我国中老年患者基层就诊状况及其影响因素  

The Status and Influencing Factors of Health Care Seeking at Grassroots Medical Institutions Among Middle-aged and Elderly Patients in China

作　　者：陆草 关婷 姚克勤 张玲华 胡序怀 LU Cao(Shenzhen Health Development Research Center,Shenzhen,Guangdong,518028,China)

机构地区：[1]深圳市卫生健康发展研究中心,广东深圳518028

出　　处：《医学与社会》2020年第10期59-64,共6页Medicine and Society

基　　金：教育部人文社会科学重点研究基地重大项目“人口老龄化与养老服务体系建设研究”,编号为16JJD840009。

摘　　要：目的:分析我国45岁及以上患者基层就诊状况及其影响因素,探究基层首诊困境,为推进分级诊疗提供参考。方法:运用2013年和2015年中国健康与养老追踪调查数据描述中老年患者基本情况、卫生服务需要和基层就诊状况,采用logistic回归模型分析中老年患者基层就诊的影响因素。结果:中老年患者卫生服务需要上升。2013-2015年城市和农村中老年患者基层就诊率均下降,整体就诊率从64.58%下降到61.47%。家庭年人均消费支出较高(OR=0.61,P<0.01)、参保城镇职工医疗保险(OR=0.26,P<0.01)、到医疗机构时长在15分钟以上的患者(OR=0.15,P<0.01)不倾向到基层就诊;城市的高血压/糖尿病患者(OR=0.48,P<0.01)、城市的其他慢性病患者(OR=0.56,P<0.01)不倾向到基层就诊。结论:我国中老年患者基层就诊推进缓慢,主要受个体因素和医疗服务可负担性影响,基层医疗机构尚未成为中老年患者慢病管理主体,其慢病管理作用需强化。Objective:To investigate the status and analyze the influencing factors of health care seeking at grassroots medical institutions among patients aged 45 and older,and then explore the dilemma of first-level diagnosis at primary level and provide a reference for the promotion of hierarchical medical system in China.Methods:The data of China Health and Retirement Longitudinal Study in 2013 and 2015 were used to investigate the basic situation,health service needs and status of health care seeking at grassroots medical institutions among middle-aged and elderly patients.Logistic regression model was used to analyze the influencing factors of health care seeking at grassroots medical institutions.Results:The health service needs of patients aged 45 and older in China increased.But the visit rate of grassroots medical institutions in urban and rural areas decreased from 2013 to 2015,and the whole visit rate decreased from 64.58%to 61.47%.The middle-aged and elderly patients who had lower annual per capita consumption expenditure of households(OR=0.61,P<0.01),participated in urban and rural resident medical insurance(OR=0.26,P<0.01),and usually take less than 15 minutes visit to the medical institutions(OR=0.15,P<0.01),as well as the middle-aged and elderly patients living in urban areas suffering with hypertension or diabetes(OR=0.48,P<0.01),or other chronic disease(OR=0.56,P<0.01),were more unlikely to visit the grassroots medical institutions.Conclusion:It makes relatively slow progresses on the promotion of grassroots medical care for middle-aged and elderly patients in China.The desires of middle-aged and elderly patients’health care seeking at grassroots medical institutions were mainly affected by their personal characteristics and affordability of medical services.The grassroots medical institutions have not yet become the main manager of chronic disease management among middle-aged and elderly patients,and the role of chronic disease management of the grassroots medical institutions needs to be further stren

关 键 词：基层就诊 分级诊疗 中老年患者 影响因素 

分 类 号：R197[医药卫生—卫生事业管理]