吉林省老年人分级诊疗现状及影响因素

Status Quo and Influencing Factors of Hierarchical Diagnosis and Treatment Among Elderly in Jilin Province

目的:分析吉林省2008年、2013年60岁及以上居民门诊首诊机构选择的状况及影响因素。方法:描述老年人卫生服务需要、利用情况与两周内首诊机构选择情况,采用Logistic回归分析居民首诊机构选择的影响因素。结果:老年人卫生服务需要与利用显著上升;基层首诊率城市地区上升明显(63.3%,74.0%),农村地区基本持平(87.3%,85.4%)。糖尿病/高血压患者基层首诊率明显上升(OR=4.6,P<0.01);在总人群与糖尿病或高血压患者群体中,个人受教育程度与基层首诊比例呈统计学意义的负相关,且总人群中家庭人均收入较高组基层首诊率较低(OR=0.3,P<0.01)。结论:国家基本公共卫生服务项目推行以来,糖尿病/高血压患者利用基层卫生服务的比例增加,但个体因素仍是影响患者首诊机构选择的主要因素,基层医疗机构服务能力仍需进一步加强。

Objective： To analyze the status quo,trends and influencing factors of choice of first contact care institutions among outpatients aged 60 and older in Jilin in 2008 and 2013. Methods： We described the health service needs,utilization and choice of first contact care institutions within 2 weeks of the elderly. Based on logistic model,we investigated the influencing factors of the choice of institutions to get first contact care. Results： The health service needs and utilization increased apparently. The rate of first contact care in primary institutions increased from63.3% to 74.0% among population of urban areas,but it was stable in rural areas（ 87.3% vs. 85.4%）. The initial diagnosis rate at the grass-roots level of patients with diabetes or hypertension increased significantly（ OR = 4.6,P〈0.01）. Education was negatively associated with the rate significantly in the whole population as well as in the patients with hypertensives and diabetics,and those with higher income had a lower initial diagnosis rate at the grass-roots level（ OR = 0.3,P〈0.01）. Conclusion： Basic public health services program had made a difference in leading patients to use primary health care. And individual characteristic was the main influencing factor of seeking first contact care in primary institutions. The service ability of primary medical institutions need to be further strengthened.