基于Anderson模型社区老年人医养结合服务的利用水平及影响因素研究

Study on utilization level and influencing factors of combined medical and nursingservices of elderly people in community based on Anderson model

目的探究基于卫生服务利用的Anderson模型,了解社区居家老年人目前医养结合服务利用水平及影响因素,旨在推进优化服务体系建设。方法对上海市浦东新区某街道内长护险服务覆盖的居家养老老年人进行问卷调查并分析,调查内容包括倾向特征、促进资源和需要三个层面的影响因素和医养结合服务利用水平现状。结果调查共收到问卷2348份,有效问卷2302份,问卷有效回收率为98.04%。不同长护险评估等级的老年人中年龄段(年龄段占比)、文化程度、疾病数量、需要帮助程度,差异均有统计学意义(P<0.05)。27项生活护理服务中,利用率排名前六的项目依次为指/趾甲护理、手/足部清洁、沐浴、梳理/洗发、温水擦浴、头面部清洁;15项常用医疗护理服务方面,目前“未利用任意一项”的占比为61.86%。多元线性回归模型提示,倾向因素中的年龄对生活照护服务、整体医养结合服务利用均有正向影响(P<0.05),文化程度对生活照护服务、整体医养结合服务利用均有负面影响(P<0.05);促使因素中的医保类别、生活来源、照护费用对各服务利用均无影响(P>0.05);需要因素中的需要帮助程度、疾病数量、长护险等级对生活照护服务、医疗护理照护服务、整体医养结合服务利用均有正向影响(P<0.05)。结论长护险制度协调了居家养老的老年人的服务需求与服务供给,各项服务的利用水平仍有待进一步提升,服务模式有待优化。

Objective To use the Anderson model in health services to understand the current level and influencing factors of the use of medical and elderly care combination among elderly people living at home in the community,and to promote the construction of an optimized service system.Methods From February 23,2021 to June 22,2021,a questionnaire survey was conducted on elderly people living at home covered by long-term care insurance services in a street in Pudong New Area,Shanghai.The survey includes three levels of influencing factors which were tendency characteristics,promotion resources,and needs,as well as the current level of utilization of integrated medical and nursing services.A total of 2348 questionnaires were received during the survey,with 2302 valid questionnaires and a valid response rate of 98.04%.Results A total of 2348 questionnaires were received in the survey,with 2302 valid questionnaires.The effective response rate of the questionnaires was 98.04%.There were statistically significant differences(P<0.05)in age group(proportion of age group),educational level,number of diseases,and degree of need for help among elderly people with different levels of long-term care insurance evaluation.Among the 27 daily care services,the top 6 in terms of utilization rate were finger/toenail care,hand/foot cleaning,bathing,combing/shampooing,warm water bath,and head and face cleaning.In terms of 15 commonly used medical and nursing services,61.86%currently did not utilize any of them.The multiple linear regression model suggests that the age of the propensity factor there were positive impact on the utilization of life care services and overall integrated medical care services(P<0.05).Education level there were negative impact on the utilization of daily care services and integrated medical and nursing services(P<0.05).The types of medical insurance,sources of livelihood,and care costs that contribute to factors there were no impact on the utilization of various services(P>0.05).The degree of need for help,the number of diseases,and the level of long-term care insurance there were positive impact on the utilization of daily care services,medical care services,and overall medical and nursing integrated services(P<0.05).Conclusion The long-term care insurance system coordinates the service demand and supply of elderly care at home.The utilization level of various services still needs to be further improved,and the service model needs to be optimized.