北京市社区居民持续频繁就诊现状分析  

Current Status of Continuous and Frequent Visits of Community Residents in Beijing

作　　者：季燕[1] 巫继东[1] 冯爱 薛庆韵 丁静[1] JI Yan;WU Jidong;FENG Ai;XUE Qingyun;DING Jing(Yuetan Community Health Service Center,Fuxing Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]首都医科大学附属复兴医院月坛社区卫生服务中心,北京市100045

出　　处：《中国全科医学》2023年第1期91-96,共6页Chinese General Practice

基　　金：北京市西城区卫生健康委员会青年科技人才(科技新星)培养项目(XWKX2020-17);首都全科医学研究专项(21QK20)。

摘　　要：背景 随着我国全科医学的发展,社区卫生服务机构就诊次数增多,存在间断和持续频繁就诊现象,而部分属于异常频繁就诊,造成社区医疗资源的不合理利用。目的 了解北京市社区居民间断和持续频繁就诊现状,并分析持续频繁就诊人群特征、发现频繁就诊原因。方法 回顾性选取2017年1月至2019年12月在北京市三里河二区社区卫生服务站就诊的居民为研究对象,以年度(1—12月)就诊量排在前10%的居民为频繁就诊者,以3年内每年就诊次数均在前10%者为持续频繁就诊者,以仅有1年或2年就诊次数在前10%者为间断频繁就诊者。对患者的就诊情况、基本资料和疾病情况进行分析,并采用访谈法对间断和持续频繁就诊者各5例进行“面对面”访谈,以获知其频繁就诊原因。结果 本研究共纳入频繁就诊者639例,分为持续频繁就诊组(92例)、间断频繁就诊组(547例)。两组间性别、年龄、婚姻状况、学历、超重/肥胖者占比、已签约家庭医生者占比比较,差异无统计学意义(P>0.05)。两组频繁就诊者的慢性病患病率排在前5位的均为高血压、2型糖尿病、血脂异常、冠心病、脑卒中;两组间高血压、2型糖尿病、血脂异常、冠心病、脑卒中患病情况及疾病复杂程度比较,差异无统计学意义(P>0.05)。进一步访谈可知,居民选择到社区就诊的前3位原因包括地理优势明显且候诊时间短(n=9),医患关系良好且基本满足日常医疗需求(n=7),报销比例高于专科医院(n=6);间断频繁就诊的前3位原因包括遵医行为改善(规范用药行为、就诊习惯改变)后疾病控制平稳从而就诊次数减少(n=2),急性病症发作或慢性病病情变化导致就诊次数一过性增多(n=2),阶段性受“情绪”困扰而反复就诊(n=1);持续频繁就诊的前3位原因包括因单盒药物的可服用次数与疾病周期服药次数不匹配而每月多次就诊取药(n=3),倾向于原研�Background With the development of general medicine in China,the number of visits to community medical institutions has increased,and the phenomenon of intermittent and continuous frequent visits exists,while some of these visits are abnormally frequent,resulting in the irrational use of community medical resources.Objective To understand the current situation of intermittent and continuous frequent visits among community residents in Beijing,and to analyze the characteristics of people with continuous frequent visits and discover the causes of frequent visits.Methods Residents who visited the community health service stations in Sanlihe District 2,Beijing from January 2017 to December 2019 were retrospectively selected as the study subjects,and those who visited the top 10% of the community health service stations in a year(from January to December)were considered frequent patients,those who visited the top 10% of the community health service stations in each of the three years were considered continuously frequent visited patients,and those who visited the top 10% of the community health service stations in only one or two years were considered intermittent frequent patients.Patients’ visits,basic information and illnesses were analyzed,and "face-to-face" interviews were conducted with five patients each from intermittent and frequent visitors to find out the reasons for their frequent visits.Results A total of 639 frequent patients were included in the study,divided into a continuous frequent group(92 patients) and an intermittent frequent group(547 patients).There were no statistically significant differences between the two groups in terms of gender,age,marital status,education,proportion of overweight/obesity people,and proportion of people who have signed up with a family doctor(P>0.05).The top 5 chronic diseases in both groups were hypertension,type 2 diabetes,dyslipidaemia,coronary heart disease and stroke;there was no statistically significant difference between the two groups in terms of hypertension

关 键 词：社区卫生服务 卫生服务 门诊 门诊病人 频繁就诊 全科医学 医疗资源 

分 类 号：R197[医药卫生—卫生事业管理] R-05[医药卫生—公共卫生与预防医学]