四川省城乡居民就医路径及医疗机构选择的影响因素研究

目的 通过纵向随访数据分析四川省城乡居民的就医路径特征和就医机构选择的影响因素。方法 从四川省第五次卫生服务调查的样本区(县)中抽取1个城市点和1个农村点,监测居民3个月的卫生服务利用行为，定性描述居民就医路径特征，采用重复测量资料的多水平Logistic模型分析就诊医疗机构选择的影响因素。结果 患病后，城市点以遵医嘱治疗为主，农村点则以就诊为主；就诊时，城市以县(市、区)级医疗机构为主，农村以基层医疗机构为主；影响就诊医疗机构选择的因素有就业状况、是否患有慢性疾病。结论 四川省城乡居民就医路径特征不同，城市居民就诊机构的流向存在不合理分布。应加强城市点分级诊疗制度的推行，规范城市居民就医行为。

Health care seeking path and the influencing factors for health care provider selecting among urban and rural residents of Sichuan province

Objective The aim of this study was to address health care seeking behaviors of residents in Sichuan province, including health care seeking path and health care provider selecting. Methods According to the Fifth National Health Services in Sichuan province, a city point and a rural point were chosen. The demographic characteristics and disease treatment situation were investigated in households. The process of health care seeking was studied by qualitative research methods. Multinomial logistic model was performed to explore the factors associated with the choice of health care providers. Results After being sick, residents from urban area followed the doctor’s treatment advice mostly, while residents from rural area saw a doctor directly. Residents from city preferred the medical institutions at county level, while residents from rural selected the community medical institutions instead. The main factors affecting the priory of health care providers selecting involved employment status, and whether suffering from chronic diseases. Conclusion Health care seeking paths in urban and rural were different. The choice of medical institutions made by urban residents was not reasonable. More measures should be taken to strengthen the implementation of the hierarchical medical system among urban residents.