慢性病患者就医选择的影响因素

The influencing factors of health-seeking behaviors of patients with chronic diseases

目的探讨中老年慢性病患者就医时对不同类型医疗机构的选择意愿及其影响因素,为分级诊疗背景下慢病防治策略提供参考建议。方法对中国健康与养老追踪调查(CHARLS)中健康行为问卷受访者的数据进行分析,纳入调查时近1个月内有就诊经历的慢性病患者769例,以Andersen卫生服务利用模型为依据选取慢性病患者就医选择影响因素,通过二项logistic回归,分析影响就医选择行为的因素。结果性别、户口类型、每周运动天数、吸烟、就诊自付比例及就诊单程交通费用是影响慢性病患者是否到基层医疗机构就诊的因素(P<0.05)。结论建设易于访问的卫生系统,加强不同特征慢性病人群的健康教育和卫生政策宣传,增强经济杠杆的调节作用以及基层卫生体系能力建设,是引导慢性病患者基层就医、提升慢性病管理防治效果亟需关注的重点。

Objective To investigate the behavior and influencing factors of middle and elderly-aged patients with chronic diseases in different medical institutions,and to provide policy suggestions for the prevention and treatment of chronic diseases under the hierarchical medical system.Methods According to the Andersen behavior model,based on the data of 769 chronic disease patients who accepted outpatient care within a month from China health and retirement longitudinal study(CHARLS),the influencing factors of health-seeking by Binomial logistic regression model were analyzed.Results Gender,account,weekly exercise days,smoking,proportion of out-of-pocket visits and one-way transportation costs were the factors influencing chronic disease patients′choice of primary health care institutions(P<0.05).Conclusion The construction of accessible health system,the health education and health policy propaganda of different characteristics of chronic patients,economic regulation,building the capacity of the primary health care system are the key points for guiding patients with chronic disease to seek medical treatment of primary health care institutions and improving the effectiveness of chronic disease management.