长沙市某社区老年慢性病患者首选就诊机构及影响因素分析  

Analysis of the treatment institution selection and its influencing factors in elderly patients with chronic diseases in a community in Changsha

作　　者：姚慧卿[1] 熊昌辉[1] 晏强[1] 黄莉[1] 张莉[1] 颜艳[1] 

机构地区：[1]中南大学公共卫生学院流行病与卫生统计学系,长沙410008

出　　处：《中华老年医学杂志》2014年第1期88-92,共5页Chinese Journal of Geriatrics

基　　金：中国社区卫生科研基金项目（2012-4-13）

摘　　要：目的了解长沙市某社区老年慢性病患者患病首选就诊机构的现状及影响因素。方法采用系统抽样的方法于2012年6—8月对长沙市某社区400例老年慢性病患者用自行设计的调查问卷，以面对面询问的方式进行入户调查，并依据反应变量数目不同分别采用二分类或多分类Logistic回归模型分析老年人慢性病患者首选就诊机构的影响因素。结果老年慢性病患者自觉病情较轻时，206例（51．5％）患者就诊首选社区卫生服务中心，首选私人诊所、市级医院、三甲医院者分别为67例（16．8％）、92例（23．0％）和35例（8．8％）；而当自觉病情较重时，择医倾向全部集中在市级医院（162例，40．5％）和三甲医院（238例，59．5％），无患者首选私人诊所或社区卫生服务中心（x^2=443．24，P=0．000）。自觉病情较重时首选就诊机构的影响因素分析显示，与市级医院比较，在岗人员（OR=32．38）和离退休人员（OR=15．17）、收入在5000元／月及以上者（OR=134．28）、农村合作医疗患者（OR=661．42）、对社区卫生服务机构信任度高者（OR=4．23）、测血压血糖等健康指标频率在1～3个月者（OR=83．93）、不知道社区卫生服务机构电话者（OR=3．02）及距社区医疗卫生服务机构较远者（OR=15．70）、对社区医疗卫生服务机构不太了解者（OR=1．62）更愿意选择到三甲医院接受诊治；患者自觉病情较轻时首选就诊机构的影响因素分析显示，与去私人医院就诊比较，小学文化程度者（OR=0．15）、离退休者（OR=0．14）、对健康重视程度较高者（每周测量血压血糖等健康指标）（OR=0．26）更倾向首选社区卫生服务中心，而对健康不太重视者（体检频率在两年以上）（OR=10．65）和距离社区卫生服务中心距离较远者（OR=5．22）则更愿意选择私人医院。结论患者选择就诊机构主要受自觉病�Objective To investigate the status of treatment institution selection and its influencing factors in elderly patients with chronic diseases in a community in Changsha. Methods By using systematic sampling, 400 elderly patients with chronic diseases from June to August 2012 were included in the investigation by questionnaires. The influencing factors were analyzed by binary logistic regression model or multinomial logistic regression model on the basis of the numbers of response variables. Results In mild conditions in self-consciousness, more than half of the elderly patients with chronic diseases （206 cases, 51.5%） preferred community health service centers including private clinics （67 cases, 16.8%）, municipal hospitals （92 cases, 23.0%）, third-grade class-A hospitals （35 cases, 8.8%）. In serious conditions in self-consciousness, patients preferred third-grade class-A hospital （238 cases, 59.5%） and municipal hospitals （162 cases, 40.5%）, no one selected the private clinics or community health service center （x^2= 443. 240, P〈 0. 001）. The analysis of impact factors for the first treatment institution selection in patients with serious conditions in self-consciousness showed that, compared with patients selecting the municipal hospital, the following personnel preferred to choose third-grade class-A hospital： patients in the staff remaining in positions （OR = 32.38） and retirees （OR= 15. 17）, patients with monthly income more than 5,000 yuan （OR= 134.28）, rural cooperative medical patients （OR= 661.42）, patients with highly trusting in community health service centers （OR= 4.23）, patients with BP and serum glucose determination at a frequency of once a month to every three months （OR=83.9a）, patients unknowing the telephone numbers of community health service centers（OR-3.02）and patients living far away from community health service centers （OR= 15.70）, patients with little information about community health service centers （OR = 1.62）. The an

关 键 词：社区卫生服务 慢性病 

分 类 号：R197.1[医药卫生—卫生事业管理]