Abstract: 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 （-2LL） values in models Ⅱ and Ⅲ were smaller，while Cox＆Snell R2 and Nagelkerke R2 were greater.Moreover，the -2LL of model Ⅲ was smaller，while Cox＆Snell R2 and Nagelkerke R2 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.

Key words: Health services needs and demand, Medical-nursing combined service, Aged, Andersen's behavioral model

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 R2、Nagelkerke R2均大于模型Ⅰ；模型Ⅲ的-2LL小于模型Ⅱ，Cox＆Snell R2、Nagelkerke R2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。

关键词: 卫生服务需求, 医养结合, 老年人, Andersen行为模型