山东省农村老年住院患者向下转诊意愿及其影响因素分析

Willingness for downward referral and its influencing factors among rural elderlies with hospital stay in Shandong province

目的了解山东省过去1年有过住院经历的农村老年人的转诊情况及其向下转诊意愿,探索农村老年住院患者向下转诊意愿的影响因素。方法于2017年8月,采用多阶段分层随机抽样方法,在山东省内抽取3个地级市,对60周岁及以上的在过去1年内有住院经历的910名农村老年人开展问卷调查。调查内容包括老年人的基本情况、住院相关信息、国家基本药物制度认知状况、自我心理弹性、转诊情况及下转意愿等。采用秩和检验、χ2检验及独立样本t检验进行单因素分析,应用二元logistic回归方法进行多因素分析。结果910名过去1年内有住院经历的农村老年人中,最近1次住院经过转诊的有53人,占5.8%;愿意向下转诊的有597人,占65.6%。不愿向下转诊的主要原因是认为基层医疗卫生机构技术水平低,愿意向下转诊的主要原因是离家近方便。婚姻状况、对国家基本药物制度的总体满意程度以及自我心理弹性,是农村老年住院患者向下转诊意愿的影响因素(P<0.05)。结论山东省农村老年住院患者的转诊率和向下转诊意愿较低。应进一步提升基层医疗卫生机构服务水平,加强国家基本药物制度的宣传与落实,注重疏导老年人因疾病产生的不良情绪,提高其心理弹性。

Objective To understand the referral status and the willingness for downward referral among rural elderlies with hospital stay experiences in the past year in Shandong province,and to explore its influencing factors on the willingness for downward referral.Methods Three prefecture-level cities in Shandong province were sampled by multi-stage stratified random sampling in August 2017.Questionnaire survey was conducted among 910 rural elderlies(over 60 years old)who had been hospitalized in the past year.The study included the basic information,the hospitalization experience,and perception of essential medicines system,ego-resiliency,the referral status and willingness for downward referral.Rank sum test,Chi-square test and t test were used for univariate analysis,and logistic regression was applied for influencing factors.Results Among 910 rural elderlies who had been hospitalized in the past year,53(5.8%)were referred to other medical institutions in their recent hospitalization,and 597(65.6%)were willing to be referred downward.The main reason for their reluctance for downward referral was that the medical competency of primary medical institutions was low;and the main reason for willingness for downward referral was being close to home.The results showed that marital status,impression for the national essential medicines system and ego-resiliency were the influencing factors of their willingness to downward referral among rural elderlies who had been hospitalized in the past year(P<0.05).Conclusions The referral rate and willingness for downward referral among the rural elderlies in Shandong province are relatively low.We should further enhance the service capacity of primary medical institutions,strengthen the publicity and implementation of the national essential medicines system,pay attention to help with the elderlies′negative emotions caused by diseases,and improve their ego-resiliency.