中国全科医学 ›› 2025, Vol. 28 ›› Issue (29): 3688-3693.DOI: 10.12114/j.issn.1007-9572.2024.0182

• 论著 • 上一篇    下一篇

中老年慢性病患者卫生服务利用及影响因素研究

唐玲1, 张国良1, 李振坤2, 司圣波3, 刘强4, 陈任5,*(), 任佰玲3,*()   

  1. 1.230001 安徽省合肥市,中国科学技术大学附属第一医院(安徽省立医院)北区医务科
    2.230001 安徽省合肥市,中国科学技术大学附属第一医院(安徽省立医院)病案统计室
    3.230001 安徽省合肥市,中国科学技术大学附属第一医院(安徽省立医院)北区综合办公室
    4.230001 安徽省合肥市,中国科学技术大学附属第一医院(安徽省立医院)北区总务科
    5.230032 安徽省合肥市,安徽医科大学卫生管理学院
  • 收稿日期:2024-07-19 修回日期:2024-08-22 出版日期:2025-10-15 发布日期:2025-08-26
  • 通讯作者: 陈任, 任佰玲

  • 作者贡献:

    唐玲提出主要研究目标,负责研究的构思、设计、实施,撰写论文;张国良、李振坤进行数据的收集与整理,统计学处理,图表绘制与展示;司圣波、刘强进行论文修订;陈任、任佰玲负责文章的质量控制与审查,对文章整体负责,监督管理。

  • 基金资助:
    国家自然科学基金资助项目(72274068)

The Utilization and Influencing Factors of Health Services for Middle Aged and Elderly Chronic Disease Patients

TANG Ling1, ZHANG Guoliang1, LI Zhenkun2, SI Shengbo3, LIU Qiang4, CHEN Ren5,*(), REN Bailing3,*()   

  1. 1. North District Medical Department, the First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Hospital, Hefei 230001, China
    2. Medical Records & Statistics Office, the First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Hospital, Hefei 230001, China
    3. North District Comprehensive Office, the First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Hospital, Hefei 230001, China
    4. North District General Affairs Department, the First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Hospital, Hefei 230001, China
    5. School of Health Management, Anhui Medical University, Hefei 230032, China
  • Received:2024-07-19 Revised:2024-08-22 Published:2025-10-15 Online:2025-08-26
  • Contact: CHEN Ren, REN Bailing

摘要: 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年数据库中≥45岁且患有慢性病的样本5 280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 5 280例慢性病患者中,1 487例(28.16%)患者过去1个月有门诊就诊行为,1 393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。

关键词: 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

Abstract:

Background

Middle aged and elderly people are at high risk of chronic diseases, and 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 factors, providing a basis for improving the level of health service utilization.

Methods

Selected 5 280 samples aged ≥45 with chronic diseases from the China Health and Retirement Longitudinal Study (CHARLS) 2020 database. Drawing on the Anderson Health Service Utilization Behavior Model, the study variables include: (1) propensity factors, including demographic characteristics such as age, gender, place of residence, marital status, smoking, alcohol consumption, social structure, and health behavior. (2) Enabling factors include the ability to access healthcare services, such as economic living standards (personal annual income), medical insurance, and delayed or cancelled medical services due to the impact of the pandemic. This study ranked individual annual income in descending order and divided it into three equal parts on average. The first third was the low-income group, the middle third was the middle-income group, and the last third was the high-income group. (3) Demand factors, including activities for daily living (ADL) status, self-rated health status, life satisfaction, number of chronic diseases, and personal cognition and evaluation. Dependent variable: health service utilization (outpatient/inpatient service utilization). Using multiple 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 patients, 1 487 (28.16%) had outpatient visits in the past month, and 1 393 (26.38%) had inpatient visits in the past year. The results of multiple Logistic regression analysis showed that self-assessment of health status, delayed or cancelled medical services due to the impact of the epidemic, chronic disease incidence, and daily living activity ability were the influencing factors of outpatient service utilization (P<0.05). Alcohol consumption, medical insurance, self-assessment of health status, postponement or cancellation of medical services due to the impact of the epidemic, chronic disease incidence, and daily living activity ability were the influencing factors of hospitalization service utilization (P<0.05) .

Conclusion

Strengthen attention to middle-aged and elderly chronic disease patients who drink alcohol, lack medical insurance, self evaluate poor health, have a large number of chronic diseases, and have ADL dysfunction, pay attention to the medical and health service needs of this population, and further improve the utilization level of health services.

Key words: Utilization of health services, Middle-aged and elderly people, Chronic diseases, Root cause analysis, Anderson health service utilization behavior model

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