分级诊疗视角下糖尿病患者就诊机构选择及影响因素分析  

Choice of healthcare institution and influencing factors among patients with diabetes from the perspective of hierarchical medical system

作　　者：冯霞 张玉[1,2] 陈存川 吕玉玉[1,2] 王海鹏 FENG Xia;ZHANG Yu;CHEN Cunchuan;LYU Yuyu;WANG Haipeng(Center for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine,Shandong University,Jinan,Shandong 250012,China;NHC Key Lab of Health Economics and Policy Research(Shandong University),Jinan,Shandong 250012,China)

机构地区：[1]山东大学齐鲁医学院公共卫生学院卫生管理与政策研究中心,山东济南250012 [2]国家卫生健康委员会卫生经济与政策研究重点实验室(山东大学),山东济南250012

出　　处：《中国农村卫生事业管理》2024年第1期38-43,共6页Chinese Rural Health Service Administration

基　　金：山东省自然科学基金项目(ZR2016GQ02);国家重点研发计划项目(2020YFC2006505)。

摘　　要：目的 分析糖尿病患者的就诊机构选择及其影响因素,为完善糖尿病管理和分级诊疗相关政策提供参考依据。方法 采用分层随机抽样的方法,在山东省东、中、西部地区选择900名纳入基本公共卫生服务管理的糖尿病患者开展问卷调查,有效问卷共876份,对数据进行描述性分析、卡方检验和多因素logistic回归分析。结果 过去半年糖尿病患者到基层医疗机构就诊的占比为65.2%,未绕过基层到非基层医疗机构就诊的占比为6.5%,绕过基层直接到非基层医疗机构就诊的占比为7.9%。影响患者到基层就诊的主要因素为地区(OR=1.53,P=0.03)、(OR=2.80,P<0.01),城市(OR=0.68,P=0.03);影响患者未绕过基层就诊的主要因素为婚姻状况(OR=0.40,P=0.02),地区(OR=0.27,P<0.01)、(OR=0.46,P=0.02),城市(OR=2.39,P=0.02);影响患者绕过基层就诊的主要因素为性别(OR=O.49,P=0.02)、医疗保险(OR=0.44,P=0.02)、并发症(OR=4.06,P<0.01)、其他慢性病(OR=2.15,P=0.04)。结论 糖尿病患者就诊机构选择仍然存在改善空间,急需采取提升基层卫生服务能力、完善医保支付等措施来引导患者合理选择就诊机构。Objective To analyze the choice of healthcare institution and influencing factors among pa-tients with diabetes,and to provide reference for improving diabetes management and policies for hierarchical med-ical system.Methods Using stratified random sampling method,900 diabetic patients enrolled in basic public health service management in eastern,central and western Shandong province were selected for a questionnaire survey,with a total of 876 valid questionnaires.Descriptive analysis,Chi-square test and multivariate Logistic re-gression analysis were performed on the data.Results In the past six months,65.2%of diabetic patients went to primary care institutions for treatment,6.5%went to non-primary care institutions after visiting primary care insti-tutions,and 7.9%went to non-primary care institutions without visiting primary care institutions.Region(OR=1.53,P=0.03),(OR=2.80,P<0.01),city(OR=0.68,P=0.03)were the main factors influencing patients'visiting primary care institutions.The main factors that affect patients'decision to still visit primary care institutions were marital status(OR=0.40,P=0.02),region(OR=0.27,P<0.01),(OR=0.46,P=0.02),city(OR=2.39,P=0.02).The main factors that affect patients'decision not to visit primary care institutions were gender(OR=0.49,P=0.02),medical insurance(OR=0.44,P=0.02),complications(OR=4.06,P<0.01)and other chronic diseases(0R=2.15,P=0.04).Conclusions There is still room to improve in the choice of healthcare institutions for patients with diabetes,and it is urgent to take measures such as improving basic health service capacity and medical insurance payment to guide patients to choose healthcare institutions rationally.

关 键 词：分级诊疗 糖尿病患者 就诊机构选择 影响因素 基层就诊 山东 

分 类 号：R197[医药卫生—卫生事业管理]