Chinese General Practice ›› 2022, Vol. 25 ›› Issue (22): 2726-2732.DOI: 10.12114/j.issn.1007-9572.2022.0371

Special Issue: 健康公平性最新文章合集 老年问题最新文章合集

• Original Research·Clinical Quality Improvement • Previous Articles     Next Articles

Utilization of Outpatient Services and Associated Factors in Older People

  

  1. Department of Electronic Business, South China University of Technology, Guangzhou 510006, China
  • Received:2022-04-11 Revised:2022-06-20 Published:2022-08-05 Online:2022-06-23
  • Contact: Mingjie GUO
  • About author:
    SHI Y Q, GUO M J, ZHANG Z Y. Utilization of outpatient services and associated factors in older people[J]. Chinese General Practice, 2022, 25 (22) : 2726-2732.

老年人门诊服务利用情况及其影响因素研究

  

  1. 510006 广东省广州市,华南理工大学电子商务系
  • 通讯作者: 郭铭杰
  • 作者简介:
    石永强,郭铭杰,张智勇. 老年人门诊服务利用情况及其影响因素研究[J]. 中国全科医学,2022,25(22):2726-2732.[www.chinagp.net] 作者贡献:石永强负责文章的构思与设计、文章的修订、监督管理;郭铭杰负责数据申请、数据整理与统计分析、文章撰写,并对文章整体负责;张智勇负责文章的质量控制及审校。
  • 基金资助:
    广东省自然科学基金项目(2022A1515010966)

Abstract:

Background

The needs of outpatient services, a key accessible health resource, are increasing in an increasingly aging population in China. So rational allocation of outpatient service resources to meet older people's health needs is a key to improving their health level.

Objective

To explore the factors affecting the utilization of outpatient services in the elderly, to provide feasible suggestions for improving older people's health level and the allocation of medical resources.

Methods

This study was conducted in 2021 using the data of older people (≥60 years old) attending the CHARLS 2018. The number of using outpatient services in these people in the past month prior to the CHARLS 2018 and associated factors were studied using a system developed based on the framework of Anderson's Behavioral Model of Health Services Use, with sex, age, marital status, the type of hukou (rural or urban), education level, smoking and drinking were classified as predisposing factors, health insurance, monthly household income per capita and the average distance from home to medical institutions as enabling factors, and chronic disease prevalence and self-rated health as need factors. The zero-inflated negative binomial regression (ZINB) was used to identify factors associated with the use of outpatient services.

Results

In all, 9 551 older people were included for analysis. Among them, non-users of outpatient services in the past month numbered 8 038 (84.16%), and one-time, two-time, and three or more-time users numbered 749 (7.84%), 367 (3.84%), and 397 (4.16%), respectively. The number of using outpatient services differed statistically by the type of hukou, education level, smoking, drinking, health insurance prevalence, monthly household income per capita, chronic disease prevalence, and self-rated health status (P<0.05). The results of Logit regression model (one part of the ZINB) in fitting the data indicated that older age, high school education or above, having health insurance, suffering from a chronic disease and poor self-rated health were associated with increased probability of utilizing outpatient services (P<0.05). And the results of negative binomial count model in fitting the data indicated showed that the age of 70-74 years was associated with decreased probability of utilizing outpatient services, while an average distance of greater than 1 km but less than 10 km between home and medical institutions, and three types of self-rated health (good, poor and very poor) were associated with increased probability of utilizing outpatient services (P<0.05) .

Conclusion

Our study indicates that the use of outpatient services was insufficient in these older people, which was associated with predisposing, enabling and need factors. To improve this, it is suggested to rationally strengthen the provision of outpatient services to vulnerable groups with underuse of such services and individuals with needs of high-quality services. In addition, attention should be given to chronic disease management and self-rated health of the elderly to improve their awareness and level of health management.

Key words: Aged, Ambulatory care, Root cause analysis, CHARLS, Zero-inflated negative binomial regression

摘要:

背景

门诊服务是老年人可利用的重要医疗卫生资源,随着我国社会人口老龄化程度加深,老年群体的门诊服务需求将会更加突出,合理配置门诊服务资源,满足老年群体需求成为提升老年人口健康水平的关键。

目的

探析影响老年人门诊服务利用的因素,为提升老年群体健康水平、优化医疗资源配置提供可行的建议。

方法

2021年,从2018年中国健康与养老追踪调查(CHARLS)数据中选取≥60岁老年人为研究对象,基于安德森行为模型构建门诊服务利用的影响因素体系,研究老年人过去1个月内的门诊服务利用次数情况及其影响因素,其中倾向性特征因素包括性别、年龄、婚姻状况、户口类型、受教育程度、吸烟情况、饮酒情况,能力资源因素包括医保参与、家庭人均收入、医疗机构平均距离,需要因素包括罹患慢性病、健康状况自评,通过零膨胀负二项(ZINB)回归模型分析影响老年人门诊服务利用次数的因素。

结果

9 551例老年人中,8 038例(84.16%)过去1个月没有利用过门诊服务,749例(7.84%)曾利用1次门诊服务,367例(3.84%)曾利用2次门诊服务,397例(4.16%)曾利用≥3次门诊服务。不同户口类型、受教育程度、吸烟情况、饮酒情况、医保参与情况、家庭人均收入、罹患慢性病、健康状况自评的老年人门诊服务利用次数比较,差异有统计学意义(P<0.05)。ZINB模型拟合结果的Logit回归部分结果表明,年龄大、高中及以上文化水平、参与医保、罹患慢性病、健康状况自评差是老年人门诊服务利用概率的促进因素(P<0.05);ZINB模型拟合结果的负二项回归部分表明,70~74岁高龄会减少老年人门诊服务利用次数,而医疗机构平均距离为>1~10 km,健康状况自评为好、不好、很不好是老年人门诊服务利用次数的促进因素(P<0.05)。

结论

老年人未能充分利用门诊服务,老年人门诊服务利用会受到倾向性特征、能力资源、需要因素的共同影响。建议对于门诊服务利用不充分的弱势群体、服务需求水平高的高需群体进行合理的门诊服务资源倾斜,以满足其门诊服务需求。同时着重关注老年人的慢性病管理和自我感知健康状况,提升老年人的健康管理意识和水平。

关键词: 老年人, 门诊医疗, 影响因素分析, 中国健康与养老追踪调查, 零膨胀负二项回归模型