基于二元logistics回归的患者过度医疗检查认知及影响因素研究

Studying onthe Patients'Cognitive Status on Excessive Medical Examination and Its Influencing Factors Based on Binary Logistic Regression

目的了解患者对于过度医疗检查的认知现状,为政府采取相应干预措施,降低患者医疗检查费用、促进合理医疗检查提供参考。方法通过问卷调查获取数据并对数据进行描述性分析、卡方检验和二元logistics回归分析。结果调查样本总的过度医疗检查发生率为28.87%;年平均医疗费用、检查费用占比、是否了解检查项目意义这3个变量是患者对于过度医疗检查认知的影响因素,(P值分别为0.001,0.000,0.031),性别、年龄、医保类型、对医疗检查的看法都不是患者对于过度医疗检查认知的影响因素(P值依次为0.704,0.646,0.861,0.476)。在医疗费用中,以0~500元为参考组,≥500元的过度医疗检查发生率0~500元的2.314倍(P=0.005)。在检查费用占比中,以0~31%为参考组,31%-50%的过度医疗检查发生率是0-31%的3.394倍(P=0.000);51%-70%的过度医疗检查发生率是0-31%的.3.843倍(P=0.002);71%及以上占比的是0~31%的10.152倍(P=0.000);在检查项目意义上,以不了解为参考组,很了解的过度医疗检查发生率是其0.099倍(P=0.012)。结论过度医疗检查现象时有发生,随着新医改取消药品加成政策的实施,医疗检查占总医疗费用比例增加。需加强医患双方沟通,使患者明白所做检查项目的意义;提高现有检查技术水平;完善医疗检查流程;完善监督机制,避免过度医疗检查。

Objective To explore the patients’ cognitive status on excessive medical examination, and provide references for the government to take appropriate intervention measures, reduce the cost of medical examination and promote reasonable medical examination. Methods Data was obtained through questionnaire survey and analyzed with descriptive analysis, Chi-square test and binary logistic regression analysis. Results The incidence of excessive medical examination was 28.87%. Annual average medical cost, the proportion of examination cost, and the cognition of the significance of examination projects were the factors to influence the patients’ cognition on excessive medical examination. And the factors of gender, age, type of medical insurance, and attitude towards medical examination were not the influencing factors. The incidence of excessive medical examination in group of medical cost ≥500 yuan was 2.314 times higher than that of group of 0~500 yuan. In the proportion of medical examination expenses, taken the group of 0~31% as reference, the incidence of excessive medical examination in group of 31%~50% was 3.394 times higher, was 3.843 times higher in group of 51%~70%, and 10.152 times higher in group of ≥71%. The incidence of excessive medical examination in group of understanding the meaning of examination projects was 0.099 times. Conclusion The phenomenon of excessive medical examination occurs frequently. With the implementation of new medical reform, the proportion of medical examination account to total medical expenses has increased. It is necessary to strengthen the communication between doctors and patients, improve the existing examination technology, perfect the medical examination process and supervision mechanism.