基于Andersen行为模型的社区老年人医养结合养老需求分析
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摘要
背景我国医养结合发展中屡遇瓶颈,仍有诸多问题亟待解决。而老年人多阶段、多层次、多元化的医养结合养老需求是影响机构发展及其服务实现的"源头性"问题,精准把握并分析其需求现状,是健康合理发展医养结合、改善供需错位状况、实现资源优化配置的有力保障。目的调查泸州市社区老年人对医养结合的认知及需求情况,并分析其影响因素,为发展医养结合养老模式提供依据。方法 2018年2—5月采用便利抽样法选取泸州市符合纳入标准的社区老年人650例,采用一般资料调查表、医养结合相关情况调查表、衰弱综合评估量表、抑郁自评量表、社会支持评定量表进行调查;以Andersen行为模型为基础,将调查内容中关于社区老年人医养结合养老需求的影响因素分别纳入倾向性因素、使能因素和需求性因素,构建3个Logistic回归模型进行分析,采用Hosmer-Lemeshow检验模型预测概率及拟合优度,采用二元Logistic回归分析社区老年人医养结合养老需求的影响因素。结果共发放问卷650份,回收有效问卷627份,有效回收率为96.5%。627例老年人中,340例(54.2%)对医养结合有所了解,416例(66.3%)表示有医养结合养老需求。模型Ⅱ和模型Ⅲ的-2对数似然值(-2LL)均小于模型Ⅰ,Cox&Snell R~2、Nagelkerke R~2均大于模型Ⅰ;模型Ⅲ的-2LL小于模型Ⅱ,Cox&Snell R~2、Nagelkerke R~2均大于模型Ⅱ,表明模型Ⅲ对样本的拟合程度最好。二元Logistic回归分析结果显示,年龄[OR=1.692,95%CI(1.118,2.560)]、子女数[OR=0.571,95%CI(0.407,0.800)]、就医方便度[OR=2.931,95%CI(2.117,4.058)]、社会支持度[OR=0.455,95%CI(0.326,0.635)]、慢性病患病情况[OR=1.999,95%CI(1.343,2.975)]、医养结合认知水平[OR=1.719,95%CI(1.222,2.418)]、衰弱程度[OR=2.495,95%CI(1.666,3.736)]、抑郁程度[OR=1.914,95%CI(1.296,2.827)]是社区老年人医养结合养老需求的影响因素(P<0.05)。结论泸州市社区老年人医养结合知晓、需求水平较高,医养结合养老需求受多种因素的影响,建议政府、企业及后续研究者在今后的调查研究过程中对不同影响因素加以分类分析。医养结合养老服务仍需先行试点,逐步开展。
Background The development of integrated medical and nursing care in China frequently encounters bottlenecks,and numerous problems need to be urgently solved. Typically,the demand of a multi-stage,multi-layered and diversified medical and nursing care for the elderly is the source issue that affects institutional development and service implementation. Therefore,targeting and analyzing the demand can guarantee that integrated medical and nursing care will develop healthily,improve supply-demand balance,and optimize the allocation of resources.Objective To investigate the awareness,demand and influencing factors of integrated medical and nursing care among community-dwelling elderly in Luzhou City,so as to provide evidence for the development of delivery modes of this kind of care.Methods From February to May 2018,a cross-sectional survey was conducted in Luzhou City among a convenience sample of 650 community-dwelling elderly individuals who were eligible for the study.The Self-developed General Demographic Questionnaire and Integrated Medical and Nursing Care Questionnaire,Chinese version of the Comprehensive Frailty Assessment Instrument(CFAI),Chinese version of the Zung Self-Rating Depression Scale(SDS),and Social Support Rating Scale(SSRS) were adopted for the survey.Based on the framework of Andersen's behavioral model,3 Logistic regression models(named as model Ⅰ,model Ⅱ,model Ⅲ) incorporated with predisposing,enabling and need factors(obtained from the survey results),respectively,were established and their estimated probability and goodness of fit were assessed by Hosmer-Lemeshow test.Binary Logistic regression analysis was performed to investigate the influencing factors of community-dwelling elderly' needs for integrated medical and nursing care.Results A total of 650 sets of questionnaires were distributed,and 627 responsive ones were collected,with a response rate of 96.5%.Among the 627 respondents,340(54.2%) were aware of the integrated medical and nursing care,and 416(66.3%) demanded for this kind of care.Compared with model Ⅰ,the-2 log likelihood(-2 LL) values in models Ⅱ and Ⅲ were smaller,while Cox & Snell R~2 and Nagelkerke R~2 were greater.Moreover,the-2 LL of model Ⅲ was smaller,while Cox &Snell R~2 and Nagelkerke R~2 were greater compared with model Ⅱ,suggesting that model Ⅲ displayed the best goodness of fit to the sample.Additionally,binary Logistic regression analysis indicated that,age[OR=1.692,95%CI(1.118,2.560)],number of children [OR=0.571,95%CI(0.407,0.800)],convenience of seeking healthcare[OR=2.931,95%CI(2.117,4.058)],social support degree [OR=0.455,95%CI(0.326,0.635)],chronic disease prevalence [OR=1.999,95%CI(1.343,2.975)],awareness level of integrated medical and nursing care [OR=1.719,95%CI(1.222,2.418)],frailty degree [OR=2.495,95%CI(1.666,3.736)],and depression degree [OR=1.914,95%CI(1.296,2.827)] were the influencing factors of demand for integrated medical and nursing care among the community-dwelling elderly(P<0.05). Conclusion Both the levels of awareness and needs of integrated medical and nursing care among the community-dwelling elderly people in Luzhou are relatively high.As the needs of such care are affected by multiple factors,it is recommended that the government,enterprises and subsequent researchers carry out classification analysis of these factors during the investigation.In addition,the delivery of integrated medical and nursing care should be gradually developed after pilot implementation.
Background The development of integrated medical and nursing care in China frequently encounters bottlenecks,and numerous problems need to be urgently solved. Typically,the demand of a multi-stage,multi-layered and diversified medical and nursing care for the elderly is the source issue that affects institutional development and service implementation. Therefore,targeting and analyzing the demand can guarantee that integrated medical and nursing care will develop healthily,improve supply-demand balance,and optimize the allocation of resources.Objective To investigate the awareness,demand and influencing factors of integrated medical and nursing care among community-dwelling elderly in Luzhou City,so as to provide evidence for the development of delivery modes of this kind of care.Methods From February to May 2018,a cross-sectional survey was conducted in Luzhou City among a convenience sample of 650 community-dwelling elderly individuals who were eligible for the study.The Self-developed General Demographic Questionnaire and Integrated Medical and Nursing Care Questionnaire,Chinese version of the Comprehensive Frailty Assessment Instrument(CFAI),Chinese version of the Zung Self-Rating Depression Scale(SDS),and Social Support Rating Scale(SSRS) were adopted for the survey.Based on the framework of Andersen's behavioral model,3 Logistic regression models(named as model Ⅰ,model Ⅱ,model Ⅲ) incorporated with predisposing,enabling and need factors(obtained from the survey results),respectively,were established and their estimated probability and goodness of fit were assessed by Hosmer-Lemeshow test.Binary Logistic regression analysis was performed to investigate the influencing factors of community-dwelling elderly' needs for integrated medical and nursing care.Results A total of 650 sets of questionnaires were distributed,and 627 responsive ones were collected,with a response rate of 96.5%.Among the 627 respondents,340(54.2%) were aware of the integrated medical and nursing care,and 416(66.3%) demanded for this kind of care.Compared with model Ⅰ,the-2 log likelihood(-2 LL) values in models Ⅱ and Ⅲ were smaller,while Cox & Snell R~2 and Nagelkerke R~2 were greater.Moreover,the-2 LL of model Ⅲ was smaller,while Cox &Snell R~2 and Nagelkerke R~2 were greater compared with model Ⅱ,suggesting that model Ⅲ displayed the best goodness of fit to the sample.Additionally,binary Logistic regression analysis indicated that,age[OR=1.692,95%CI(1.118,2.560)],number of children [OR=0.571,95%CI(0.407,0.800)],convenience of seeking healthcare[OR=2.931,95%CI(2.117,4.058)],social support degree [OR=0.455,95%CI(0.326,0.635)],chronic disease prevalence [OR=1.999,95%CI(1.343,2.975)],awareness level of integrated medical and nursing care [OR=1.719,95%CI(1.222,2.418)],frailty degree [OR=2.495,95%CI(1.666,3.736)],and depression degree [OR=1.914,95%CI(1.296,2.827)] were the influencing factors of demand for integrated medical and nursing care among the community-dwelling elderly(P<0.05). Conclusion Both the levels of awareness and needs of integrated medical and nursing care among the community-dwelling elderly people in Luzhou are relatively high.As the needs of such care are affected by multiple factors,it is recommended that the government,enterprises and subsequent researchers carry out classification analysis of these factors during the investigation.In addition,the delivery of integrated medical and nursing care should be gradually developed after pilot implementation.
引文
[1]范宁玥,田帆,王阳,等.中国老年人对医疗服务与长期照料服务的需要与利用研究——基于中国健康与养老追踪调查的实证分析[J].现代预防医学,2018,45(9):1618-1621,1666.FAN N Y,TIAN F,WANG Y,et al.Needs and utilization of health services and long-term care services among Chinese elderly:an empirical analysis based on CHARLS data[J].Modern Preventive Medicine,2018,45(9):1618-1621,1666.
[2]王浦劬,雷雨若,吕普生.超越多重博弈的医养结合机制建构论析——我国医养结合型养老模式的困境与出路[J].国家行政学院学报,2018,20(2):40-51.WANG P Q,LEI Y R,LYU P S.Analysis on the construction of the mechanism of combination of medicine and support beyond the game of multiple Dilemma and outlet of the pattern of the combination of medicine and support for the aged in our country[J].Journal of Chinese Academy of Governance,2018,20(2):40-51.
[3]米玛多吉,田晓洁,邵志民,等.上海市部分城区老年人医养需求调查与研究[J].中国卫生经济,2016,35(10):43-45.DOI:10.7664/CHE20161011.MI M D J,TIAN X J,SHAO Z M,et al.Survey and research on the elderly's demand for medical and nursing services in some districts of Shanghai[J].Chinese Health Economics,2016,35(10):43-45.DOI:10.7664/CHE20161011.
[4]吴侃,胡晓,杨展,等.成都市居民对“医养结合”养老需求分析[J].医学与哲学,2016,37(12):52-54.DOI:10.12014/j.issn.1002-0772.2016.12a.14.WUK,HUX,YANGZ,etal.Analysisondemandof“combination of medical care and pension service” among residents in Chengdu[J].Medicine&Philosophy,2016,37(12):52-54.DOI:10.12014/j.issn.1002-0772.2016.12a.14.
[5]韩杨,李红玉.锦州市老年人医养结合机构养老意愿及其影响因素分析[J].中国全科医学,2018,21(12):1456-1460.DOI:10.3969/j.issn.1007-9572.2018.00.087.HAN Y,LI H Y.Analysis of the willingness of elderly people in Jingzhou City to choose medical-nurse combined care institutionsand of associated influencing factors[J].Chinese General Practice,2018,21(12):1456-1460.DOI:10.3969/j.issn.1007-9572.2018.00.087.
[6]韩秉志.完善养老保险制度繁荣养老服务市场[N].经济日报,2017-03-29(003).HAN B Z.Perfecting the system of endowment insurance and prospering the market of endowment services[N].Economic Daily,2017-03-29(003).
[7]DEWITTEN,GOBBENSR,DEDONDERL,etal.The comprehensive frailtyassessment instrument:development,validity and reliability[J].Geriatr Nurs,2013,34(4):274-281.DOI:10.1016/j.gerinurse.2013.03.002.
[8]王坤,陈长香,李淑杏.衰弱综合评估工具的汉化及信效度检验[J].中国康复理论与实践,2017,23(1):72-76.DOI:10.3969/j.issn.1006-9771.2017.01.017.WANG K,CHEN C X,LI S X.Reliability and validity of Chinese version of Comprehensive Frailty Assessment Instrument[J].Chinese Journal of Rehabilitation Theory and Practice,2017,23(1):72-76.DOI:10.3969/j.issn.1006-9771.2017.01.017.
[9]王征宇,迟玉芬.抑郁自评量表(SDS)[J].上海精神医学,1984,26(2):71-72.WANG Z Y,CHI Y F.Self-rating Depression Scale,SDS[J].Shanghai Archives of Psychiatry,1984,26(2):71-72.
[10]肖水源.《社会支持评定量表》的理论基础与研究应用[J].临床精神医学杂志,1994,4(2):98-100.XIAO S Y.Theoretical basis and research and application of Social Support Rating Scale[J].Journal of Clinical Psychological Medicine,1994,4(2):98-100.
[11]ANDERSEN R M.National health surveys and the behavioral model of health services use[J].Med Care,2008,46(7):647-653.DOI:10.1097/MLR.0b013e31817a835d.
[12]陈英耀,王立基,王华.卫生服务可及性评价[J].中国卫生资源,2000,3(6):279-282.CHEN Y Y,WANG L J,WANG H.Health service accessibility evaluation[J].Chinese Health Resources,2000,3(6):279-282.
[13]王懿俏,闻德亮,任苒.Andersen卫生服务利用行为模型及其演变[J].中国卫生经济,2017,36(1):15-17.DOI:10.7664/CHE20170203.WANG Y Q,WEN D L,REN R.Andersen's health services utilizationbehavioralmodelanditsevolution[J].Chinese Health Economics,2017,36(1):15-17.DOI:10.7664/CHE20170203.
[14]李月娥,卢珊.医疗卫生领域安德森模型的发展、应用及启示[J].中国卫生政策研究,2017,10(11):77-82.DOI:10.3969/j.issn.1674-2982.2017.11.013.LI Y E,LU S.The development,application and implications of the Andersen model in the field of healthcare[J].Chinese Journal of Health Policy,2017,10(11):77-82.DOI:10.3969/j.issn.1674-2982.2017.11.013.
[15]胡金伟,尹文强,赵延奎,等.基于Andersen模型的居民对基本药物使用偏好的相关因素研究[J].中华医院管理杂志,2016,32(3):184-187.DOI:10.3760/cma.j.issn.1000-6672.2016.03.007.HU J W,YIN W Q,ZHAO Y K,et al.Study on the correlation factors of residents in preferentially using essential medicines based on Andersen behavior model[J].Chinese Journal of Hospital Administration,2016,32(3):184-187.DOI:10.3760/cma.j.issn.1000-6672.2016.03.007.
[16]王振振,李敏,雍岚.供给视角下老年人参与社区互助养老意愿影响因素研究——基于安德森(Andersen)行为模型的实证研究[J].社会保障研究,2017,59(1):101-112.WANG Z Z,LI M,YONG L.Study on the influencing factors of elderly's willingness to participate in community mutual support from the perspective of supply:an empirical study based on Andersen's behavior model[J].Social Security Studies,2017,59(1):101-112.
[17]彭希哲,宋靓珺,黄剑焜.中国失能老人长期照护服务使用的影响因素分析——基于安德森健康行为模型的实证研究[J].人口研究,2017,41(4):46-59.PENG X Z,SONG L J,HUANG J K.Determinants of long-term care services among disabled older adults in China:aquantitative study based on Andersen's behavioral model[J].Population Research,2017,41(4):46-59.
[18]HOLTZMAN C W,SHEA J A,GLANZ K,et al.Mapping patient-identified barriers and facilitators to retention in HIV care and antiretroviral therapy adherence to Andersen's behavioral model[J].AIDS Care,2015,27(7):817-828.DOI:10.1080/09540121.2015.1009362.
[19]肖畅,孙瑞华,刘梦,等.北京市医养结合定点机构周边社区老年人对医养结合的认可度调查[J].医学与社会,2017,10(2):22-25.DOI:10.13723/j.yxysh.2017.02.007.XIAO C,SUN R H,LIU M,et al.Investigation of elderly's recognition degree of integration of pension service and medical service in surrounding communities of Beijing's fixed-point institutions of medical care and elderly care combination[J].Medicine and Society,2017,10(2):22-25.DOI:10.13723/j.yxysh.2017.02.007.
[20]李腾,陈佳林,吕飞露,等.天津市居民对“医养结合”的认知、态度及影响因素分析[J].科技创业月刊,2015,29(21):39-42.DOI:10.3969/j.issn.1665-2272.2015.21.017.LI T,CHEN J L,LYU F L,et al.Analyzing the residents'cognition,attitude and influence factors of medical-nursing combined care model in Tianjin[J].Pioneering With Science&Technology Monthly,2015,29(21):39-42.DOI:10.3969/j.issn.1665-2272.2015.21.017.
[21]李秀明,冯泽永,成秋娴,等.重庆市主城区老年人医养结合需求情况及影响因素研究[J].中国全科医学,2016,19(10):1199-1203.DOI:10.3969/j.issn.1007-9572.2016.10.019.LI X M,FENG Z Y,CHENG Q X,et al.Demand for medicalnursing combined service among elders in the main urban areas of Chongqing and the influencing factors[J].Chinese General Practice,2016,19(10):1199-1203.DOI:10.3969/j.issn.1007-9572.2016.10.019.
[22]黄素芬,黄菲菲,龚国梅,等.泉州市社区空巢老年人对医养结合服务的需求及影响因素研究[J].护理研究,2017,31(20):2517-2520.DOI:10.3969/j.issn.1009-6493.2017.20.025.HUANG S F,HUANG F F,GONG G M,et al.Research on demands of the empty nest elderly in quanzhou to combinati on of medical and nursing services and its influencing factors[J].Chinese Nursing Research,2017,31(20):2517-2520.DOI:10.3969/j.issn.1009-6493.2017.20.025.
[23]李茂全,陈星,贺然,等.成都市医养结合养老模式需求的相关影响因素[J].成都医学院学报,2017,12(4):406-409.DOI:10.3969/j.issn.1674-2257.2017.04.008.LI M Q,CHEN X,HE R,et al.The relevant influence factors of the demands for the new pattern of the combination of medical care and support for the aged in Chengdu[J].Journal of Chengdu Medical College,2017,12(4):406-409.DOI:10.3969/j.issn.1674-2257.2017.04.008.
[24]张持晨,赵慧宁,郑晓,等.中国空巢老人领域研究现状及热点[J].中国老年学杂志,2018,38(2):421-424.DOI:10.3969/j.issn.1005-9202.2018.02.071.ZHANG C C,ZHAO H N,ZHENG X,et al.Analysis of research hot spots and status of empty-nest elderly study in China[J].Chinese Journal of Gerontology,2018,38(2):421-424.DOI:10.3969/j.issn.1005-9202.2018.02.071.
[25]孙长安,鲍谧清,韦洪涛.江苏省苏州市50岁及以上人群主观幸福感及其影响因素研究[J].中国健康教育,2016,32(12):1095-1098.DOI:10.16168/j.cnki.issn.1002-9982.2016.12.009.SUN C A,BAO M Q,WEI H T.Subjective well-being and its influencing factors among residents aged 50 and over in Suzhou City of Jiangsu Province[J].Chinese Journal of Health Education,2016,32(12):1095-1098.DOI:10.16168/j.cnki.issn.1002-9982.2016.12.009.
[26]李敏,郭继志,贾君杰,等.山东农村老年人心理健康状况及其影响因素研究[J].中国健康教育,2016,32(10):888-891.DOI:10.16168/j.cnki.issn.1002-9982.2016.10.006.LI M,GUO J Z,JIA J J,et al.Status of mental health among aging population in rural areas of Shandong Province[J].Chinese Journal of Health Education,2016,32(10):888-891.DOI:10.16168/j.cnki.issn.1002-9982.2016.10.006.
[27]孙永河,赵叶叶,杜元伟.医养结合新型养老模式的风险评估研究[J].昆明理工大学学报(社会科学版),2018,18(3):56-64.DOI:10.16112/j.cnki.53-1160/c.2018.03.008.SUN Y H,ZHAO Y Y,DU Y W.The risk assessment for the new mode of combining medical care and pension service[J].Journal of Kunming University of Science and Technology(Social Sciences Edition),2018,18(3):56-64.DOI:10.16112/j.cnki.53-1160/c.2018.03.008.
[28]张晓杰.医养结合养老创新的逻辑、瓶颈与政策选择[J].西北人口,2016,37(1):105-111.DOI:10.3969/j.issn.1007-0672.2016.01.018.ZHANG X J.Study on innovation of the medical-nursing combined care mode:logic,bottleneck and policy choices[J].Northwest Population Journal,2016,37(1):105-111.DOI:10.3969/j.issn.1007-0672.2016.01.018.
[29]全国护理事业发展规划(2016—2020年)[J].中国护理管理,2017,17(1):1-5.DOI:10.3969/j.issn.1672-1756.2017.01.001.National nursing development plan(2016—2020)[J].Chinese Nursing Management,2017,17(1):1-5.DOI:10.3969/j.issn.1672-1756.2017.01.001.
[30]赵斌,陈曼莉.社会长期护理保险制度:国际经验和中国模式[J].四川理工学院学报(社会科学版),2017,32(5):1-22.DOI:10.11965/xbew20170501.ZHAO B,CHEN M L.International experience on and China practice of social long term care insurance[J].Journal of Sichuan University of Science&Engineering(Social Sciences Edition),2017,32(5):1-22.DOI:10.11965/xbew20170501.
[31]ENGELMAN L.Long-termcareinsurance:US20080215376[P].2008-02-07.
[32]张建,雷丽华.日本长期护理保险制度的运营现状与发展趋势[J].西北人口,2017,38(6):72-79.DOI:10.15884/j.cnki.issn.1007-0672.2017.06.010.ZHANG J,LEI L H.Operational experience and development trend of Japan's long-term care insurance system[J].Northwest Population Journal,2017,38(6):72-79.DOI:10.15884/j.cnki.issn.1007-0672.2017.06.010.
[2]王浦劬,雷雨若,吕普生.超越多重博弈的医养结合机制建构论析——我国医养结合型养老模式的困境与出路[J].国家行政学院学报,2018,20(2):40-51.WANG P Q,LEI Y R,LYU P S.Analysis on the construction of the mechanism of combination of medicine and support beyond the game of multiple Dilemma and outlet of the pattern of the combination of medicine and support for the aged in our country[J].Journal of Chinese Academy of Governance,2018,20(2):40-51.
[3]米玛多吉,田晓洁,邵志民,等.上海市部分城区老年人医养需求调查与研究[J].中国卫生经济,2016,35(10):43-45.DOI:10.7664/CHE20161011.MI M D J,TIAN X J,SHAO Z M,et al.Survey and research on the elderly's demand for medical and nursing services in some districts of Shanghai[J].Chinese Health Economics,2016,35(10):43-45.DOI:10.7664/CHE20161011.
[4]吴侃,胡晓,杨展,等.成都市居民对“医养结合”养老需求分析[J].医学与哲学,2016,37(12):52-54.DOI:10.12014/j.issn.1002-0772.2016.12a.14.WUK,HUX,YANGZ,etal.Analysisondemandof“combination of medical care and pension service” among residents in Chengdu[J].Medicine&Philosophy,2016,37(12):52-54.DOI:10.12014/j.issn.1002-0772.2016.12a.14.
[5]韩杨,李红玉.锦州市老年人医养结合机构养老意愿及其影响因素分析[J].中国全科医学,2018,21(12):1456-1460.DOI:10.3969/j.issn.1007-9572.2018.00.087.HAN Y,LI H Y.Analysis of the willingness of elderly people in Jingzhou City to choose medical-nurse combined care institutionsand of associated influencing factors[J].Chinese General Practice,2018,21(12):1456-1460.DOI:10.3969/j.issn.1007-9572.2018.00.087.
[6]韩秉志.完善养老保险制度繁荣养老服务市场[N].经济日报,2017-03-29(003).HAN B Z.Perfecting the system of endowment insurance and prospering the market of endowment services[N].Economic Daily,2017-03-29(003).
[7]DEWITTEN,GOBBENSR,DEDONDERL,etal.The comprehensive frailtyassessment instrument:development,validity and reliability[J].Geriatr Nurs,2013,34(4):274-281.DOI:10.1016/j.gerinurse.2013.03.002.
[8]王坤,陈长香,李淑杏.衰弱综合评估工具的汉化及信效度检验[J].中国康复理论与实践,2017,23(1):72-76.DOI:10.3969/j.issn.1006-9771.2017.01.017.WANG K,CHEN C X,LI S X.Reliability and validity of Chinese version of Comprehensive Frailty Assessment Instrument[J].Chinese Journal of Rehabilitation Theory and Practice,2017,23(1):72-76.DOI:10.3969/j.issn.1006-9771.2017.01.017.
[9]王征宇,迟玉芬.抑郁自评量表(SDS)[J].上海精神医学,1984,26(2):71-72.WANG Z Y,CHI Y F.Self-rating Depression Scale,SDS[J].Shanghai Archives of Psychiatry,1984,26(2):71-72.
[10]肖水源.《社会支持评定量表》的理论基础与研究应用[J].临床精神医学杂志,1994,4(2):98-100.XIAO S Y.Theoretical basis and research and application of Social Support Rating Scale[J].Journal of Clinical Psychological Medicine,1994,4(2):98-100.
[11]ANDERSEN R M.National health surveys and the behavioral model of health services use[J].Med Care,2008,46(7):647-653.DOI:10.1097/MLR.0b013e31817a835d.
[12]陈英耀,王立基,王华.卫生服务可及性评价[J].中国卫生资源,2000,3(6):279-282.CHEN Y Y,WANG L J,WANG H.Health service accessibility evaluation[J].Chinese Health Resources,2000,3(6):279-282.
[13]王懿俏,闻德亮,任苒.Andersen卫生服务利用行为模型及其演变[J].中国卫生经济,2017,36(1):15-17.DOI:10.7664/CHE20170203.WANG Y Q,WEN D L,REN R.Andersen's health services utilizationbehavioralmodelanditsevolution[J].Chinese Health Economics,2017,36(1):15-17.DOI:10.7664/CHE20170203.
[14]李月娥,卢珊.医疗卫生领域安德森模型的发展、应用及启示[J].中国卫生政策研究,2017,10(11):77-82.DOI:10.3969/j.issn.1674-2982.2017.11.013.LI Y E,LU S.The development,application and implications of the Andersen model in the field of healthcare[J].Chinese Journal of Health Policy,2017,10(11):77-82.DOI:10.3969/j.issn.1674-2982.2017.11.013.
[15]胡金伟,尹文强,赵延奎,等.基于Andersen模型的居民对基本药物使用偏好的相关因素研究[J].中华医院管理杂志,2016,32(3):184-187.DOI:10.3760/cma.j.issn.1000-6672.2016.03.007.HU J W,YIN W Q,ZHAO Y K,et al.Study on the correlation factors of residents in preferentially using essential medicines based on Andersen behavior model[J].Chinese Journal of Hospital Administration,2016,32(3):184-187.DOI:10.3760/cma.j.issn.1000-6672.2016.03.007.
[16]王振振,李敏,雍岚.供给视角下老年人参与社区互助养老意愿影响因素研究——基于安德森(Andersen)行为模型的实证研究[J].社会保障研究,2017,59(1):101-112.WANG Z Z,LI M,YONG L.Study on the influencing factors of elderly's willingness to participate in community mutual support from the perspective of supply:an empirical study based on Andersen's behavior model[J].Social Security Studies,2017,59(1):101-112.
[17]彭希哲,宋靓珺,黄剑焜.中国失能老人长期照护服务使用的影响因素分析——基于安德森健康行为模型的实证研究[J].人口研究,2017,41(4):46-59.PENG X Z,SONG L J,HUANG J K.Determinants of long-term care services among disabled older adults in China:aquantitative study based on Andersen's behavioral model[J].Population Research,2017,41(4):46-59.
[18]HOLTZMAN C W,SHEA J A,GLANZ K,et al.Mapping patient-identified barriers and facilitators to retention in HIV care and antiretroviral therapy adherence to Andersen's behavioral model[J].AIDS Care,2015,27(7):817-828.DOI:10.1080/09540121.2015.1009362.
[19]肖畅,孙瑞华,刘梦,等.北京市医养结合定点机构周边社区老年人对医养结合的认可度调查[J].医学与社会,2017,10(2):22-25.DOI:10.13723/j.yxysh.2017.02.007.XIAO C,SUN R H,LIU M,et al.Investigation of elderly's recognition degree of integration of pension service and medical service in surrounding communities of Beijing's fixed-point institutions of medical care and elderly care combination[J].Medicine and Society,2017,10(2):22-25.DOI:10.13723/j.yxysh.2017.02.007.
[20]李腾,陈佳林,吕飞露,等.天津市居民对“医养结合”的认知、态度及影响因素分析[J].科技创业月刊,2015,29(21):39-42.DOI:10.3969/j.issn.1665-2272.2015.21.017.LI T,CHEN J L,LYU F L,et al.Analyzing the residents'cognition,attitude and influence factors of medical-nursing combined care model in Tianjin[J].Pioneering With Science&Technology Monthly,2015,29(21):39-42.DOI:10.3969/j.issn.1665-2272.2015.21.017.
[21]李秀明,冯泽永,成秋娴,等.重庆市主城区老年人医养结合需求情况及影响因素研究[J].中国全科医学,2016,19(10):1199-1203.DOI:10.3969/j.issn.1007-9572.2016.10.019.LI X M,FENG Z Y,CHENG Q X,et al.Demand for medicalnursing combined service among elders in the main urban areas of Chongqing and the influencing factors[J].Chinese General Practice,2016,19(10):1199-1203.DOI:10.3969/j.issn.1007-9572.2016.10.019.
[22]黄素芬,黄菲菲,龚国梅,等.泉州市社区空巢老年人对医养结合服务的需求及影响因素研究[J].护理研究,2017,31(20):2517-2520.DOI:10.3969/j.issn.1009-6493.2017.20.025.HUANG S F,HUANG F F,GONG G M,et al.Research on demands of the empty nest elderly in quanzhou to combinati on of medical and nursing services and its influencing factors[J].Chinese Nursing Research,2017,31(20):2517-2520.DOI:10.3969/j.issn.1009-6493.2017.20.025.
[23]李茂全,陈星,贺然,等.成都市医养结合养老模式需求的相关影响因素[J].成都医学院学报,2017,12(4):406-409.DOI:10.3969/j.issn.1674-2257.2017.04.008.LI M Q,CHEN X,HE R,et al.The relevant influence factors of the demands for the new pattern of the combination of medical care and support for the aged in Chengdu[J].Journal of Chengdu Medical College,2017,12(4):406-409.DOI:10.3969/j.issn.1674-2257.2017.04.008.
[24]张持晨,赵慧宁,郑晓,等.中国空巢老人领域研究现状及热点[J].中国老年学杂志,2018,38(2):421-424.DOI:10.3969/j.issn.1005-9202.2018.02.071.ZHANG C C,ZHAO H N,ZHENG X,et al.Analysis of research hot spots and status of empty-nest elderly study in China[J].Chinese Journal of Gerontology,2018,38(2):421-424.DOI:10.3969/j.issn.1005-9202.2018.02.071.
[25]孙长安,鲍谧清,韦洪涛.江苏省苏州市50岁及以上人群主观幸福感及其影响因素研究[J].中国健康教育,2016,32(12):1095-1098.DOI:10.16168/j.cnki.issn.1002-9982.2016.12.009.SUN C A,BAO M Q,WEI H T.Subjective well-being and its influencing factors among residents aged 50 and over in Suzhou City of Jiangsu Province[J].Chinese Journal of Health Education,2016,32(12):1095-1098.DOI:10.16168/j.cnki.issn.1002-9982.2016.12.009.
[26]李敏,郭继志,贾君杰,等.山东农村老年人心理健康状况及其影响因素研究[J].中国健康教育,2016,32(10):888-891.DOI:10.16168/j.cnki.issn.1002-9982.2016.10.006.LI M,GUO J Z,JIA J J,et al.Status of mental health among aging population in rural areas of Shandong Province[J].Chinese Journal of Health Education,2016,32(10):888-891.DOI:10.16168/j.cnki.issn.1002-9982.2016.10.006.
[27]孙永河,赵叶叶,杜元伟.医养结合新型养老模式的风险评估研究[J].昆明理工大学学报(社会科学版),2018,18(3):56-64.DOI:10.16112/j.cnki.53-1160/c.2018.03.008.SUN Y H,ZHAO Y Y,DU Y W.The risk assessment for the new mode of combining medical care and pension service[J].Journal of Kunming University of Science and Technology(Social Sciences Edition),2018,18(3):56-64.DOI:10.16112/j.cnki.53-1160/c.2018.03.008.
[28]张晓杰.医养结合养老创新的逻辑、瓶颈与政策选择[J].西北人口,2016,37(1):105-111.DOI:10.3969/j.issn.1007-0672.2016.01.018.ZHANG X J.Study on innovation of the medical-nursing combined care mode:logic,bottleneck and policy choices[J].Northwest Population Journal,2016,37(1):105-111.DOI:10.3969/j.issn.1007-0672.2016.01.018.
[29]全国护理事业发展规划(2016—2020年)[J].中国护理管理,2017,17(1):1-5.DOI:10.3969/j.issn.1672-1756.2017.01.001.National nursing development plan(2016—2020)[J].Chinese Nursing Management,2017,17(1):1-5.DOI:10.3969/j.issn.1672-1756.2017.01.001.
[30]赵斌,陈曼莉.社会长期护理保险制度:国际经验和中国模式[J].四川理工学院学报(社会科学版),2017,32(5):1-22.DOI:10.11965/xbew20170501.ZHAO B,CHEN M L.International experience on and China practice of social long term care insurance[J].Journal of Sichuan University of Science&Engineering(Social Sciences Edition),2017,32(5):1-22.DOI:10.11965/xbew20170501.
[31]ENGELMAN L.Long-termcareinsurance:US20080215376[P].2008-02-07.
[32]张建,雷丽华.日本长期护理保险制度的运营现状与发展趋势[J].西北人口,2017,38(6):72-79.DOI:10.15884/j.cnki.issn.1007-0672.2017.06.010.ZHANG J,LEI L H.Operational experience and development trend of Japan's long-term care insurance system[J].Northwest Population Journal,2017,38(6):72-79.DOI:10.15884/j.cnki.issn.1007-0672.2017.06.010.