北京市医保高血压患者门诊就医选择及其影响因素分析  

Analysis of outpatient choice and its influencing factors of hypertensive patients with medical insurance in Beijing

作　　者：海鹏程 玄律 郑杰[2] 何永洁 王晨 Hai Pengcheng;Xuan Lv;Zheng Jie;He Yongjie;Wang Chen(School of General Practice and Continuing Education,Capital Medical University,Beijing 100069,China;Medical Insurance Center of Beijing Healthcare Security Bureau,Beijing 100161,China;Beijing Community Health Service Association,Beijing 100054,China)

机构地区：[1]首都医科大学全科医学与继续教育学院,北京100069 [2]北京市医疗保险事务管理中心,北京100161 [3]北京市社区卫生协会,北京100054

出　　处：《中华医院管理杂志》2022年第2期115-120,共6页Chinese Journal of Hospital Administration

摘　　要：目的分析北京市医保高血压患者门诊就医机构选择现状及其影响因素,为推动高血压慢性病的分级诊疗、引导患者基层就诊提供依据。方法提取2019年4月至2020年1月北京市基本医疗保险数据库中所有门诊高血压患者就医数据,分析患者的主要人口学特征、患者门诊就医机构的选择及其影响因素。组间比较采用χ2检验,影响因素采用多因素logistic回归分析。结果共纳入高血压患者284.21万例,其中39.03%仅在基层医疗机构门诊就医,5.16%仅在二级医疗机构门诊就医,17.34%仅在三级医疗机构门诊就医,其余38.47%在两种及以上类别的医疗机构门诊就医。影响北京市医保高血压患者门诊就医选择的因素包括性别、年龄、医保类型、居住地、中草药使用、中成药使用、多重用药、门诊化验检查需求。结论目前北京市医保高血压患者基层就诊格局已初步形成,但影响患者门诊就医机构选择的因素较多。未来应进一步优化医疗资源配置,推动医保支付方式改革,加强基层医疗机构建设,拓展家庭医生签约覆盖面,引导患者基层就诊。Objective To investigate the current status and influencing factors of outpatient institution choice for hypertensive patients with basic medical insurance in Beijing,for reference to promote the implementation of the hierarchical medical system and guiding hypertensive patients to seek healthcare in primary care.Methods Based on data of hypertensive outpatients from the basic medical insurance database of Beijing from April 2019 to January 2020,we analyzed major demographic characteristics of hypertensive patients,the selection of outpatient institutions and its influencing factors.The chi square test was used for comparison between groups,and the multivariate logistic regression model was used to analyze influencing factors.Results 2.8421 million outpatients with hypertension were enrolled.39.03%of them chose primary healthcare institutions,5.16%chose secondary healthcare institutions,and 17.34%chose tertiary healthcare institutions,while the rest 38.47%chose two or more types of healthcare institutions.Gender,age,type of medical insurance,place of residence,utilization of Chinese herbal drugs,utilization of Chinese patent drugs,polypharmacy,needs of outpatient tests and examinations were the influencing factors for their selection of primary healthcare institutions for hypertensive outpatients under Beijing basic medical insurance.Conclusions At present,the primary institutions have become the first choice for the majority of hypertensive patients with medical insurance in Beijing,but there are still many influencing factors on their choice of institutions.In the future,we should optimize the allocation of medical resources,promote the reform of medical insurance payment methods,strengthen the construction of primary medical institutions,expand the coverage of contracted services of family doctors,and reasonably guide the patients to seek healthcare in primary healthcare institutions.

关 键 词：高血压 患者 医疗保险 门诊就医选择 影响因素 

分 类 号：R197.3[医药卫生—卫生事业管理]