中国居民两周患病基层医疗卫生机构就诊情况及其影响因素分析

Clinic visits at primary medical and health institutions and its associates among community residents with two-week illness:a nation-wide online cross-sectional survey

目的了解中国居民两周患病基层医疗卫生机构就诊情况及其影响因素,为规范居民就诊行为提供参考依据。方法于2019年3—4月采用多阶段随机抽样方法在中国31个省(自治区、直辖市)抽取174500名居民进行线上问卷调查,采用多因素非条件logistic回归模型分析居民两周患病基层医疗卫生机构就诊的主要影响因素。结果本研究最终纳入7295名调查前两周患病且到医疗卫生机构就诊的中国居民进行分析,其中选择到基层医疗卫生机构就诊者4305人,基层医疗卫生机构就诊率为59.0%;多因素非条件logistic回归分析结果显示,女性、文化程度大专及以上、患慢性病、步行至最近基层医疗卫生机构时间≥15 min、自报经济状况一般和好的中国居民两周患病更不愿意到基层医疗卫生机构就诊,中部地区、农村户籍、流动人口、参加城乡居民基本医疗保险和饮酒的中国居民两周患病更愿意到基层卫生医疗机构就诊。结论中国居民两周患病到基层医疗卫生机构的就诊率较低,性别、文化程度、地区、户籍、是否流动人口、医疗保险类型、自报经济状况、是否饮酒、是否患慢性病和步行至最近基层医疗卫生机构时间为中国居民两周患病基层医疗卫生机构就诊的主要影响因素。

Objective To investigate the situation and influencing factors of clinic visits at primary medical and health institutions among Chinese residents with two-week illness for providing evidence to the intervention on medication seeking behavior of the residents.Methods With multistage random sampling and a self-designed questionnaire,we conducted an online survey among 174500 urban and rural residents in 31 provincial-level administrative divisions across China during March-April 2019;the data on 7295 residents attending outpatient clinics within previous two weeks were analyzed.Multivariate logistic regression model was used to explore main influencing factors for the residents'medication seeking behavior.Results Of the 7295 outpatient clinic attendees,4305(59.0%)reported visiting a doctor in primary medical and health institutions.The results of multivariate logistic regression analysis showed that the outpatient clinic attendees with following characteristics were less likely to have clinic visits at primary medical and health institutions:being female,having the education of college and above,suffering from chronic disease,being not capable of reaching the nearest primary medical or health institution within 15 minutes by walking,and reporting a fair or better economic status;but those living in central China,with rural household registration,being migrants,participating in basic medical insurance for urban and rural residents,and having alcohol drinking were more likely to seek medication in primary medical and health institutions.Conclusion The proportion of clinic visits at primary medical and health institutions was not high and mainly influenced by gender,education background,living region,household registration,migration status,type of medical insurance,self-reported economic status,alcohol consumption,chronic disease condition,and the time to reach the nearest primary medical and health institution by walking among Chinese residents with two-week illness.