脑出血恢复期患者就诊医疗机构选择的影响因素分析  

Analysis of influencing factors of medical institution choice for convalescent patients with intracerebral hemorrhage

作　　者：郭媛[1] 张天清 陈爱迪 温娟 白三晋 袁江 龚柳盛 唐宇凤[6] 段丽娟[7] 樊朝凤[7] 曹华[7] GUO Yuan;ZHANG Tian-qing;CHEN Ai-di;WEN Juan;BAI San-jin;YUAN Jiang;GONG Liu-sheng;TANG Yu-feng;DUAN Li-juan;FAN Chao-feng;CAO Hua(Outpatient Department of West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China;不详)

机构地区：[1]四川大学华西医院门诊部,四川成都610041 [2]成都市芳草社区卫生服务中心 [3]眉山市心脑血管病医院 [4]泸州市叙永县人民医院 [5]简阳市人民医院 [6]绵阳市中心医院 [7]四川大学华西医院神经综合科,四川成都610041

出　　处：《现代预防医学》2023年第13期2436-2440,2446,共6页Modern Preventive Medicine

基　　金：四川省科技厅课题(2021JDKP0085)。

摘　　要：目的分析四川省脑出血恢复期患者选择医疗机构的影响因素,以期为我省医疗服务特别是基层医疗机构的进一步发展提供建议。方法本研究以2021年6月—2022年6月四川省医疗机构的脑出血恢复期患者为研究对象,以安德森行为模型为分析框架,分析我省脑出血恢复期患者选择就诊医疗机构的影响因素。结果本研究共纳入脑出血恢复期患者1826例,单因素分析显示仅35.0%的脑出血恢复期患者选择基层医疗机构就诊。多因素回归结果表明,影响脑出血恢复期患者选择基层医疗机构的影响因素是居住地在农村(OR=1.87,95%CI:1.02-3.43,P=0.010)、保险类型为新农合(OR=3.71,95%CI:1.96-7.05,P<0.001)、认为我国医疗系统主观评价好(OR=2.69,95%CI:1.58-4.60,P=0.006)、自我健康评价越好(P trend<0.001)。影响脑出血恢复期患者选择综合医疗机构的影响因素是患者年龄越大(Ptrend=0.018)和家庭年收入越高(P trend<0.001)。结论四川省脑出血恢复期大部分患者受年龄、居住地、保险类型等的影响选择综合医疗机构就诊,未来应进一步优化医疗资源配置,采取有效措施提高基层医疗机构技术及服务质量,加大对基层医疗机构的医保政策倾斜,构筑更合理的医疗服务体系。Objective To analyze the factors influencing the choice of medical institutions for convalescent patients with intracerebral hemorrhage in Sichuan Province,so as to provide suggestions for the further development of medical services,especially primary medical institutions in Sichuan Province.Methods The convalescent patients with cerebral hemorrhage in Sichuan Province from June 2021 to June 2022 were included in this study,and the Anderson behavior model was used as the analytical framework to analyze the factors affecting the choice of medical institutions for convalescent patients with cerebral hemorrhage.Results A total of 1826 convalescent patients with cerebral hemorrhage were included in this study.Univariate analysis showed that only 35.0%of the convalescent patients with cerebral hemorrhage chose primary medical institutions.The results of multivariate regression showed that the factors influencing the choice of primary medical institutions for convalescent patients with cerebral hemorrhage were residence in rural areas(OR=1.87,95%CI:1.02-3.43,P=0.010),the insurance type of New Rural Cooperation Insurance(OR=3.71,95%CI:1.96-7.05,P<0.001),positive subjective evaluation of Chinese medical system(OR=2.69,95%CI:1.58-4.60,P=0.006),and better self-rated health(Ptrend<0.001).The factors influencing the choice of comprehensive medical institutions for convalescent patients with intracerebral hemorrhage were older age(Ptrend=0.018)and higher annual family income(Ptrend<0.001).Conclusion Most of the patients with cerebral hemorrhage in Sichuan Province choose comprehensive medical institutions due to the influence of age,place of residence,and type of insurance.In the future,we should further optimize the allocation of medical resources,take effective measures to improve the quality of primary medical technology and services,increase the preference of medical insurance policies for primary medical institutions,and build a more reasonable medical service system.

关 键 词：脑出血 基层医疗 影响因素 横断面研究 

分 类 号：R197.1[医药卫生—卫生事业管理]