月坛社区高血压患者频繁就诊现状及其影响因素分析

Analysis of the Current Situation of Frequent Visits and Influencing Factors of Hypertension Patients in Yuetan Community

背景频繁就诊不仅造成社区医疗资源不合理应用,而且增加全科医生的工作负担。目的了解北京市月坛社区高血压患者频繁就诊现状并对相关影响因素进行分析。方法回顾性选取2017年7月—2018年6月在首都医科大学附属复兴医院月坛社区卫生服务中心有完整门诊就诊记录的434例高血压患者为研究对象,对患者的基本情况(性别、年龄、婚姻状况、职业状态、文化程度、是否签约家庭医生服务协议)、疾病情况(体质指数、合并其他慢性病情况)、就诊情况(单纯咨询次数、口服高血压药物种类、测量血压次数)进行分析。结果434例高血压患者共就诊9910次,其中频繁就诊组(年就诊次数>24次)160例(36.9%),共就诊5694次(57.5%);常规就诊组(年就诊次数≤24次)274例(73.1%),共就诊4216次(42.5%)。频繁就诊组的年龄构成、签约家庭医生服务比例、体质指数及合并冠心病、脑卒中比例与常规就诊组比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,签约家庭医生服务〔OR=2.467,95%CI(1.536,3.964)〕和合并脑卒中〔OR=2.702,95%CI(0.449,1.106)〕为频繁就诊的危险因素。结论频繁就诊高血压患者占用了大量社区医疗资源,签约家庭医生服务、合并脑卒中为频繁就诊的危险因素,应加强对频繁就诊的重视程度并筛查干预不必要的就诊行为,有助于更好地发挥全科医生的作用、充分利用社区医疗资源。

Background Frequent visits not only causes unreasonable application of community medical resources,but also increases the workload of general practitioners.Objective To understand the current situation of frequent visits to patients with hypertension in Beijing Yuetan Community and to analyze related influencing factors.Methods 434 hypertensive patients with complete outpatient visit records in Yuetan Community Health Center,Fuxing Hospital,Capital Medical University from July 2017 to June 2018 were retrospectively selected as the research object and their basic information(gender,age,marital status,occupational status,education level,whether to contract a family doctor service agreement),disease atatus(body mass index,combination with other chronic diseases),status of visits(number of simple consultations,types of oral hypotensive drugs,times of blood pressure measurement)were analyzed.Results 434 patients with hypertension paying a total of 9910 visits,among them,there were 160 patients(36.9%)in the frequent visits group(the annual visiting times>24),with a total of 5694 visits(57.5%);274 patients(73.1%)in the routine visits group(the annual visiting times≤24),with a total of 4216 visits(42.5%).There were statistically significant differences in age composition,proportion of contracted family doctor services,body mass index,proportion of patients with coronary heart disease and stroke between the two groups(P<0.05).Multivariate Logistic regression analysis showed that the contracted family doctor services〔OR=2.467,95%CI(1.536,3.964)〕and combination with stroke〔OR=2.702,95%CI(0.449,1.106)〕were risk factors for frequent visits.Conclusion Frequent attenders in hypertension patients occupy a large amount of community medical resources,contracted family doctor services and combination with stroke are the are the risk factors of frequent visits.We should enhance the importance of frequent visits,screen and interven unnecessary medical visits,so as to help play better role of general practitioners and make full use of community medical resources.