分级诊疗背景下上呼吸道感染儿童的就医行为及影响因素分析  

Healthcare-seeking Behavior and Influencing Factors of Children with Upper Respiratory Tract Infection in the Context of Hierarchical Medical System

作　　者：张利峰[1] 张凝凝 秦秀群[2] 杨翊 钟冬梅 刘劭菲 戴雨珅 王晓丹[1] 王明飞 ZHANG Lifeng;ZHANG Ningning;QIN Xiuqun;YANG Yi;ZHONG Dongmei;LIU Shaofei;DAI Yushen;WANG Xiaodan;WANG Mingfei(School of Nursing,Sun Yat-sen University,Guangzhou 510080,China;Department of Pediatrics,the Third Affiliated Hospital,Sun Yat-Sen University,Guangzhou 510630,China;Community Health Service Center,Shipai Street,Tianhe District,Guangzhou 510630,China;School of Public Health,Southern Medical University,Guangzhou 510515,China;Department of Hospital Administration,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学护理学院,广东省广州市510080 [2]中山大学附属第三医院儿科,广东省广州市510630 [3]天河区石牌街社区卫生服务中心,广东省广州市510630 [4]南方医科大学公共卫生学院,广东省广州市510515 [5]中山大学医院管理处,广东省广州市510080

出　　处：《中国全科医学》2023年第26期3269-3275,共7页Chinese General Practice

基　　金：教育部人文社会科学研究项目(21YJAZH117)。

摘　　要：背景推进分级诊疗是解决儿科医疗资源不合理利用的关键,但目前尚缺乏儿童分级诊疗执行现状的相关研究。目的总结上呼吸道感染儿童的就医行为,包括就诊次数和就诊机构,并探讨基层(社区卫生服务中心)首诊的主要影响因素。方法采用便利抽样法,于2019年3—7月、2022年2—7月分别在广州市中山大学附属第三医院儿科门诊及同一行政区的天河区石牌街社区卫生服务中心就诊的儿童家长进行2次问卷调查。按照调查时间将研究对象分为2019年组(n=419)和2022年组(n=307)。本研究以安德森模型为理论指导,自行设计上呼吸道感染儿童的就医行为及影响因素的调查问卷。采用单因素及多因素Logistic回归分析探讨上呼吸道感染儿童基层首诊的影响因素。结果2019年组的419例儿童,第1次(首诊)、第2次、第3/4次就诊者分别为301例(71.84%)、87例(20.76%)、31例(7.40%),首诊、第2次、第3/4次选择社区卫生服务中心就诊比例分别为47.49%、27.12%、16.13%;2022年组的307例儿童,第1次、第2次、第3次就诊者分别为219例(71.34%)、72例(23.45%)、16例(5.21%),首诊、第2次、第3/4次选择社区卫生服务中心就诊比例分别为41.04%、39.77%、43.75%。多因素Logistic回归分析结果显示,最近的医疗机构不是社区卫生服务中心[OR=0.220,95%CI(0.147,1.056),P<0.001]、父母文化程度为高中及以下[OR=0.584,95%CI(0.365,0.936),P=0.025]、家长评估疾病严重程度较轻、一般[OR(95%CI)=0.399(0.207,0.768)、0.388(0.226,0.665),P=0.006、0.001]、儿童年龄3岁以下相比7~13岁[OR=0.537,95%CI(0.309,0.930),P=0.027]时选择社区卫生服务中心首诊的可能性较低;家长对分级诊疗认知比较了解[OR=2.139,95%CI(1.284,3.564),P=0.003]及家长对分级诊疗态度比较赞同[OR=2.841,95%CI(1.937,5.779),P=0.004]时选择社区卫生服务中心首诊的可能性更高。结论儿童上呼吸道感染的多次就诊现象较普遍,基层就诊�Background Promoting hierarchical treatment is the key to solve the irrational utilization of pediatric medical resources,but there is a lack of relevant studies on the current status of implementation of hierarchical diagnosis and treatment for children.Objective To describe the healthcare-seeking behavior of children with upper respiratory tract infection,including number of visits and health-seeking institutions and explore the main influencing factors of first visit of priamry care(community health services).Methods Two questionnaires were administered to the parents of children attending the pediatric outpatient department of the Third Affiliated Hospital of Sun Yat-sen University and the Community Health Service Center in Shipai Street,Tianhe District in the same administrative district from March to July in 2019 and from February to July in 2022 using convenience sampling method,respectively.The included subjects were divided into the 2019 group(n=419)and 2022 group(n=307)according to the survey time.The questionnaire on the healthcare-seeking behavior and its influencing factors of children with upper respiratory tract infection using Anderson model as a theoretical guide was involved,univariate and multivariate Logistic regression analyses were used to explore the influencing factors of the first visit of children with upper respiratory tract infection in primary care.Results Among the 419 participated children in 2019,301(71.84%)visited for the first time,87(20.76%)for the second time and 31(7.40%)for the third time and fourth time,with 47.49%,27.12%and 16.13%visited the conmmunity health services centers,respectively.Among the 307 participated children in 2022,219(71.34%)visited for the first time,72(23.45%)for the second time and 16(5.21%)for the third time or fourth time,with 41.04%,39.77%and 43.75%visited the conmmunity health services centers,respectively.The results of multivariate Logistic regression analysis showed that the nearest medical institution was not a community health service center〔

关 键 词：上呼吸道感染 就医行为 分级诊疗 基层首诊 儿童 社区卫生中心 安德森模型 影响因素分析 

分 类 号：R725[医药卫生—儿科] R197[医药卫生—临床医学]