中老年慢性病患者卫生服务利用及影响因素研究
he Utilization and Influencing Factors of Health Services for Middle Aged and Elderly Chronic Disease Patients
背景 中老年人是慢性病高发人群，慢性病给中老年卫生服务带来挑战，探索中老年慢性病患者卫生服务利用的影响因素具有重要意义。目的 了解我国中老年慢性病患者卫生服务利用情况及其影响因素，为提高中老年慢性病患者的卫生服务利用水平提供依据。方法 选取中国健康与养老追踪调查（CHARLS）2020数据库中≥45岁且患有慢性病的样本5280例。以过去1个月的门诊服务利用情况、过去1年的住院服务利用情况为因变量；基于安德森卫生服务利用行为模型（以下简称Anderson模型）选取自变量，其中，倾向因素纳入人口学特征、社会结构特征及健康行为指标，使能因素纳入个人年收入、医疗保险、受新型冠状病毒感染（COVID-19）疫情影响导致推迟或取消医疗服务情况，需求因素纳入日常生活能力（ADL）、自评健康状况、生活满意度、患慢性病数量。采用多因素Logistic回归模型分析中老年慢性病患者卫生服务利用情况的影响因素。结果 5280例慢性病患者中，1487例（28.16%）患者过去1个月有门诊就诊行为，1393例（26.38%）患者过去1年有住院就诊行为。多因素Logistic回归分析结果显示，受COVID-19疫情影响导致推迟或取消医疗服务、ADL、自评健康状况、患慢性病数量是中老年慢性病患者门诊服务利用情况的影响因素（P<0.05），饮酒、医疗保险、受COVID-19疫情影响导致推迟或取消医疗服务、ADL、自评健康状况、患慢性病数量是中老年慢性病患者住院服务利用情况的影响因素（P<0.05）。结论 应加强对饮酒、无医疗保险、自评健康差、患慢性病数量多、ADL功能障碍的中老年慢性病患者的关注，注重该人群的医疗卫生服务需求，进一步提高其卫生服务利用水平。
Background Middle aged and elderly people are at high risk of chronic diseasesand chronic diseases pose challenges to healthcare services for them. Exploring the influencing factors of healthcare service utilization for middle aged and elderly patients with chronic diseases is of great significance. Objective Analyze the utilization of health services among middle-aged and elderly patients with chronic diseases and its influencing factorsproviding a basis for improving the level of health service utilization. Methods Selected 5 280 samples aged 45 with chronic diseases from the the China Health and Retirement Longitudinal StudyCHARLS 2020 database. Drawing on the Anderson Health Service Utilization Behavior Modelthe study variables include1propensity factorsincluding demographic characteristics such as agegenderplace of residencemarital statussmokingalcohol consumptionsocial structureand health behavior. 2Enabling factors include the ability to access healthcare servicessuch as economic living standardspersonal annual incomemedical insuranceand delayed or cancelled medical services due to the impact of the pandemic. This study ranks individual annual income in descending order and divides it into three equal parts on average. The first third is the low-income groupthe middle third is the middle-income groupand the last third is the high-income group. 3Demand factorsincluding activities for daily livingADL statusself-rated health statuslife satisfactionnumber of chronic diseasesand personal cognition and evaluation. Dependent variablehealth service utilizationoutpatient/inpatient service utilization. Using Logistic regression model to analyze the influencing factors of health service utilization among middle-aged and elderly patients with chronic diseases in China. Results Among 5 280 chronic disease patients1 48728.2% had outpatient visits in the past monthand 1 39326.4% had inpatient visits in the past year. The results of multiple logistic regression analysis showed that self-assessment of health statusdelayed or cancelled medical services due to the impact of the epidemicchronic disease incidenceand daily living activity ability were the influencing factors of outpatient service utilizationP<0.05. Alcohol consumptionmedical insuranceself-assessment of health statuspostponement or cancellation of medical services due to the impact of the epidemicchronic disease incidenceand daily living activity ability are the influencing factors of hospitalization service utilizationP<0.05.Conclusion Strengthen attention to middle-aged and elderly chronic disease patients who drink alcohollack medical insuranceself evaluate poor healthhave a large number of chronic diseasesand have ADL dysfunctionpay attention to the medical and health service needs of this populationand further improve the utilization level of health services.
唐玲、张国良、李振坤、司圣波、刘强、陈任、任佰玲
医药卫生
卫生服务利用中老年人慢性病影响因素分析安德森卫生服务利用行为模型
唐玲,张国良,李振坤,司圣波,刘强,陈任,任佰玲.中老年慢性病患者卫生服务利用及影响因素研究[EB/OL].(2024-11-26)[2024-12-12].https://chinaxiv.org/abs/202411.00264.点此复制
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