养老机构五保老人就医利用状况及影响因素分析
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摘要
目的调查养老机构五保老人的就医利用状况及影响因素,为改善医疗服务利用不足的现状提供参考。方法采用分层随机抽样法,抽取山东省某地级市≥60岁的五保老人331例,应用Barthel指数评定量表及自行设计的问卷进行调查。对拿药、住院地点选择、住院次数作单因素分析,对患病未就诊原因作描述性分析及二分类Logistic回归分析。结果年龄、文化程度、入住时间、健康自评、经济自评对五保老人住院地点选择差异有统计学意义(P<0.05)。性别、婚姻状况不同,其拿药地点选择差异有统计学意义(P<0.05)。不同性别、年龄、日常生活能力、健康自评的老人过去1年住院次数的差异有统计学意义(P<0.05)。自我感觉没有大问题和经济困难是患病未就诊的关键因素。自理状况、健康自评、经济自评好的老人会因"自我感觉没有大问题"不去就诊。结论五保老人就医主动性有待提高。应落实五保政策,强化与医疗救助的制度衔接;同时提升基层诊疗水平,强化健康宣教,提高五保老人健康管理意识,进而改善卫生服务利用。
Objective To survey the medical treatment of elderly five guarantees in pension institutions and its influence factors and to provide reference for improving the inadequate utilization of medical services. Methods With a self-designed questionnaire and the Barthel index of ADL, 331 elderly people aged 60 or above from a prefecture level city in Shandong Province were selected by stratified random sampling method. Single factor analysis was carried out for where to purchase the medication, hospital selection, and the number of hospitalization and descriptive analysis and binary logistic regression analysis for the reason of non-seeking medical service. Results Age, education background, the stay length in pension institutions, self assessment of health and economic status were the influence factors of the choice of hospital location(P<0.05) and gender and marital status exerted influence on where to purchase the medication(P<0.05). Different gender, age, daily living skills, self-assessed health status were influence factors of the frequency of hospitalization in the past year(P<0.05) and feeling well and economic difficulties were key factors affecting seeking health service. Conclusion It is necessary to strengthen the implementation of the Five Guarantees supporting system and to strengthen the cohesion between the system and medical assistance. Meanwhile, the improvement of medical service in basic hospitals, the promotion of health education and the improvement of health management awareness of the elderly are critical for the improvement of the utilization of health services.
Objective To survey the medical treatment of elderly five guarantees in pension institutions and its influence factors and to provide reference for improving the inadequate utilization of medical services. Methods With a self-designed questionnaire and the Barthel index of ADL, 331 elderly people aged 60 or above from a prefecture level city in Shandong Province were selected by stratified random sampling method. Single factor analysis was carried out for where to purchase the medication, hospital selection, and the number of hospitalization and descriptive analysis and binary logistic regression analysis for the reason of non-seeking medical service. Results Age, education background, the stay length in pension institutions, self assessment of health and economic status were the influence factors of the choice of hospital location(P<0.05) and gender and marital status exerted influence on where to purchase the medication(P<0.05). Different gender, age, daily living skills, self-assessed health status were influence factors of the frequency of hospitalization in the past year(P<0.05) and feeling well and economic difficulties were key factors affecting seeking health service. Conclusion It is necessary to strengthen the implementation of the Five Guarantees supporting system and to strengthen the cohesion between the system and medical assistance. Meanwhile, the improvement of medical service in basic hospitals, the promotion of health education and the improvement of health management awareness of the elderly are critical for the improvement of the utilization of health services.
引文
[1]潘丹.中国农村居民医疗服务利用影响因素分析[J].农业技术经济,2010(7):41-46.DOI:10.13246/j.cnki.jae.2010.07.012.
[2]翟景花,杨海霞,宋爱芹,等.空巢老人卫生服务需求与利用及其影响因素的研究[J].中国卫生事业管理,2015,32(4):306-309.
[3]平卫伟,翟艳丽,原建慧,等.老年人卫生服务需求与利用的现况调查及影响因素[J].中国老年学,2015(11):3093-3094.
[4]Mahoney F I,Barthel D W.Functional Evaluation:The Barthel Index[J].Md State Med J,1965(14):61-65.
[5]孟祥麒.长春市老年人就医行为及其影响因素研究[D].长春:吉林大学,2013.
[6]Boeckxstaens P,De G P.Primary Care and Care for Older Persons:Position Paper of the European Forum for Primary Care[J].Qual Prim Care,2012,19(6):369-389.
[7]苏吉儿,夏雅雄,方仕婷,等.养老机构护理员岗位胜任现状及影响因素分析[J].护理学报,2016,23(17):51-53.DOI:10.16460/j.issn1008-9969.2016.17.051.
[8]游毅.我国九省老年人就医行为的变化趋势及影响因素研究[D].北京:北京中医药大学,2015.
[9]李明,杨坤,董志新.卫生服务需要、需求与利用研究——以四川省为例[J].经济体制改革,2016(2):41-46.
[10]Sun X,Sleigh A C,Carmichael G A,et al.Health Payment-induced Poverty under China’s New Cooperative Medical Scheme in Rural Shandong[J].Health Policy Plan,2010,25(5):419-426.DOI:10.1093/heapol/czq010.
[11]孔令磷,胡瑶,赵梦遐,等.咸宁市城市养老机构护理员培训现状及需求调查[J].护理学报,2016,23(1):42-45.DOI:10.16460/j.issn1008-9969.2016.01.042.
[2]翟景花,杨海霞,宋爱芹,等.空巢老人卫生服务需求与利用及其影响因素的研究[J].中国卫生事业管理,2015,32(4):306-309.
[3]平卫伟,翟艳丽,原建慧,等.老年人卫生服务需求与利用的现况调查及影响因素[J].中国老年学,2015(11):3093-3094.
[4]Mahoney F I,Barthel D W.Functional Evaluation:The Barthel Index[J].Md State Med J,1965(14):61-65.
[5]孟祥麒.长春市老年人就医行为及其影响因素研究[D].长春:吉林大学,2013.
[6]Boeckxstaens P,De G P.Primary Care and Care for Older Persons:Position Paper of the European Forum for Primary Care[J].Qual Prim Care,2012,19(6):369-389.
[7]苏吉儿,夏雅雄,方仕婷,等.养老机构护理员岗位胜任现状及影响因素分析[J].护理学报,2016,23(17):51-53.DOI:10.16460/j.issn1008-9969.2016.17.051.
[8]游毅.我国九省老年人就医行为的变化趋势及影响因素研究[D].北京:北京中医药大学,2015.
[9]李明,杨坤,董志新.卫生服务需要、需求与利用研究——以四川省为例[J].经济体制改革,2016(2):41-46.
[10]Sun X,Sleigh A C,Carmichael G A,et al.Health Payment-induced Poverty under China’s New Cooperative Medical Scheme in Rural Shandong[J].Health Policy Plan,2010,25(5):419-426.DOI:10.1093/heapol/czq010.
[11]孔令磷,胡瑶,赵梦遐,等.咸宁市城市养老机构护理员培训现状及需求调查[J].护理学报,2016,23(1):42-45.DOI:10.16460/j.issn1008-9969.2016.01.042.