尘肺病患者的应住院未住院情况及影响因素分析

Hospitalized but not admitted and influencing factors for pneumoconiosis patients

目的研究尘肺病患者应住院未住院情况,分析其住院医疗服务受限的主要原因和影响因素,为相关政策制定提供参考依据。方法于2017年3月至2018年1月,采取分层抽样调查和典型调查相结合的方法,在浙江、江苏、山东、河北等9个省,以经过职业病诊断的尘肺病患者和临床诊断的尘肺病患者为研究对象,以《尘肺病患者就医行为及其影响因素》问卷为调查工具,对其门诊、住院等就医行为进行问卷调查。分析模型采用安德森医疗卫生服务利用行为模型(BMHUS);单因素分析用χ2检验,多因素分析用多元logistic回归分析。结果共调查1 037例尘肺病患者,平均年龄(55.9±11.2)岁,67.5%(700/1 037)长期居住在农村;以工伤保险、城乡居民医疗保险为主,分别占40.9%(424/1 037)、59.4%(616/1 037);共有177例(17.1%)患者曾因尘肺被医生要求住院而未住院,农村和城镇尘肺病患者应住院未住院的比例分别为20.1%(141/700)、10.7%(36/337),差异有统计学意义(χ2=14.38,P<0.05)。未能住院的主要原因以经济困难(12.0%,124/1 037)和自感病较轻为主(3.2%,33/1 037)。模型分析显示,安德森模型中的倾向性因素、能力因素、健康需求、就医行为和健康自评估因素均有统计学意义(P<0.05),患者应住院未住院比例较高的特征主要有个人月收入1 000元以下(OR无收入=2.92,95%CI:1.14~7.48;OR^1 000元=3.55,95%CI:1.35~9.35)、无工伤保险(OR=2.05,95%CI:1.16~3.43)以及并发肺气肿(OR=1.98,95%CI:1.12~3.50)等。结论农村尘肺病患者应住院未住院比例较高,经济收入低、无工伤保险和并发肺气肿等是尘肺病患者住院服务利用的主要制约因素。

Objective To investigate the situation where pneumoconiosis patients who should be in hospital are not hospitalized, to analyze the main reasons and influencing factors for their restricted use of hospitalization medical services, and to provide a reference for relevant policy making. Methods Subjects were sampled in nine provinces, including Zhejiang, Jiangsu, Shandong, and Hebei, using a method that combined stratified sampling and typical sampling, from March 2017 to January 2018. These subjects were patients occupationally diagnosed with pneumoconiosis and patients clinically diagnosed with pneumoconiosis. The questionnaire The health seeking behaviors of pneumoconiosis patients and their influencing factors was used as the survey tool to investigate their health seeking behaviors such as going to the outpatient clinic and being hospitalized. Andersen's Behavioral Model of Health Services Use was used as the analysis model;The χ2 test was used for univariate analysis, and the multivariate logistic regression model was used for multivariate analysis. ResultsA total of 1 037 patients with pneumoconiosis were surveyed, with a mean age of 55.9±11.2 years and 67.5%(700/1 037) living in rural areas for a long time. Occupational injury insurance and medical insurance for urban and rural residents were the main insurances used, accounting for 40.9%(424/1 037) and 59.4%(616/1 037) of the cases, respectively. A total of 177 (17.1%) patients were once advised by the doctors to be hospitalized because of pneumoconiosis, while they did not. The proportion of patients who should be in hospital but did not do so among rural patients was significantly higher than that in urban patients (20.1%(141/700) vs 10.7%(36/337), P<0.05). Financial difficulties (12.0%, 124/1 037) and self-rated mild symptoms (3.2%, 33/1 037) were the main reasons for not being hospitalized. Model analysis showed that the propensity factor, ability factor, health needs, health seeking behaviors, and self-rated health factor in the Anderson model were all statistically significant (P<0.05). The main features of high proportion of patients who should be in hospital but did not do so were as follows: personal monthly income below 1 000 RMB (odds ratio[OR]of no income=2.92, 95% confidence interval[CI]: 1.14-7.48;OR of less than 1 000 RMB=3.55, 95%CI: 1.35-9.35), no occupational injury insurance (OR=2.05, 95%CI: 1.16-3.43), and concurrent emphysema (OR= 1.98, 95%CI: 1.12-3.50). Conclusion Low income, no occupational injury insurance, and concurrent emphy-sema are the main constraining factors for hospitalization services use in pneumoconiosis patients.