基于安德森模型的高血压患者就诊行为影响因素研究  

Influencing Factors of Healthcare Seeking Behavior of Hypertension Patients:an Analysis Based on Anderson’s Model

作　　者：毛琪 俞意 刘晓强[2] 薛成兵[2] 徐爱军 MAO Qi;YU Yi;LIU Xiaoqiang;XUE Chengbing;XU Aijun(School of Health Economics and Management,Nanjing University of Chinese Medicine,Nanjing 210000,China;Jiangsu Health Statistics Information Center,Nanjing 210000,China)

机构地区：[1]南京中医药大学卫生经济管理学院,江苏省南京市210000 [2]江苏省卫生统计信息中心,江苏省南京市210000

出　　处：《中国全科医学》2020年第3期333-337,共5页Chinese General Practice

基　　金：国家社科基金冷门“绝学”和国别史等研究专项(2018VJX065);江苏省中医药局重点项目(ZD201801);江苏省社会科学基金资助项目(15GLB019)——2016居民卫生服务利用行为监测数据深入分析项目

摘　　要：背景高血压等慢性病已成为我国重要的公共卫生问题,了解高血压患者的就诊行为及其影响因素,有利于引导患者有序就医,改善生命健康质量。目的利用安德森模型,探讨高血压患者就诊行为的影响因素,为促进高血压患者积极有效地利用医疗卫生服务提供参考。方法2018年810月,利用全国第六次卫生服务调查中江苏地区高血压患者的调查数据,将调查对象中年龄≥15周岁、已确诊患有高血压的1953例患者为研究对象,以修正后的安德森模型为理论框架,探究情景特征、人群特征和健康行为对高血压患者就诊行为的影响。结果高血压患者两周就诊率为18.69%(365/1953)。多因素Logistic回归分析显示,到达最近医疗机构花费时间[6~10 min:OR=1.448,95%CI(1.045,2.005);≥11 min:OR=1.143,95%CI(0.814,1.606)]、城乡分布[OR=0.604,95%CI(0.449,0.813)]、家庭人均年收入[中等收入:OR=0.979,95%CI(0.674,1.421);高收入:OR=1.387,95%CI(1.049,1.832)]、参保情况[城镇职工基本医疗保险:OR=0.502,95%CI(0.200,1.260);城乡居民基本医疗保险:OR=0.705,95%CI(0.529,0.938)]、自感疾病严重程度[一般:OR=0.469,95%CI(0.317,0.694);不严重:OR=0.519,95%CI(0.394,0.683)]是高血压患者就诊行为的影响因素(P<0.05)。结论情景特征(医疗机构花费时间)和人群特征(城乡分布、家庭人均年收入、参保情况、自感疾病严重程度)不同程度地影响着高血压患者就诊行为,建议相关部门继续提高医疗服务可及性,完善医疗保障制度,着重关注老年和低收入高血压患者医疗服务需求,加强高血压健康教育工作,增强高血压患者健康意识。Background Hypertension and other chronic diseases have become an important public health problem in China.To understand the behavior of patients with hypertension and its influencing factors is conducive to guiding patients to seek medical treatment orderly and improving the quality of life and health.Objective To explore the influencing factors of healthcare seeking behaviors in hypertension patients using Anderson’s model,providing data reference for promoting active and effective use of medical and health services in this group.Methods From August to October 2018,we collected data from the Jiangsu part of the Sixth National Health Services Survey in China,and enrolled 1 953 hypertension patients(≥15 years old)from Jiangsu people who participated in the survey.Using the framework of modified Anderson’s model,we explored the influence of contextual characteristics,population characteristics and health behaviors on healthcare-seeking behaviors of hypertension patients.Results The two-week visiting rate in these hypertension patients was 18.69%(365/1 953).Multivariate Logistic regression analysis showed that:time required to arrive at the nearest medical institution from home〔6-10 min:OR=1.448,95%CI(1.045,2.005);≥11 min:OR=1.143,95%CI(0.814,1.606)〕,urban and rural distribution〔OR=0.604,95%CI(0.449,0.813)〕,annual household income per capita〔medium income:OR=0.979,95%CI(0.674,1.421);high income:OR=1.387,95%CI(1.049,1.832)〕,insurance participation 〔basic medical insurance for urban employees:OR=0.502,95%CI(0.200,1.260);basic medical insurance for urban and rural residents:OR=0.705,95%CI(0.529,0.938)〕,self-perceived severity of disease〔general:OR=0.469,95%CI(0.317,0.694);not serious:OR=0.519,95%CI(0.394,0.683)〕 were influencing factors of healthcare seeking behaviors in patients with hypertension(P<0.05).Conclusion Contextual characteristic(time taken to the nearest medical institution from home)and population characteristics(urban and rural distribution,annual household income per capita,

关 键 词：高血压 就诊行为 安德森模型 卫生服务利用 卫生服务研究 

分 类 号：R544.1[医药卫生—心血管疾病]