长沙市某医院老年肿瘤患者对就诊机构选择与认知的调查
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摘要
目的了解老年肿瘤患者就诊机构选择与认知现状并分析其影响因素,为老年肿瘤患者就医分流提供依据。方法利用自制问卷对长沙市270名老年肿瘤患者进行调查,问卷内容包括基本情况、就诊机构选择情况、对选择市县级医院的态度三大部分,采用Logistic回归分析老年肿瘤患者对市县级医疗机构选择的相关因素。结果 70.8%的患者就医选择省级大医院,医院技术水平、医院规模等级等是其考虑的主要因素;61.2%的患者愿意于市县级医院进行治疗,尤其是当病情好转,医生建议转诊到市县级医院维持治疗(85.4%);老年肿瘤患者中60～69岁、家住县城的更倾向选择在市县级医院就诊,且随着收入水平的减少,选择于市县级医院就诊的倾向性越高;而男性、职业为公务员干部或企事业单位、农民、家住城市的老年肿瘤患者不愿选择到市县级医院就诊。结论老年肿瘤患者就医集中于省级大医院但不排斥到市县级医院治疗,其自身居住地、职业、收入等是影响选择市县级医院的主要因素。老年肿瘤患者对选择医院存在困难,需建立适宜机制合理分流就医患者,积极引导老年肿瘤患者对市县级医院的利用。
Objective To investigate the selection and cognitive status of the elderly patients with tumor to medical institutions,and analyze the influencing factors in order to provide evidence for the treatment of elderly patients with tumor.Methods A self-designed questionnaire was used to investigate 270 elderly tumor patients in Changsha.The questionnaire includes three parts:the basic situation,the choice of the medical institutions and the attitude to the primary health service institutions(municipal or county hospital).Descriptive analysis was used to show elder patients preferred hospital type,main factors of choosing hospital and attitude towards the treatment in municipal or county hospital.Logistic regression was used to analyze the related influencing factors of treating in municipal or county hospital for elderly tumor patients.Results 70.8% patients chose provincial hospital,and the hospital technical level,hospital scale were the main factors;61.2% patients were willing to be treated in the municipal or county hospital,especially when their conditions improved and their doctors recommended them to transfer treatment to the municipal or county hospital(85.4%);The elderly tumor patients in the 60 to 69 years old group and lived in the county were more likely to choose treatment in municipal or county hospital,and with the decrease of income level,the tendency to choose to treat in municipal or county hospital was higher;and the male served for government or enterprise,farmers,and lived in city were unwilling to treat in municipal or county hospital.Conclusion Elderly patients with tumor mainly visit large provincial hospitals,but they don't refuse treatment in the municipal or county hospitals.Residence locations,occupation,type of insurance are the main factors for elderly patients with tumor choosing municipal or county hospital.There is difficulty for them to choose hospital.We need to establish appropriate mechanisms to promote reasonable medical institutions triage,and actively guide the elderly patients enjoying primary health service.
Objective To investigate the selection and cognitive status of the elderly patients with tumor to medical institutions,and analyze the influencing factors in order to provide evidence for the treatment of elderly patients with tumor.Methods A self-designed questionnaire was used to investigate 270 elderly tumor patients in Changsha.The questionnaire includes three parts:the basic situation,the choice of the medical institutions and the attitude to the primary health service institutions(municipal or county hospital).Descriptive analysis was used to show elder patients preferred hospital type,main factors of choosing hospital and attitude towards the treatment in municipal or county hospital.Logistic regression was used to analyze the related influencing factors of treating in municipal or county hospital for elderly tumor patients.Results 70.8% patients chose provincial hospital,and the hospital technical level,hospital scale were the main factors;61.2% patients were willing to be treated in the municipal or county hospital,especially when their conditions improved and their doctors recommended them to transfer treatment to the municipal or county hospital(85.4%);The elderly tumor patients in the 60 to 69 years old group and lived in the county were more likely to choose treatment in municipal or county hospital,and with the decrease of income level,the tendency to choose to treat in municipal or county hospital was higher;and the male served for government or enterprise,farmers,and lived in city were unwilling to treat in municipal or county hospital.Conclusion Elderly patients with tumor mainly visit large provincial hospitals,but they don't refuse treatment in the municipal or county hospitals.Residence locations,occupation,type of insurance are the main factors for elderly patients with tumor choosing municipal or county hospital.There is difficulty for them to choose hospital.We need to establish appropriate mechanisms to promote reasonable medical institutions triage,and actively guide the elderly patients enjoying primary health service.
引文
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[2]中华人民共和国国家统计局.中华人民共和国2015年国民经济和社会发展统计公报[EB/OL].[2016-02-29].http://www.gov.cn/inwen/content_5047274.htm.
[3]李亚运,钱东福,周守君,等.某地区肺癌住院患者直接经济负担城乡差异比较研究[J].重庆医学,2016,45(5):661-663.
[4]李祎,白继庚,程景民.推进分级诊疗有效落实的策略研究[J].中国社会医学杂志,2016,33(4):305-307.
[5]邱胜,刘俊荣.广州市某医院肿瘤患者的就医选择影响因素与心理分析[J].医学与社会,2016,29(3):90-92.
[6]张岚,张研.患者选择医院的影响因素间相关关系分析[J].中国社会医学杂志,2011,28(3):173-175.
[7]中华人民共和国人力资源与社会保障部.人力资源社会保障部关于印发国家基本医疗保险、工伤保险和生育保险药品目录(2017年版)的通知[EB/OL].[2017-02-15].http://www.mohrss.gov.cn/gkml/xxgk/t20170223_266775.html.
[8]中华人民共和国国家卫生计生委医政医管局.卫生部办公厅关于开展市、县级医院常见肿瘤规范化诊疗试点工作的通知[EB/OL].[2017-02-15].http://www.nhfpc.gov.cn/yzygj/s3590/201012/325 fdbaf4f46402680518dab22665760.shtml.
[9]丁罡,徐卫国.农村地区以医院为中心的肿瘤综合防治探索[J].上海医药,2013,34(16):3-4.
[10]刘霞.新医学模式在社区肿瘤医疗中的应用探讨[J].山西科技,2016,31(2):47-48.
[11]王欢,叶芳.我国医联体诊疗现状研究[J].中国医药导报,2016,13(26):168-172.