Chinese General Practice ›› 2018, Vol. 21 ›› Issue (17): 2101-2105.DOI: 10.3969/j.issn.1007-9572.2018.00.210

• Monographic Research • Previous Articles     Next Articles

Healthcare-seeking Behavior among Pregnant and Parturient Women from Medical Institutions of Guangzhou:a Decision Tree-based Analysis

  

  1. 1.Guangdong General Hospital/Guangdong Academy of Medical Science,Guangzhou 510080,China
    2.Guangdong Medical University,Dongguan 523808,China
    *Corresponding authors:YANG Yun-bin,Professor;E-mail:yyb08@126.com;GENG Qing-shan,Chief physician;E-mail:gengqsh@163.net
  • Published:2018-06-15 Online:2018-06-15

不同级别医疗机构孕产妇就医行为的决策树分析研究

  

  1. 1.510080广东省广州市,广东省人民医院 广东省医学科学院 2.523808广东省东莞市,广东医科大学
    *通信作者:杨云滨,教授;E-mail:yyb08@126.com 耿庆山,主任医师;E-mail:gengqsh@163.net
  • 基金资助:
    广东省科技计划项目(2017ZC0276);广东省医学科研基金项目(B2016090)

Abstract: Objective To investigate the characteristics of healthcare-seeking behavior among pregnant and parturient women from medical institutions in Guangzhou,providing a reference for guiding such populations to seek healthcare in a scientific way and for the development of hierarchical medical system.Methods We conducted a survey in 675 randomly selected pregnant and parturient women seeking healthcare in a stratified and typical case sample consisting of a primary hospital (Guangzhou Zengcheng District Xintang Hospital,changed to secondary hospital now),a secondary hospital (Zengcheng District Maternal and Child Care Hospital) and a tertiary hospital (Sun Yat-sen Memorial Hospital Sun Yat-sen University) during May to September 2016 with a self-developed questionnaire based on the Andersen healthcare utilization model.A decision tree-based analysis of the survey results was performed to determine the associated factors for pregnant and parturient women seeking healthcare in the chosen hospital.Results The number of participants seeking healthcare in the primary hospital,secondary hospital and tertiary hospital was 207 (30.7%),219 (32.4%),249 (36.9%),respectively.The level of hospital selected for obtaining healthcare differed significantly by age,home-to-hospital distance,waiting time for receiving healthcare,annual household net disposable income per capita,history and number of antenatal examination,number of pregnancy,history of abortion,number of live births,history of premarital checkup,history of pregnancy loss,and level of satisfaction with healthcare(P<0.05).Furthermore,the level of hospital selected for early antenatal registration varied obviously according to medical cost(low or not),quality of care(excellent or not) and home-to-hospital distance(short or not) (P<0.05).Decision tree analysis found that,the accuracy of No.1 decision tree model for predicting the selected primary hospital was much higher compared with predicting the selected secondary hospital (χ2=111.023,P<0.001);Both No.2 and No.3 decision tree models had much higher overall predictive accuracy than No.1 decision tree model(P<0.05).In terms of the causes for choosing the hospital for obtaining healthcare(including early antenatal registration),analysis with No.1 decision tree model demonstrated that those selecting the primary or secondary hospital was mainly due to short waiting time for receiving healthcare and low medical cost,analysis with No.2 decision tree model showed that those choosing the secondary or tertiary hospital was mainly out of annual household net disposable income per capita,number of antenatal examination,number of pregnancy and short home-to-hospital distance,and analysis with No.3 decision tree model presented that those choosing the primary or tertiary hospital was mainly for annual household net disposable income per capita,number of pregnancy,number of live births,and short home-to-hospital distance.Conclusion Policy guidance of the implementation of hierarchical medical system should be strengthened.Pregnant and parturient women without any adverse factors should be guided to seek healthcare in primary or secondary medical institutions.Those choosing tertiary medical institutions just because of high household income should be guided for choosing medical institutions more reasonably.In addition,the importance of undergoing regular prenatal care should be reinforced for pregnant and parturient women seeking healthcare in primary or secondary medical institutions.

 

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摘要:

目的 分析广州市孕产妇就医行为特征及就诊医疗机构的选择,为引导孕产妇科学就医及分级诊疗提供参考。方法 2016年5—9月采用分层典型抽样的方法,选取广州市一级、二级和三级医院〔分别为增城区新塘医院(现更改为二级医院)、增城区妇幼保健院、中山大学孙逸仙纪念医院〕各1家作为调查点,随机选取在调查点就医的675例孕产妇,采用基于Andersen卫生服务利用行为模型设计的问卷进行调查,采用决策树分析方法分析孕产妇选择不同级别医疗机构的影响因素。结果 选择一级医院207例(30.7%),二级医院219例(32.4%),三级医院249例(36.9%)。不同年龄、与医院的距离、等候时间、家庭年人均纯收入、产检次数、妊娠次数、流产史、活产子女、婚前检查、不良孕史、产前检查、认为选择的早孕建卡机构费用低、认为选择的早孕建卡机构服务资质优、认为选择的早孕建卡机构距离近、总体满意度的孕产妇选择医院级别比较,差异均有统计学意义(P<0.05)。决策树分析结果显示,决策树1的一级医院预测正确率高于二级医院(χ2=111.023,P<0.001),决策树2、3的总预测正确率高于决策树1(P<0.05)。决策树1显示,等候时间、认为选择的早孕建卡机构费用低是决定孕产妇选择一级或二级医院的主要原因;决策树2显示,家庭年人均纯收入、产检次数、妊娠次数、认为选择的早孕建卡机构距离近是决定孕产妇选择二级或三级医院的主要原因;决策树3显示,家庭年人均纯收入、妊娠次数、活产子女、认为选择的早孕建卡机构距离近是决定孕产妇选择一级或三级医院的主要原因。结论 应加强分级诊疗的政策引导,引导无危险因素的孕产妇去一级或二级医院就诊;引导因家庭收入高去三级医院就诊的孕产妇合理选择医疗机构;一、二级医院应提高对孕产妇定期产检的要求。

关键词: 孕妇, 就医行为, 决策树, 问卷调查