI（0. 170,0. 861）〕,the family annual per―capita income of 10 000 ― 〈30 000 yuan〔OR﹦2. 886,95﹪CI（1. 365,6. 105）〕and 50 000 ― 〈100 000 yuan〔OR ﹦4. 172,95﹪ CI（1. 323,13. 160）〕,and chronic diseases〔OR ﹦ 0. 272,95﹪ CI（0. 140,0. 529）〕significantly influence rural patients in choosing private clinics （ p 〈0. 05 ） . Conclusion The situation of patients choosing private clinics because of ＂ high skill＂ and ＂ having acquaintance＂ and ＂ having trusted doctor＂ is common in downtown, while patients choosing private clinics because of ＂ having trusted doctor＂ is commonly seen in rural areas. Occupation being retirees,the unemployed and farmers,and chronic diseases are the influencing factors of patients choosing private clinics in urban areas. The occupation being workers,family annual per capita income of 10 000― 〈30 000 yuan and 50 000― 〈100 000 yuan are the influencing factors of patients choosing private clinics in rural areas.