高龄老人居家养老健康管理需求及制约因素研究

Study on the needs and constraints of home care health management for elderly people

目的了解北京市某社区高龄老人居家养老健康管理需求及制约因素。方法采用便利抽样法抽取北京市某社区1300例≥80岁的高龄老年人为研究对象,调查高龄老人基本情况、躯体和心理健康状况以及对社区卫生服务的需求和评价;采用深度访谈方法从居家养老健康管理的提供方和需求方两个角度了解开展健康管理工作的制约因素。结果45.1%(554例)的高龄老人了解社区卫生服务中心(站)开展的医养结合居家养老服务,健康管理需求排在前3位的是定期体检(82.0%,1008例)、输液打针(72.2%,887例)和预防保健(51.3%,631例)。21.2%(260例)的高龄老人不会选择社区卫生服务机构就诊,原因排在前3位的是没有需要的检查设备(45.6%,561例)、药品种类少(28.8%,354例)、医生水平信不过(8.2%,101例)。供需不匹配、经费不足和缺少工作激励机制、医护人员上门存在安全隐患、一些项目无收费标准、医疗保险不报销等因素是制约高龄老人居家养老工作的主要原因。结论社区卫生服务中心(站)开展医养结合健康管理工作有着可及、方便、质优、价廉等天然优势,需加大人才引进力度、制定可行激励机制、鼓励社会力量共同参与,以满足高龄老人居家养老健康管理的需求。

Objective To understand the needs and constraints of home care health management for elderly people in a community in Beijing.Methods A total of 1300 elderly people(≥80 years old)were selected from a community in Beijing by convenience sampling method.The basic situation,physical and mental health status of elderly people and their needs and evaluation of community health services were investigated.The method of in-depth interview was used to understand the constraints of the implement of health management from the perspectives of home care health management providers and demanders.Results There were 45.1%(554 cases)of elderly people who knew about the combination of medical and senior health care services conducted by community health service centers(stations),and the top three health management needs were regular physical examination(82.0%,1008 cases),infusion injection(72.2%,887 cases)and preventive health care(51.3%,631 cases).There were 21.2%(260 cases)of elderly people would not choose community health service institutions for consultation,and the top three reasons were lack of necessary examination equipment(45.6%,561 cases),less types of medicines(28.8%,354 cases),and losing trust in doctors(8.2%,101 cases).The main reasons that restricted the home care work for elderly people were mismatch between supply and demand,shortage of funds and lack of work incentive mechanism,hidden danger of safety of on-site medical staffs,lack of charge standard for some projects,no reimbursement by medical insurance.Conclusions The community health service centers(stations)have the natural advantages of accessibility,convenience,high quality and low price to carry out the health management of the combination of medical and senior health care.It is necessary to increase the efforts of talent introduction,develop feasible incentive mechanism and encourage social forces to satisfy the needs of home care health management for elderly people.