超重肥胖老年人家庭医生签约服务与门诊卫生服务利用:性别与城乡差异

Study on the Family Doctor Contracted Services and Outpatient Health Service Utilization among the Overweight and Obese Elderly from Gender and Urban-rural Differences

目的:分析山东省超重肥胖老年人家庭医生签约服务与门诊卫生服务利用之间关系,并进一步探讨这种关系间存在的性别和城乡差异,为改善卫生服务利用及优化家庭医生服务制度提供科学依据。方法:数据来源于2018年山东省第六次卫生服务调查,共有4,247名60岁及以上的超重肥胖老年人被纳入分析。采用logistic回归模型分析家庭医生签约服务与门诊卫生服务利用之间关系,并研究其在性别和城乡间差异。结果:山东省超重肥胖老年人门诊卫生服务利用率和家庭医生服务签约率分别为21.92%和66.47%。调整混杂因素后,家庭医生签约服务与山东省超重肥胖老年人门诊卫生服务利用呈显著正相关(OR=1.291,95%CI:1.091~1.527,P=0.003),且存在性别和城乡差异。家庭医生签约服务与门诊卫生服务利用关系在超重肥胖的老年女性中有统计学意义(OR=1.559,95%CI:1.237~1.965,P<0.001);且仅在农村的超重肥胖老年人中,家庭医生服务签约者比没有签约的更有可能利用门诊卫生服务(OR=1.673,95%CI:1.330~2.106,P<0.001)。结论:家庭医生签约服务与超重肥胖老年人门诊卫生服务利用之间的关系因性别和城乡而异。政府应制定个性化签约服务项目,以满足不同类型居民的差异性需求,尤其要重点针对女性和农村老年超重肥胖人群,从而推动家庭医生签约服务制度良性发展,优化医疗资源合理配置,助力健康老龄化战略实施。

Objective To analyze the relationship between family doctor contracted services and outpatient health service utili-zation among the overweight and obese elderly in Shandong Province,and further explore the gender and urban-rural differences,so as to provide a scientific basis for improving health service utilization and optimizing the family doctor service system.Methods Data were obtained from the sixth Health Services Survey of Shandong Province in 2018,from which a total of 4,247 overweight and obese older adults aged 60 years and above were included in the analysis.Logistic regression models were used to investigate the relationship between family doctor contracted services and outpatient health service utilization,and gender and urban-rural differences.Results The utilization rate of outpatient health services and the contracted rate of family doctor services among over-weight and obese older adults in Shandong Province were 21.92%and 66.47%,respectively.After adjusting the confounding fac-tors,family doctor contracted services were significantly positively associated with outpatient health service utilization among over-weight and obese older adults in Shandong Province(0OR=1.291,95%CI:1.091~1.527,P=0.003),with gender and urban-rural differences.The relationship between family doctor contracted services and outpatient health service utilization was significant among overweight and obese older women(OR=1.559,95%CI:1.237~1.965,P<0.001).Only among the rural overweight and obese older adults,those who were contracted for family doctor services were more likely to use outpatient health services than those who were not contracted(0R=1.673,95%CI:1.330~2.106,P<0.001).Conclusion The relationship between family doctor contracted services and outpatient health service utilization among overweight and obese older adults varies by gender and urban-rural areas.The government should develop personalized contracted service programs to meet the differential needs of resi-dents with different types,especially focusing on female and rural overweight and obese older adults,so as to promote the positive development of family doctor contracted service system,optimize the rational allocation of medical resources,and contribute to the implementation of healthy aging strategies.