尘肺病患者门诊与住院服务利用情况及影响因素分析  

Analysis on the utilization and influencing factors of outpatient and inpatient services in patients with pneumoconiosis

作　　者：喻文鳌 魏宇豪 周家青 周丁子 伍东升 张勤 姜侠 廖加强 周敏 伏代刚 彭莉君 沈江 张本 王焕强[2] 吕向裴[2] 杜文 YU Wen-ao;WEI Yu-hao;ZHOU Jia-qing;ZHOU Ding-zi;WU Dong-sheng;ZHANG Qin;JIANG Xia;LIAO Jia-qiang;ZHOU Min;FU Dai-gang;PENG Li-jun;SHEN Jiang;ZHANG Ben;WANG Huan-qiang;LV Xiang-pei;DU Wen(West China Occupational Pneumoconiosis Cohort Working Group,West China School of Public Health,Sichuan University/West China Fourth Hospital,Chengdu,Sichuan 610041,China;不详)

机构地区：[1]四川大学华西公共卫生学院/华西第四医院,华西职业性尘肺病队列工作组,四川成都610041 [2]中国疾病预防控制中心职业卫生与中毒控制所

出　　处：《现代预防医学》2024年第7期1193-1198,共6页Modern Preventive Medicine

基　　金：国家自然科学基金区域创新发展联合基金项目(U22A20359);四川省科技厅自然科学基金项目(2023NSFSC1729,2023NSFSCO649)。

摘　　要：目的了解尘肺病患者门诊与住院服务利用情况及其影响因素。方法采取便利抽样方法,在四川大学华西第四医院选取共199名尘肺病患者,使用中国疾病预防控制中心编制的《尘肺病患者就医行为及其影响因素问卷》调查其人群特征、就医行为与影响因素。采用多因素logistic回归模型与多因素poisson回归模型分析患者门诊与住院服务利用的影响因素。结果调查的尘肺病患者两周门诊率为27.6%,一年利用门诊次数中位数为2次;一年住院率为61.8%,对已住院患者,一年住院次数中位数为1次,住院累积天数中位数为30 d;患者平均直观式健康标尺(VAS)得分为(48.3±17.4)分。多因素logistic回归与多因素poisson回归分析显示,已参加基础医保(OR=0.067,95%CI:0.006~0.716)、用药频率更高(OR=0.100,95%CI:0.037~0.269)、VAS得分更低(OR=0.992,95%CI:0.988~0.997)的尘肺病患者利用门诊服务更少,近期出现咳嗽加重(OR=5.530,95%CI:2.446~12.501)、有工伤保险(OR=1.183,95%CI:1.015~1.379)、收入较低(OR=0.980,95%CI:0.965~0.997)的尘肺病患者利用门诊服务更多;已婚(OR=0.063,95%CI:0.005~0.771)、VAS得分更低(OR=8.463,95%CI:3.090~23.248)的尘肺病患者利用住院服务更少;用药频率更高(OR=8.463,95%CI:3.090~23.248)、合并肺心病(OR=1.855,95%CI:1.307~2.634)、获得尘肺赔偿(OR=3.358,95%CI:1.183~9.529)、获得社会救济(OR=1.402,95%CI:1.047~1.877)、更主动与病友交流病情(OR=2.158,95%CI:1.061~4.390)的尘肺病患者利用住院服务更多。结论尘肺病患者门诊与住院利用率均高于全国平均水平。尘肺病患者自身健康状况、经济水平和社会支持水平是影响其就医行为的重要因素。Objective To investigate the utilization of outpatient and inpatient services in patients with pneumoconiosis and its influencing factors.Methods By using the convenient sampling method,199 pneumoconiosis patients were selected from the West China Fourth Hospital,and their population characteristics,medical treatment-seeking behavior,and influencing factors were investigated by using the questionnaire on pneumoconiosis patients and its influencing factors compiled by CDC of China.Multivariate logistic regression model and multivariate poisons regression model were used to analyze the influencing factors of outpatient and inpatient service utilization.Results The two-week outpatient rate of pneumoconiosis patients surveyed was 27.6%,the median number of outpatients used in one year was twice,and the annual hospitalization rate was 61.8%.For hospitalized patients,the median number of hospitalizations per year was 1,and the median cumulative hospitalization days was 30 days.The average visual health scale(VAS)score of patients was 48.3±17.4.Multivariate logistic regression and multivariate poisons regression analysis showed that pneumoconiosis patients with basic health insurance(OR=0.067,95%CI:0.006-0.716),higher frequency of medication(OR=0.100,95%CI:0.037-0.269),and lower VAS score(OR=0.992,95%CI:0.988-0.997)had less use of outpatient services.Pneumoconiosis patients with recent exacerbation of cough(OR=5.530,95%CI:2.446-12.501),work injury insurance(OR=1.183,95%CI:1.015-1.379),and lower income(OR=0.980,95%CI:0.965-0.997)had more use of outpatient services.Pneumoconiosis patients who were married(OR=0.063,95%CI:0.005-0.771)and had lower VAS scores(OR=8.463,95%CI:3.090-23.248)had less use of inpatient services.Pneumoconiosis patients with higher frequency of medication(OR=8.463,95%CI:3.090-23.248),complicated with core pulmonale(OR=1.855,95%CI:1.307-2.634),pneumoconiosis compensation(OR=3.358,95%CI:1.183-9.529),social relief(OR=1.402,95%CI:1.047-1.877)and more active communication with patients(OR=2.158,95%CI:1.0

关 键 词：尘肺病 就医行为 住院 门诊 社会支持 

分 类 号：R135.2[医药卫生—劳动卫生]