北京市失能老年人对上门医疗服务利用现状的混合方法学研究  

Utilization of Home-based Medical Services in Disabled Elderly People in Beijing:a Mixed-method Study

作　　者：赵春艳[1] 余晓英[1] 杨姗姗[1] 邵爽 杜娟 ZHAO Chunyan;YU Xiaoying;YANG Shanshan;SHAO Shuang;DU Juan(Community Health Center,Beijing University of Posts and Telecommunications,Beijing 100876,China;School of General Practice and Continuing Education,Capital Medical University,Beijing 100069,China)

机构地区：[1]北京邮电大学社区卫生服务中心,北京市100876 [2]首都医科大学全科医学与继续教育学院,北京市100069

出　　处：《中国全科医学》2021年第13期1676-1683,共8页Chinese General Practice

基　　金：2017年度教育部人文社会科学研究一般项目(17YJAZH020)。

摘　　要：背景随着全球人口老龄化的加剧,失能、半失能老年人迅速增加,以全科医生团队为基础、面向家庭的上门医疗服务成为世界新趋势。目前我国的上门医疗服务还缺乏规范的管理制度和系统的运作机制。目的基于失能老年人的视角,探讨北京市上门医疗服务利用现状和存在问题,为构建合理化社区上门服务体系提供建议。方法采用质性研究和量性研究相结合的方法。2018年5—6月,采用目的抽样法选取8名失能老年人的主要照顾者进行个人深入访谈,内容包括对上门医疗服务的需求情况、了解程度、利用情况及其满意度和具体意见建议等。2018年7—9月,采用多阶段抽样方法对北京市6家社区卫生服务中心的370名失能老年人照顾者进行问卷调查,收集失能老年人的健康状况、照顾资源、对上门医疗服务项目内容的利用和满意度情况。结果质性研究发现上门医疗服务能部分满足失能老年人的需求,但患者担心上门医疗费用较高且无法医保结算、上门医疗服务知晓率低、社区卫生机构的上门医疗服务能力有限,影响了上门医疗服务的有效利用。量性研究结果显示:370例失能老年人平均年龄(80.9±8.4)岁,202例(54.6%)中度、重度失能,256例(69.2%)患有3种及以上慢性病,168例(45.4%)需要聘请保姆照顾;314例(84.9%)愿意接受上门医疗服务,但仅76例(20.5%)实际利用过社区上门医疗服务,利用程度较高的前5项服务项目依次是测量血压血糖心电图〔49(13.2%)〕、康复型家庭病床〔26(7.0%)〕、治疗型家庭病床〔22(5.9%)〕、化验标本采集〔22(5.9%)〕、定期性家访〔21(5.7%)〕;56例(15.1%)不愿意接受上门医疗服务,不愿意接受上门服务的前5位原因依次是担心收费较高〔39(69.6%)〕、担心费用无法报销〔23(41.1%)〕、不了解服务项目内容〔21(37.5%)〕、认为服务内容少或能力有限〔14(25.0%)〕、担心泄漏个人Background The number of disabled and semi-disabled elderly people is increasing rapidly along with global aging.To satisfy their healthcare needs,the delivery of home-based medical services provided by general practitioner teams has been a new global medical service trend.However,there is a lack of standardized management system and systematic operational mechanism for such services in China.Objective To investigate the utilization of home-based medical services in the disabled elderly in Beijing,to identify the existing problems in the delivery of such services,and to provide suggestions for building a reasonable home-based medical service system.Methods An approach of mixed methods of qualitative and quantitative was adopted.During May to June,2018,personal in-depth interviews were carried out in a purposive sample of the major caregivers(n=8)of 8 disabled elderly people for collecting their evaluation of disabled elderly people's needs and utilization of home-based medical services,their understanding of,satisfaction with and suggestions on the services.During July to September,2018,a questionnaire survey was conducted in a multi-stage sample of caregivers(n=370)of 370 disabled elderly people receiving management services from 6 community health centers of Beijing to collect their evaluation of disabled elderly people's health status,accessible care resources,and utilization of home-based medical services,and their satisfaction with such services.Results Interviews results revealed that home-based medical services could partly meet the healthcare needs of disabled elderly people.The effective utilization of home-based medical service was affected deeply by worrying about the cost of home-based medical services being high priced and unreimbursed,low awareness of home-based medical services and limited service capability of community hospitals to provide.It was indicated by the questionnaire survey that:The 370 disabled people had an average age of(80.9±8.4)years,202(54.6%)of them suffered from severe or moder

关 键 词：老年人 失能 老年人保健服务 利用现状 混合研究 北京 

分 类 号：R197[医药卫生—卫生事业管理]