尘肺合并肺结核患者门诊服务利用及相关因素分析  

Outpatient health service utilization and its influencing factors among pneumoconiosis patients combined with tuberculosis

作　　者：罗凤萍 王焕强[1] 曹殿凤[2] 李涛[1] LUO Fengping;WANG Huanqiang;CAO Dianfeng;LI Tao(National Institute of Occupational Health and Poison Control,Chinese Center for Disease Control and Prevention,Beijing 100050,China;Department of Occupational Diseases,Zibo Prevention and Treatment Hospital for Occupational Diseases,Zibo,Shandong 255067,China)

机构地区：[1]中国疾病预防控制中心职业卫生与中毒控制所,北京100050 [2]山东省淄博市职业病防治院职业病科,山东淄博255067

出　　处：《环境与职业医学》2024年第2期139-145,共7页Journal of Environmental and Occupational Medicine

基　　金：国家重点研发项目(2021YFC2500700)。

摘　　要：[背景]肺结核是尘肺患者最常见的合并症,可使尘肺病病程进展加速。尘肺合并肺结核对患者的健康危害较大。[目的]了解尘肺合并肺结核患者门诊服务利用情况及其主要相关因素。[方法]2017年12月—2021年6月,采用分层随机抽样和非随机抽样相结合的方法,使用自制《尘肺病患者就医行为及其影响因素调查问卷》对全国27个省级行政区(不含上海市、天津市、海南省、西藏自治区、台湾省地区和港澳特别行政区)共11181名尘肺病患者进行调查,问卷内容包括尘肺病患者基本信息、尘肺病患者门诊以及住院服务利用情况、就医行为影响因素等,问卷有效回收率90.7%。本研究选取调查对象中所有尘肺合并肺结核患者(n=762)为研究对象,分析近两周门诊利用情况、门诊医疗机构选择、应就诊未就诊原因的城乡差异,以及门诊服务利用的影响因素。[结果]研究对象以矽肺合并肺结核(502名,占65.9%)和煤工尘肺合并肺结核(232名,占30.4%)为主,年龄(58.6±12.5)岁;调查地区主要分布在西部地区(45.1%),其次为东部地区(22.1%)、中部地区(20.2%)、东北地区(12.6%)。患者两周门诊利用率38.5%(293/762),主要就诊医疗机构为省市级医院(32.0%)、区县级医院(28.6%)、乡镇卫生院卫生服务中心(17.5%);离家近(20.7%)、有专科和(或)专家门诊(16.7%)、医疗水平高(14.8%)和医疗费用低(12.3%)为患者选择医疗机构考虑的主要原因。患者近两周出现症状加重前往门诊就医存在城乡差异,农村高于城镇(P<0.01)。应就诊未就诊原因除直接住院113例(41.4%)、自己买药46例(16.8%)外,还包括自感症状较轻(15.0%)、看病费用高且无法报销(9.5%)等。多因素分析结果显示,西部地区尘肺合并肺结核患者门诊率高于东部地区(OR=1.66,95%CI:1.03~2.68);相对于个人年收入>35500元的患者,个人年收入在10000~35500元的患者门诊率高(OR=2.54,95%CI:1.49~4.36);矽�[Background]Tuberculosis is the most common complication of pneumoconiosis,which accelerates the progression of pneumoconiosis.Pneumoconiosis combined with tuberculosis is a major health risk.[Objective]To understand the outpatient health service utilization for patients of pneumoconiosis combined with tuberculosis and its main influencing factors.[Methods]A stratified random sampling combined with non-random sampling was used to select 11181 pneumoconiosis patients in 27 provincial administrative regions(excluding Shanghai,Tianjin,Hainan,Tibet Autonomous Region,Taiwan,Hongkong and Macao Special Administrative Regions)from December 2017 to June 2021.A self-constructed questionnaire,i.e.Health Seeking Behaviors of Pneumoconiosis Patients and Their Influencing Factors,was used,which included basic information,outpatient and inpatient service utilization,and influencing factors of medical treatment behaviors of pneumoconiosis patients.The effective recovery rate of the questionnaire was 90.7%.All patients of pneumoconiosis combined with tuberculosis(n=762)were included as the study subjects.The difference of outpatient utilization in the past two weeks,choosing medical institutions,and the reasons of not seeking medical treatment between urban and rural areas,and the influencing factors of outpatient service utilization were analyzed.[Results]The study subjects were mainly silicosis combined with tuberculosis(502 cases,65.9%)and coal workers'pneumoconiosis combined with tuberculosis(232 cases,30.5%),aged(58.6±12.5)years old.The main region was Western China(45.1%),followed by Eastern China(22.1%),Centeral China(20.2%),and Northeastern China(12.6%).The outpatient utilization rate in the past two weeks was 38.5%(293/762),and the main medical institutions consulted were municipal or provincial hospitals(32.0%),district or county hospitals(28.6%),and township hospitals or health service centers(17.5%).Short distance(20.7%),the availability of specialist outpatient services(16.7%),high level of medical care(14.8%),and l

关 键 词：尘肺病 肺结核 门诊服务利用 就医行为 

分 类 号：R135[医药卫生—劳动卫生] R19[医药卫生—公共卫生与预防医学]