上海市大场地区申请长护险老年人的就诊行为与影响因素分析

Analysis of medical visits and influencing factors among the elderly people applying for long-term care insurance in Dachang Area of Shanghai

目的:了解不同类别老年人在各级医疗机构的就诊情况,为更好地推动分级诊疗制度建设提供参考。方法:于2021年5月—2022年2月选取上海市宝山区大场镇申请长期护理保险的512名老年人作为调查对象,在上门进行长期护理保险评估时就问卷内容对申请者进行面对面询问与填写。结果:老年人的Barthel指数平均得分为(57.63±18.54)分,属于生活自理能力中度依赖水平,平均患有(2.58±0.91)种慢性疾病,每日平均服药种类为(5.34±2.24)种,近3个月内平均就诊次数为(10.19±4.92)次。单因素分析结果显示,性别、年龄、学历、月收入、婚姻状况、家人陪伴状况、家人支持度、养老方式、生活自理能力等级、慢性病患病数量是对老年人近3个月内在不同等级医疗机构就诊人次数具有统计学意义的影响因素(P<0.05)。Post hoc testing检验结果显示,男性、80岁及以上、小学及以下学历、月收入≥5000元、无配偶、与子女同住、在养老院养老、生活自理能力中度依赖、慢性病患病数量为3~4种的老年人倾向于在一级医疗机构就诊。结论:应进一步提升家庭医生诊疗水平,吸引社区居民、尤其是老年人群进行就近签约和就诊,不断强化基层医疗机构的服务功能,更好地推动分级诊疗制度的建设。

Objective:To understand the medical visits of different categories of the elderly people in medical institutions at various levels,and to provide reference for better promoting the construction of hierarchical diagnosis and treatment system.Methods:From May 2021 to February 2022,512 elderly people who applied for long-term care insurance in Dachang Town of Baoshan District,Shanghai were selected as the survey objects,during the on-site assessment of long-term care insurance,the applicants were asked and filled in the questionnaire face-to-face.Results:The average Barthel index score of the elderly people was(57.63±18.54)points,which belonged to the moderately dependent level of activities of daily living(ADL),and the elderly suffered from(2.58±0.91)kinds of chronic diseases on average,took(5.34±2.24)kinds of medicine on average every day,and the mean number of medical visits was(10.19±4.92)in the past 3 months.Univariate analysis results showed that gender,age,education background,monthly income,marital status,family accompanying status,family support,pension mode,ADL level,and number of chronic diseases were statistically significant factors affecting the number of medical visits in different levels of medical institutions in the past 3 months(P<0.05).The results of post hoc testing showed that the elderly people who were male,80 years old or above,primary school education or below,monthly income≥5000 yuan,no spouse,living with their children,living in a nursing home for the aged,moderate dependence on ADL and having 3~4 chronic diseases tended to seek medical treatment in first-level medical institutions.Conclusion:It is necessary to further improve the diagnosis and treatment level of family doctors,so as to attract community residents,especially the elderly population to sign contracts and seek medical treatment nearby,continuously strengthen the service function of primary medical institutions,and better promote the construction of hierarchical diagnosis and treatment system.