分级诊疗视角下中老年人基层首诊影响因素分析

Analysis of Influencing Factors of First Diagnosis at Primary Medical Institutions for Middle-aged and Elderly People from the Perspective of Hierarchical Diagnosis and Treatment

目的:探究河南省中老年人两周内基层首诊医疗机构选择情况及影响因素,为优化基层首诊就医选择提供建议。方法:采用多阶段分层整群随机抽样法,抽取河南省9个省辖市≥45岁的中老年人进行问卷调查。运用SPSS24.0进行描述分析、单因素分析以及二分类logistic回归分析,探究中老年人在两周病伤内首诊医疗机构选择及影响因素分析。结果:77.47%的中老年人选择到基层医疗机构首诊。回归分析结果表明,城镇职工基本医保、是否有健康档案、焦虑或抑郁、自评健康、是否饮酒、是否有其他慢性病是影响中老年人在两周病伤内选择基层首诊的因素。结论:基层医疗机构应充分发挥医疗保险的优势,完善健康档案,关注中老年人群的身心健康,采取针对性措施提升慢性病诊疗水平,加强健康管理宣教,加大分级诊疗宣传力度,合理引导中老年人选择基层医疗机构就诊。

Objective : The paper attempts to explore the factors influencing the selection of primary medical institutions for the first diagnosis of the middle-aged and elderly people within two weeks of illness and injury, so as to provide the reference for optimizing the selection of primary medical institutions for the first diagnosis. Methods: Multi-stage stratified cluster random sampling method was used to select middle-aged and elderly persons aged ≥45 years from 9 cities in Henan Province for the questionnaire survey. SPSS 24.0 was used for descriptive analysis, single factor analysis and binary logistic regression analysis. Results: 77.47% of the middle-aged and elderly go to medical institutions at the grassroots level for the first diagnosis. Regression analysis results show that basic medical insurance for employees, health records, anxiety or depression, self-reported health,alcohol drinking and chronic diseases af fect the middle-aged and the elderly to choose first diagnosis at the grassroots level within two weeks of illness and injury. Conclusion: Primary medical institutions should give full play to the advantages of medical insurance, improve and optimize health records, pay attention to the physical and mental health of middle-aged and elderly people, and take targeted measures to improve the diagnosis and treatment of chronic diseases, strengthen publicity and education of health management. increase publicity on hierarchical diagnosis and treatment and guide middle-aged and elderly people to choose community-level medical institutions within two weeks of illness and injury.