基于Andersen行为模型的养老机构内老年人卫生服务项目利用的影响因素调查研究  

Influencing Factors of Health Services Utilization among the Elderly in Elderly Care Institutions:a Study Using Andersen’s Behavior Model

作　　者：杨郗 李娟萍 郑凯 何娉婷 李雪峰 熊林平 王颖[3] YANG Xi;LI Juanping;ZHENG Kai;HE Pingting;LI Xuefeng;XIONG Linping;WANG Ying(Pudong New Area Dongming Community Health Center,Shanghai 200123,China;The Second Military Medical University,Shanghai 200433,China;School of Public Health,Fudan University,Shanghai 200032,China)

机构地区：[1]上海市浦东新区东明社区卫生服务中心,200123 [2]海军军医大学,上海市200433 [3]复旦大学公共卫生学院,上海市200032

出　　处：《中国全科医学》2019年第23期2841-2849,共9页Chinese General Practice

基　　金：上海市卫生和计划生育委员会科研课题(201740270);浦东新区卫生和计划生育委员会卫生科技项目(PW2016C-24)

摘　　要：背景当前养老机构内老年人患病率高,但对养老机构提供的卫生服务利用率低。明确养老机构内老年人对卫生服务项目利用的影响因素,有助于指导社区卫生服务中心与养老机构合作开展医养结合服务,改善养老机构内老年人卫生服务利用率,提高健康水平。目的研究养老机构内老年人卫生服务项目利用的影响因素,为社区卫生服务中心与养老机构合作开展医养结合服务提供决策依据。方法2017年9-12月,选取上海市浦东新区东明社区卫生服务中心所辖区域内的两家养老机构内老年人进行问卷调查。调查内容包括:个人基本信息、健康状况、经济条件、可利用的区域卫生服务资源及卫生服务利用情况。基于Andersen行为模型,分析养老机构内老年人卫生服务项目利用的影响因素,采用Logistic模型中自变量相对重要性的优势分析方法,计算倾向因素、使能因素和需求因素的调整R2值和相对重要性权重。结果共发放问卷368份,回收问卷353份,有效问卷344份,问卷有效回收率为93.5%。养老机构内老年人利用频率最高的3项卫生服务分别为体检(95.6%)、门诊(92.4%)和药事服务(83.4%)。多因素Logistic回归分析结果显示,性别、曾从事职业类型为养老机构内老年人体检利用情况的影响因素(P<0.05);入住养老机构时间、护理等级、两周内是否患病、养老机构为养老机构内老年人健康教育与咨询利用情况的影响因素(P<0.05);性别、朋友同事来养老机构探望频率、月收入、医疗保险类型为养老机构内老年人门诊利用情况的影响因素(P<0.05);医疗保险类型、养老机构为养老机构内老年人临床护理利用情况的影响因素(P<0.05);子女来养老机构探望频率、护理等级、两周内是否患病为养老机构内老年人急诊利用情况的影响因素(P<0.05);朋友同事来养老机构探望频率、两周内是否患病为养老机构内�Background In elderly care institutions,the elderly people have a high prevalence of diseases but a low health services use rate.Identification of the influencing factors of health services use in this group,helps to guide the cooperation of community health centers (CHCs) and elderly care institutions in codelivering integrated medical and nursing care,and improve the health services use rate and health status in this population.Objective To explore the influencing factors for health services use in the elderly in elderly care institutions,providing a reference for decision making during the codelivery of integrated medical and nursing care by CHCs and elderly care institutions.Methods From September to December 2017, a survey was carried out in the elderly people in two elderly care institutions in the service area of Pudong New Area Dongming Community Health Center,Shanghai.A self-developed questionnaire was used in the survey,which is composed of basic personal conditions,health status,economic conditions,available local health resources and use of heath services.Influencing factors for health services use in the elderly were analyzed with the Andersen's behavior model.Dominance analysis approach was used to compare the relative importance of the independent variables in Logistic model.The adjusted R2 value and relative importance weight of predisposing,enabling and need factors were calculated.Results Among the 368 cases participating in the survey,353 handed in the questionnaires,and 344 of them returned responsive ones,obtaining a response rate of 93.5%.The most frequently used 3 services were physical examination (95.6%),outpatient services (92.4%),and pharmaceutical services(83.4%).Multivariate Logistic regression analysis showed that gender and types of occupation were associated with the utilization of physical examination (P<0.05).Admission time to elderly care institutions,level of nursing care,two-week morbidity,and accessible medical institution were associated with health education and counseling

关 键 词：养老机构 老年人 社区卫生服务 Andersen行为模型 影响因素分析 

分 类 号：R161.7[医药卫生—公共卫生与预防医学]