政策因素对精神分裂症患者就医行为的影响研究

Background In Chinaschizophrenia patients have a high demand for basic medical carebut irrational healthcare-seeking behaviors among them may cause a waste of health resources. So relevant policies have been promulgated to improve the ensuring of healthcare and reasonably guide schizophrenia patients to seek medical care. The current research?on policy factors and healthcare-seeking behaviors has rarely addressed the association between mental health policies and healthcare-seeking behaviors of patients with schizophrenia. Objective To analyze the influence of policy factors on healthcareseeking behaviors in schizophrenia patientsto understand the status and outcome of health service utilization in this group under the guidance of basic medical insurance policies and mental health policiesproviding empirical evidence for policy improvement. Methods In November 2019we obtained a sample of 2 314 schizophrenic individuals with valid key data by matching the personal data in the three-level psychiatric prevention and treatment network system in a district of Chongqing in 2018with information related to personal health service utilization in the district obtained from the medical insurance information platform of Chongqing Human Resources and Social Security Bureau. Multivariate Logistic regression analysis was conducted with healthcareseeking behaviors and the medical institution chosen for treatment as explained variablesparticipation in basic medical insuranceincluding basic medical insurance for rural and urban non-working residents or basic medical insurance for urban employeesand reimbursement for medical cost due to special outpatient diseases and mental health policy coverageinvolving community rehabilitation servicesguardianship subsidysubsidy from the local disability federationsubsidy from the 686 programand free second-generation antipsychoticsand the mental disability certificate as key explanatory variablesand patients'demographic characteristics as control variables. Results Of the participants1 91582.76% had medical visitsincluding 1 482 seeking outpatient treatmentand 795 seeking inpatient treatment. Among those seeking outpatient treatmentthe prevalence of choosing primarysecondary and tertiary care institutions was 17.01%252/1 48272.87%1 080/1 482and 10.12%150/1 482respectively. And the prevalence of choosing primarysecondary and tertiary care institutions for inpatient treatment was 4.78%38/79565.16%518/795and 30.06%239/795respectively. Logistic regression analysis showed that the type of basic medical insurancereimbursement for medical cost due to special outpatient diseasesreceiving community rehabilitation servicesenrolment in the 686 program and involvement in the free second-generation antipsychotics program were factors associated with healthcare-seeking behaviorsP<0.05. The type of basic medical insurancereimbursement for medical cost due to special outpatient diseasesreceiving community rehabilitation servicesenrolment in the free second-generation antipsychotics programand the level of mental disability were factors associated with choosing outpatient settings for treatmentP<0.05. The type of basic medical insurance and the level of mental disability were associated with choosing inpatient settings for treatmentP<0.05. Conclusion Policy factors played a positive role in guiding schizophrenia patients to seek medical treatmentbut some problems were also revealedsuch as low patient participation and insufficient coverage pathways. In view of thisefforts should be made as soon as possible to optimize mental health policies and the social support and assistance systemincrease patient participation of relevant programs via strengthening the publicity of relevant policiesactively guide home-based rehabilitation activitiesfurther promote community-based delivery of mental health servicesand continuously improve the mental health security system.