基于安德森模型的农村居民基层就医行为研究  

Analysis on rural residents’health seeking behavior of primary health care institutions based on Anderson model

作　　者：周林星 杨威怡 蒋梓轩 胡蕊 龙宇 郭新雨 赵莉 ZHOU Lin-xing;YANG Wei-yi;JIANG Zi-xuan;HU Rui;LONG Yu;GUO Xin-yu;ZHAO Li(West China School of Public Health/West China Fourth Hospital,Sichuan University,Chengdu,Sichuan 610041,China)

机构地区：[1]四川大学华西公共卫生学院/华西第四医院,四川成都610041

出　　处：《现代预防医学》2023年第9期1630-1636,共7页Modern Preventive Medicine

基　　金：四川省卫生健康委员会项目(2016WJW)四川省地方性法规《四川省医疗机构管理条例》修订研究。

摘　　要：目的了解农村居民基层就医行为现状及其影响因素,为引导农村居民合理就医、促进分级诊疗提供研究证据。方法基于Anderson模型在四川省采用分层整群抽样方法抽取3个县(区)农村居民进行入户调查,有效样本共5299人,采用单因素分析、多因素logistic回归和多重中介模型对农村居民基层就医行为及影响因素进行分析。结果72.8%的农村居民患病时选择基层医疗机构就诊,对基层医疗服务机构整体满意度大于90%,花费满意度为83.3%,担心误诊为18.5%。年龄较大者(OR45~59=1.249,95%CI:1.033~1.510;OR_(≥60)=1.892,95%CI:1.552~2.305)、家庭月收入较高者(OR_(4000~9999)=1.409,95%CI:1.076~1.845;OR_(≥10000)=2.478,95%CI:1.520~4.041)、城乡医疗保险者(OR=2.152,95%CI:1.492~3.103)、到最近医疗点所需时间≤15 min者(OR=1.814,95%CI:1.595~2.063)、多病种患病者(OR=1.711,95%CI:1.393~2.101)、未患病者(OR=1.983,95%CI:1.719~2.288)、一年内未参与体检者(OR=2.097,95%CI:1.817~2.419)倾向于基层就医;未接受过健康教育讲座者(OR=0.666,95%CI:0.575~0.770)、体力活动足够者(OR=0.807,95%CI:0.710~0.919)基层医疗机构就诊率较低。结论农村居民就医以基层医疗机构为主但对其信任度不高,促进资源是农村居民基层就医行为的主要影响层面,应以此为突破口,进一步推进分级诊疗。Objective To investigate the current status of rural residents’health seeking behavior of primary health care(PHC)institutions and explore the related influencing factors,so as to provide research evidence for guiding rural residents to reasonably seek medical treatment and promoting first-visit at PHC institution.Methods A total of 5299 rural residents were selected by stratified cluster random sampling method from three counties in Sichuan Province based on Anderson model and surveyed by household interviews.We used univariate analysis,multivariate logistic regression,and multiple mediation model to analyze the health seeking behavior and influencing factors of rural residents.Results In total 72.8%of rural residents chose PHC institutions for treatment when they were ill.The overall satisfaction with PHC institutions was more than 90%and 83.3%with the cost,but 18.5%of them were concerned about misdiagnosis.The rural residents with older age(OR45-59=1.249,95%CI:1.033-1.510;OR_(≥60)=1.892,95%CI:1.552-2.305),higher household economic status(OR_(4000-9999)=1.409,95%CI:1.076-1.845;OR_(≥10000)=2.478,95%CI:1.520-4.041),urban and rural medical insurance(OR=2.152,95%CI:1.492-3.103),no more than 15 minutes to reach the nearest medical institution(OR=1.814,95%CI:1.595-2.063),multiple diseases(OR=1.711,95%CI:1.393-2.101),and without any disease(OR=1.983,95%CI:1.719-2.288)or physical examination in the past year(OR=2.097,95%CI:1.817-2.419)were more likely to seek medical treatment at PHC institutions.However,those who never attended health education lectures(OR=0.666,95%CI:0.575-0.770),and having sufficient physical activity(OR=0.807,95%CI:0.710-0.919)had a lower rate of visiting PHC institutions.Conclusion Rural residents seek medical treatment mainly at primary medical institutions,but the trust degree is not high.Resource promotion is the main influencing factor of rural residents’behavior of seeking medical treatment at the grass-roots level,which should be taken as a breakthrough to further promote graded diag

关 键 词：ANDERSON模型 农村居民 基层就医 分级诊疗 

分 类 号：R197.1[医药卫生—卫生事业管理]