辽宁省6619名城乡居民首诊医院选择及影响因素分析

Analysis of the choice and influencing factors of the first visit hospitals for 6619 urban and rural residents in Liaoning Province

目的:了解辽宁省城市和农村居民目前首诊选择医疗机构的现状,分析影响居民首诊选择医疗机构的主要因素,为有关部门引导居民基层首诊、更好推进分级诊疗制度的实施提供意见。方法:采用系统抽样和简单随机抽样对辽宁省部分地区共计6 619名居民进行问卷调查,用SPSS25.0对数据进行单因素检验以及多因素logistic回归模型分析。结果:超半数城市居民(56.9%)更愿意选择三级医院进行首诊,近半数农村居民(49.8%)倾向于首选基层医疗机构进行就诊;文化程度、医保类型、年家庭收入、职业状况、身体健康状况、是否了解分级诊疗制度共同影响城乡居民的首诊医院选择;性别、年龄对农村居民首诊医院选择有影响。医生的诊疗水平、医疗机构设备水平、疾病严重程度均为城乡居民首要考虑的客观因素。结论:辽宁省总体基层医疗机构首诊率不高,城乡居民首诊选择存在较大差异;需要相关政府部门与各级医疗机构共同努力,提升基层医疗机构服务能力,正确引导居民合理选择医疗机构就诊,真正落实分级诊疗制度。

Objective: To understand the current status of urban and rural residents in Liaoning Province choosing medical institutions for the first visit, analyze the main factors that affect residents’ choice of medical institutions for the first visit, and provide suggestions for relevant departments to guide residents to first visit at the grassroots level level and to better promote the implementation of the graded diagnosis and treatment system. Methods: The survey method used systematic sampling and simple random sampling to conduct a questionnaire survey on a total of 6619 residents in some areas of Liaoning Province.SPSS25.0 was used to conduct single factor χ2 test and multinomial logistics regression model analysis. Results: Over half of urban residents(56.9%) are more willing to choose Grade Ⅲ hospitals for the first visit, and nearly half of rural residents(49.8%) prefer to prefer the grassroots level medical institutions for treatment;education level, medical insurance type, annual family income, occupational status, physical health status, and whether to understand the hierarchical medical system all affect the choice of the first hospital for urban and rural residents;gender and age have an impact on the choice of the first visit hospital for rural residents. The level of diagnosis and treatment of doctors, the level of equipment in medical institutions, and the severity of diseases are all objective factors that are the primary consideration for urban and rural residents. Conclusion:Liaoning Province has a low rate of first visits in the grassroots level medical institutions, and there is a big difference between urban and rural residents. Therefore, relevant government departments and medical institutions at all levels need to work together to improve the service capabilities of the grassroots level medical institutions, so that residents can reasonably choose medical institutions for treatment, and truly implement the hierarchical medical system.